HV 713 M2.7 CORNELL UNIVERSITY LIBRARY GIFT OF Estate Of Dr. Elsie Murray „ Cornell University Library *1HV713 .M27 ^ Problems of child welfare. olin 3 1924 032 579 561 DATE DUE The original of tliis bool< is in tlie Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924032579561 Social Science ITextsBoofts Edited bt RICHARD T. ELY PROBLEMS OF CHILD WELFARE SOCIAL SCIENCE TEXT-BOOKS OUTLINES OF ECONOMICS By Richard T. Ely, Ph.D., LL.D. Revised and enlarged by the Author and Thomas S. Adams, Ph.D., Max 0. Lorenz, Ph.D., Alltn A. Young, Ph.D. HISTORY OF ECONOMIC THOUGHT By Lewis T. Haney. BUSINESS ORGANIZATION AND COMBINATION By Lewis T. Haney. PROBLEMS OF CHILD WELFARE By George B. Mangold, Ph.D. PROBLEMS OF CHILD WELFARE BY GEORGE B. MANGOLD, Ph.D. DIRECTOR SCHOOL OF SOCIAL ECONOMY OF WASHINGTON UNIVERSITY Njfa got* THE MACMILLAN COMPANY 1919 All rights reserved Copyright, 1914, By the MACMILLAN COMPANY. Set up and electrotyped. Published July, 1914. rh(oi-j~ioi X Nocinooti ^tese J. B. CuBhlag Co. — Berwick & Bmith Co. Norwood, Mass., U.S.A. PREFACE With the gradual shifting of the emphasis from remedial to preventive and constructive work, problems of child welfare have received much attention, largely on the theory that work with children is fundamentally constructive in its nature. Be- lieving that the best results are achieved by beginning with the child, the author has attempted to present in a systematic way the principles of child welfare, and to correlate the different problems involved. The task consists mainly of adjusting the constructive philanthropy of to-day to the needs of the child, his improvement being the direct objective. While it is recog- nized that every social problem involves children, those ques- tions that affect them only in an indirect way are excluded from the book, and the subject matter is limited to the problems of direct and immediate interest, so as to make a consistent treat- ment of the subject possible. To meet the need as adequately as the author can hope to do in a single volume, each separate problem has been analyzed with reference to causes and con- ditions, to the existing social machinery for coping with the prob- lem, and to a plan and program of improvement or prevention. The book is designed especially for use by college and university students in courses on constructive and preventive philanthropy. However, the general reader has not been for- gotten, and it is hoped that the book will appeal to that growing class of men and women who in a systematic way are endeavor- ing to acquaint themselves with the various aspects of practical sociology. The author is happy to express his indebtedness to Professor Richard T. Ely for his suggestions as to the form and subject matter of the book, for his careful reading of the manu- script, and for his many valuable criticisms and suggestions for improvement. TABLE OF CONTENTS Introduction 1. The Child and Heredity 2. The Factor of Environment 3. Child Problems and Statistics 4. The Social Obligations to Childhood a. The Preservation of Life . b. The Preservation of Health c. The Opportunity to Play . d. Freedom from Toil . e. Education of Children f. Care of Dependent Children FAGB 1-15 1 5 9 10 10 11 12 13 14 16 PART I. THE CONSERVATION OF LIFE CHAPTER I. Births and Birth Rates 19-30 1. Historical Data 19 2. Decline in Birth Rates 20 3. Costs of Motherhood 23 4. Fecundity of Women 24 5. Sterility 26 6. Still-births 27 7. Causes of Declining Birth Rates 28 8. Registration of Births 30 II. The Waste of Life 31^3 1. The Waste of Life 31 2. Decline in the Death Rates of Children ... 32 3. Historical Stages . 33 a. First Period 33 b. Second Period . 35 c. Third Period. Preventive Methods ... 36 4. Economic Cost of Child Mortality .... 37 5. Mental and Moral Effects 39 6. Physical Degeneracy ....... 40 vii Vlll TABLE OF CONTENTS CHAPTER PAGB III. Conditions Underlying Child Mo~rtality . . 44—58 1. Rural vs. Urban Mortality 2. Negro vs. White Death Rates 3. Social and Industrial Conditions 4. Illegitimacy .... 5. Age and Sex as Factors 6. The Reduction of Infant Mortality 7. Infant Mortality in Foreign Countries 44 46 48 50 50 51 56 IV. Physiological and Social Causes of Child Mortality 59-78 1. Diseases of Children 59 a. Diphtheria. ....... 59 b. Measles and Scarlet Fever .... 62 c. Whooping Cough and Respiratory Diseases . 63 a. Diseases of the Digestive System ... 64 e. Diseases of Early Infancy .... 67 f. Meningitis and Convulsions .... 68 g. Proportionate Mortality from Principal Diseases 68 2. Ultimate Causes of Child Mortality .... 70 a. Causes as classified by Farr and by Newsholme 71 b. Causes according to Newman .... 71 c. Detailed Table of Causes 71 3. Analysis of Important Causes 73 a. Poverty 73 b. Use of Cow's Milk 73 c. Ignorance and Indifference .... 77 d. Bad Housing Conditions 78 V. The Milk Problem ....... 79-96 1. Introduction 79 2. Clean Milk 79 3. Temperature 80 4. Methods of Providing Good Milk 82 5. Significant Forms of Municipal Control ... 84 a. The Experience of Rochester, New York . 85 6. New York City . 88 c. Other Cities 89 d. Efifects of Inspection on Disease ... 90 6. State Control 91 7. Classification of Dairy Milk 92 8. Modified Milk 93 9. Milk Depots 93 TABLE OF CONTENTS IX CHAPTER FACE VI. Methods of Preventive Work 97-115 1. Encouragement of Maternal Feeding .... 97 2. Prenatal Work 98 3. Visiting Nurse Work 102 4. The Day Nursery 104 5. Education of Girls and Boys 104 6. Prevention of Overcrowding ...... 107 7. Prevention of Employment of Married Women . . 109 8. Provisions for Fresh Air . • . . . . 110 9. Reduction of Poverty and Vice Ill 10. Control of Midwifery Ill 11. Municipal Campaigns against Infant Mortality . . 113 12. Cooperation among Preventive Agencies . . . 114 PART II. HEALTH AND PHYSIQUE I. Physical Conditions of Children .... 119-135 1. Standards of Physique ....... 119 2. Comparative Development of Social Classes . . 120 3. Causes of Deterioration ...... 124 4. Physical Defectiveness ....... 124 a. Blindness ........ 125 b. Deafness 126 c. Physical Deformities 128 d. Tubercular Tendencies ..... 130 e. Minor Physical Defects 132 II. Care of Health and Physique 135-150 1. The Problem of Medical Inspection .... 136 a. Theory of Inspection 136 b. The Scope of Inspection 138 2. Organization of Medical Inspection .... 139 3. Methods of Examination 141 a. Medical Inspection 141 b. Physical Examination ..... 143 c. Examinations by Teachers .... 144 4. The Removal of Defects 144 5. Progress of Medical Inspection 149 III. Care and Training of Physical Defectives . . 151-165 1. The Blind 151 2. The Deaf . 153 3. Crippled Children 155 4. Tubercular and Anaemic Children 156 5. Underfed School Children 161 X TABLE OF CONTENTS CHAPTER PAGE IV. Play and Recreation 166-188 1. Values of Recreation 167 a. Physical Values ....... 167 h. Social Values . . . . . . . 167 c. Mental Values 169 2. Recent Appreciation of Play 170 3. Facilities for Recreation ...... 171 a. Roof and Basement Playgrounds . . . 171 b. Streets and Vacant Lots 172 c. Public Recreation Centers .... 173 4. Types of Recreation Centers ..... 173 5. Progress of the Playground Movement .... 177 6. Supervision ......... 179 7. Administration ........ 181 8. Special Outdoor Activities 182 9. Commercial Recreations 184 V. Wider Uses of the Schools 189-202 1. School Playgrounds 189 2. Evening Centers 190 3. Social Centers 192 4. Physical Training 197 5. Vacation Schools ........ 200 6. School Gardens ........ 201 PART III. TRAINING AND EDUCATION I. The Mental Classification of Children. 1. Mental Types 2. Causes of Mental Abnormality a. Feeble-mindedness, Hovif Caused b. Causes of Backwardness . II. Education of Exceptional Children 1. Need of Classification of Children 2. Care of the Idiot 3. Education of the Feeble-minded . 4. Education of Backward Children ;" . a. Methods of Providing for Education b. History and Extent of the Movement c. Principles of Care and Training d. Results ...... e. The Montessori Method . 5. Facilities for the Gifted ..... 205-214 . 205 . 209 . 209 . 211 215-227 . 215 . 216 . 217 . 219 . 219 . 220 . 223 . 224 . 225 . 226 TABLE OF CONTENTS id CHAPTER PAGE III. Some Social Aspects of Education .... 228-243 1. School Attendance 228 2. Illiteracy 231 3. Distribution of Children in Grades .... 233 4. Retarded and Underaged Children .... 236 5. Causes of Retardation and Elimination .... 238 6. Compulsory Education 240 7. Truancy 242 IV. Industrial Education 244-256 1. The Adaptation of Education 244 2. The Untrained Child in Industry 245 3. Vocational Guidance 246 4. Preparation for Industrial Training .... 247 a. Manual Training 247 i. Pre-vocational Schools 248 5. Forms of Industrial Training 249 a. Apprenticeship Schools ..... 249 i. Continuation Schools 251 c. Trade Schools 252 6. Plans for Vocational Education ..... 254 7. History and Development of Industrial Education . 255 V. Moral and Sex Education 257-268 1. Causes of Sex Irregularities 257 2. Results of Ilhcit Relations 259 3. Measures of Prevention 260 a. Societies of Social Hygiene .... 260 i. Public Educational and Preventive Work . . 262 c. Sex Education in the Schools .... 262 d. Education of Parents 266 e. The Church and Sex Education . . . 267 PART IV. CHILD LABOR Causes op Child Labor 271-283 1. Greed of Parents 271 2. Poverty 274 3. The Attitude of the Child 276 4. Demand for Child Labor 277 5. Modem Industrial Conditions . . ■ . . 280 6. Indifference of the Public 281 Xll TABLE OF CONTENTS CHAPTER II. Factors of the Child Labor Problem 1. Occupations of Children 2. Age of Children 3. Literacy and Education . 4. Wages and Wage Advancement 5. Night Work and Overtime . III. General Effects of Child Labor IV. Child 1. 2. Introduction .... Economic Cost of Child Labor Social Costs .... Moral Effects .... Physiological Aspects of Child Labor a. Need of Good Physique . b. Effect of Premature Employment c. Incidental Results of Child Labor d. Unhealthful Occupations e. Effect of Night Work f. Summary . d. e. Legislation Labor Reform Constructive Effort Legislation a. Agencies supporting b. Uniformity of Laws c. A Standard Law Age Limits Physical Qualifications /. Educational Requirements g. Hours of Labor . h. Night Work i. Working Papers /. Dangerous Trades k. Industries Exempted /. Street Trades Legislation . m. Minimum Wage Legislation Enforcement of Law PAGE 284-296 . 284 . 289 . 291 . 293 . 295 297-318 297 298 302 304 310 310 312 313 313 316 318 319-341 . 319 . 320 . 321 . 322 . 323 . 326 . 327 . 328 . 330 . 331 . 331 . 333 . 335 . 336 . 338 . 338 PART V. JUVENILE DELINQUENCY Causes and Nature of Juvenile Delinquency . 345-362 1. Evolution of the " Juvenile Delinquent "... 345 2. Moral Classification of Children 347 TABLE OF CONTENTS XUl CHAPTER PAGE 3. Conditions underlying Juvenile Delinquency . . 348 a. Changing Social Conditions .... 348 b. Home Conditions ...... 349 c. Environment and Associations .... 355 d. Criminal Tendencies 357 e. Retardation and Defectiveness .... 357 / Child Labor ....... 358 g. Poverty 359 4. Offenses of Delinquents 360 5. Number of Delinquents 352 II. The Juvenile Court 363-376 1. The Juvenile Court Movement 363 2. Extension and Organization 364 3. Selection and Qualifications of Judges '. . . . 366 4. Appearance of the Delinquent in Court . . . 368 5. Court Hearings • 369 6. Disposition of Offenders 371 7. Evolution of the Juvenile Court 373 8. The Juvenile Court in Other Countries . . . 375 III. The Probation System 377-391 1. Development of the Probation System .... 377 2. Probation Officers and their Duties .... 378 a. Investigating Officials 378 h. Officials engaged in Probationary Work . . 379 c. Volunteer Workers 381 d. The Judge as Probation Officer . . . 383 e. The Police as Probation Officials . . . 384 3. Qualities of Probation Officers . . , , . 384 4. Selection of Probation Officers 384 5. Probation Districts 385 6. Length of Probation 386 7. Number of Cases per Official 387 8. County Probation 387 9. Results of Probation 388 10. Probation and Cooperating Agencies .... 390 IV. Other Reformatory Agencies 392-406 1. Detention Homes ........ 392 2. Disciplinary Schools 392 3. Institutional Care 393 a. Evolution of Institutional Care .... 394 b. Present Functions of Institutions . . . 396 XIV TABLE OF CONTENTS CHAPTER PACK 4. Types of Institutions 396 a. Parental or Truant Schools .... 397 b. Training and Industrial Schools . . . 398 c. State Reform Schools 399 d. Republics 400 5. Principles of Institutional Care 400 a. Separation of the Sexes 400 b. The Cottage System 401 c. Physical Training 402 d. Industrial and Literary Training . . . 402 e. Discipline ........ 405 6. Placing in Family Homes 405 V. Measures of Child Protection 407-418 1. Introduction ......... 407 2. Contributory Delinquency and Non-support Laws . 407 3. Age of Consent Laws 410 4. Neighborhood Activities 410 5. Parks and Playgrounds ....... 413 6. Prevention of Idleness . 414 7. The Training of Parents 415 8. Reduction of Personal Vice 416 9. Additional Measures of Protection .... 417 PART VI. PROBLEMS OF DEPENDENT CHILDREN I. The Dependent and Neglected Child . . . 421-432 1. Definitions 421 2. Types of Dependents ....... 421 3. Causes of Dependency ....... 423 4. Number of Dependent Children 429 II. Problems and Principles of Child Saving . . 433-448 1. General Principles of Child Saving .... 433 a. Principles asserted at the White House Con- ference ....... 434 b. The Importance of the Home .... 434 c. The Foster Home 435 d. The Cottage Plan 436 e. State Supervision and Incorporation of Private Agencies . 437 / Records 439 g. Cooperation 439 k. Requisites of Institutional Care . . . 441 i. Prohibition of Children in Almshouses . . 441 TABLE OF CONTENTS XV CHAPTER PAGE 2. Special Problems 442 a. Desertion and Non-support .... 442 b. The Illegitimate Child 444 c. The Defective Child 447 3. Conclusion 448 III. Private Child-Saving Agencies 449-473 1. Home and Aid Societies 449 2. Work of the New York Society 451 3. Denominational Placing-out Agencies .... 452 4. The Placing-out Problem 453 5. Difficulties of Placing-out 457 6. The Temporary Home 458 7. Indenture 458 8. Boarding Homes for Children 459 9. Results of the Placing-out System .... 450 10. Adoption 461 11. Societies for the Prevention of Cruelty to Children . 461 a. Functions . 463 b. Work of Typical Societies .... 465 12. The Institution 467 a. Advantages of the Institution .... 468 b. Disadvantages 468 13. The Day Nursery 470 14. Needs and Reforms 472 IV. Public Child- Saving Agencies 474-487 1. The State School System 474 a. Essential Elements of the State School System 475 b. Placing-out 476 c. Results of System ...... 477 2. Boarding and Placing-out Systems .... 478 a. Child Saving in New Jersey .... 478 b. The Massachusetts Plan 479 c. City Systems 479 3. The County Home System 480 4. The Subsidy System 481 5. Care of Neglected Children 481 6. Pensions for Mothers . 482 Conclusion 488-492 Selected Bibliography 493-511 Index 513-522 PROBLEMS OF CHILD WELFARE INTRODUCTION In modem social work the emphasis has been shifted from the parent to the child. The fact that this is so is due largely to belief in the principle " an ounce of prevention is worth a pound of cure." Not relief but prevention is the slogan of modern social work ; not palliatives but fundamental social reforms are demanded to-day. It is well then to begin with the child, for he presages the coming man. He is the plastic material that can be molded ill or well ; he is gigantic in possibilities, but dwarfed if without opportunity. We are beginning to realize that the more time and energy that are spent on the child, the more lasting and profitable is the investment. ~To educate and train the child is worth in- finitely more than to labor with the deficiencies of the man with his crystallized habits and morals. Again, child welfare involves adequate physical, mental, and moral development. If proper attention is not given to this, it is not possible to cope successfully with the varied problems of daily life. Childhood is the time of preparation; afterward little can be accomplished. Let society concentrate more of its energies on the child, instead of scattering them as it does to- day, and then with an equal expenditure of effort it will accom- plish more good than can be realized in any other way. I. The Child and Heredity. At once the twin forces of heredity and environment confront society and complicate the problems which are to be solved. Of the two, heredity has probably been the subject of the more serious study. Biologists and psychologists are continually adding to our knowledge of the power and influence of heredity, and of its capability of benefiting or injuring the race. The i Problems of child welfare term heredity has no uniform use in popular language. It will, therefore, for the sake of clearness, be limited in meaning in this book to the transmission by the parent to the offspring of those physical and mental characteristics which are potentially present in the germ-plasm of the parent. These characteristics in turn may be inherited or may be the result of toxins that injure the germ-plasm. Usually they are present at birth ; often, however, they do not appear until later in life ; for example, many cases of insanity appearing in middle life are truly inherited. On the other hand, certain defects present at birth are not necessarily innate. Instead of being inherited, they are due to peculiar pre- natal conditions of the mother. These defects are classified as " acquired," and the offspring will not bequeath them to sub- sequent progeny. Certain facts have been so definitely established by students of heredity that the sociologist can use them as corner stones on which to build a system of preventive work. In many cases the child is doomed before birth, and no later training can prepare him for a normal social life. Thus defective heredity is respon- sible for a large proportion of the children who are condemned to such lifelong abnormalities as idiocy, imbecility, backwardness, deaf-mutism, criminality, and certain forms of constitutional disease. As a result, these defects may be expected to reappear in the offspring of each subsequent generation. It is further an unfortunate fact that some of these defective groups are much more proHfic than the normal classes. A recent English Royal Commission states that the birth rate among the feeble-minded is double that of the general population. It is apparent from this that there is danger of a gradual dilution of the quality of the race unless preventive measures are adopted. Within the last decade the application of the principles of heredity for the purpose of raising the physical and mental standards of the race has been much discussed, and a plan of practical eugenics is being gradually formulated. Strictly speaking, eugenics is the art of improving the race by selecting for survival the superior qualities inherent in men and rejecting those which are inferior. It means race development, and is INTRODUCTION 3 concerned with improvements of a permanent nature. So- called practical eugenics is often made to apply wrongly to methods of promoting individual strength and capacity. The eugenist is correct in emphasizing the principle that every child be well born, that he be innately endowed with the capacity for development into a normal adult. The diflSculty, however, lies in the carrying out of a program of attainment. For this reason two phases of the subject have been developed ; " nega- tive " and " positive " eugenics. „-— Negative eugenics deals exclusively with the unfit classes. Among them reproduction is to be prevented, so that they may be gradually eliminated. The marriage of a feeble-minded person must not only be prohibited, but such steps must be taken as will insure his practical sterilization. By segregating idiots, imbeciles, instinctive criminals, and other groups in institutions this can be accomplished. But custodial care must be perma- nent to make this plan successful. So large a proportion of these classes are eventually released that one group of social workers favors sterilization as the best preventive measure- Eight states have already passed laws providing for a limited amount of sterilization in institutions. With one exception, however, these laws have so far generally remained inoperative. Without doubt the most serious cases of defect can be handled either through sterilization or custodial care. From the eugenic point of view, in fact, these offer fewer difficulties than do the thousands who suffer from slighter defects. Most of the latter are capable of partial self-support, and are not regarded as sub- jects for institutional care. Besides, the cost seems almost prohibitive. But these people will not refrain from intermarry- ing with others who are similarly defective, while sterilization cannot even be mentioned. No generally accepted program of action to solve this question has as yet been developed. How- ever, sentiment is growing in favor of the gradual segregation of these groups. Laws prohibiting intermarriage between first cousins and other near relatives may be considered a form of negative eu- genics. The large proportion of defectiveness among Jews, 4 PROBLEMS OF CHILD WELFARE Mennonites, and other consanguineous groups shows how im- portant such prohibitions are. The consanguineous marriages per se are not blameworthy, and it may safely be said that if the intermarrying stocks are vigorous, no harm will result. There are probably no perfect families, however, and strains of weak- ness are present in all. If two persons affected with the same weakness, as is likely in the case of relatives, marry each other, this weakness will probably be intensified in their children. For this reason such marriages should be prohibited. The re- cent agitation in favor of a certificate of health prior to marriage is also based on the desire to prevent the birth of unhealthy children. Turning to the field of positive eugenics, we find that this has been cultivated but sparsely. The elementary principles have not even been established. The first step to be taken is the creation of a standard of superiority or perfection. This has not been done, nor can it be done with our present Umitations of knowledge. We do not know how much bulk and how many parts each organ of the body must contribute to the whole to form the man, perfect in body, in mind, and soul. When stand- ards are established, how will they be applied ? How can people be persuaded to apply them? According to a recent English investigation, defectives are found in larger proportion among the first and second born than among the younger children. Further investigation may show that environment is a factor in determining this condition ; if not, then large families will give us a smaller proportion of feeble-mindedness. But does any eugenist believe that we can or will return to an era of large families ? Suppose the eugenist has worked out the proper correlation between physical organ and mental quality ; suppose the innate tendencies of parents are known and we can predicate absolutely the characteristics of their children; then the most difficult problem of all remains, — that of mating individuals properly adapted to each other. To-day marriages depend on love, financial condition, the coercion of custom, and other factors. Is it possible for the course of love to be deflected by eugenic INTRODUCTION 5 considerations ? Will the intermarriage of fortunes be prevented for similar reasons ? It is true that occasional cases of foresight and self-restraint occur from time to time, but for the masses the near future holds no such hope in prospect. Education for decades, and perhaps for centuries, is necessary to make even a beginning in the art of positive eugenics. Francis Galton and his followers are the practical originators of the eugenic idea. These men have held to the Neo-Darwinian theory of heredity and have opposed the theory that acquired characteristics are inherited. Eugenic philosophy, therefore, adheres largely to the views of its founders. Race progress by selection is the dominant note. The recently rediscovered Mendelian law threatens to complicate the problem, and its application to the human race will be exceedingly diflScult. Often the effects would not be apparent until the second genera- tion, when, of course, it would be too late. Positive eugenics cannot make much substantial progress until it considers the mental and moral qualities of men as well as the physical ; but this step will at once involve the problem and will make it diffi- cult to realize the aims of the eugenic philosophy. 2. The Factor of Environment. The term environment covers a multitude of influences. Some of these act before birth, but the majority are postnatal in character. These influences affect both body and mind, and thus help to determine physique and mentality. In many re- spects environment is the dominating factor of human develop- ment, and this appUes especially to the period of childhood. The physiology of children proves them to be extremely plastic in body, and psychology has rendered a similar verdict in respect to their mental qualities. Men are not grown up children, as the philosopher has said; they have been developed and trans- formed. A man having the same proportions as a child would be a monstrosity. The water constituency of a foetus is 97 per cent ; of a child, 74 ; of a man, only 58. Truly age withers the human being. The infant has a large head, and the child at five has a head which has nearly reached its maximum growth, but his legs are short and his arms lack the proportions that exist in 6 PROBLEMS OF CHILD WELFARE the adult. So with the internal organs ; at birth the weight of the human brain is almost exactly one-seventh of that of the entire body, while in adult life it is about 2.4 per cent. Propor- tionately the former is six times as heavy as the latter, but the brain of the child is largely water, the gray and the white matter are not clearly distinguishable, and the convolutions are not marked. The babe is absolutely helpless. Most mammals have more initial capacity for self-support than he, but the brain and nervous system of the child, with its splendid possibilities, offers a remarkable field for the operation of environmental forces. The blood constituency of the child is peculiar, for there is a large disproportion of white corpuscles and a singular absence of red ones. Strength and vitality come with a shifting of these proportions. Again, the child has much muscular tissue, but undeveloped and weak tendons. His heart is comparatively large, and so in general are the other internal organs. So differ- ent is the child from the man, that the right food, proper exer- cise, and correct training given throughout the period of flex- ibility should be capable of wonderful results. Prenatal conditions must be studied and their effects noted. Then proper attention must be demanded for the prospective mother during the period of gestation. Formerly it was gener- ally beUeved that a special mental bent or potential proficiency in some art could be deliberately imparted by the foresighted mother. This belief, however, has become antiquated and lacks scientific support, but a new question has recently arisen. What influence has the physical condition of the expectant mother on the physique of her child? Investigation shows this influence to be considerable, and that the child may suffer con- stitutionally if subjected to abnormal conditions during his prenatal life. Nature has done her utmost to protect the child, and sacrifices the mother thereby, but complete protection is not afforded. The foetus receives its nourishment through ab- sorption of food, still toxins affecting the mother are passed on. If it is insufliciently nourished, it is surely retarded in develop- ment, and sometimes defects of a permanent character are pro- duced. INTRODUCTION 7 Since the nutritive process is so important, it must be carefully controlled. Any interruption in the continuous absorption of the food elements may halt the regular development of the chUd. Therefore it must not be allowed to suffer from malnutrition. Many causes, however, operate to produce injurious results. Perhaps the mother is overworked and has no surplus energy to impart to the child. Worry interferes with digestion and may injure the child. Fright has no direct effect, but the shock to the nervous system means interference with the nutritive sys- tem and a possible interruption in the free development of the foetus. Finally the mother may herself suffer from malnutrition. At all events, the injury is accomplished chiefly through the in- terrupted development caused by interferences with the nutri- tive processes, and peculiar defects frequently result. Conse- quently this becomes a matter of tremendous importance. The early postnatal life of the chUd must be guarded in a similar manner. John Fiske first saw that the helplessness of the newly born babe coupled with the prolongation of his period of childhood furnished untold possibilities of development. The relative importance of instinct and the remarkable plasticity of the child allow the marvelous development of reason that man has enjoyed. A long childhood makes room for the play of environ- mental forces, and this influence is stronger in proportion to the initial helplessness of the child. The more the native flexibility, the greater is the capacity for training and for nurture. The im- pressionable child easily yields to the influence of contact with the remaining members of the family. In early life certain char- acteristics and psychical traits become relatively fixed, owing to constant association with special mental types. That part of the child's psychical nature which is clearly and absolutely individual and his own is relatively small. The greater portion of his characteristic mental endowment is gained from the inter- action of his own small mental nucleus with the minds of his parents and other members of the family. It is well known how ardently adults cling to the beliefs and traditions acquired during childhood. Social heredity within the family — that is, 8 PROBLEMS OF CHILD WELFARE the transmission of ancestral ideas, traditions, prejudices, and knowledge — is a powerful factor in the life of every normal individual. " Like father, Kke son," is often largely the result of this kind of communication and influence. Thousands of years of stationary civilization in China furnish a most striking example ; likewise the forces that have retarded the woman's movement of the nineteenth century. The general tendency of children to follow the religious and political beliefs of their parents illustrates the power of social heredity, but social hered- ity is only a form of environment. The fixation of mental and moral traits in the human being should be a paramount consid- eration in the training and development of the child during the entire adolescent period of his life. Right training from the earliest self-conscious moments of life is therefore a matter of great sociological importance. Most important among the conditions of environment are the home surroundings of the child. His home environment con- tinues comparatively unchanged for a longer period of time than do external conditions. Home life and adequate home training are therefore vital in the development of the child. Unless prevented, the child, particularly the boy, soon becomes subject to influences emanating from without the home, and these in turn tend to mold his character as well as to afiect his physical well-being. His associates, the manner of his life, the sanitary conditions of school, street, alley, or workshop, — all of these considerations directly afiect both his physique and his charac- ter. Attention to the environment of the child both within and without the home is accordingly the sine qua non of the solution of our child problems. In the study of the influence of environment, the opinion of the expert sociologist should carry weight, and his investigations are establishing certain conclusions upon which definite rules of action can now be based. The knowledge that a bad environ- ment is responsible for the seriousness of many of our child prob- lems paves the way for an easier and more efiective treatment of the subject than could be given if bad heredity were the root of the difficulties. Much has already been accomplished by carry- INTRODUCTION 9 ing into effect the suggestions of sociologists holding this point of view. 3. Child Problems and Statistics. The need for accurate sociological facts is great. Recently an enormous amount of statistical material has been given to the public, but we are far from the possession of satisfactory infor- mation. The time has come when sensational overstatement and complacent depreciation of facts must be supplanted by scientific analyses of the real conditions. Too many of our so- called accumulated facts have not been properly digested and interpreted. A recent bulletin of the United States Bureau of Education contains an address in which it is stated that five million, or one-fourth of the American school children, were suffering from malnutrition. If this statement is true, then our chUd problems are acute indeed. But malnutrition is not defined, and no in- dication is given of the actual gravity of conditions, nor are the investigations discussed on which this high estimate is placed. The public thinks of malnutrition as serious underfeeding, or as such flagrant misfeeding as causes injurious physical conse- quences. In a sense, every person suffers from malnutrition ; that is, probably no one eats exactly the right quantity and qual- ity of food necessary for the highest physical welfare. Only the hopelessly squeamish speak of this as malnutrition. Again, defective teeth prevent proper mastication of food, yet it is almost unfair to the public to charge such a condition to mal- nutrition. Is the country boy, gorged with underripe apples and berries, also included ? Many other questions at once sug- gest themselves. Are the proportions in small towns and large cities the same ? Does the city exceed the rural districts ? Are the proportions in the various rural sections of the country similar? Are rural Iowa and the mountains of North Carolina on a par? To have genuine sociological value, estimates must not only indicate the evidence on which they are based, but must also make due allowance for differences among cities and rural districts. The number of defective children in the United States also 10 PROBLEMS OF CHILD WELFARE lends itself to statistical manipulation. Usually nothing is said about the proportion who can easily be cured. For instance, a large percentage of these children have defective teeth ; and a dentist and an hour's time can easily reclassify a child. The amount of child labor, the prevalence of tuberculosis among children, preventable infant mortality, and other problems suffer in a similar manner. Our program of reform must de- pend on the collection and use of correct information; otherwise it is impossible to correlate properly the work of preventive agencies. 4. The Social Obligations to Childhood. Nowhere in history does it appear that so many rights were accorded to childhood as is the case to-day. Men have been accustomed to concern themselves with the present, taking but little thought for the morrow. They have scarcely considered the influence of present-day conditions on the society of the future. As thought for the morrow increases, society becomes more unselfish and begins to build for the interests of the coming generations, but this frequently involves a costly subordination of immediate interests. The future well-being of the race often means the sacrifice of present pleasures. Carried out consist- ently, a policy of social betterment results in the development of certain obligations to childhood. Some of these are not yet fully recognized by society, but more and more they are receiving the sanction of our present civilization. Without such sanc- tion we cannot hope for successful social reform. a. The Preservation of Life. The first claim which the child makes upon society is the right to proper care while a helpless babe, so that he may retain the independent life given to him at birth. He was not consulted about the desirability of coming into existence, and had no power to will or forbid this event. It is a serious thing to bring a child into the world, and the individuals responsible for his birth have thereby incurred new responsibilities and obligations. The child has a right to a fair chance for life. If parents are dehn- quent in furnishing their children with this opportunity, it is the dear duty of the state to interfere in behalf of defrauded child- INTRODUCTION II hood. Earth holds no greater tragedy than the ruthless destruc- tion of a sturdy human life not even conscious of its own exist- ence and without knowledge of its capacity and opportunities. The duty of society to the child must be gradually extended be- cause neglect of child life means a relatively greater loss and cost as civilization advances and becomes more complex. Society should determine what class of children shall be allowed to come into existence, but, once born, all normal children have the abso- lute right to be saved from all forms of preventable death. The right to life is indicated in the penalty for the premedi- tated destruction of foetal life. In spite of this, hundreds of abortions are performed every year by physicians on whom moral obligations rest but lightly. Primitive society did not respect life, and many tribes even claimed the right to sacrifice all chil- dren who were not desired. Infanticide has been a common practice among nearly all savage peoples and was not unknown among semi-civilized tribes. The Africa and Asia of to-day still furnish numerous examples of this practice. Not only has it been customary to slay the weak, crippled, and defective, but the life of all, especially that of female children, depended upon the caprice of the parents. Fortunately, civilized nations with higher ideals have controlling power among these barbarous peoples, and the crime of infanticide has been almost abolished. b. The Preservation of Health. Next to the duty of preserving life comes that of maintaining health. Nothing prevents future industrial and social efficiency so much as does the absence of health. Without health, edu- cation and training are almost impossible, and the physical and mental faculties &,re permanently impaired. Boys need to be given the opportunity to grow up into robust men. For girls physical training and muscular exercise are even more necessary, especially since the tendency of civilization has been to retard , that symmetrical development which our future mothers need. The keen competition of to-day and the new demands of social and industrial life are so important that we must demand for the growing child that he be physically prepared to meet the exi- gencies of the new era. Otherwise he will soon join the ranks of 12 PROBLEMS OF CHILD WELFARE the great and constantly increasing army of the unfit and the un- employable. A changing social attitude toward the problem of the child's health is a natural consequence of this danger. The recent movement in favor of medical inspection of school children is a case in point. Society must care for the diseased and disabled. But much more important is the task of repairing the minor defects of our children so that the age of incapacity may be definitely postponed. Such a program demands an ex- tension of public authority which may at present appear almost entirely unwarranted, but the course of civilization is always carrying us in this direction. The right to prohibit child labor is in part based upon the physical injury which such work entails. The danger emanates from two sources — the pernicious influence of factory life upon the immature and undeveloped body, and the inability of this plastic and growing body to withstand continued manual labor. That the child must not be compelled or allowed to sacrifice his health for the mere pittance which he earns is now generally accepted ; although not more than seventy-five years ago, rep- utable economists opposed interference by the state in behalf of the little children who were enslaved in the factories, mines, and workshops of England. To-day all this is changed, and child labor legislation is supported by economist and sociologist alike. c. The Opportunity to Play. All animals play. Play is likewise one of the fundamental instincts of the child. It carries with it immeasurable benefits, but the exact results still remain uncertain. It is unquestionable, however, that play promotes the physical and mental develop- ment of the child and that it is no mean factor in his social and moral elevation. In fact, the social value of play furnishes one of the best reasons for the furtherance of the playground move- ment. Likewise the democratic impulses which well regulated play fosters are urgently needed to-day ; consequently the op- portunities for wholesome play must be greatly extended. The ancient attitude toward play was that of toleration of the ebuUient spirits of the growing boy. It was a rampant impulse which could not be checked, so parents submitted from necessity. INTRODUCTION 13 The utilitarian function of play was unthought of. The physical weakness of the child and his incapacity for concentrated thought and endeavor saved to him the enjoyment of play until his par- ents could use his services in some gainful occupation. Work was substituted for play as soon as the most limited degree of success offered some justification for such action. Play — the most enjoyable right of childhood — was almost forbidden, and even at the present day its value is minimized by many who do not recognize its varied functions. Disregarding the different theories of the origin of play, either in animals or in man, the present social values of play cannot be denied. Play involves freedom from work and adequate leisure from the duties of the schoolroom. Nor can it be socially successful without sufficient space or playground facilities. Conse- quently a new duty of society has arisen — that of providing the child with ample field for the enjoyment of the opportunity to play. d. Freedom from Toil. The prevention of premature toil is one of the first obligations to childhood. Children should be relieved from the task of earn- ing money either for their own support or to increase the family income. Employment of children imder a certain age in fac- tories, mills, workshops, mercantile establishments, and in the street trades inflicts irremediable consequences. Among the principal results of such premature child labor are : the danger to health and physical development; the handicap in the ac- quisition of a trade ; the mental retardation involved ; the real loss of opportunity for self -development ; the bar to future social and industrial efficiency ; the incentive to criminality and the consequent moral degradation. The question of child labor is therefore fraught with deep meaning for future generations and has become an important social problem. The enlightened view of to-day refuses to regard the child as a mere commercial asset of the parents. On the contrary, the relation of the two is exactly reversed. Until children reach a certain age it is absolutely necessary that they be supported by their parents, and society must enforce this obligation^ 14 PROBLEMS OF CPHLD WELFARE Furthermore, it is the duty of parents to provide education, train- ing, and if possible a wholesome environment. In the enligh1> ened civilization of our present industrial age the child must not be considered as interest-bearing capital. The right of society to restrict labor in factories and establishments of all kinds, while now generally recognized, does not include the right to restrain parents from exploiting their children in other ways for private ends. Until the community recognizes the social in- terests involved, private agencies must work to save children and must labor for the adoption of higher community standards. Freedom from work does not legitimize idleness. The idle child soon becomes the victim of wayward impulses, or of in- corrigible companions, and rapidly degenerates. The evils of idleness are perhaps more serious than those of work, but this fact in no way justifies premature child labor. Many opponents of child labor reforms base their arguments on the evils of idle- ness. This attitude is utterly unwholesome and unscientific, in that it imphes that child labor is the only alternative for child idleness. The substitutes for idleness are education and prop- erly directed recreation. Youth is the period of training when preparation for the duties of life is being made, and while society must demand rigid requirements of the growing child, these requirements should be entirely consistent with his general wel- fare. The adjustment of the individual in his industrial and social relations is so delicate that nothing can be overlooked to make that adjustment perfect. The more diflScult the individ- ual's life-work, the greater the need of previous training. e. Education of Children. The educational advantages which society must grant to the child are at least threefold ; literary and industrial training, moral education, and a knowledge of the elements of sex physiology. Without coordinate education along all of these important lines, many social ills will remain to retard the progress of mankind. In the complex social life of to-day, education has assumed a startling importance. Until recently, illiterate men have been able to advance rapidly and even to acquire large fortunes. This is no longer possible, and without training few INTRODUCTION 15 men can hope to succeed. A large percentage of our recent im- migrants are illiterate ; but illiteracy abroad, owing to relatively simple conditions, does not constitute the handicap that it does in the United States. The injury resulting from ignorance is not confined to the individual afiEected, but an entire group may suffer because of the ignorance of one of its members. The community therefore is justified in interfering and demanding compulsory education. The training required must meet the direct occupational need of the child. Otherwise it is only a halfway measure, and so- ciety has not fully discharged its obligations. Machine pro- duction and the consequent extensive division of labor necessi- tate some preparation for trade life. The growing problem of unemployment cannot be solved unless more attention is paid to the untrained chUd. Low wages, poverty, unemployment, and shameful conditions of living are partly due to defective education. Society must furnish the individual with the initial equipment necessary for a life of usefulness and profit. But training for industrial eflSciency must not displace literary train- ing. In fact, education gives the child a symmetrical develop- ment. He must be equipped for work, but, more than that, for service as a man and a citizen. Recent developments also demand a revision of the methods pursued in providing our youth with a moral education. The child is the unshaped marble out of which is hewn the virtuous man or the criminal. Shall no one superintend the sculptor's work? The results of improper and insufficient moral training are already too evident. The methods of church and Sunday school must be made more efficient. The public schools like- wise cannot afford to neglect the problem. Furthermore, the American home has become somewhat indifferent to the moral welfare of children. By providing effective moral training for the child, society can prevent much juvenile delinquency, and can arm children against the temptations of a vicious environ- ment. Moral training must have a prominent place in a pro- gram of child welfare. A form of education which is now demanding increased at- l6 PROBLEMS OF CHILD WELFARE tention is proper education along the lines of sex physiology. So direful have been the consequences, especially to the female sex, of the absence of needed knowledge, that thinking people are justly demanding reform. The adolescent youth of to-day shoiild be protected from the bitter results of a system which depends upon the ignorance and mistaken ideals of parents and upon the failure of the schools to appreciate the problem. The growing thoughtlessness and perhaps immorality of girls also presents a grave question. The physical welfare of society, the happiness of the home, and the social emancipation of woman depend in large part upon sufficient rational and timely instruc- tion in physical hygiene. This must, however, be deeply tinc- tured with the development of high moral standards ; otherwise the knowledge acquired will not gain the end in view. Nor can we wait until the young mind is blackened by the evil teaching of the vicious. /. Care of Dependent Children. The duty of society to care for the dependent and neglected child admits of no controversy. Such children are not respon- sible for their misfortunes, and society is pledged to grant them opportunities for a useful life. Every child has a right to a home, and should have the opportunity to enjoy a parent's care and fondness, since the home gives to childhood a service which no other agency can supply. The child without a good home suffers an enormous handicap. What hope remains for children whose constant environment lacks the guidance of a kind and dutiful parent? Special efforts are necessary to give justice to the imfortunates. PART I THE CONSERVATION OF LIFE CHAPTER I BIRTHS AND BIRTH RATES In discussing the vital problem of child life it seems most convenient to begin with births and birth rates ; for, although high or low birth rates do not necessarily imply high or low death rates, they definitely limit our infant mortality. The actual relation between the two, however, is of extreme impor- tance, because upon it depends the aggregate of surplus popu- lation. I. Historical Data. Little is known of the fecundity of the white race in ancient times. Vital statistics belong entirely to modern history, and even now our records are so incomplete that full information cannot be had. However, hints by ancient writers and knowl- edge of conditions among primitive peoples of to-day give rise to some observations which are not entirely conjectural. That birth rates were high in the infancy of human' society is not certain, but on the contrary the works of many students of primitive people indicate that a comparatively low death rate prevailed among the savage races. Some of the causes are also known; among them a long period of suckling. Babies were often allowed to nurse for two or three years ; nor is this method of prevention confined to primitive peoples, since even now it is employed in Europe and the United States. A second cause was licentiousness, which frequently induced sterility. In- fertility was without doubt an additional cause, and there is evidence that preventive methods were used directly. The cooperation of these causes frequently Umited fecundity to three or four children per marriage, while the large family of nine or ten children was comparatively rare. 19 20 PROBLEMS OF CHILD WELFARE Exorbitant birth rates belong to a later period. The dense hives of people in India and China are there to-day because of an enormous birth rate, which annually adds millions of babies to the population. A large number of these die in infancy; some suffer from disease; others, because of overpopulation, are the victims of infanticide. During the Middle Ages Europe was stationary in population. The enormous death rate counteracted the effects of a multitude of births ; otherwise the population would have grown amazingly. The age of marriage was low, and as late as the first half of the nineteenth century a large proportion of the girls were married before their eighteenth year. The decline of the domestic system with its long apprenticeships, together with the advent of the industrial revolution, retarded the movement toward later marriages. High birth rates were the natural conse- quence ; many wives died prematurely, while husbands married twice or oftener, and huge families were common. The average family of Franklin's day is the exceptional family of the pres- ent time. 2. Decline in Birth Rates. The general decline in birth rates began during the last half of the nineteenth century. In France, however, the movement began about 1800. It reached England next, and other coun- tries have followed one by one until nearly every country in Western Europe has witnessed a considerable decline. The following table attempts to present some figures relative to the changes that have occurred in a number of countries within a comparatively short space of time.i It appears that Northwest Europe furnishes quite a contrast to South and East Europe, the highest rates remaining in Russia, Austria, Hungary, and the Balkan States. Here the birth rates continue almost unchanged, and methods of restriction are not in vogue ; likewise the decHne has been less rapid in Catholic than in Protestant countries. In New Zealand and Australia a remarkable decline in birth rate has occurred. The few American states which collect birth statistics show ' Mulhall, Dictionary of Statistics. BIRTHS AND BIRTH RATES 21 Crude Birth Rates pee iooo of Population in Various Countries' Austria England and Wales . France Germany Sweden Ireland Hungary ... . . Russia in Europe . . Italy Bulgaria New Zealand . . . United States — Mass. Conn. 1841-1850 1871-1880 1891-19C0 37-6 3Q-0 37-1 32.6 3S4 30.0 27.2 254 22.1 36.1 39-1 36-1 311 30-S 27.1 26.S 23.0 40.6 49.2 36-9 . 34-9 40.7 26.7 2S-9 27-3 24.7 24.1 31-4 28.1 21.3 34-8 26.1 23.2 37-2 324 40.9 26.6 25.2 22-5 but little change during the period covered. The rate for the entire United States in 1910 was probably about 27 per 1000 population, a rate similar to that prevailing in Western Europe. Our native population has a much lower birth rate than has the foreign element, so that conditions in the United States are varied as the immigrant population is unevenly distributed. In the South, however, birth rates among the native-born are still comparatively high. In Massachusetts the birth rates among the foreign born, properly corrected for age distribution, are about twice those of the native American population, but in general all civilized countries indicate a tendency to reduce their birth rates to comparatively low figures. Formerly the proportion of births was relatively high in the cities and the rural rate lagged somewhat. This condition is being reversed ; the cities are rapidly reducing their rates, while the rural districts are slowly following. Several examples of this movement are indicated in the following table of birth rates prevailing in a group of the largest cities of Europe and the United States. 1 Crude birth rates do not afford a satisfactory basis of comparison, but they do indicate general tendencies. 22 PROBLEMS OF CHILD WELFARE Birth Rates per iooo Popttlation' City 1901 Boston . . . New York (old) Philadelphia Brooklyn . . St. Louis . . London . . . Paris .... Vienna . . . Glasgow . . Liverpool . . Berlin . . . 28.16 26.07 2S-S 27.6 21.3 24.S (10) 18.4 26.8 18.2 22.1 (10) 29.0 24.7 21.3 17.2 29.9 20.1 31-7 27.7 32.1 30.1 26.7 20.8 These figures show that in the four largest cities of Western Europe — London, Paris, Berlin, and Vienna — birth rates are below the average for their respective countries. In Great Britain this tendency is less marked, while in the United States the large immigrant population of the cities somewhat obscures the trend. The apparent increase in birth rates in several American cities is probably the result of better registration. The cities showing a decline are a better index of changing conditions. A high birth rate has not shown itself necessary for the realiza- tion of the dream of those statesmen who believe that national strength lies in a large aggregate of population. The increase in numbers depends on the difference between the birth and the death rates, or the annual surplus of births, but countries with the highest birth rates do not necessarily enjoy the largest ratio of survivals. Frequently the converse is true, and countries having high birth rates suffer from enormous death rates, and especially from a heavy infant mortality. Until recently the relative gain in East Europe, in spite of the high birth rate, was less than that in West Europe, where the birth rate was nearly one-third less. More important than the number of births is the reduction of the mortality. The menace begins only when ' Boston Board of Health, Report, rgij, p. 255. BIRTHS AND BIRTH RATES 23 the birth rate has fallen below the death rate and a stationary or decUning population is threatened. 3. Costs of Motherhood. The subject of births cannot be discussed without reference to the physical cost that is involved. The burden of mother- hood is not Ughtly borne. The civilization of to-day has in fact aggravated the pain and suffering of parturition. Compara- tively easy confinements are the rule among primitive people as well as among the European peasants, but the imnatural life of modem civilization has induced a physiological condition which makes labor difiicult. One of the current problems is the task of relieving childbirth of its acquired terrors. Among animals reproduction is the Alpha and Omega of in- dividual life, and everything is subordinated to the life of the species. Among men, conditions are different. To perpetuate the race is not the sole task of our species, and the rights, no less than the duties, of women must receive consideration. On the other hand, the duty of motherhood must not be evaded, and wUl remain for all time. The necessary hardships involved must be borne as all pain and suffering arc borne. Nowhere are men or women free from physical pain. However, fecundity is less important than intelligent motherhood; and the brutal birth rates of the past have not made society more eflBicient. The mother of many children has only stood more often by the open grave. A reasonable birth rate has decided advantages, because the mother concentrating her thought on a few healthy children is charged with power to promote their future welfare ; but if her energy is dissipated among a company of short-lived and un- wanted children, the social consequences cannot be hopeful. A reasonable increase in population is a goal of all thinkers on social subjects, and the small families that threaten the extinc- tion of the race cannot be condoned. The average family must not only be large enough to replace its parents but must cover the losses resulting from deaths, celibacy, and infertility. This would result in the maintenance of a stationary population. An actual increase will require a somewhat larger number of children per family ; and a reasonable birth rate should meet this con- 24 PROBLEMS OF CHILD WELFARE dition. On the other hand, the imprudent, inconsiderate, and machine-like regularity of increase as effected among certain classes of people finds no rational justification to-day. 4. Fecundity of Women. The actual number of children bom to individual families throws light on the fecundity of a population. Especially is this true if the proportions of single persons in the communities contrasted are approximately the same. A study of the number of births per married woman is, however, of no uncertain value, and the recent investigations of the Immigration Commission established by Congress are very significant. They covered Rhode Island, the cities of Cleveland and Minneapolis, and parts of rural Ohio and rural Minnesota. The figures, based on the census of 1900, are summarized in the following table. Ndmber oe Births per Family among Women under 45, MARRIED 10-19 Years ' Nationality Total Area Rhode Island Cleve- land Minne- apolis Rural Ohio Rural Minne- sota All classes A.l 3-8 2-S A. 3-S 2.4 4.0 3-4 S-o 3-4 Native whites of native parents 2.7 2.4 Whites of foreign parents . . 4-4 4-5 4-3 3-8 4-5 5-2 First generation .... 4-7 4-7 4-7 4.0 4.6 S-5 Second generation . . . 3-9 3-9 3-3 3-4 3-8 4-7 Polish, first generation . . 6.2 * 6.1 5-4 .■;.6 6.Q Canadian French, first gen- eration S.8 S-9 * 4.8 * 6.1 Russian, first generation . . 5-S * s-s S-i S-4 5-9 Italian, first generation . . 4.8 S-o 4-7 * 4-5 * German, first generation . . 4.9 3-9 4-7 4.0 4-7 S-6 English, first generation . . 3-7 3-7 3-5 3-0 4.0 4.2 Swedish, first generation . . 4-3 3-9 3-7 4.0 4-3 S-i * Number insufficient to establish proportions. Considering all classes, it appears that the number of births per marriage was 4.1. The number among whites of native 'Report of the Immigration Commission, Vol. 2, p. 497. The above table is not complete, but is representative of conditions, a limited number of nationaUties being included for purposes of illustration. BIRTHS AND BIRTH RATES 25 extraction was only 2.7. The whites of foreign parentage were divided into two groups — immigrants, and native-bom of foreign parents. In each of the five areas studied the fecimdity of im- migrants exceeded that of the second generation — a fact which was also true of almost all nationalities studied. The contacts and conditions of American civilization clearly reduce the aver- age number of children born per marriage. In Rhode Island, which is largely urban, we find a sharp con- trast between the fecundity of women of native and of foreign extraction — a difference of two births per marriage, with the highest figures reported for Italians and Poles. The facts for the city of Cleveland are very similar. There the number of births for all classes was 4, and for women of native extraction 2.4. The largest average number of births per marriage was found among the Poles — 6.1, with the amazing regularity of a birth every 2.3 years, which is 2^ times the rate among the American women. The French Canadians stood second, and the Italians third. The study of the rural districts adduced some interesting in- formation. In rural Ohio and rural Minnesota the average married woman of native parentage bore 3.4 children, exactly one more than her Cleveland and Minneapolis sisters. Strangely enough, the fecundity in the rural sections of these states seems very similar, and the two cities likewise closely resemble each other. In rural Ohio a birth among the women of native ex- traction occurred every 4.1 years. It seems therefore that the native birth-rate in the rural districts is not only much higher than that in the cities, but is also suflScient to maintain the population and even increase it slightly, since the infant mortality in country localities is low. Little difierence in the rates of country and towns was discovered for the foreign born; nearly everywhere they are more prolific than the Americans. The summary for the entire area investigated indicates the fecundity per marriage as follows : Poles, 6.2; French Canadian, 5.8; Russian, 5.5; German, 4.9; Swedish, 4.3 ; English, 3.7; American, 2.7; all classes, 4.1. For good or for ill the native blood in the cities is being gradually displaced with stock that 26 PROBLEMS OF CmLD WELFARE is essentially foreign. In the country districts nationality counts for less and the native stock is holding its own, and so large a proportion of the United States is still rural that if the rates discussed above are representative for the entire rural area, the displacement will be less rapid. Then too it is certain that among the almost exclusively native population of the South, the birth rate is comparatively high. The situation is also somewhat modified by the higher death rates among children of foreign parentage. As a result, the difierence in fecundity is much greater than the actual size of family would indicate. 5. Sterility. The problem of sterility is rapidly gaining in importance. Society is directly interested because birth rates are retarded, while individuals mourn their loss. Some facts representing the conditions in the area investigated by the Immigration Commission are shown in the following table. Percentage of Women under 45, married 10 to 19 Years, having HAD no Children 1 Nationality Total Area Rhode Island Cleve- land Minne- apolis RlTRAL Ohio Rural Minne- sota All classes Native whites of native parents White of foreign parents . . Women of foreign birth : Bohemian German Italian 7-4 5-7 2.4 3-9 A 11.3 17.5 8.0 * 9-5 5-1 * 8.9 * 7.6 8.1 15.2 6.3 2.4 4-7 4.9 2-3 11.4 2-3 8.6 8.5 12.7 6.9 0. S-4 * 9-7 II. I 3-5 S-9 S-2 S-7 S-i 6.4 3-8 4-5 2.8 S-3 2-S 5-0 3-0 S-i 2.7 2.4 1.8 * PoUsh 2.6 1-7 6 8 Scotch 8.0 1.8 Irish 7.4. 7.2 * Number insufficient to establish proportions. Most startling differences occur among the various groups. More than one-eighth of the American women are sterile, but 1 Report of the Immigration Commission, Vol. 2, p. 495. BIRTHS AND BIRTH RATES 27 rates in the city are much higher than in the country. In Rhode Island we find 17.5 per cent, in rural Minnesota only 5.1 per cent. The rates among women of foreign parentage are lower in every instance, and among the more prolific immigrant groups are almost negligible, — - among Russians, Poles, and Bohemians not over 2.6 per cent, or one woman out of 40. As sterility is socially undesirable, its causes need urgent study, and if possible should be removed. Although no data are available, many physicians claim that a large proportion of it is due to the prevalence of those social diseases which induce sterility in women. If this is the primary cause, then men in the rural districts are more moral and are freer from disease than men in the cities ; this the author firmly believes to be the case. It also indicates that a high degree of morality exists among our recent immigrant classes. On the other hand, dis- ease of various kinds has rendered many women sterUe. Im- morality cannot be blamed for this. Some sterility also exists among men, and without doubt a small but increasing proportion of women deliberately refuse to bear children. This percentage is larger among the American than among the immigrant groups. Immorality is baneful, not so much in preventing all births as in rendering women sterile when one birth has occurred. It is a fruitful cause of one-child marriages, and even among Ameri- cans, where at least two children are desired in a family, fre- quently the second child is never born. Moreover, the pangs of childbirth once experienced deter American women more than immigrant mothers who, on the whole, have easier confine- ments and also believe that conscious restriction is unethical. The comparative importance of the different causes of sterility is unknown, but it is plain that strenuous eSorts are needed to save women from the ravages and disasters of the social dis- eases. Men alone can accomplish this end by keeping their minds clean and their lives pure. 6. Still-births. Our vital statistics have imprudently neglected the still-births. These are included neither under births nor deaths, so that fre- quently no count whatever is made of their number. In consid- 28 PROBLEMS OF CHILD WELFARE ering the problem of the potential life of a community, however, the number and proportion of still-births must be calculated, since fecundity is not correctly measured by Hving births, but by the sum of still and living births. In American cities about 4 per cent of all babies are born dead, which means about one still-birth annually for every looo of the population — cer- tainly an item of considerable importance. Widespread knowl- edge in regard to the causes is necessary, and the public must know of the menacing effects of alcohol, social disease, and over- work, for most still-births could be avoided. The development of eflScient methods of prenatal care, as will be shown later, will go far toward adding this group of cases to the living births and thereby contributing to our potential population. 7. Causes of Declining Birth Rates. The desirability of comparatively low birth rates is being recognized; nevertheless rates in France and among some native American classes are too low to be socially justified. The causes of this condition may, however, be partly subject to treatment and removal. To begin with, it is probable that the proportion of couples deliberately remaining childless is small, but it is true that a large percentage of the boarding-house population refuses to rear children. Natural causes play a prominent part in reducing the birth rate. The rising age of marriage deducts several years from the pro- ductive period of life ; and American women marry at an average age of 25 years, whereas it was formerly customary to marry before 21. This alone accounts for a reduction of at least one child per family. As present economic conditions do not favor a return to earlier marriages this cause is likely to become com- paratively permanent. The voluntary avoidance of large families is probably the prin- cipal cause of the decline in birth rates ; and since among native American women especially, the ethics of restriction are justified, the birth rate is definitely controlled. As a causative force the cost of living is a decided factor, for with the constant raising of standards, men with large families cannot afford the coveted plane of living. Young couples frequently find that a child BIRTHS AND BIRTH RATES 29 would handicap them financially and socially, so they avoid family obligations until they believe themselves ready. Any such delay necessarily results in a lower birth rate. Among the well-to-do the love of ease and of pleasure is a more important factor than visions of a high standard of living. Many women prefer cats and dogs to babies, and do not wish to be handicapped in their daily routine of social duties by babies that need attention. They are not willing to sacrifice either time or energy for the most important race duty, but live self- ishly, trying to glean sheaves of enjoyment in the field of artificial pleasures. This group, because of its financial capacity for properly rearing a family, needs more than any other to develop a consciousness of its moral obligation to the race and of its overbearing and undermining selfishness. A considerable proportion of men and women do not marry, and consequently do not become parents. In 1910 88.5 per cent of the women from 35 to 44 years of age were married, widowed, or divorced, — figures which indicate that 11. 5 per cent, of child-bearing age, were still single. Probably but few of these marry, so that, having escaped responsibility of chUd- bearing, they throw a greater burden on the remainder. From the sociological point of view all women who are physically and mentally fit should marry and have a part in the perpetuation of the race. Natural and artificial causes are both contributing to a decline in our.birth rates, but in so far as they do not deplete our popu- lation, they do not offer a serious problem. Opposition to a judicious limitation of size of family is reactionary and unsocial. Infertility and undue restrictions, however, furnish several prob- lems which must be fearlessly attacked and solved. Among the necessary reforms are : The reduction of sterility, whether due to conscious action or disease. The elimination of still-births, through the development of proper prenatal care, through protection from disease, and through the removal of other causes. An increase in the marriage rate and a reduction in the num- 30 PROBLEMS OF CHILD WELFARE ber of marriageable celibate men and women. This reform in- volves considerable change in economic conditions and will be difficult to achieve. 8. Registration of Births. American states have been very negligent in providing for the proper registration of births. In 191 1 the six New England states, with Pennsylvania and Michigan, were the only ones which provided for adequate birth registration, and even here the machinery for collecting the records is not entirely satisfac- tory. Many of the large cities also provide for the regular re- porting of all births and have gathered fairly accurate statistics by means of birth certificates which usually contain the names, ages, and occupations of fathers and mothers; also the legiti- macy of the child, and the number of the birth in the famUy. However, if the chUd is illegitimate, the father's name is not usually entered — a serious injustice to mothers and babies that can be righted only with the greatest diffictilty, because immoral men will not deHberately bear the burden and shame of their own misdeeds. The Federal Children's Bureau is endeavoring to create senti- ment in favor of better birth records, so that the small "birth registration area " of the United States may make a consistent increase. Physicians and midwives must both be required to obey the law and file properly filled out records. At present the ignorance of midwives frequently prevents them from re- turning acceptable certificates, while many physicians are too careless and non-social to perform their duty conscientiously. CHAPTER II THE WASTE OF LIFE I. The Waste of Life. The law of natural selection has been a tremendous factor in fixing the physiological traits of human kind. From the begin- ning of human life up to the present time it has been ceaseless in its operation, but has diminished in intensity with the gradually increasing control by man of the natural environment. The waste which natural selection incurs among animal life is stu- pendous. But for the rigorous processes and destructiveness of nature, even the most slowly reproducing animals would soon overstock the earth. The early life of man is a constant story of struggle and contest, and the primitive races have always suffered from an enormous waste of lives. Every advance in civilization means a saving of human life and a more economical use of nature's bounties. Civihzation implies an increasing use of all our mental and physical powers and the most efi&cient utilization of the many forces of nature. The more primitive a society, the more absolute is its subjection to the conditions of environment and the more helpless are its members in the face of disease and death. Probably in no other field of human activity has man's igno- rance been more lamentable in its consequences than in that of rearing children — the future parents of the race. Even the slow increase of savage tribes is purchased at a tremendous expenditure of energy, and the number of infants and little children whose physical and economic cost has never been com- pensated for by useful and productive lives has been appalling. Although decreasing costs of progress characterize an advancing 31 32 PROBLEMS OF CHILD WELFARE civilization, nations have but recently begun to realize the costs involved in the loss of infant and child lives.^ The sacredness of human life is no longer a mere principle. It is a rule of action and has found expression in the voluntary efiorts made to reduce the death rates. Happily the history of recent centuries demonstrates the possibility of tremendous progress, and the gradual decrease in mortality indicates that medical and sanitary science has been slowly gaining ground. Mortality rates both for infants and adults depend upon many complex considerations, and society has been learning the social, economic, and physiological factors which determine the fluctua- tions, gains, and losses. The economic conditions, the social environment, the moral and intellectual standards, and the ad- vance in medical science of any community are especially re- flected in the vitality of its children. In fact, the infant and child mortality of a people is a barometer of their social progress. The problem of infant mortality formerly received but little attention apart from occasional references to the subject by phy- sicians. When birth rates were high, the social consequences of a large annual loss of life were hardly apparent, and the matter received but little consideration. Besides, economic necessity pressed men down and prevented them from attempting reforms. In recent years, because life has become a more precious posses- sion, the individual has gained in value, and moral obligations now compel us to save life whenever possible. Infants naturally reap their share of the advantages that have followed the greater consideration of human life. In fact, the history of infant mortality indicates that special attention has been given to the children. 3. Decline in the Death Rates of Children. Whatever be the present waste of child life we must not over- look the progress of the last two centuries. Historically speak- ing, the gain has been almost immeasurable. Two hundred years ago a large majority of the children born in London per- ished before they reached the fifth year of life, but to-day the proportion is less than one-fifth. Yet the beginnings of national • As used in tins book "infant" refers to a child under one year of age. THE WASTE OF LIFE 33 life throughout Europe were everywhere accompanied by a similar waste of child life. Therefore the population of nearly every European country remained almost stationary for decades and rose but slowly until about 1750. The infant mortality of London was little higher than that of other English cities, and all England, as well as the continent, lived beneath the pall of the blighting destroyer of little children. As late as 1761, 50 per cent of the English population died before reaching the age of 20. The enormous gain of to-day is not appreciated until one realizes that at present one-half of the people of England live until the fifty-fourth year has been reached. It is not surprising to learn that in Prussia during the decade 1751-1760 nearly seven-tenths of the children failed to reach the age of ten.^ Practically three-fourths of the entire population died before they were able to contribute to society and while they were stUl a cost to parents. Russia likewise gave but little attention to the moral and social conditions which result in a low infantile death rate. It has been estimated that at the beginning of the nineteenth century only one-third of the children of Russian peasants grew to maturity, and not more than 36 per cent of the entire population of Russia reached the age of twenty years. Not so many years ago many scientists believed that a city popu- lation left to its own reproductive powers would gradually die out, and doubtless this was at one time true. Luckily this dis- mal philosophy has been dissipated by the humanitarian and scientific progress of our recent civilization. Cities actually do maintain themselves and boast of a birth rate larger than their death rate. Although they draw heavily upon the rural districts, they would still increase in size were they to rely en- tirely upon their own native vitality. 3. Historical Stages. a. First Period. Three separate stages or periods may be observed in the his- tory of infant mortaUty, and each is characterized by its own dis- 1 Roscher, William, Political Economy, Vol. II, p. 307. These statistics, as well as most figures for the eighteenth century and before, probably contain a consider- able percentage of error. D 34 PROBLEMS OF CHILD WELFARE tinctive features and results. The first stage began with society itself and represents the period during which ignorance and in- difference were slowly succeeded by increased attention to the lot of the new-born and helpless child. Only the most patent and active causes of mortality were removed, however. During this period began the triumph of man's power over disease, but the absence of preventive medicine and the incapacity to cure disease were serious handicaps. Probably the history of the Caucasian race furnishes no more striking example of the power and havoc of scourge than that of smallpox. Formerly it was the most frightful of contagious diseases, and very few individ- uals — probably not more than 4 per cent of all persons reach- ing the age of thirty — escaped all attacks of this ever-present plague. Two-thirds of the entire infant population are said to have been attacked, and a large mortality resulted. Wester- gaarde tells us that in Sweden during the decade 1751-1760, 13 per cent of all deaths was due to smallpox — a proportion far in excess of that caused by the " White Plague " of to-day. During certain years the proportion in France rose to 10 per cent, while that in Liverpool has been as high as 20 per cent. Toward the close of the eighteenth century the remarkable discoveries of Jenner finally brought smallpox into subjection. A very rapid decline in the mortality from this disease imme- diately took place, so that deaths from smallpox have become an almost negligible factor in the records of present vital statistics. If Sweden's mortality during the decade 1 751-1760 were dupli- cated to-day, it would mean approximately 3000 deaths annually in a city of 700,000 population, yet in St. Louis, a city of this size, not a single death from this cause occurred in 1912. Boston, with nearly the same population, reported only three deaths and twenty-five cases in eight years (1904-1911). The pitted faces once so common are seldom seen to-day. Smallpox was formerly a children's disease, simply because almost all adults had been attacked in early youth. Without quarantine facilities, and with no knowledge of preventive meas- ures, it was absolutely impossible for children to escape exposure to the disease, but to-day the average age of persons dying from THE WASTE OF LIFE 35 smallpox is twenty-seven years. Vaccination has proven a most remarkable boon, and has saved more lives than any other specific for disease. So insidious and contagious is smallpox, that the method of vaccination is still necessary to protect a community. Because of the practical elimination of smallpox, largely through vaccination, the average duration of hfe has been increased three and one-half years. The opponents of vaccination have no sound arguments to support their conten- tions, for the historical evidence in favor of the use of vaccine is absolutely overwhelming. The progress made during this period is further Ulustrated by the decreased variations in the general death rates of London.' For example, in the decade 1740-17 50 the rates fluctuated as much as 60 per cent from year to year, and during the following half century fluctuations of 33! per cent were common, but in the decade 1820-1830 the variations did not exceed 20 per cent. Even such a percentage would furnish occasion for alarm at the present day. In fact, a variation from the normal of i| deaths per 1000 of the population, that is, of about 10 per cent, would at once force a board of health to institute a searching investi- gation of the causes. This period closed about 1840, by which time the infant mor- tality was reduced to a rate but little higher than that prevailing at the beginning of the twentieth century. Among the improve- ments which had been made and which were largely responsible for the reduced death rates were the following : improved hous- ing, more efiective sanitation, better hygiene, an increase in the general food supply, the elimination of famine, the development of safeguards against pestilence, and increased knowledge of medical science. b. Second Period. The second period lasted until the very recent past, and many localities still retain the characteristics of this stage. Extensive gains had been made during the former period, but nothing was as yet known about the germ. Improvements of many kinds were made, but the chief gainers were adults: for example, ' Roscher, William, Political Economy, Vol. II, p. 308. 36 PROBLEMS OF CHILD WELFARE between 1850 and 1900 the death rate in England for children under one year of age remained practically unchanged, but the general death rate fell 18 per cent. This fact indicates either iadifference to the causes of infant mortality or inability to pre- vent disease. The condition, however, was general; France actually showed an increase in infant death rates between 1840 and 1880, and in many German localities alarming rates still prevail. In Massachusetts the mortality of children under the age of one increased slightly between 1856 and 1895, t)u.t mean- while the death rates of children under five slowly declined. It is probable therefore that the needs of infants were not under- stood, nor were the means of meeting such needs known. The peculiar susceptibility of the babe to the slightest change, either in external conditions or in the character of the food given, was not appreciated nor understood. Furthermore, infants suffered from the comparatively low valuation at which they were rated. The child generally receives a smaller per capita amount of appreciation in a large family than he does in a small one, and in this period the former was still the rule. Perhaps the all-absorbing growth of industrialism deflected attention from many of the serious social problems of the day. The doctrine of personal liberty also had a firm hold on the people, and interference with individuals to save them from the consequences of their own ignorance was hardly justified. Laws affecting child labor and the employment of women had indeed been passed and put into operation, but no strong sentiment supported such laws. To carry the work of education to the parents' homes was too bold a proposition, for society was not privileged to interfere. Philanthropy was busy with a reme- dial program, and but little attention was paid to preventive methods. c. Third, Period. Preventive Methods. The third period, which is characterized by intensive methods of saving human life, has only recently begun. In order to make progress, old principles must be discarded and new ones accepted, it having been especially necessary to abandon the theory of laissez faire. Problems of human betterment must be solved THE WASTE OF LIFE 37 in a practical manner. To recognize the social importance of the birth of a child is to recognize the duty of society to grant that child an opportunity. Following this principle every large American city has redoubled its efforts in recent years to reduce its infant mortality, medical science having provided the greatest incentive to preventive work. The rapid growth of knowledge about the microorganisms or germs that attack the human body is proving of tremendous value. The investigations and discoveries of Pasteur have done more to stimulate intensive methods of lessening infant mortality than any other factor. It has been learned that the most dangerous and destructive , children's diseases can be almost entirely eliminated by recently ' discovered methods of attacking germ diseases. If vigorously applied, they should bring about an enormous reduction in the infant mortality of the day. 4. Economic Cost of Child Mortality. Industrial progress has far outstripped our advance in stand- ards of life. The utilization of material formerly wasted has been developed into a science, and in some cases the difference between profit and loss has been measured by this saving. The continued decrease of necessary cost and labor is one of the aims of industry, and if we apply this principle to the cost of propagat- ing the human race, we find that society has hardly begun to conserve its physical powers in economical ways. Thousands of lives are stUl needlessly sacrificed because of failure to appre- ciate the loss. Every child born into this world represents an investment, the value of which is measured by his expectation of life at birth ; and if his expectation is low, society cannot hope for a heavy gain from its outlay, since the economic advantage derived from his services will be small, and will correspond to a low rate of interest on an investment. Productive human lives are the assets of society, and the dividends of progress depend upon the sum total of years spent in useful service. The heavy economic loss resulting from a high infant mortality can be but vaguely expressed in figures of mortality or longevity. The loss of time and energy by the expectant mother is also an item of great importance. It is difficult to approximate the probable 38 PROBLEMS OF CHILD WELFARE cost incurred in rearing the children who die before the age of fifteen has been reached. In most cases the child before this age is not a producer, but a consumer, and remains an economic cost to society. In addition, vast sums are expended to develop the eflSciency of the children, and hundreds of dollars are lavished on them, society naturally expecting some reimbursement for its expenditure. If we pause to consider that every death of a child below the age of puberty means an absolute loss of poten- tial capital and productive power, our imagination slowly begins to appreciate the appalling loss to society that high death rates among children involve. The older the child, the greater the cost which he has entailed, and the greater the loss in case of death. It has been estimated that among the Bontoc Igorrote of the Philippines, 60 per cent of all persons die before the age of puberty is reached. Much of their energy is spent in simply trying to maintain their present numbers. Western civilization has suffered severely from its tardy atten- tion to problems of health and vitality. Estimates based on records for Geneva, Switzerland, indicate that the expectation of life at birth rose from twenty-one and one-sixth years in the last half of the sixteenth century to forty and two-thirds years in the first quarter of the nineteenth. Considered from the economic point of view, however, the productivity per equal amounts of population in the latter period is much greater than in the former. The duration of life after the fifteenth year was about six years in the sixteenth century, but twenty- five in the nineteenth. This makes the average individual of the last century of far greater economic value to his community than the individual of the earlier period. Productive human lives have been purchased at an enormous cost, and an increas- ing age at death represents a great social advance. England, France, Germany, and the minor European coun- tries all testify to the gradually increasing expectation of life of their inhabitants. The tables computed for Netherlands show a most remarkable degree of progress: for example, in the period 1811-1825 one-half of the males died before reaching the age of twenty-five, but during the decade 1 860-1 869 forty THE WASTE OF LIFE 39 years represented a probable lifetime. The table by Van Pesch for 1 890-1 899 shows that the fifty-sixth year is now passed before one-half of the males perish, although only one-fourth were left at that age in the period 1816-1827. American records also indicate the heavy economic loss due to high rates of mortality. In 1900 the average expectation of life in Massachusetts was forty-six years, and that for the entire United States probably did not differ much from this. At least 25 per cent of all children die before the age of fifteen ; only about 75 per cent reach the productive period of life and begin to yield returns upon the social investment. Risking the possibility of a future advantage from their services, society has, through their parents, provided the children with food, clothing, shelter, and other necessary means of subsistence. It has given the older children educational advantages and, through the agency of the commimity, has ofiered moral and religious instruction. Fortunately five-eighths of the total mortality of the children under fifteen falls within the first five years of life, when the economic cost of the child has not assumed extensive proportions. The importance and significance of this economic problem has not received due recognition. 5. Mental and Moral Effects. From the moral and intellectual point of view, the infant mortality of the ages has been a constant reproach to men. It is a remarkable fact that a high infant mortality tends to inflict upon a people a fatalistic belief from which recovery is very difiScult. It fetters the minds and the souls of men and causes them to rest the blame upon the Divine instead of placing it where it belongs — upon social neglect. Even to-day, many a mother consoles herself with the thought that it was God's will to take from her the victim of contagion or digestive disease. She does not know of the apparent discriminations against the poor, the overcrowded, and the ignorant. Ignorance develops fatalism, and fatalism checks the advance of science. Another obstacle to progress has been the attitude of a group of impassioned religionists, who alleged that woman was irrev- ocably cursed to suffer, and to bring forth her offspring in pain 40 PROBLEMS OF CHILD WELFARE and sorrow. Protest against the use of an anaesthetic to assuage the pain of an expectant mother is a case in point. Medical science must frequently combat religious prejudice, which has no right to interfere with social reform. The achievements of medicine and of sanitary science have done much to emanci- pate the human mind, and to prepare men for the acceptance of a program of social betterment, but the social and moral energy of a people living under bad conditions is to a large extent misdirected and impotent. 6. Physical Degeneracy. A final consideration worthy of notice is the relation of infant and child mortality to physical deterioration and to our stand- ards of physique. To this question no definite answer has as yet been given, and data upon the subject are too inadequate for broad and definite conclusions. The eugenists are busy gathering facts on this subject, but they must always work imder very serious limitations. They cannot easily separate the inherited from the acquired weaknesses, and it is difficult to prove their case. Meanwhile prenatal work among prospective mothers is pointing the way to individual improvement. The author has no patience with those men, whether eugenists or not, who regard with favor a considerable wastage of child life because it accords with their theory of the improvement of the human race through the operation of the law of natural selec- tion. Beneficent as results may be for the race of the future, this law, unmitigated and untempered by human hands and hearts, is harsh and cruel, and its operation tends to debase the sensibilities of men and to retard progress. Race improvement cannot be left to the cold-hearted methods of unconscious nature, and man can act less harshly and with equal effect by means of a process of social selection. Instead of permitting the imfit to die, the more humane and economical method is that of refusing to permit the unfit to come into the world. This avoids the brutality of natural selection, and accomplishes the same result. Standards of fitness must eventually be created, and these must be positive in character and independent of the caprices of environment. Accordingly they cannot be secured THE WASTE OF LIFE 41 through the operation of natural selection ; for mind, not matter ; reason, not instinct, must hereafter direct our line of progress. Before the days of the physician, disease could not be con- trolled, and the weaker individuals perished, because mankind suffered from a long category of children's diseases. Certain races and peoples have in this way purchased considerable immunity from various diseases. The individuals most unfit to withstand some particular disease succumbed, and this long-continued process of elimination resulted in strengthening a people against further attacks of disease. We are so far from a knowledge of what constitutes a correct standard of fitness that we must be cautious in our methods of attempting to improve the race. For example, when measles was first introduced into the Hawaiian Islands, it proved a terrible and most deadly plague, but later epidemics were less severe, and the present population is still susceptible to the disease, though not in such a severe form. A selection of this kind protects against certain forms of attack but does not immunize a people from other diseases. It is not clear that in. this way a race is provided with the physical standards best adapted to the conditions of modern life. We must not assume that the malaria-breeding mosquito and other germ-carrying insects form a necessary part of the environment of men. The susceptibility of the negro to yellow fever is unquestionably less than that of the white man, but this comparative immunity does not extend to all diseases, and in other respects the white man enjoys a similar superiority. Again immunity from disease is not the chief or only ground on which to judge physical stand- ards. In fact, some diseases prefer the strong rather than the weak, and race vigor and susceptibility to a certain disease may indeed go together. Actual physical strength, productive capacity, and mental and moral vigor are the criteria of fitness, but immunity from disease bears no direct causal relation to these qualities. Furthermore, no single race has gained a su- periority in all these respects. Smallpox serves as an eloquent illustration of the fact that we have little to fear from the elimination of such diseases. 42 PROBLEMS OF CHILD WELFARE How brutally selective this malignant scourge has been can be read in the history of its ravages among the savage tribes to which civilization has introduced it. Their proneness to the disease is due in part to their former isolation from the small- pox germs. The determining question, however, is, has the elimination of the children vulnerable to this disease improved the race or people long subject to smallpox ? It has imdoubtedly lessened the relative intensity of future attacks upon the Cau- casian race : for example, an athletic Indian of splendid physique may succumb, while a diminutive Englishman or American may escape with a slight attack only. Who then can measure the actual physical gain from the decimating effects of smallpox? There is no certainty that it has accomplished anything in that direction which other forces would not have done with equal efficiency ; and so with the entire army of germ diseases. They have been selecting for survival those most capable of resist- ing the germ, but here their labors cease. Being proof against germs is not an inherent characteristic of good physique. The two, on the contrary, have very loose connections. In the future we will endeavor to destroy the germ as well as to discover anti- dotes for the disease, and if any deterioration should accom- pany these scientific triumphs, the remedy will consist in posi- tive measures to rear a more vigorous progeny, not to eliminate weaklings. The most that we can hope to gain from immunity against some particular germ is the elimination of the disease of which the germ is the cause, for physical strength and bodily vigor will be but slightly affected thereby. Although death rates may represent certain forms of physio- logical selection, infant mortality is hardly a method of such selection. It is really a measure of the depths of the ignorance and backwardness of a civilization. If the reduction in infant mortality which will follow aggressive social reform should occasion a positive loss in physique and strength, then only will it become necessary to utilize positive methods of selection. Meanwhile the problem of physical degeneracy need cause little worry. The increasing death rate among persons in the higher age groups cannot be charged to a reduced infant mortality, THE WASTE OF LIFE 43 since death rates were high when those now dying at the age oi sixty were mere infants. The indifEerence and moral obtuse- ness consequent upon a misunderstood infant mortality should have no place in the lives of men and women, and opportunity for enjoying the fruits of life should be provided for all. Then only have we instituted a proper system of social economy. CHAPTER III CONDITIONS UNDERLYING CHILD MORTALITY Health conditions, climate, customs, and industries in the United States vary widely from the conditions prevailing in Western Europe, and therefore the problem of infant and child mortality is somewhat different in character. Until recently our population has been largely rural, but with the development of urban and industrial centers and the increase of a wage-earning class, new conditions have been thrust upon us. These condi- tions are reflected in the varied rates of infant mortality. I. Rural vs. Urban Mortality. The first characteristic variation in infant death rates is the difference between the mortality of rural and urban districts. This difference, although not necessarily inherent, will tend to persist for an indefinite length of time. Our urban growth has been so rapid that cities of 10,000 and over now contain more than three-eighths of our entire population ; consequently a steadily increasing percentage of children are becoming subject to the health conditions of the cities. City life has suffered from a number of very grave and almost insuperable disad- vantages, and for these reasons the urban death rate has ap- peared hopeless. For a long time to come children in the city must suffer from a congestion of population. A pall of smoke or dust continually hovers over some cities and contaminates the air; the atmosphere is always more or less vitiated by impurities, and billions of injurious germs are ever ready to destroy human life. The lack of fresh air is perhaps the city's chief handicap, although children also suffer from an insufficient amount of light and sunshine. The salubrious effects of nature's healing forces are well known, but the country child is the chief gainer, as it is difficult to provide adequately for the city child. 44 CONDITIONS UNDERLYING CHILD MORTALITY 45 Danger from contagion is much greater in the city than in the country districts, since even the most painstaking measures of quarantine and isolation wUl not obviate the differences. The ebb and flow of city populations tend to perpetuate disease and to carry it from place to place, but from these dangers the rural districts are almost immune. Hvmdreds of children are gathered together in city schools, and disease can easily be spread among them. Furthermore, crowds frequently assemble and scatter contagion. The cities offer the lurking germs a better opportunity to hide themselves, and the squalor and poverty of the " other half " render them easy victims of disease. Federal statistics indicate that such children's diseases as diphtheria, scarlet fever, smallpox, and the diarrhoeal diseases are much more frequent in the cities than elsewhere. The pro- portion of deaths in England caused by immaturity is twice as heavy in the cities as in the country, while that for epidemic diarrhoea is seven times as high. Another handicap which the city chUd must suffer is dependence upon an imported food supply which is subject to deterioration while on the way. Especially is this true of milk, from the bad eSects of which thousands of children die every year, the immediate cause being some form of diarrhoeal disease. Various contagious diseases are sometimes traceable to an infected milk supply, while fruits, vegetables, eggs, and meat are often partly spoiled before they reach the consumer in the city. Bad city water is a source of danger to thousands, whereas a single well or even a number of wells in the country will affect comparatively few people. Urban life therefore is inferior to rural life in three important respects : first, there is an insufficiency of fresh air, of sunlight, and of healthful outdoor life ; second, contagious diseases are more common and less easily suppressed; third, the food and drink consumed in the city have a relatively greater deleterious effect. The statistical results of the differences that exist are briefly indicated in the following table of mortality. The rates for the diseases specified show the proportion of deaths per 100,000 population in urban as contrasted with rural communities. 46 PROBLEMS OF CHILD WELFARE Death Rate from Specified Diseases in Registration Area per 100,000 Population. (1911) ' Diseases Registration Cities Rural Parts 01 Registration States Measles Scarlet fever 10.2 II. 2 10.9 21.9 9S-3 85.2 9-7 6.0 Whooping cough Diphtheria and croup Diarrhceal diseases (under two years) . Congenital debiUty and malformation 11.8 SS.8 71.7 The above statistics are not based on age groups, as they should be, because the Bureau of the Census failed to make these com- parisons. Accordingly the principal children's diseases have been selected and the mortality noted. It is evident that with the exception of whooping cough and measles, there is a large discrepancy between the rural and the urban rates. The latter are 75 per cent higher for the diarrhceal diseases, nearly 90 per cent higher for scarlet fever, 45 per cent for diphtheria, and 19 per cent for congenital debility. Although no adequate Ameri- can statistics are available, these facts as well as older figures clearly show that the child in the country has a great advantage over the city child as far as freedom from disease is concerned. Furthermore, the lowest mortality from the children's diseases is reported from the states which are largely rural. European statistics corroborate these conclusions. 2. Negro vs. White Death Rates. There is a marked difference between the death rates of negro and of white children. This difference is so wide as to make it a problem of the utmost gravity for the negro race. The negro possesses certain constitutional disqualifications which result in a uniformly high death rate in every age period of life, but other considerations also affect his vitality. Among these are his poverty, ignorance, bad housing conditions, sexual excesses, poor food, and general negligence. 1 United States Bureau of the Census, Mortality Statistics, 191 1, p. 74. CONDITIONS UNDERLYING CHILD MORTALITY 47 The very unsatisfactory federal statistics for 1900 indicated that the mortality of negro children was double that of the white, and that in the cities three-eighths of the children under five were regularly lost. In the rural districts, however, the rate was one-third lower, less than that still existing among the white population of Eastern Europe. The wide disparity between the rural and urban rates is a hopeful sign for the negro, for it indicates that a considerable proportion of the excessive mor- tality is due to environmental factors and therefore subject to human control. The latest available statistics — 1911 — do not make a general comparison of infant death rates possible because of the inadequacy of the data. They show, however, that the general death rate of the negro has fallen to 23.7 per 1000, but it is still 73 per cent higher than that of the white race, and in many Southern cities, an enormous mortality stUl prevails among negro children. Carefully compiled records for 191 1 show that the mortality of colored children under five as compared with the white was as follows : for Washington, 88 per 1000 population of corresponding ages as against 32.5 ; for New Orleans, 75.1 compared with 37.8 ; for Baltimore, in. 2 and 43.2 respectively. Scarlet fever and diphtheria have been less severe in their attacks upon the negro child than upon the native whites, but the relative fatalities from the diarrhoeal diseases have been distressingly larger, and so with the mortality from the respira- tory diseases and from congenital debility. A lower death rate from certain diseases clearly indicates the comparative immu- nity of the negro race in these respects. On the other hand, higher rates do not in themselves prove a greater susceptibility to other diseases, because the precise influence of inferior social conditions cannot be determined. The latter seldom favor the negro child, who, if he refuses to succumb to disease, clearly demonstrates superior resisting power. Although the negroes on the Panama canal had a death rate two times as high as that of the white laborers, the comparative mortality of negroes and whites, living under practically the same conditions in our cities, is not so varied. It is fairly clear that a considerable 48 PROBLEMS OF CHILD WELFARE proportion of the excess death rate among negro children is due to the unfortunate and dismal homes in which they live, and to the ignorant parents on whom they must depend for care. 3. Social and Industrial Conditions. The difEerence between good and bad social and industrial conditions is roughly measured by the difference between intelli- gent care and neglect of children, although poverty is of course a dominant factor. The infant mortality in our slum sections and industrial centers is almost invariably larger than that in the other parts of our cities, the conspicuous exception to this rule being the low mortality of Jewish chUdren, in spite of their life in the slums and among almost intolerable conditions. Industrial cities are prone to develop conditions inimical to child life. Frequently the number of married women employed is so large as to affect vitally the degree of care which can be bestowed on the child. The large factory towns of New England are conspicuous examples, since a considerable foreign population has entered the manufacturing establishments there; women are employed in large numbers in the mills, and consequently many children are neglected. In Massachusetts the infant mor- tality of the industrial centers where tenement houses are common, as in Fall River, is more than twice as large as that of the residential towns. Cities in which mixed conditions prevail show a proportionate mortality, the rates declining as residential features gain in comparative importance. Cholera infantum has been shown to have a direct relation to the number of married women employed away from home. The number of deaths from the diarrhoeal diseases in the industrial sections is appalling, and must be deiinitely attributed to the gross neglect of the children by their hard-working parents. The misery of the slum is a well-known fact, and the poor districts of a city suffer from the excessive infant mortality imposed upon them by their surroundings. In Chicago, for instance, the Stockyards section is hopelessly inferior to a resi- dence section such as Hyde Park. Some slum districts in spite of their high birth rate do not add so large a proportion to the total population as do the better sections with a smaller birth CONDITIONS UNDERLYING CHILD MORTALITY 49 rate and a lower infant mortality. In the worst sections of St. Louis the infant death rate is twice that of the city as a whole, while English statistics show that the infant mortality of the wealthiest counties is slightly less than half that of the worst industrial county, the highest rates being found in the cities which are the seat of the pottery, textile, and mining industries. The laboring classes suffer from a much higher infant mor- tality than do the salaried and professional classes. Some years ago Wolf ^ presented statistics for Erfurt, Germany, which indicated that 505 out of every 1000 infants died among the working classes ; that the relative mortality among the middle classes was 173 ; that among the rich it was only 89. The principal cause of this lower rate among the wealthy was their greater capacity to care for their children in the right way. The industrial cities of Lowell and Fall River are the only American cities of more than 100,000 population which in 1911 reported an infant death rate of more than 200 per 1000 of the population under one year of age. Although grave difficulties exist among the various classes in the United States, they are less marked than abroad. Nevertheless the condi- tions of environment are uniformly superior for the child of wealthy parents ; the housing is better, the food is more adapt- able, a physician is always procurable, detailed care can be given, and disease can be more successfully combated. The proportion of wealthy children dying from measles and sum- mer complaint is comparatively small. The higher mortality among the children of the working classes is due to the absence of these advantages, and even where women are not compelled to work away from home, other handicaps often exist. But when the mother must enter the gainful occupations, the situa- tion is well-nigh hopeless. The influence of ignorance is clearly seen in such rates as those prevailing in Moscow, Russia, which in 1910 had an infant death rate of 297 per 1000 births, while that of Amsterdam stood at 78. In thirty years the former city reduced its rate 7.9 per ' See Spargo, The Bitter Cry of the Children, p. 7. 50 PROBLEMS OF CHILD WELFARE cent, the latter, 55.7 per cent. Where people are intelligent and the rate of illiteracy is low, there the preventable diseases of iafancy are rapidly coming under control. In several Euro- pean countries the agricultural districts suffer from very high infant death rates, which are mainly due to the enforced absence of the mother from the home, and to the utter ignorance of many of the peasants. Home conditions suffer if the mother is compelled to spend her time in the fields. In this way the superior advantages of the country are largely lost. 4. Illegitimacy. Illegitimate children sufEer from an enormous death rate, which usually ranges at about twice that of legitimate children. The differences are partly due to the fact that many fatherless babies are cared for in inferior institutions, partly to the igno- rance or neglectfulness of the mother, who also has usually but little assistance in supporting her baby. She must work to maintain both herself and her child; accordingly the child frequently receives altogether too little care. If given as much care as the legitimate child, the death rates are but slightly dif- ferent.' In the Poor Law Institution in London the rate per 1000 for legitimate children during the first two weeks of life was 47.2 in 1907 ; that for the illegitimate children was i.x per cent less, but in the institutions outside of London the rate for the illegitimates was 2.4 per cent higher than for the others. Given a similar environment, the death rates do not vary much from each other. 5. Age and Sex as Factors. A remarkable proportion of the infants that die are lost within the first three months of life ; for example, in England, in 1909, 55.1 per cent of the infant mortality occurred during this period. In the registration area of the United States in 1911, the propor- tion was nearly 60 per cent and 42.2 per cent of the deaths occurred during the first month. The mortality for the first month of life is apparently eight times as heavy as for the remainder of the first year, but this is not all, for a still more startling condition exists. English statistics indicate that 2.4 ' Minority Report of the Royal Commission on the Poor Laws, igog, pp. 86, 87. CONDITIONS UNDERLYING CHILD MORTALITY 51 per cent of the newly bom die during the first week. At that rate no children would remain at the end of 42 weeks. In the United States nearly one-fourth of the infant deaths occur within one week from birth, while in some cities this rate is actually exceeded. Nearly 10 per cent of the deaths imder one year occur the first day. The average mortality for the first week is sixteen times as high as for the remainder of the year. To summarize : the infant mortality is very high during the first week, it remains high for a period of three months, then grad- ually declines month by month. In some cities, however, it rises again toward the close of the year because of the weaning of babies and the extended use of animal milk and other arti- ficial foods. About 106 boys are bom to every 100 girls, this excess being necessary to offset the higher mortality among boy babies which continues throughout the first five-year age period. It seems that the resisting power of girls is somewhat greater than that of boys, but the reasons for this are somewhat obscure. 6. The Reduction of Infant Mortality. The gravity of the problem in the United States is measured by the difierence between the actual and the non-preventable infant mortality. Social progress demands that the rate be reduced to the lowest minimum consistent with the physical welfare of the people. There is a limit below which the reduc- tion of infant mortality would only result in an increase of the death rate throughout the childhood period, or in the preserva- tion to adult years of men and women doomed to early death on account of constitutional weaknesses. The infant mortality is becoming a constantly decreasing proportion of all deaths, as more infants are being saved than formerly, while the gains for adults are less favorable. This does not necessarily imply a weakening of the race, but may simply mean preventive work where it was not applied before. The saving of weaklings may be of doubtful benefit to society, yet social progress should be possible without the sacrifice of child lives. The present problem consists in reducing the infant mortality to the lowest point which enlightened civilization 52 PROBLEMS OF CHILD WELFARE can accomplish. The reasonable bed-rock is far from present attainment, and experiments in limited areas where exceptional care could be given to children have resulted in remarkable reductions of the infant mortality. Because such experiments are necessarily local, the death rates which are attained represent a figure lower than the average to which general rates can be reduced for a considerable time to come. In order to indicate the changes that have occurred in the United States, the following somewhat incomplete statistics are presented.^ Death Rates or Children by Age Geodps Area and Ages Rate per rooo of Specefied Ages Pergentage of Decldie 191 1 1900 States included in registration area in 1900: Under i year 1 to 4 years Under 5 years S to 9 years 10 to 14 years States included in registration area in 1911 : Under i year I to 4 years Under 5 years S to 9 years 10 to 14 years 125.S 12.8 36.6 3-2 2.2 112.9 11.8 32-9 3-1 2.2 161.9 19.8 49.9 4-7 3-0 22 35 27 32 26 Consistent progress has been made since 1900. The states for which continuous records for 12 years are available indicate a decline in the infant death rate of nearly one-fourth, while the mortality under five has decreased even more rapidly. Notable gains have also been made for the older children, among whom less progress might be expected. Roughly speaking, about one-eighth of the children in these states die under one 1 United States Bureau of the Census, Mortality Statistics, 191 1, pp. 14 and 20. CONDITIONS UNDERLYING CHILD MORTALITY 53 year of age. Although, in 1900, the proportion was about one- sixth and in 1890, according to very incomplete statistics, about one-fifth. A notable saving in life has thus been effected. Probably about one-fourth of the population in these states dies before the age of fifteen, although in the present registration area the proportion is apparently somewhat less. Here the infant death rate is only 112. 9 per 1000 population under one year of age, and in 10 out of the 22 states included the recorded rate is less than 100, the lowest being that of the state of Wash- ington, 64.6. Wide differences still exist among the cities, as is shown in the following table. Death Rate pee. iooo Popdiation at SpEcirrED Ages ' Cities 1911 1900 Percentage of Under i I to 4 Under 5 Under i Decline Fall River Lowell Richmond Philadelphia .... New York City . . . Boston Chicago St. Louis Los Angeles Minneapolis 239-S 203.4 197.6 141-9 130.6 i6o.g 123-3 123.8 100. 1 106.4 23.2 19.5 20.4 18.8 17.4 16.9 16.0 16.0 II-5 9.6 74.0 60.6 61.5 45-3 42,0 47-6 39-S 38-3 3°-i 30.0 304-7 275-5 300.7 201.9 189.4 194.I 146.6 162.4 175-I 102.0 21 26 34 30 31 17 16 24 43 +4 Such a divergence of rates needs explanation. No doubt natural climatic advantages lie at the base of some of the in- trinsic differences. Good climate and a diminutive slum popu- lation check the rates in the cities of the West and Northwest, most of which have low rates. Contrasted with these is a group whose rates are almost twice as high. In the South these exces- sive rates are due to intense summer heat, malarial conditions, and contaminated water, as well as to the presence of the negro. In the North it is clearly due to bad housing and poor food and ' United States Bureau of the Census, Mortality Statistics, 1911, pp. 14 and 23. 54 PROBLEMS OF CHILD WELFARE to ignorance among those classes which allow the mothers to enter the mills and factories. In nearly all of the large cities a considerable reduction in the infant death rate occurred during the decade, — an improve- ment due to the vigor with which the cities have wrestled with the problem. A decline of from 20 to 30 per cent has been common, the most conspicuous gain being that of New York City, which in spite of its congestion, and its unfortunate classes, has reduced its infant mortaUty more rapidly than have the other large cities. A few cities in the West have increased their rates, but natural conditions have been so favorable that little preventive work has been done. As the cities grew and condi- tions became worse a higher death rate followed, but in spite of this rise the rates are still comparatively low. In a sense the great proportion of all infant mortality is theoretically preventable ; yet, as in the case of crime, industrial accidents, etc., a fairly regular recurrence of cases from year to year may be expected. Consequently the socially preventable mortality of to-day is much smaller than that which in course of time will become absolutely preventable. In the rural dis- tricts and the smaller towns, where a salubrious climate prevails, the chances are so strongly in favor of the child that not more than 6 per cent of the infants should be expected to die during the first year. A number of rural counties in Scotland now en- joy a rate of less than 70 deaths per 1000 living births — a rate very similar to that of the state of Washington. Among indi- vidual families still lower rates are frequently found. The author knows of a man who had 41 first cousins, only one of whom died in infancy; yet it is useless to hope for a general rate of infant mortality as low as 2J per cent. The Western cities should be able to reduce their infant mortality to about 75 per 1000 births within the present decade, and conditions are favorable for this decline. Even then bed-rock will not be in sight. The larger cities of the United States have yet to reduce their infant death rate to one death for every ten births, and it will take some years to bring the average down to 78 — the recent rate for Amsterdam — but to do so will mean an immense saving of chUd lives. CONDITIONS UNDERLYING CHILD MORTALITY 55 In 1909 Professor Irving Fisher of Yale University computed the following ratio of preventability of death from certain diseases in which the median age at death is under five : ' pre- mature birth, 40 per cent; congenital debility, 40; diarrhcea and enteritis, 60 ; measles, 40 ; broncho-pneumonia, 50 ; whoop- ing cough, 40; meningitis, 70; diphtheria, 70; croup, 75. He concluded that of all diseases in which the median age at death is one year the percentage of preventability was 47 and of other diseases of childhood, 67.^ This would have made the number of preventable deaths among children approximately 200,000 per year. In 1900 the number of deaths of children under five years of age in the United States was 317,532, or 30.5 per cent of all deaths, and the total deaths under one were 199,325, or 19 per cent of the mortality at all ages. In 1905 the registration area showed an aggregate of deaths almost identical with its record of 1900. The more satisfactory records of 1911 show that 209,482 children under five years of age died in that year in the registration area. If similar proportions were maintained throughout the United States, the loss to the country must have been more than 332,000 children, of whom over 95,000 were above one year and less than five, while the remainder, or 237,000, were under one. But the non-registration area contains three- fourths of the 10,000,000 negroes in the United States, the whites of the mountains of the South with their unhealthful conditions, and also the healthy rural classes of the North and West. Whether these varying conditions neutralize each other so as to make the death rate for the entire country similar to that of the registration area cannot be known without additional statistical information. It is not likely, however, that the total infant mortality will vary more than 20,000 above or below the estimate given. If the rate of infant mortality in the rural districts of the reg- 1 See Bulletin of the Committee of One Hundred on National Health. Report on National Vitality, its Waste and Conservation. ' Median age represents that age before which 50 per cent of the instances have occurred. 56 PROBLEMS OF CHILD WELFARE istration area in 1900 had been general throughout this area, the number of deaths would have fallen from 102,220 to about 72,300, or a gain of nearly 30,000 infants, while the gain for the entire United States would have reached a total of 59,000. For children under five the rural rate was one-third less than the general rate, and its application to the entire country would have resulted in a constructive saving of 105,000 lives. The reduction, however, was so great by 191 1 that the rural rate applied to the entire United States would have saved only about S4,ooo. But the rural rates are too high, and a standard infant mortaUty of 6 per cent would save over 100,000 infants annually. At least half of the mortality of children between one and five years is preventable. These children have passed the age when constitutional weaknesses destroy life, so their death is usually an evidence of some form of social neglect. The net saving which would result from a proper reduction of our child mortality would therefore approximate 150,000 hves annually. This surely constitutes one of the grave child problems of the day. 7. Infant Mortality in Foreign Countries. Foreign countries differ widely in their proportions of infant and child mortality. The table on the next page presents fig- ures for a selected group of countries.'^ These statistics may be measured by comparing them with the mortality rates in the United States and by contrasting them with the minimum standard that we have allowed. Making the first comparison, we find that in Northwest Europe and New South Wales, which exemplifies all Australia, the rates both for infants and for children under five are considerably lower than those in the United States. All of these countries have an intelligent population, and climatic conditions have also favored them. Systematic efforts have likewise been made to reduce the mortality, and campaigns in favor of breast feeding, the establishment of mUk stations, the improvement of the mUk supply, and the regulation of the employment of women have contributed largely to this result. 'United States Bureau of the Census, Mortality Statistics, 191 1, pp. 14 and i6, and The New York Milk Committee, Infant Mortality and Milk Stations, p. 17. CONDITIONS UNDERLYING CHILD MORTALITY 57 Comparative Mortality in Various Coitntries Deaths under one per Deaths under five per 1000 population COUHTRY Year Rate Year Rate England and Wales .... 1909 109 igoo-1902 53-52 Ireland .... 1909 92 1900-1902 37.22 New South Wales 1909 74 1900-1902 32-52 Denmark . . . 1908 123 I goo- I 90 2 38-31 Sweden 1908 8S 1899-1901 37-48 Prussia 1909 164 1899-1901 73-95 Hungary 1909 212 1899-1901 91.96 Austria 1907 204 1899-1901 86.71 France 1907 13s 1900-1902 47.64 Spain . 1907 173 1900-1902 104.14 Chili . 1908 320 I 900-1 90 2 Russia 1896-1900 261 I 896-1 898 134-50 United States 1900 51-86 1911 112.9 ' 1911 32-9 Spain, France, and Prussia exceed the American rates, al- though the last two countries have also given considerable atten- tion to their infant mortality. Especially is this true of France, where strenuous efforts have been made' to reduce the rate, but the prevalence of artificial feeding and the ignorance of the poorer classes have retarded the decline of the death rate. In Spain the mortality remaias high for the entire first five-year period, practically one-half of the children dying during this time. Russia, Hungary, and Austria exemplify conditions in Eastern Europe, where a heavy rate of infant mortality still prevails. In each of these countries more than one-fifth of the babies die during the first year of life. For nearly a century Northwest Europe has enjoyed rates lower than those now obtaining in East Europe, where although climatic conditions are not unfavorable, the level of intelligence is low and the 'This represents the number of deaths under one per 1000 of the population under one. S8 PROBLEMS OF CHILD WELFARE stolid peasant classes are helpless to prevent disease. Further- more, their governments have given the subject little thought. The European countries may be roughly classed in three groups; Northwest Europe has low rates of infant mortaUty, Middle and South Europe have fairly high rates, while South and Southeast Europe still sufier from exorbitant rates. If a minimum mortality of six per cent be allowed as at present socially non-preventable, then the unnecessary death rate reaches enormous proportions. In the best portions of Europe the mortality is about 50 per cent above this standard, in Middle Europe it is more than double, and in the most backward coun- tries it is three or four times as high. It is clear then that more than 1,000,000 preventable infant deaths occur in Europe every year. CHAPTER IV PHYSIOLOGICAL AND SOCIAL CAUSES OF CHILD MORTALITY I. Diseases of Children. Children are particularly susceptible to certain diseases, and therefore the average age at death of persons dying from these diseases is comparatively low. The term " children's diseases " may therefore be properly applied to a number of such affec- tions, of which the following are the principal ones : ' Children's Diseases and Median Age at Death, igii Disease Median Age at Death 3 years I year 4 years Under i Measles Scarlet fever Whooping cough Broncho-pneumonia 1 year 2 years Under i week Diseases of early infancy Smallpox was formerly a children's disease, but now the average age at death is nearly 28 years. This change is not due to any transformation of the disease, but to the splendid achieve- ments of medical science which has almost exterminated it. Vaccination has rendered the child comparatively immime, and since adults are now more frequently exposed than are chil- dren, they likewise more often acquire the disease. a. Diphtheria. This disease has been the chief terror of childhood since the virtual elimination of smallpox. It is an extremely malignant • Computed from United States Bureau of the Census, Mortality Statistics, 1911. 59 6o PROBLEMS OF CHILD WELFARE disease, as is evidenced by its continued high case fatality. The remarkable change, however, which medicine has accom- pKshed since 1890 is shown by the foUowmg facts: in 1891 the percentage of diphtheria cases in Brooklyn which proved fatal was 63.6 ; in New York City (old) it was 36.5 ; in Balti- more in 1894 it was 74 per cent, but at present in each of these cities the rates have been reduced to less than 10 per cent. In Boston in 191 1 the rate had fallen to 5.8S per cent, and during the decade 1900-1910 the general death rate throughout the United States fell 50 per cent. The reduction in the death rate has been largely due to the extended use of anti-toxin, which was first introduced in 1895. Chicago presents an excellent example of its value. During the decade 1897-1906 the case fatality in this city from cases treated with anti-toxin by the bureau of health was only 6.5 per cent. Chicago's experience also illustrates the advantage of early treatment of the disease, since' the results of the treat- ment of 8372 cases during the period given above show that if the administration of anti-toxin occurred on the first day of the disease, the mortality was .32 per cent; if on the second day, 1.51 per cent ; if on the third day, 3.38 per cent ; if on the fourth, 1 1. 1 5 per cent ; but if an ti- toxin was not used until a later day, the rate rose to 22.01 per cent.^ Furthermore, during this period more than 9000 persons who had been exposed to the disease were treated with immunizing doses of anti-toxin, and of these persons only 51 afterwards contracted the disease, aU of whom subsequently recovered. Some difficulty has been experienced in securing an ample supply of serum. Private manufacturers have not always acted generously toward cities in need of anti-toxin, so occa- sionally a shortage has occurred, and cities are sometimes com- pelled to borrow a supply from other localities to meet an emergency. In spite of recent progress, diphtheria is not yet wiped out, and is still the cause of many deaths. Diphtheria and croup cause more than twice as many deaths as scarlet fever and nearly 1 Report o£ the Department of Health, Chicago, 1906, p. 129. CAUSES OF CHILD MORTALITY 6 1 twice as many as measles, and the case fatality, although greatly reduced since 1895, is still higher than that of either of these diseases. The following steps are gradually being taken to save the children from this disease : first, a bacteriological diagnosis of the case, which has resulted in the positive identi- fication of cases, which were then properly quarantined, thereby checking contagion. New York City began this in the year 1892, and accomplished good results through the exercise of this precaution. Second, the estabhshment of a rigid quaran- tine, and in the larger cities of medical inspection in the schools, by means of which many incipient cases of diphtheria are discovered. The rates of morbidity are thereby considerably decreased. Third, the extensive use of anti-toxin, which has saved thousands of lives. The efiectiveness of the virus is evident from the work done in the tenement house districts of New York City, where the case fatality in 1903 among the poor who were treated free of charge by the health officials was only 5.7 per cent, as compared with an average of 10.5 per cent for the entire city. The existence of this remedy has lessened the tendency of many parents to conceal the fact that some of their children are suffering from the disease. The serum is still rather costly, and the poor are unable to pay for its use, but all of the large cities have liberally provided for the free distribution of anti- toxin to those unable to engage the services of a physician directly, and private charity has provided adequate hospital room. Accordingly, no one need forego the enlightened treat- ment which the present day affords. Undue caution, how- ever, frequently results in a tardy diagnosis, with consequent disaster to the child. Fourth, the tracing of the contagion to the place of origin and ascertaining its communicating medium. Bad milk, sweat- shop goods, unclean food, and other agencies which carry the disease are being more carefully inspected than formerly. In many cities pasteurization has acted as a deterrent ; for example^ in the city of Washington, where the prevalence of diphtheria has declined, owing largely to this method of caring for mUk. 62 PROBLEMS OF CHILD WELFARE Pure food laws and the inspection of goods made in tenements are additional measures that reach the disease at its sources and decrease the danger of contagion. Climatic and racial conditions influence the prevalence of diphtheria, it being largely a winter disease, for comparatively low rates of mortality prevail during the summer months. The negro child enjoys a somewhat greater immunity from the disease than does the white child. Owing to these difierences, the children of the South sufEer less from this ailment than do children in the remainder of the United States. In European coimtries rates do not differ materially from the ones prevailing here, and the use of anti-toxin is working similar results. b. Measles and Scarlet Fever. Although less dangerous than diphtheria, measles and scarlet fever are extremely contagious. Science has as yet discovered no specific for them, and victims must rely upon the old methods of treatment. The case fatality of measles is less than 2 per cent, but the mortality is greater than that from scarlet fever. In 1911 measles caused 5922 deaths in the registration area of the United States, or approximately 9400 for the entire country. Measles is especially fatal during the second year of life, while the season of greatest prevalence is from February to May; that is, it is .a spring disease, but the number of cases fluctuates widely from year to year, with a general average that changes but little. In New York City waves of incidence seem to appear every second year. Since the disease has been quaran- tined and fumigation practiced, a favorable decline in the num- ber of cases has occurred, but cities stUl suffer disproportionately, and far exceed the rural districts in their fatalities. The disease could be more effectively checked but for the attitude of many mothers, who regard measles as an unavoidable disease and who permit their children to be exposed to it. Wage-earn- ing mothers frequently hide the fact from the health officials and so evade quarantine. The general feeling of unconcern results in lax attention to the disease, so it is carried to school by children and spread far and wide. In spite of the law, physicians do not always require quarantine, nor are the health CAUSES OF CHILD MORTALITY 63 officials or the public sufficiently cautious, as is indicated by the enormous variation in the death rates among diEEerent cities. The mortality from measles can be entirely wiped out. Scarlet fever causes slightly fewer deaths than does measles, but its case fatality is from two to three times greater, the heav- iest mortality occurring during the third and fourth years of life, whUe the season of greatest prevalence is during the late winter months. The disease frequently leaves very serious after-effects, the most important of which is impaired hearing or total deafness. No other disease causes so much defective- ness except meningitis and possibly ophthalmia ; consequently there is special need of guarding against it. Scarlet fever is practically unknown in those countries, such as Japan, that do not use cow's nulk as food ; it is evident, therefore, that a close relation exists between the use of the milk and the disease, the elimination of which consequently depends largely upon the purification of the mUk supply. An epidemic has on several occasions been traced to a dairy farm where vic- tims of the fever have infected the milk. Buffalo, Chicago, and other cities have endeavored to prevent the disease by at- tempting to discover its source. The scarlet fever germ will lie dormant for years, and then infect through contact with the individual. Accordiugly the disease should be subjected to the strictest quarantine, precautionary methods should be adopted, and thorough fumigation required, since more easily than any other malignant disease can it be carried about by old or exposed clothes. The poor and constitutionally weak are more prone to succumb to this disease than are the strong and well-fed, since the former have less power of resistance. Better nutrition, sufficient food, and more adequate care of the young are needed to resist attacks of the fever. c. Whooping Cough and Respiratory Diseases. Whopping cough is decidedly a disease of infancy, since more than one-half of the deaths from this disease occur during the first year of life, and five-sixths under two. Formerly, rates in the country were lower than those in the city, but in 191 1 the rural rates were slightly higher. Epidemics in the cities 64 PROBLEMS OF CHILD WELFARE have been greatly reduced by medical inspection of schools, by the exercise of greater precaution than heretofore, and by a poUcy of systematic quarantine. The American mortality from this cause is hardly one-half that of England or Germany. Whooping-cough is most common during the summer and au- tumn months ; nearly every one contracts the disease at some time, and the annual deaths are about equal to those from measles. Acute bronchitis is a disease of childhood as well as of old age. About one-half of all deaths from this cause occur during the first year of life; more than two-thirds take place during the first five-year period, and nearly all of the remainder occur after the forty-fifth year. The total death rate for both bron- chitis and pneumonia is much higher than the rate for measles, scarlet fever, or whooping cough. Here the rural districts show lower rates than do the cities, but the difference is not a marked one. The winter months are especially favorable to a high mortality from these respiratory diseases; for example, in the registration area in 1911 the deaths from bronchitis were four times as numerous and from pneumonia six times as high in January as in July. Among children under five, broncho- pneumonia is by far the most fatal respiratory disease, it caus- ing more deaths than any other disease except diarrhoea and enteritis and the diseases of early infancy. With the other respiratory diseases it emphasizes the need of fresh air, proper ventUation, and the avoidance of undue exposure. d. Diseases of the Digestive System. The most deadly of all diseases of infancy and chUdhood are the various forms of acute intestinal diseases, including diarrhoea and enteritis. Effective work in saving child lives is largely measured by the success attained in decreasing the mortality from the diseases of the digestive system. Success in this re- spect indicates a high water mark in the history of preventive work, while failure to reduce the death rate indicates that a community has not awakened to the problem of infant mor- tality. The following table illustrates the situation in the registration area of the United States : ' ' United States Bureau of the Census, Mortality Statistics, 1900-1904, 1908, igii. CAUSES OF CHILD MORTALITY 6S Deaths under Two Years prom Diarrhcea and Enteritis per 100,000 Population Aexa Average 1900-1904 1908 1911 Registration area Registration cities Registration states Cities in registration states .... Rural part of registration states . . Registration cities in other states . . I12.8 126.0 II3-4 139-9 80.3 111.8 1 16.0 128.0 116.2 I33-S 96.9 1 14.6 77-4 9S-3 73-6 91.0 SS.8 1 19.6 In 1 911, 45,868 children in the registration area died from these diseases, and the total mortality for the United States at the same rate must have been approximately 73,000, or four times the number of deaths from diphtheria and croup. About four- fifths of these deaths occur during the first year of life. The urban rate is much higher than the rural rate, and the industrial cities show a distinctively heavy mortality. In the decade 1900-1910, the rate throughout the registration area fluctuated but slightly, the year 1905 marking a high point. The year 1911, however, was noted for a much lower death rate — lower than any during the preceding decade. Many individual cities have successfully reduced their mortality from the intes- tinal diseases by insisting upon the proper preventive measures. Among cities having a population of more than 100,000, Fall River, Massachusetts, reported the highest rate in 191 1, its mortality being 318.9 per 100,000 of population, or more than three times the average rate for the registration cities. Local so- cial and industrial conditions are largely responsible for this fact. Likewise in Lowell and in other manufacturing cities the rates tend to remain stationary or to decline but slowly, because of the high proportion of ignorant, non-English speak- ing people. Here the city oflicials are less alert, and the instruc- tion of mothers is a difficult problem. In some of the smaller towns also almost unbelievable rates still prevail. Several large cities have, however, in spite of the difficulties attending 66 PROBLEMS OF CHILD WELFARE the work, succeeded in reducing the mortality from the diarrhceal diseases. Greater New York City lost 4590 children xmder two years of age in 191 1, and while the absolute number of deaths has remained almost stationary, the rate has decreased considerably since 1895, when a decided fall in the mortality from this source first took place. In spite of its size and conges- tion. New York City has made splendid progress, while Phila- delphia, with ample room and many homes, has a much higher rate. So has Chicago, although vigorous attempts have been made to diminish the digestive diseases there. The lowest rates occur in the rural districts of the Northwest and the far West. The distribution of the diseases throughout the different months of the year is most significant, as in no other case does the death rate vary so heavily from season to season. The pre- dominating influence of weather conditions as a cause — direct or indirect — of the violent fluctuations in rates is therefore at once apparent. The following table shows the proportion of deaths each month of the year, according to figures based on the mortality in the registration area of the United States dur- ing the year 1911. Proportion of Deaths from Diarrhcea and Enteritis.^ (CnnjjREN DNDER 2.) (Base = 1000) Months Proportion Months Proportion January 36 July 202 February 33 August 2ri March 39-3 September 152 April 41.6 October 84 May 52.7 November 41 June 77-4 December 31 This table shows that during the winter and spring months the mortality is comparatively low, that it rises as summer approaches, reaches its highest point in August, and then grad- ually declines. The rate for August is six times that of the 1 United States Bureau of the Census, Mortality Statistics, 1911. CAUSES OF CHILD MORTALITY 6^ winter months, and more than half of the deaths occur during the summer season. Particularly hot summers also cause an excessive death rate from these diseases ; but as they are germ diseases, heat must be regarded as a contributory rather than a primary cause. Attention must, therefore, be given to the fundamental causes, so that the heat will not aggravate them. After the first month of life, the diarrhoeal diseases are the principal single cause of death for the remainder of the first year ; in fact, during the second quarter of the year, over 40 per cent of the deaths are caused by these diseases. The rates, however, decline slowly month by month but remain compara- tively high during the first half of the second year because of weaning and the subsequent use of cow's mUk and milk substi- tutes. In many cities half of the deaths during the second quarter of the first year are due to diarrhoea and enteritis, — a fact due largely to a failure to institute the preventive measures which have been so successful in some localities. e. Diseases of Early Infancy. The diseases of early infancy have not received much atten- tion from social workers until recently, since deaths from these causes have been considered inevitable. Malformations were responsible in 1911 for about 10,000 deaths in the United States. Probably very little can be done to reduce this mortality, al- though prenatal work might lessen the number of abnormalities. From the eugenic point of view the race would be strengthened by the elimination of this group. Premature birth and congenital debUity are the principal diseases of early infancy, having caused 42,119 deaths in the registration area in 1911 and probably 66,000 throughout the United States. Two-thirds of the deaths during the first day of life are due to these two causes, which are also responsible for more than half of the mortality of the first month. Nearly all of the fatal premature birth cases die before the chUd is four weeks old, but many congenital debility cases linger beyond this time. However, nearly all the deaths occur before the end of the third month. 68 PROBLEMS OF CHILD WELFARE The death rate in the United States from the entire group oi diseases classed under the term " early infancy " shows but little change. There are slight fluctuations from year to year, but the mortality rate in 191 1 was higher than during the years 1901-1905. It appears therefore that practically no progress has been made against the conditiohs responsible for this very heavy mortality. In England, where the death rate from these causes is higher than in the United States and is 40 per cent of the entire infant mortality, the rate is increasing — a fact which is a cause of great concern. The so-called, " wast- ing diseases," which include premature births, congenital defects, lack of breast mUk, starvation, atrophy, debility, and marasmus, are a cause of half of the infant mortality. It seems that the rate is higher among the poor than among the well- to-do, and that it is lower in the country than in the cities. These differences indicate that social and industrial conditions affect the rates and that heredity is not the only factor. The prenatal condition of the mother is also an important con- sideration, and may outweigh all other factors. /. Meningitis and Convulsions. Another ailment responsible for many fatalities among chil- dren is meningitis, which destroys about as many children as does measles, although the death rate has fallen more than 50 per cent during the last decade. Physicians are seeking earnestly for some specific with which to cure the disease, for it cripples a large number of the children it attacks. More than 4000 children died in 1911 in the registration area from " convulsions." This term is used loosely in designat- ing deaths that really result from some preceding cause, such as diarrhoea or injuries at birth, a severe case of which may cause convulsions. Then the victim dies, although the fatality would not have occurred but for the principal disease. g. Proportionate Mortality from Principal Diseases. Having completed this short summary of children's diseases, the following table showing the distribution of mortahty among several groups of diseases is particularly significant. CAUSES OF CHILD MORTALITY 69 Proportionate Mortality erom Principal Diseases in the Regis- tration Area of the United States in igii' Diseases Percentage Under i Under s Diseases of early infancy Diarrhoea and enteritis Bronchitis and pneumonia (including broncho-pneumonia) All other causes 313 25.2 I4-S 29.0 22.3 23.0 16.6 38.1 This table indicates that three groups of diseases are respon- sible for nearly three-fourths of the deaths of infants, and for over 60 per cent of the deaths of children under five. The first group causes nearly one-third of the infant mortality — more than any other cause. How much is due to constitutional weakness of father and mother? How much to overwork and improper care of the prospective mother? How much to mal- nutrition ? These are questions still unanswered. So enormous is the proportionate mortality from diseases of early infancy that a study of prenatal conditions is necessary to determine what particular environmental factors contribute to this result. The general failure to reduce these rates within the last decade indi- cates that new lines of attack are necessary, although the evi- dence that a large percentage is preventable is very strong. Consequently in the near future this will furnish a fertile field for the operations of the social workers, especially in view of the constantly declining birth rates. The next group — diseases of the digestive system — cause more than one-fourth of all deaths under one and an almost equal percentage of the mortality under five. Here we are dealing almost exclusively with post-natal conditions, and the great majority of all these deaths are preventable, for the causes are well known, and the eugenic consideration hardly '■ Computed from Report of the United States Bureau of the Census, Mortality Statistics, igii. 70 PROBLEMS OP CHILD WELFARE enters. The need now is an adequate program of prevention. Owing to the many deaths after the first year, this group causes the largest mortality under five, which means that the loss to society is comparatively high; for the social cost in- volved increases with the age of the child. No other phase of the mortality problem needs so much attention as does this. The respiratory diseases claim about one-sixth of the child mortality, much of which can likewise be prevented, but the method is difiicult. The causes lie chiefly in two extremes of conduct — lack of ventilation and bad air on the one hand, over-exposure on the other. Ignorance, bad housing, and poverty are prime factors in the problem, and these it will indeed be diflacult to remove. All the other causes, including the contagious diseases, pro- duce but one-fourth of the infant mortality and slightly more than one-third of that under five. While all of these causes must be understood and methods of prevention instituted, they do not lend themselves to some simple unified program of action. We therefore find three principal groups of diseases, each of which can be largely counteracted by some specific method of control, as foUows: (i) Diseases of the Digestive System — through proper control of the milk supply. (2) Diseases of Early Infancy — by instituting prenatal and neo-natal work. (3) Respiratory Diseases — by providing children with pure air. 2. Ultimate Causes of Child Mortality. In the foregoing pages we have detailed the more important pathological causes of infant mortality. These, however, are not fundamental, but are induced by more remote or ultimate causes ; and it is the latter with which we must deal in order to eliminate disease. Preventive medicine is more important than the art of healing, but even this does not touch bottom. The sociologist asks, what are the hereditary and environmental factors which aid the disease germs ? Would not the improve- ment of social and personal conditions, coupled with direct CAUSES OF CHILD MORTALITY 71 methods of preventing disease, practically eliminate many of the iUs of childhood? a. Causes as classified by Farr and by Newsholme. Writing in 1862, Dr. Farr, the eminent English vital statis- tician, concluded that the conditions in respect to food, water, cleanliness, malnutrition, and midwifery were the principal causes of the unnecessary infant mortality in England. Arthur Newsholme in 1899 gave the following classification of causes : (i) Premature Births and Congenital Defects. (2) Hereditary Tendencies. (Inheritance of syphilis, drimk- enness, etc.) (3) Inexperience and Neglect of Mothers. (4) Industrial Conditions. (Women working during and after pregnancy.) (5) Social Conditions. (6) Improper Food. (7) Deaths from Accidental or Homicidal Violence. b. Causes according to Newman. George Newman regards the prenatal influence as a most prominent cause of infant mortality in England. Among the important factors he includes the ill efiects of poisoning caused by the work of mothers in certain dangerous trades, the action of alcohol upon foetal life, poor physique and ill health in the mother, previous miscarriages, poverty and Lnsufl&ciency of food, and overwork by the mother. Among the postnatal causes are : the occupation of mothers who leave their children at home without providing them with proper care ; the preva- lence of city life ; poor housing ; bad social conditions ; artifi- cial feeding of infants ; the use of contaminated milk ; and igno- rance and carelessness on the part of mothers. This ignorance manifests itself in the methods of feeding, in imcleanliness, in exposure, in drunkenness, and in indifference to parental obli- gations. To poverty as a cause Newman does not attach much weight. c. Detailed Table of Causes. The underlying causes with special reference to the United States may be conveniently classified as follows : 72 PROBLEMS OF CHILD WELFARE I. Improper Feeding. (i) Artificial Feeding. (2) Use of Indigestible Foods. (3) Use of Bad MUk. II. Underfeeding. (i) Caused by Ignorance of Mother. (2) Caused by Failure of Natural Food Supply. (3) Caused by Poverty of Parents. III. Unsanitary Conditions. (i) Bad Housing Conditions, such as Insufficient Light and Air. (2) Overcrowding. (3) Filthy Homes. (4) Absence of needed Sanitary Arrangements, e.g. Sewage Systems, (s) Germ-laden Water. (6) Lack of Park Area. IV. Ignorance of Parents. (i) As to Need of Pure Air. (2) As to Right Methods of feeding the Child. (3) As to Proper Way to protect Child from Ex- posure. (4) As to Intelligent Care of the Sick ChUd. V. Inadequate Quarantine System. VI. General Influence of City Life. VII. Negligence of Parents. VIII. Climatic Conditions. (i) Extremes of Heat and Cold. (2) Dampness. IX. Occupation of Mother. X. Prenatal Influences. (i) Effects of Overwork by Mother. (2) Toxic Influence on Foetal Life. (3) Malnutrition of Mother. (4) Condition inducing Abortion, Premature Birth, and Malformation. CAUSES OF CHILD MORTALITY 73 XI. Hereditary Causes, (i) Defectiveness. (2) Constitutional Weakness. (3) Inherited Diseases. XII. Poverty. 3. Analysis of Important Causes. a. Poverty. Poverty is both a cause and an effect, and is usually part of a vicious circle which must be broken before the revolving train of consequences can be checked. Indirectly, poverty is a serious factor. Infant mortality is high among the poor, not because they are poor, but because, being poor, they cannot take advan- tage of the opportunities needed to prevent and to cure disease. Frequently ignorance accompanies poverty and ignorance leads often to sickness and death. In England out of 3000 infants born in homes in which the weekly income averaged less than $5, 15 per cent died within the first week; this, in spite of the fact that charity nurses were sent to each case. In an Eng- lish private hospital attended largely by the well-to-do, the death rate was only two-thirds as high. In St. Louis the general infant death rate is slightly more than half as large as that of the most wretched of the city's districts. b. Use of Cow's Milk. Nature has provided a rnost satisfactory way of feeding the infant, but civilization has recently begun to substitute other methods. So far the substitutes have not been generally suc- cessful, although there is no inherent reason why they may not eventually be so perfected that efficient results will follow. Many mothers now feed their babies on cow's milk, and have discontinued breast feeding. This is probably true of a majority of the wealthy classes and of a large minority of the poor, it having been estimated that about 60 per cent of the wealthy and well-to-do use artificial foods. Many mothers do not want to bother with the nursing of their babies and turn the important task of feeding them over to the nurse girl. Recent investiga- tions indicate that among the poor the proportion of mothers who do not practice maternal feeding is somewhat less than 20 74 PROBLEMS OF CHILD WELFARE per cent. If in these cases ordinary raw dairy milk is used, the result is frequently disastrous to the child, but the effects of milk substitutes are, on the other hand, still more fatal, and both classes of food may be heavily laden with disease and death. Tests made in European countries have revealed the fact that breast feeding yields the lowest infant mortality, that the use of animal milk causes a larger death rate, and that the milk substitutes are responsible for the highest rates. There are some very striking differences between cow's and human milk. The former contains 3.5 per cent of proteids, the latter 1.5 ; the percentage of mUk sugar is 4.5 and 7 respectively ; of ash .75 and 2 ; the water and the fat constituencies are prac- tically the same ; in the former 4.3 per cent is nitrogenized, in the latter 1.9 ; whUe the one has an acid, and the other an alkali, reaction. Cow's mUk was intended for calves, not for babies, so in order to become an adequate substitute for mother's nulk it must be modified, and modification must proceed along very definite lines. The high percentage of proteids must be reduced by adding water ; that of milk sugar must be raised by sweetening the mUk ; then additional cream is necessary, because the water- ing has decreased the proportion of fat; finally limewater is introduced to obtain the alkali reaction. Only by changing the ingredients in this way does it possess the proper proportions for the chUd. If the use of cow's mUk is to increase, its modi- fication will be necessary in the case of thousands of infants in order to prevent their becoming victims of disease. Many children are able to thrive on undiluted cow's milk, but it is precisely because large numbers are incapable of adapting them- selves to this unnatural diet that diseases of the digestive system attack and destroy them. Furthermore, breast mUk changes its constituency, varying with the age of the child — an accommo- dation which has been worked out by nature for the advantage of the babe. Animal milk, on the other hand, does not vary to meet the changing needs of the infant, and consequently is an inferior and imsatisfactory food. The proper modification of animal food requires various mixtures, each adapted to a spe- CAUSES OF CHILD MORTALITY 75 cific age period of the infant, at least three or four modifications being needed during the first six months of life. Experiments conducted by the Rockefeller Institute of New York City to test the relative merits of the different kinds of rmlk used for infants resulted in the following statistics based on a study of 400 families divided into four equal groups, each of which used a different kind of milk. The results secured are given in the subjoined table. Mekits of Dipfeeent KnsDS of Milk Kinds oe Milk Results Good Bad Condensed milk S6 60 61 81 44 40 39 19 Bottled milk Straus and diet kitchen milk .... The store milk was sold from the open cans, and was therefore subject to rapid deterioration and multiplication of bacteria. It yielded the worst results, with the exception of the condensed mUk, which is not adapted to the small child and which cannot from its very nature be expected to succeed. Bottled milk proved slightly more favorable, but the pasteurized and specially prepared milk alone showed a high percentage of good results. The difference between the last grade and the rest is sufficiently striking to illustrate the necessity of constant attention to the character of food given to the infant. The investigation made in 1907 by the summer corps of in- spectors and nurses of the New York City Department of Health yielded the following very interesting conclusions in regard to the resxilts of feeding children with various kinds of milk. Of the total number of children under nine months of age, 81.15 per cent were being breast fed, and only 18.85 per cent received cow's milk or other forms of artificial food. The latter group of children, however, furnished 57.53 per cent of all cases of 76 PROBLEMS OF CHILD WELFARE diarrhoea, while the former, comprising more than four-fifths of all the children investigated, supplied less than one-half (42.47 per cent) of the cases. Of the children under nine months of age who died of diarrhoeal disease, 25.04 per cent had been breast fed, whUe 74.96 per cent had been artificially fed. The propor- tions for children over nine months were almost similar, being 23.72 and 76.28 per cent respectively.^ Accordingly, three- fourths of the deaths from these diseases were furnished by a group containing less than one-fifth of the total number of chil- dren ; that is, the death rate from diarrhceal diseases was twelve times as high among the children using animal mUk or substi- tutes as among those nursed directly by their mothers. In the summer of 1910 a limited study was made in St. Louis of the feeding history of babies. The facts show that while only 15.5 per cent were bottle-fed, these furnished 74 per cent of the digestive trouble, or 15 times their proper proportion. When the mother nurses the child, such disease is exceptional, but when cows' mUk is used it is the most common of the dis- eases. Two well-known illustrations may properly be cited here. The siege of Paris during the Franco-Prussian war forced many mothers to nurse their babies, and although the general death rate rose because of the scarcity of food, that of infants declined precipitately. The great strike in the cotton mills in Manches- ter, England, sent hundreds of mothers home, with the result that their children were properly nursed, and the infant mortality fell 40 per cent. The superiority of mother's milk and the bad effects under ordinary conditions of the various forms of arti-, ficial foods are thus clearly demonstrated. The first step advocated by many physicians is the return to breast feeding wherever that is possible, because a pure, clean food is thereby assured. In an increasing number of cases, how- ever, this seems impossible, hence the market supply of milk must be improved to insure the health of the babies and small children. The milk supply of our cities receives but little attention, because its importance has not yet been ap- preciated. 1 See Report of the Department of Health of New York City, 1907, pp. 43 ff. CAUSES OF CHILD MORTALITY 77 c. Ignorance and Indifference. Apart from the inadaptability of prepared foods, disease is not a necessary consequence of their use, since the care of the food is the principal factor in its disease-producing effects. Dirt and germs are introduced into cow's mUk at the first con- tact with the air. Frequently disease germs are present, and these soon multiply imder the effects of heat, and through the milk infect the babies. The principal specific result is the occurrence of diseases of the digestive system, and these, as has already been shown, form the most important group of causes of infant and child mortality. The special incidence of a high death rate duriag the summer months depends largely upon the effect of the heat upon the milk. The mUk deteriorates, and the harmful bacteria multiply in a very short time. Accordingly the chUd suffers more in summer from the use of milk originally as good and as carefully handled as the mUk supplied during the winter months, a fact which should stimulate producers of mUk and dealers to take every precaution. In summer the milk must be kept cleaner and cooler than during the remainder of the year. Com- mercialism rather than philanthropy has guided men, however, and duriag the hottest months of the year, when babies need the best of foods, they are rewarded with the most germ-laden milk. Mothers too are very neglectful, and usually they do not know that dirty milk allowed to become stale and warm increases the probability of disease. They do not understand the germ theory, so they blindly persist in feeding babies with mUk that is no longer fit for food. The milk contains germs to begin with and the effect of the heat is largely indirect. It is unsanitary con- ditions in the production and the care of milk that cause the germs to be introduced, but heat multiplies the germ very rapidly, and in a short time the babies suffer from intestinal disorders. Babies do not usually die of excessive heat, but from diseases which have been superinduced by the effect of heat upon their food. The emphasis, then, must be placed not on protection from the heat but on protection from vitiated milk. Neglect and ignorance are regarded as three times as serious in their results as the heat. 78 PROBLEMS OF CHILD WELFARE d. Bad Housing Conditions. The bad housing conditions of the poor also undennine the health of the children. The effects, however, are not so evident upon the suckling child, which draws upon the mother for its vitality and therefore does not suffer as far as the food item is concerned. The absence of light, of fresh air, and simshine bears more heavily upon the child beyond this age, since he is weak- ened and devitalized thereby and becomes a prey to disease. To some extent inferior housing is a reflection of the poverty of the people, and poverty, not housing, should be charged with the results. Overcrowding, however, no matter how caused, does result in an increased child mortality, and several investi- gations of tenement districts have disclosed the fact that a large proportion of deaths occur in the rear and more poorly con- structed and worse situated houses than in those facing the street. Rents are also lower ; so the victims of poverty gravi- tate toward the alley. They are not able to command the serv- ices of a physician, and are further oppressed by unsanitary and dilapidated homes. A heavy mortality is the natural re- sult. CHAPTER V THE MILK PROBLEM 1. Introduction. The milk problem is constantly becoming a more important one, since a larger number of babies are being fed on milk than ever before and the danger to their health is constantly increasing. Bacteriology, however, has made possible a knowledge of the condition of milk and thus opened the way for whatever meas- ures may be necessary for the elimination of disease germs and the production of good milk. When the connection between bad milk and disease was discovered, the cities began to consider plans for lessening the evil. The mUk consumed in rural dis- tricts is usually so fresh that comparatively few bad results follow, but cities are not so favored. Accordingly, boards of health have begun to solve the problem, and are suggesting meas- ures of control. Public opinion likewise is demanding proper protection for the babies, while private philanthropy is feebly struggling to supplement the work left undone by the state and municipal agencies. 2. Clean Milk. Specialists now demand that all nulk meet two requirements — cleanliness and proper temperature. The former is the supreme need, as without cleanliness the development of bacteria cannot be prevented. Bacteria are usually introduced from the out- side and are of two kinds : first, the harmless bacteria which comprise the great majority of all the germs present and are factors in causing the milk to soxir ; second, the disease germs, which become a source of danger when the mUk is consumed. Many diseases may be carried in this way, chief among these' being scarlet fever, diphtheria, t3^hoid fever, and especially the 79 8o PROBLEMS OF CHILD WELFARE diseases of the digestive system. Tuberculosis also is probably carried by infected milk. In this case, however, the germ is not brought in by uncleanly processes, but is introduced into the milk at the time of its secretion. Bacteriologists have not as yet been able to isolate disease germs in milk, but they can tell whether the bacteria are few or many. If a large number are present, it is probable that harmful germs are included. Accordingly the bacterial count — the number of bacteria per cubic centimeter — is recognized as the proper standard by which to judge mUk. In spite of this if acid- forming bacteria alone have been introduced, the slides may show an enormous number ; yet there will be no danger of dis- ease. On the whole, however, the number of bacteria is usually a good indication of the fitness of the milk, which is commonly considered to be of good quality if it contains not more than 50,000 bacteria per cubic centimeter. The principal considerations upon which clean mUk depend are the following : cows must be in good condition and incapable of responding to the tuberculin test ; dairymen and all persons handling the milk must be free from contagious diseases and must carry on their work with sufficient care to reduce to a min- imum the amount of dirt and foreign particles in the milk ; the premises as well as the cows must be kept clean to protect the milk from contamination ; water free from disease germs must be used ; cans, bottles, and all vessels containing milk need ade- quate sterilization because the bacteria lodge in the uneven surfaces of the vessels and speedily multiply in the milk ; depots must maintain sanitary conditions to prevent the infection of milk ; finally, the consumer must know the essential conditions under which milk will deteriorate and become dangerous food for small children. 3. Temperature. Proper temperature is the next essential, because it is only by rapid cooling that the deterioration of milk can be retarded. In practice there are three stages in the handling of milk : first, it is cooled at the dairy, where its temperature should be imme- diately reduced to not more than 50 degrees Fahrenheit and then THE MILK PROBLEM 8l kept at or below this figure ; second, it is transported to the place of consumption, and during this time is frequently subjected to a churning process, as it is usually carried first by wagon, then by rail, and finally again by wagon. Throughout its journey the milk should be kept at a temperature of not more than 45 degrees ; if it is shipped in refrigerator cars, it can be kept comparatively cool, but if ordinary freight cars are employed, this low tempera- ture cannot be maintained. It frequently happens in the winter months that milk is collected from the dairies not oftener than every other day ; consequently some of this milk will be 36 hours old before it leaves the shipping point, and since it is not dis- tributed to the consumer till a day later it will then be 60 hours old. This long interval between the time of milking and that of distribution demonstrates the absolute necessity of keeping milk cool while in transit. Yet even in the summer months mUk is sent to large cities in ordinary cars with the hot sun beat- ing down upon the roofs, and at least half of it is more than 36 hours old when delivered to the consumer. It sometimes happens that milk is commercially pasteurized at receiving stations in the dairy districts. Afterward this milk is mixed with other mUk, and all subjected to pasteuriza- tion at the station of the dealer in the city, where preservatives are occasionally introduced, and possibly water. The milk, which is bottled before its pasteurization, is then ready for distribution. The influence of changing temperature upon the quality of milk is demonstrated by an experiment once made in the city of Chicago. A sample of fresh milk, containing 11,500 bacteria per cubic centimeter, was divided into two equal parts labeled " A " and " B." " A " was cooled at the dairy, but only after being loaded for shipment ; " B " was immediately cooled, then iced and in a condition of refrigeration was sent to the city. Both samples were delivered to dealers, and the milk was 24 hours old when it reached the customer. The examinations showed the following results : ^ ' Report of Department of Health of Chicago, 1906, p. 15. G 82 PROBLEMS OF CHILD WELFARE Table Showing the Multiplication of Bacteria in Milk Age (Hours) Place Bacteria per Cubic Centimeter Sample " A " Sample " B " Separate Test of Best Milk o 3 6 12 24 Cow barn Shipping platform City platform Dealer's vat Delivered to consumer li.SOO i8,ooo 102,000 114,000 1,300,000 II.SOO 11,000 8,000 7,800 62,000 3,890 3,280 3,000 3,800 8,400 The first set of results clearly shows that reasonably clean milk, if properly iced at once, then kept cool while in transit and in the dealer's hands, will yield a suf&ciently low bacterial count to render its use entirely innocuous ; while a failure to observe these precautions, especially if immediate cooling is neglected, will occasion a rapid multiplication of bacteria and render the mUk unwholesome. Bulk and bottled milk as sold in the city was found to contain as many as 18,000,000 bacteria per cubic centimeter. The second experiment, the results of which are given in the last column of the table, represents the average of five tests of milk properly handled and kept. It is clearly de- monstrated that clean production and proper handling wiU prevent the rapid growth of bacteria and lessen the danger of disease resulting from the presence and development of injurious germs. This is also shown by a comparison of bottled milk with loose milk. In some cities mUk from the can is sold by grocers and other dealers. The bacterial count of this milk is usually very high, since it is not safeguarded as is milk that has been properly bottled. The fresher milk from city dairies has fewer germs than the older milk coming from the coxmtry, so the time element is an important factor. At the same time, really clean mUk does not deteriorate rapidly. 4. Methods of Providing Good Milk. The problem of providing good milk for children has been answered in two ways : the one is the pasteurization of all milk so as to kill the germs ; the other is the production and handling THE MILK PROBLEM 83 of milk under such clean conditions that raw milk will be com- paratively pure and harmless. Theoretically the use of steri- lized utensils and the exercise of every precaution represent the correct solution of the nulk problem. These conditions being observed, the milk will contain but few germs. Pasteurization, by effecting sUght chemical changes in the milk, kills the use- ful bacteria and weakens the power of resistance to germs. Therefore bacteria if again introduced multiply with amazing rapidity. The mUk also is less digestible, and as a food is much inferior to clean raw milk, since the latter has not been subjected to injurious changes. Furthermore, pasteurization promotes carelessness and discourages efforts to produce clean mUk, for it does not remove dirt from the milk, and has been opposed on the ground that, " milk cooked with the dirt in it is not so good as pure mUk." Finally, many mischievous germs escape de- struction only to threaten the life of the child. This is especially the case with the dangerous scarlet fever germ. The practical difficulty which the advocates of pure mUk en- counter is finding a feasible method of enforcing their require- ments. Who will inspect the 45,000 dairies which produce the 2,500,000 quarts of mUk consumed by New York City daily, and the vast quantities consumed by every large city? Who will enforce measures which will secure the precautions desired? For many years to come, inspection will not be adequate, yet clean milk is the goal of every hygienist. Success in this direc- tion depends in part on economies in the method of production, and at present the profits of the dairy business are not so enor- mous as to justify any considerable increase in outlay and initial expense. If necessary costs are increased, the price of milk will probably rise ; but for a large proportion of people the price is already at the maximum point ; so if it be further increased, the consumption of commercial milk must decline and an increased infant mortality follow unless philanthropy intervenes. It is probable, however, that greater cleanliness can be observed with- out increasing cost or prices; but the ultimate solution must depend on greater economies in production. The advocates of pasteurization insist that their method of 84 PROBLEMS OF CHILD WELFARE treating milk will kill the bacteria and provide the infant with a wholesome food. A proper system of pasteurization, involving the heating of milk to 140 degrees Fahrenheit for a period of 20 minutes, or to 150 degrees for 15 minutes, kills nearly all the harmful bacteria without resulting in serious injury to the milk, thus removing the chief single source of children's diseases. The most convincing argument for pasteurization is the absence of other practicable means for providing the infant with a reasonably good milk supply ; which means that the chief hope at present for decreasing infant mortality lies in the use of pasteurized mUk. Either municipal activity or the work of private philanthropies, or both, are necessary to carry out a program of pasteurization. A combination of the two methods of solution is undoubtedly the most feasible plan of operation. If carried out, such a plan would not only save countless infant lives, but would also pre- pare the way for a clean milk supply. The New York MUk Conference of 1906 decided that pasteurization is not necessary if the mUk is absolutely clean, and opposed a system of compul- sory pasteurization, but recommended that infant milk depots supply both raw and pasteurized mUk. The rapidity and facility with which germs multiply when they are reintroduced into pasteurized milk was urged as a serious objection, and there- fore special stress was laid on the necessity of procuring clean milk. Experience, however, has changed the point of view, and in 1912 the Commission on MUk Standards appointed bythe New York MUk Coi-nmittee reported, ' ' The Commission thinks that pas- teurization is necessary for all milk at all times excepting certified milk or its equivalent. The majority of the Commission voted in favor of the pasteurization of all mUk including certified." 5. Significant Forms of Municipal ControL Every large municipality now assumes some form of control over its milk supply. At first the purpose of such efforts was to secure better milk, not necessarUy for the sake of reducing the infant mortality, but rather as a form of pure food legislation. These earlier attempts at control were therefore limited largely to the enforcement of chemical standards ; that is, mUk was to contain a certain percentage of butter fats, of solids not fats, THE MILK PROBLEM 85 and it was not to contain preservatives. By means of a chemi- cal analysis the nulk was tested for preservatives, especially for formaldehyde, and if found imfit was rejected. The infant mortality, however, is hardly affected by the improvements occasioned by such work. Recently reduction of the death rate has become the prime consideration and the efforts of cities aim to promote the clean- liness of milk, a policy, however, that involves a rather complex program. One of the most important innovations is the bac- teriological examination of the nulk, to determine its relative purity. The natural sequence of the work of the laboratory is the establishment of a bacteriological standard to which milk must conform, otherwise it will be considered unfit for food. The next step has been the inspection of the dairies themselves. At first only dairies within the city limits were inspected, but gradually the work was carried on into the country districts which supply the city's milk. In addition, stringent regulations are now being enacted such as the following : the proper pasteur- ization of all commercial rmlk; the prohibition of double pas- teurization; confiscation of all condemned milk; dairies limited to cows that have been tuberculin tested ; and the care- ful limitation of the sale of unbottled milk. The cost of improv- ing the milk supply has in some instances prevented cities from aggressive action; political interference has also operated to hinder effective work ; and the dairy interests themselves have proved a powerful obstacle. a. The Experience of Rochester, New York. Rochester, New York, was one of the first American cities to make a determined attempt to reduce its infant mortality through an improvement of the milk supply. The former ex- cessive death rate among children imder five years of age called for an explanation, unclean milk being eventually charged with the responsibility. Accordingly, under the very able direction of Dr. George W. Goler, Health Officer of the city, notable ex- periments were made. Dr. Goler found that " the stables were dirty, festooned with cobwebs, and badly drained; the sur- roundings, sinks of mud and cow manure ; the utensils dirty, 86 PROBLEMS OF CHILD WELFARE often containing layers of sour milk with an admixture of count- less millions of bacteria ; and the milk itself so imperfectly cared for and badly cooled that it often soured before reaching the con- sumer." To revolutionize these conditions seemed almost an impossibility, especially without raising the price of milk, which in the early stages of the propaganda appeared undesirable. The first step taken was the pasteurization of the milk used by the poor children — the most feasible method at the time. During the summer of 1897 two milk stations were established, each with a trained nurse in charge. The stations were humble establishments provided with very simple furniture, but con- tained the needed equipment. The best mUk obtainable was secured, and after modification to suit four different age periods of the baby was pasteurized at 180 degrees Fahrenheit for twenty minutes. This milk was placed in bottles of four differ- ent sizes, to correspond to the ages of the children, and was then retailed at cost to the mothers. The purpose of the work, as wUl be seen, was to accomplish two reforms : first, to secure a cleaner milk supply ; second, to educate mothers in infant care and management, and in the proper use of food. An initial step in the organization of the work was the conference with the mother, who was often igno- rant of the proper methods of caring for her children. At the time of her first purchase of milk the mother was required to appear at the station and to bring her baby with her for examina- tion. A milk combination suited to the needs of the child was prescribed by the physician or nurse, the baby was weighed, and the mother was instructed in regard to the changing needs of the child. In addition, a pamphlet, containing advice on the care of babies, printed in various languages so as to meet the lingual conditions of the city, was distributed among the mothers. For two years the work was carried on as described above, and the number of stations was increased to four. The results were apparent in a reduced death rate for children under five and in better care of the surviving ones. The pasteurization of impure milk was, however, unsatisfactory to the authorities, and it was therefore abandoned for the policy of striving to se- THE MILK PROBLEM 87 cure milk originally pure and wholesome and consequently fit food for babies. This reform required the production of milk under clean and sanitary conditions, so in 1899 a central milk station was established on a dairy Earm. Owing to the precau- tions taken by the farmer, and the complete sterilization of all mUk utensils, pasteurization was then abandoned and the raw milk was apportioned to the stations located in the city. In order to educate producers the central station was located on a diEEerent farm each succeeding year, and as a result the influ- ence of this rotation extended far beyond the dairy directly af- fected. This aggressive method of providing the poor with good milk was supplemented by vigorous inspection of all dairies contributing to the city mUk supply. A well-developed system of markiag and grading dairy conditions, as well as the mUk placed on the market, was also established. All resulted in better standards among the dairy farmers; better milk was therefore provided for the babies, and the quality for the entire city was improved. Strict regulations were adopted, the use of preservatives was forbidden, dairjrmen were required to report certain contagious and infectious diseases in the family or among the helpers, and the license to sell nulk in the city was made revocable if the law was violated. The results of the first ten years of effort are partly shown in the effects on the mortality rates among the children. Selected facts are given in the following table : ' Deaths or Children under Five in Rochester, New York Total . . January . April . . July . . August . September November i8g7-igo6 486s 388 443 S40 603 533 293 ^ Goler, Geo., But a Thousand a Year, Charities and Commons, April, 1907, Supplement. 88 PROBLEMS OF CHILD WELFARE This table clearly indicates a tremendous reduction in the death rate of children, and particularly gratifying was the result for the summer months, when the death rate is usually enormous. Not only was the aggregate number of deaths reduced one-half during these months, but the former disproportion between the summer rates and those for the rest of the year was also sub- stantially modified. WhUe this crusade was carried on, it constantly met with the opposition of certain private interests; politics also was in- jected, and a strenuous effort made to undermine the work. As a consequence, the city has progressed less rapidly in recent years. As a pioneer, however, its work cannot be too highly praised. Other cities now see the light, and if they surpass Rochester in their splendid work, it is because the needs are great and the work efi&cient. b. New York City. Among the large cities whose preventive work deserves at- tention is New York. During the years 1880 to 1911 inclusive, its infant mortality fell 58.8 per cent, or more than half, and the reduction in the death rate from the diarrhceal diseases was al- most exactly one-half. The greatest gains have been made since the formation of the Division of Child Hygiene in 1908. Much of the progress during these thirty-two years is due to the improved quality of the milk consumed by the babies. New York City is gradually evolving a milk code which covers most of the salient points. Pasteurization is not compulsory, but where it is done, it must be carried on under special permit from the board of health. Pasteurized milk must be labeled, the hour and day of pasteurization given, the degree of heat used, the amount of time, and the number of the permit. In addition, mUk must not be kept more than 24 hours after pas- teurization, or by that time it must be in the hands of the con- sumer, and no second pasteurization is allowed. Store milk cannot be taken from the can and placed in bottles ; nor can it be kept in sleeping rooms or in unsanitary places. Milk is clas- sified according to quality, and must be labeled accordingly. Finally, condemned milk is destroyed and vendors of bad milk may be prosecuted. THE MILK PROBLEM 89 New York City has spent much effort in the wearisome task of securing an adequate inspection of dairies. The city receives nulk from six or more states, but inspectors from New York have no power to coerce dairymen in any other state ; nor even in New York, which contains 80 per cent of the dairies sending milk to the city ; yet some form of coercion is necessary. This is secured in the following way : first, a group of officials is de- tailed to inspect mUk after it is brought to the city and to decide upon its quality and cleanliness, and if found unfit for food, it is rejected, and the dairyman who produced it is no longer per- mitted to ship his milk to the city. An effective check upon un- sanitary methods of production can thus be exercised by the inspectors who perform their work within the city itself. Second, traveling inspectors who are authorized to visit the dairies. Although they are without direct power, they can threaten to order the city authorities to prohibit a recalci- trant dairyman from sending his disqualified mUk to the city, and thus they compel him to improve the conditions under which his milk is produced. The system of scoring dairies as worked out by the federal government is used, and by means of this elaborate system of grading, the comparative standing of each dairyman visited can be placed on record. Doubtful producers can be more carefully followed, and if necessary their product can be rejected. The chief obstacle to adequate in- spection is the physical impossibility of supervising the dairies and of visitiag them with sufficient frequency to ascertain whether the standards are being maintained. c. Other Cities. Boston, which receives mUk from 7000 dairies in several states, has an elaborate system of inspection in which it uses the United States score card and tries to secure inspection of each dairy at least three times a year. At first 45 per cent of the dairies were found in an unsatisfactory condition, but this proportion has not only been reduced to 5 per cent, but the city has also established a bacteriological standard for its milk — 500,000 bacteria per cubic centimeter. Frequent tests are made, and nearly go per cent of the nulk examined is well within the standard adopted. 90 PROBLEMS OF CHILD WELFARE Most other regulations only duplicate those mentioned as ex- isting elsewhere. In Washington compulsory pasteurization has been required for many years, and a well-developed system of dairy control has been evolved. Inspection has been reduced to a minimum by requiring every dairyman who wishes to sell milk in the city to secure a permit which is granted after a satisfactory evidence is given that the milk is produced under wholesome conditions ; and with the agreement that the dairyman is both to be gov- erned by the regulations of the health office of the city and that his dairy is to be inspected without notice. The milk is ex- amined from time to time, and if foimd unworthy, the license is revoked. The inspectors are educators rather than spies. They are trained dairymen who guide and instruct producers. They come as friends, and therefore the dairymen are more tractable, and more willing to improve conditions when necessary. The tuberculin test is also required of all milk cows within the city. Chicago has met with the most determined resistance in its campaign for pure mUk. The city has adopted a bacteriological standard accepting a limit of 500,000 bacteria per cubic centi- meter in the winter and 1,000,000 in the summer months as reasonable. MUk, however, is not condemned unless the count has reached 3,000,000. City ordinance requires all mUk to be pasteurized, and the process is carefully defined by statute in order that the ineffectual methods of partial pasteurization may not pass as a complete process, since interrupted pasteurization is forbidden. The mUk is then to be cooled immediately to 45 degrees without exposure to the air. Chicago has also taken steps to secure the testing of milk cows for tuberculosis, but has been hindered in this work by the state government. d. Effects of Inspection on Disease. A very wholesome effect of persistent inspection of the milk supply is the detection of contagious diseases along the route, and the immediate stoppage of the milk sent from the sources of contamination. By means of a telltale register the infected milk is discovered. Whenever a case of contagious disease is THE MILK PROBLEM 9 1 reported, it is charged to the particular dairy of which the dis- eased person is a patron, and if other cases can be similarly charged, an investigation is instituted. In case the source of contagion can be definitely traced to an offending dairy, the dairy is closed till the danger is passed. Epidemics of scarlet fever, typhoid fever, diphtheria, and even of smallpox have been effec- tually checked in this way. The danger from scarlet fever es- pecially can thus be largely minimized. Buffalo has been par- ticularly active in preventing the spread of disease through a contaminated milk supply. 6. State Control. The states are gradually assisting the cities in developing and maintaining standards. Many states require commercial milk to have a certain percentage of butter fat, while some are legis- lating in reference to bovine tuberculosis and are requiring all dairy cows to be tested, while methods of preventing disease are being introduced. Massachusetts has a state law requiring dairy inspection. New York is agitating the question of state control and the reform forces would require the state board of health to examine the employees connected with dairies, cream- eries, and shipping stations, and to insure the use of good water. They also hope to secure laws requiring the state department of agriculture to examine dairy cattle, and to inspect the premises connected with milk cows and milk production, and to grant hcenses to farmers to produce milk. Such a form of state con- trol would relieve the cities, which could then give more time to inspections within the city and to the examination of milk. The New York Milk Committee claims that a definite sum, ex- pended for laboratory purposes within the city, can accomplish ten times as much as if used to extend a municipal system of dairy inspection beyond the city limits. The logical develop- ment is in the direction of increased state control; but this cannot be realized until public opinion recognizes the value of clean milk. Even then an increased cost of production would act as a deterrent. Consequently the better sanitary handling of milk must be accompanied by economies in production. Much can be done by the various state colleges of agriculture 92 PROBLEMS OF CHILD WELFARE to improve the milk supply. Through their extension work they can educate the dairjmien and the farmers in the standards of milk production, and by emphasizing the relation to disease they can also develop a public conscience on the duty of the proper handling of the milk supply. 7. Classification of Dairy Milk. In recent years a grade of milk known as " certified milk '* has been introduced. This is a copyrighted term, and the label cannot be used unless permission is granted by the commission J controlling its use. The nulk must be produced under condi- tions which will insure its cleanliness and a very low bacterial count without being subjected to pasteurization — " certified milk " should not contain more than 10,000 bacteria per cubic centimeter. In St. Louis 30,000 are allowed. A dairy must apply for the label, and if, after subsequent inspection, a favorable report is given, the use of the term may be granted, but this right may be withdrawn whenever the milk carrying the label fails to meet the requirements. On account of the drastic conditions imposed, few dairies sell " certified milk," but the number is constantly increasing. This rmlk, which costs the consumer about 50 per cent more than ordinary milk, is not within the reach of the poor, but it can be afforded by a large portion of the middle class, among whom it finds its chief clientele. Other commercial milk can be conveniently divided into several grades. The Commission on Milk Standards appointed by the New York Milk Committee has recommended the grading of milk into four classes, as follows : certified milk or its equiva- lent ; inspected nulk ; pasteurized milk ; and mUk not suitable for drinking purposes. The bacterial count, pasteurization, and cleanliness were the chief considerations that determined this classification. The Department of Health of New York City has adopted the following gradations : Grade A (for infants and children). (i) Certified. This meets the requirements set by the Medi- cal Society of New York. THE MILK PROBLEM 93 (2) Guaranteed. Meets same requirements as certified milk but is guaranteed by the Department of Health. (3) Inspected Raw. Must have not more than 60,000 bac- teria per cubic centimeter when delivered to consumer, and dairy must meet certain requirements. (4) Selected Pasteiurized. Must have not more than 50,000 bacteria per cubic centimeter, must be labeled as to date and hour of pasteurization, and milk must be de- livered within 30 hours of pasteurization. Grade B (for adults). (i) Selected Raw. Must come from cows that have been examined and found healthy. Dairies must score 68 according to certain proportions for equipment and methods. (2) Pasteurized. Must be delivered within 30 hours of pas- teurization. Grade C (all other milk). 8. Modified Milk. In 1 89 1 a Walker-Gordon laboratory was established in Boston, and since then these laboratories have sprung up in large num- bers. Their purpose is to prepare modified milk suited to the needs of the individual child, but no two modifications are alike, as each one is made according to the physician's order. This milk, which is sold on a purely commercial basis, costs two or three times the price of ordinary rmlk, so its use is confined to the children of the wealthy classes and is quite beyond the financial reach of the poor. Made from the cleanest mUk obtainable, it serves its limited field most successfully. Modified nulk is also prepared by various philanthropic agen- cies. A mUk of good quality is chosen ; then modifications are made according to a number of formulae, each of which is pre- sumably adapted to some age period of the infant. The modified milk is then pasteurized and sold at cost or less. It is intended for the poor, to whom it is ordinarily distributed from milk sta- tions established for the purpose. g. Milk Depots. In 1892 Dr. Budin of France, moved by the numberless deaths 94 PROBLEMS OF CHILD WELFARE of babies among the poor, devised a plan of education for the mothers. He established an institution designated a " Con- sultation de Nourissons," where he attempted to reduce infant mortality according to the following plans i^ first, by encourag- ing breast feeding as far as possible ; second, by giving sterilized milk if necessary ; third, by supplementing maternal milk with good cow's milk, if the former was insuflacient ; fourth, by mak- ing systematic observations of each infant in order to note its progress. Institutions of this kind have attained considerable success in persuading mothers to nurse their children. In two years one of them increased the percentage of infants who were breast fed from 22 to 77. Many such stations have been established in France. Another form of institution known as the " goutte de lait," begun in France in 1894, provided modified cow's mUk to infants who needed to be artificially fed. Each infant received the special modification needed, and was also given regular medical examination. This type of agency has become the more popu- lar ; it has spread all over France, and has been copied by cities throughout Western Europe. In the United States the milk depot is a permanent feature in the campaign for the reduction of infant mortality. Although not the first ones, the Straus milk depots established in New York City in 1893 gave the impetus to similar work elsewhere. These depots sold pasteurized and modified milk at less than cost price, so they had to be supported by private philanthropy. They have undoubtedly been a large factor in the reduction of infant death rates in that city. Later when their founder failed to continue his support, the Straus depots were replaced by the milk stations doing a similar work. Every large American city now has milk depots which are operated by private philanthropy, but in 1912 the New York City Department of Health main- tained 55 such stations in addition to the ones under the direc- tion of private societies. In the near future many cities will imdoubtedly establish mOk stations as a part of their public social service work. ' Heath, Llewellyn, The Infant, the Parent, the State, p. 142. THE MILK PROBLEM 95 In a t5^ical milk station modified pasteurized milk is provided for poor mothers. Usually modifications, such as already noted, are made, and the milk is then sold at or below cost, and a smal/ amount may even be given away. It is ordinarily withheld, except on the prescription of a physician. If the mother can nurse her baby, she is always urged to do so. An auxiliary feature of some of the nulk depots is the babies' clinic, where infants are examined by the physician in charge, or, in his absence, by a trained nurse. As already explained in connection with the experience of Rochester, the baby is weighed, his case is carefully diagnosed, milk of the proper modification is prescribed, the mother is instructed as to the best method of feeding, and is ordered to bring the child to the depot when- ever the physician finds this necessary. The condition of the mother and her ability to care for the child are noted, and in numerous cases the trained nurse is detailed to visit the homes of the babies to supplement the work of the mother. Such efforts have a cumulative effect, since mothers communicate their experience to other women, who in turn profit from the knowledge obtained. This form of education is definitely bound up with the rmlk depot, but other methods of instruction, which will be considered later, are also employed. A third feature is the visiting nurse who goes to the homes. In so far as her work consists of instruction as to the care of nulk, or its proper modi- fication, her service is one of the necessary steps in securing good mUk for babies. In so far as it is educative along other lines, it will be discussed in the succeeding chapter. MUk stations are usually placed in localities which are in greatest need of their services ; accordingly, a knowledge of con- ditions in each commimity should precede the establishment of the station. Then mothers should learn of the existence of the depots. In New York City, mothers of babies imder three months of age, living within six blocks of a public station, are notified of its presence, and informed of its work. As many of the mothers are of foreign birth and are ignorant of the English language, specialized effort is necessary to reach them. Some milk stations operate throughout the year, but the majority are open only during the summer months. 96 PROBLEMS OF CHILD WELFARE The Rochester public milk stations furnished modified milk, but the New York City Department of Health, in establishing its depots, decided to sell whole milk of a certain quality, and then to instruct mothers in the art of modification, thus reducing the cost of the rtulk and at the same time making the reform per- manent because, having once learned how, most mothers will not forget and will become less dependent on milk stations. CHAPTER VI METHODS OF PREVENTIVE WORK I. Encouragement of Maternal Feeding. If cow's milk were the only substitute for nature's food, the reduction of infant mortality would be far simpler than it is ; but milk substitutes and other foods are used. Although bottle- feeding causes a high infant death rate, the use of substitutes for mUk is far more dangerous. WhUe a return to maternal feeding is desirable, serious obstacles sometimes present themselves. For example, pregnancies occur, and these necessitate the wean- ing of the child ; again, Hi-health or disease may intervene ; be- sides, many mothers are obliged to enter industry, and cannot afford to nurse their babies. Furthermore, well-to-do mothers frequently do not wish to undergo the inconvenience which the care of babies involves. Many infants unable to digest any other than liquid food must therefore be fed upon cow's milk or other substitutes for their mother's mUk. In the poorer districts in particular we find babies fed upon pickles, bananas, crackers, cheese, and salt-pork, etc. Needless to say, their tiny over- worked stomachs are unequal to the task of assimilation. However, an effort must be made to return to the policy of maternal feeding. This principle was recognized in France in 1876, when a society was formed whose object was to aid mothers so that they might continue to nurse their babies, and which also disseminated knowledge as to the desirability of wet nursing. Under such teaching, France has witnessed a widespread re- turn to the old and venerable method of feeding babies on breast milk. In the United States the principle is universally accepted by medical agencies, and our milk stations likewise insist that the mother do her utmost to nurse the baby, modified milk being prescribed only as a last resort. More and more, physi- H 97 98 PROBLEMS OF CHILD WELFARE cians are urging middle class mothers to nurse their babies in- stead of resorting to bottle-feeding. On the other hand, many infants fed upon mother's milk suffer and waste away. Consequences of this sort are an indica- tion that the mother is physically unfit to nurse her child. Under these conditions, breast-feeding should be abandoned unless the mother is able to recuperate so that the child will begin to thrive and become a healthy, vigorous infant. It is clear that many instances clearly justify the use of cow's milk. In France, again, a part of the remedial work consists in providing the mother with food and in restoring her health and vigor so as to enable her to nurse her baby. Poverty is usually responsible, at least in part, for the mother's ill-health ; consequently with the development of a more generous relief policy, the food provided for mothers will be more nearly adequate, and they can fit themselves for this most important duty. At present we insist that they work at some gainful occupation so as to reduce necessary relief, and as a result they are unfitted for the work of nursing. This difficulty is constantly faced by nurses engaged in postnatal care, but reform is slow, and a long time must. elapse before the question can be solved. Public lectures discussing the dangers of artifi- cial foods and presenting other subjects related to the care of babies should be given to mothers at club-meetings, settlements, milk-stations, public school buildings, playgrounds, and other gathering places. Some departments of health are now actually attempting this method of instruction, and private philanthropy has likewise carried on a limited amount of such education. 2. Prenatal Work. Apart from the unavoidable use of contaminated and over- heated milk, the ignorance of parents is the chief point of attack in lessening infant mortality, but ignorance is caused by poverty and poverty is caused by ignorance, so this evil is not a simple one. Efforts to eliminate poverty must be continued, but the reduction of infant death rates cannot be delayed until poverty is abolished ; so immediate action is necessary to educate parents in reference to this one question. Among the poorest classes, knowledge as to the feeding of babies is very meager ; little is METHODS OF PREVENTIVE WORK 99 known of the invigorating and curative properties of fresh air, the value of an outing for the baby is not appreciated, and open windows are viewed with horror and dread, and the importance of proper clothing and of frequent bathing is unknown. Many babies are stUl bundled into swaddling clothes, much to their grief and discomfort, and thousands are not dressed according to the season. In the large cities, children may be seen on cold February days clad in the frailest of garments, and in July al- most suffocating from a superabundance of clothing. Foreign mothers especially, unused to the range of our climatic condi- tions, fail to accommodate their children to the varying re- quirements. Such facts as these indicate the need of enlightening mothers. Some of the large cities require the registration of all births, and send a circular of information to the mother of every newly born infant. They usually send instructions in the language of the mother, or in several languages, but very little attention is paid to information proffered in this way. The circulars are doubted or discredited, and unless the human element enters, little is accomplished. Unless some person actually impresses the facts directly on the minds of mothers, the effort is largely wasted. In view of the ignorance of mothers which results in an exces- sive number of still births and an infant mortality especially heavy in the first few months of life, instruction should be given to prospective, as well as to actual, mothers. To meet this need prenatal work has been introduced. It was first attempted in New York City in 1908, and the woman's Mimicipal League of Boston began the work in that city in 1909. Since then a limited amount of prenatal work has been attempted in other cities, including Chicago, St. Louis, Baltimore, and Milwaukee.' The method of prenatal care is comparatively simple. Women come independently or by invitation after the fourth or fifth month of pregnancy to the dispensary, where their cases are carefully diagnosed and their history examined. Perhaps a ' See Workjor Expectant Mothers in Certain American Cities, by Ellen C. Babbitt Woman's Medical Journal, January, 1913- lOO PROBLEMS OF CHILD WELFARE little instruction is sufficient ; perhaps they are asked to report at regular intervals to receive additional care and advice. In many cases this is not sufficient, and nurses are sent to the homes to complete the instruction. The principal subjects covered are the following: food and diet, which should be intelligently regulated both as to amount and kind ; proper clothing, which will impede as little as possible the free movement of the body ; work and exercise, much advice being needed to distinguish clearly the difference in efiect between work and exercise and to convince women of the beneficial effects of the latter; indica- tions of Ul health, so that if any morbid condition exists, the serv- ices of the dispensary can be offered, and the condition can be corrected ; household sanitation, since bad conditions can often be easily remedied and headaches and other bodily ailments be avoided. After several months of instruction prospective mothers learn that they are feeling better, they become more cheerful and are much better prepared to undergo the ordeal of confinement. To be effective, the work of supervision should be carried on until the baby is at least one month old. So little prenatal care has as yet been attempted that the statistics of results are very meager, but they nevertheless indicate very successful work. The following table gives a few significant facts relating to the work carried on by the New York Milk Committee in Manhat- tan, and to that of the Pregnancy Clinic of the Boston Lying- in Hospital.' Peenatal Work Date OR TniE Babies BOEN Alive Deaths UNDER I Mo. Death Rate Stili- BmiHS Ratio TO Rate Crrif Entire City Supervised Cases Rate Ratio to Rate for City City Manhattan Boston . . 17 mo. 7 mo. 1350 910 37 9 40.2 45-7 27.4 lO.O 68.1 21.9 48 30 7I-S 79-S ' See Ellen Babbitt, in article cited ; also Sixth Annual Report of the New York Milk Committee. METHODS OF PREVENTIVE WORK loi Apart from the fact that prenatal care makes confinement easier and more regular, it appears that death rates have been materially affected thereby. In Manhattan the still-birth rate among the supervised cases was 28.4 per cent lower than that of the entire borough ; in Boston the rate was 21.5 per cent lower, and the minor experiments in other cities have yielded similar results. In each city the rate has fallen below the normal, and it must be remembered that these rates relate to the poorest and most ignorant people in the city. Since the average rate of stUl-births among the poor is undoubtedly much above the nor- mal for the entire city, the real reduction is much larger than that indicated by the percentages given. This principle also appUes to the death rates of babies under one month of age, which are largely due to diseases of early infancy, and these are several times as fatal among the poor as among the well-to-do. In Man- hattan the rate among the supervised cases was 31.8 per cent lower than that of the entire borough, while the records for the Boston Lying-in Hospital indicate a reduction of 78 per cent. This figure, however, is exceptional, and far in excess of the gains made through other experiments, whether in Boston or else- where. Nevertheless, the evidence in regard to prenatal care in- dicates a present saving of about one-third of the infants who ordinarily die of diseases of early infancy as well as the remark- able reduction in the proportion of still-births. No doubt the number of miscarriages is also reduced thereby, though the work is so recent that the maximum efficiency has not been reached. Additional experience should develop increased ability to carry on successful work. As a result, the diseases of early infancy wiU be brought under greater human control and the majority of the deaths from these diseases be avoided. In view of the heavy mortality which can be prevented, prenatal care becomes a most valuable form of preventive work. On the other hand, it has serious limitations. It cannot effectively improve the economic conditions which are in part responsible for overwork, lack of care, incompatibility, ignorance, and low ideals. It can, how- ever, bring these needs to the attention of the public, and can greatly reduce our needless infant mortality. 102 PROBLEMS OF CHILD WELFARE 3. Visiting Nurse Work. As an adjunct of the milk station, the visiting nurse gains an easy entrance into many homes. There her work includes a multitude of details. The duties of the nurses of New York City well illustrate the variety of tasks imposed.^ The nurses work in the schools during the school year and then engage in home visiting in the summer months, when they are assigned to the worst districts of the city, and each one given the supervision of 100 babies whose records are secured from the Bureau of Vital Statistics. The mothers are persuaded to nurse their children if possible ; otherwise instruction in baby-feeding and hygiene is given. Instruction is both oral and written, circulars of in- formation being regularly distributed, and the work is carried on in cooperation with the milk station in the district and mothers are connected with this if advisable. All mothers are visited every ten days ; those with sick babies oftener. Sick babies are given special attention. Private medical care is first sought for the child, but if charity is necessary, the hospital or dispensary is pressed into service. Sometimes outdoor medi- cal care is sought from the department of health, which sends one of its medical inspectors. Small groups of nurses meet regularly with an inspector for consultation over cases, and the nurses must familiarize themselves with the social agencies of the community. Finally, adequate reports on all cases, whether sick or well, are required. The nurses as shown by their duties are engaged in both remedial and preventive work. The success of the New York City nurses is indicated by the fact that during 4I months in 1911 only 1.4 per cent of the 16,987 babies under their care died. At the same rate the annual mortality would have been 37.3 per 1000 babies, or less than half that of the pre- vailing rate in the entire city. In Boston a record is being made of every baby, and its feed- ing history is noted, and if it is bottle-fed, the case is visited. If the infant has proper medical care, the case is dropped, but the neglected babies are at once given attention. Many small 1 Report of Division of Child Hygiene of the Department of Health, New York City, 1912, pp. 29-30. METHODS OF PREVENTIVE WORK 103 children have also been saved in the homes of consumptives because the treatment of the latter has been accompanied by examination of the children. In Chicago some of the " baby nurses " have been employed to make a house to house canvass of certain districts ; others confine their attention to the babies whose names have been referred for visitation. More nurses are needed for this work. Some can be recruited from the various organizations which at present engage in visit- ing the homes; many cities have visiting nurse associations maintained by private charity; some charity organization societies employ nurses directly ; some settlements also main- tain one or more nurses, and many dispensaries command the services of the trained nurse. Usually the organization which manages the milk stations is able to finance the appointment of a number of nurses. The chief rehance in the future, how- ever, must be the boards of health in our cities, which must employ a sufficient number of nurses to cover the field ade- quately. To some extent the school nurse can be used for this purpose, but additional workers will probably be needed. The ignorance of parents cannot be removed unless intensive work is done within the home. The experience of the little town of Huddersfield, England, further illustrates the effects of knowledge in the art of infant care and management.' In order to decrease the infant mor- tality of one of the bad districts of the town, the mayor in 1904 offered a small premium for every child who should reach the twelfth month of life. The promise was issued on a small card bearing the baby's name and date of birth, and the address of the parents. In addition the card contained rules of advice, most prominent of which was the appeal in favor of the use of mother's milk. This appeal was fortified by the statement that infant mortality is fifteen times greater when other means of feeding are employed. Visits were as frequent as necessary, and special efforts were made to render service to mothers at the beginning of both the hot and the cold seasons, when disease is most frequent and the mortality from certain complaints is ' See Newman, George, Infant Mortality, p. 265. I04 PROBLEMS OF CHILD WELFARE aggravated. This combination of methods gave remarkable results. During this trial year the infant mortality of the district fell from 134 per 1000 births to 54 — a decline of approx- imately 60 per cent. The value of the plan cannot be doubted, in spite of the small area covered and the temporary nature of the experiment. 4. The Day Nursery. The day nursery has a limited value in educating mothers, but the total number of children cared for at the nurseries is insignificant compared with the absolute number of children who are in need of more intelligent care. The nursery is pat- ronized almost exclusively by women who work away from home, yet thousands of mothers do not enter the gainful occu- pations, and the influence of the nursery does not reach them. This influence usually operates through the children, who are daily fed and cared for, and who reflect at home the conditions and high standards of the nursery. Indirectly therefore, the nursery transforms the life and ideals of a limited number of homes, but its work as a child-saving agency has not yet reached its full development. Its direct beneficiaries are, however, limited to small children, and the infant gains only indirectly from the new ideals established in the homes. 5. Education of Girls and Boys. Our educational system needs revision, and the school cur- riculum must be made to conform more nearly to the actual requirements of our complex life of to-day. Our emphasis upon literary education is gradually being displaced by an insist- ence upon training which will equip the growing boy and girl for industrial and trade opportunities. The economic needs are being supplied, but the social aspects of education have not received sufficient encouragement. Girls are usually kept ignorant of the significance of maternity, and receive little instruction relating thereto. They are usually required to learn everything in the school of experience. The immature girl also suffers because of her youth, statistics showing that early mar- riages yield a higher infant mortality than do later ones. If the mother is under 20, the infant death rate, particularly from METHODS OF PREVENTIVE WORK 105 the diarrhoeal diseases, is excessive. A limited investigation in Chicago among the families of immigrants indicates a higher death rate in the larger than in the smaller families. Since ignorance as well as spent energies contributes to this result, the public schools must face this problem and train our children for the varied duties of life. Our young men and young women must learn more about the requirements and needs of the home and of home life. Domestic science, the art of housekeeping, proper uses of food, the importance of cleanliness, hygiene, sanitation, infant care and management, and other items of value should become part of the instruction of every young woman. Such instruction is so fundamental that it should rank as a most important preventive measure. Domestic science must soon form part of the curriculum in every elementary school. It should be made compulsory for every girl in the seventh and eighth grades, and the amount of ground covered during these two grades ought to be sufficient to enable a young woman to learn all the rudiments necessary to begin a home on an intelligent basis. A very large percentage of public school pupils leave school before they reach these grades, many going at the end of the fifth year, while the loss during the sixth year is also very heavy. Provision of some kind for these children is also imperative, for it is precisely this class that swells the aggregate of undesirable elements in our large cities. Compulsory education wiU reach aU who are not over-aged, but the latter form a special problem and cannot be neglected. Either they must be given the training in special classes, or they must be held at school until they have had the needed training. The group of girls most in need of the training afforded by domestic science and household economy are least liable to be reached by the present halting methods of instruc- tion. The majority of cities have done little for the cause of domestic science, and therefore the chief cause of ignorance of household economy still remains. Domestic science in the high school should be encouraged, and it will be a source of pleasure and of profit to the high school girl. Instruction in this branch, however, does not benefit the children of the poor, Io6 PROBLEMS OF CHILD WELFARE because they do not reach the high school ; and effective preven- tive work for the child of the coming generation can be performed only by educating the girl and boy who are most in need of the training which these branches will yield. The introduction of such courses into the secondary schools will only touch the better classes and will affect less than lo per cent of all the people. Our schools are strangely lacking in their provisions for instruction in household economy, and the need of reform is urgent and immediate. In the larger cities many babies are really cared for a large share of the time by their older sisters. These " little mothers " are usually ignorant of the principles of baby care and are there- fore quite precarious caretakers. In New York City the De- partment of Health, realizing that for many years this practice would continue, decided to instruct the children. Accordingly a lecture on baby care is given in every public school in the city in May of each year, and little mothers' leagues are formed among girls over twelve years of age. These leagues continue the study of child care, and in 1911 239 such leagues were or- ganized, with a membership of 17,050 girls. The leagues met weekly for twelve weeks, during which time they covered an entire course on the principles of baby care. Valuable as this work is in guiding the little mother in her daily task, it will have still more value when she becomes a real mother. We can well afford to utilize school buildings for this purpose. Boys likewise need additional training, especially in home hygiene and sanitation. The value of nature's curative forces and regenerative agencies must be taught in order to give the boy a proper appreciation of the danger and injury incident to unsanitary housing conditions. The uses of fresh air, the germ-destroying power of sunlight, the effects of contamination of air, the influence of gases, standards in regard to sufficient air space, and other necessary knowledge relating to proper housing conditions must be effectually taught to all young boys. The meager knowledge of these subjects gained at present in the study of physiology is entirely insufficient, and an extension along the lines indicated is necessary ; otherwise the instruction METHODS OF PREVENTIVE WORK 107 must be given as a separate branch of the work of the school. Whatever be the course followed, it must be judged from the standpoint of efficiency. The knowledge which makes for better homes and more sanitary houses, and which will accordingly save the lives of thousands of babies, must be acquired before the homes are formed and before babies are born. If this is not done, children will always be the victims of ignorance and neglect. The evening school, with its classes in appropriate subjects for both young men and young women, and the classes formed in settlements and other institutions which strive to meet this deficiency in the education of the child, reach a small number of persons only and cannot adequately meet the situation. Furthermore, this work is or should be considered a mere tem- porary expedient, to be abandoned when the elementary schools expand their functions so as to include home science among the subjects taught. A temporary expansion of the work of these classes should be cordially welcomed, because the public school does not now meet the needs of a large bulk of our growing youth, and many anticipated reforms are not yet being realized. 6. Prevention of Overcrowding. Fatalities among children depend in part on the bad housing conditions of a city. Overcrowding may take one of the fol- lowing forms : first, an enormous number of persons may live on a single acre ; again, many families may live in a single house or tenement ; third, a large number of persons may be crowded into a single flat or group of rooms, this latter form being by far the most dangerous one. It is an appalling fact that the three- room apartment is the most common form of housing for the large families of the poor, while two-room apartments are also amazingly frequent. In England an average of more than two persons per room is considered overcrowding, but in New York City the informal standard is i^ persons per room. Owing to the small rooms in its tenements this standard is not entirely adapted to other cities, but if the sexes are to be separated, it will hold. A tremendous amount of overcrowding does exist in American cities. I08 PROBLEMS OF CHILD WELFARE The density per acre may be very heavy, yet the conditions under which the individual famiUes live accord with all the demands of sanitation and cleanliness. Tenement houses well cared for and well inspected by the city authorities may house a dense population without special injury or excessive suffering to the indwellers. This is particularly true if houses are built according to the best modern models. In actual practice, how- ever, a heavy per acre density is usually associated with tene- ment house conditions of the worst tj^e, the size of the families of the better classes being uniformly smaller and the families themselves refusing to submit to such crowding. Congestion invariably means poor conditions and inadequate eqvupment. Investigations have made quite plain the following proposi- tion in regard to the effects of crowding : first, the mortality of a population increases as the density per acre is increased, and is considerably higher when a very heavy density obtains: second, mortality is much less if single tenements only are built upon the lots than if front and rear tenements exist. Statistics for New York City (old) and for St. Louis show that the mor- tality of children under five was nearly twice as high in the latter type of buildings. Third, mortality varies inversely according to the number of rooms per apartment. English figures have shown that the one-room apartment is nearly twice as fatal as the four-room apartment. This form of overcrowding is by far the most dangerous to life and health, as it is directly related to the problem of adequate air space, especially for sleeping purposes. It also prevents the enjoyment of sufficient sunlight and ventilation. It is especially under such conditions that a large infant mortality ensues, because it becomes impossible to provide the child with a sufficient amount of nature's curative forces and properties. It has been shown that in Vienna, Austria, when 8 per cent of the population was overcrowded, the mortality increased more than loo per cent above the normal, and that all overcrowding was accompanied by a high rate of mortality.' The noxious influence of overcrowding upon the life and health ' Bailey, W. B., Modern Social Conditions, p. 323. METHODS OF PREVENTIVE WORK 109 of the young child is well known. There remains only the prob- lem of ascertaining the precise influence of this factor in order that our cities may become more resolute in providing and demanding sufficient air and room. Reform in housing condi- tions, including the bviilding of wholesome tenements, is urgently needed, as well as insistence upon better conditions in and about the two-family houses, especially in regard to plumbing, sewage, garbage disposal, closets, etc. 7. Prevention of Employment of Married Women. An additional method of lessening our infant mortality con- sists in reducing the number of married women employed in factories, offices, and mercantile estabUshments. In 1900 the total number of married women in the United States engaged in the gainful occupations was 769,477 or 5.6 per centof the entire number of married women. Although a small number, it repre- sented an increase of i per cent in the proportion of married women at work when compared with the census of 1890. Our recent immigration from Europe has probably increased this propor- tion, although statistics for 19 10 have not yet been tabulated. Many Italian, Polish, Bohemian, and French Canadian mothers are at present employed in our factories and workshops, and therefore are compelled to neglect their children. They are found in canning factories, in clothing estabhshments, in the candy, meat-packing, and cotton and wool industries, and thousands are engaged in laundry work, or clean offices and stores. In several cities women have asked for a night nursery where babies might be kept during the early part of the night, so as to make it possible to work until 10 or 11 o'clock. In Fall River, where a large percentage of the married women are at work in the cotton mills, the infant mortality is not only very high, but it exceeds that of every American city having a popu- lation of 100,000 or more, while the rates for diarrhoea and enter- itis are also disproportionately high. There can be no doubt of the causal relation between this high mortality and the pres- ence of mothers in the factories. In some European countries women are forbidden by law to work in industrial establishments for a period of from four to no PROBLEMS OF CHILD WELFARE six weeks after childbirth, but the Swiss law prohibits women from such work for two weeks before and six weeks after. In the United States, women do not wish to work until the last hour and employers ordinarily do not allow it. The foreign mothers, however, are aggravating the problem, and conditions in this respect must be carefully watched. Furthermore, over- work in the home is also frequently disastrous, the expectant mother not being in a position to consider the needs of the child. Prenatal and postnatal work may result in better care of self and of baby, but the pressure of poverty is not relieved thereby. Laws such as those enacted in European countries may improve conditions, though they do not solve the problem. 8. Provisions for Fresh Air. The fierce summer heat not only spoils milk but affects babies directly, so illness is aggravated and mortality much increased. One method of escape from heat is the summer outing, but the poor unfortunately can hardly get away from home. Perhaps they can afford a day or two. Sometimes a private organiza- tion, like the St. John's Guild of New York City, with its floating hospital, brings the fresh air to a mother and her sick baby. Sometimes the outing farms and convalescent homes are very helpful to the needy by taking weak and sickly children and placing them in the cool fresh country, where after a week or two of rest and recreation, they are invigorated and strength- ened and nursed back to health. The recent appreciation of this problem has greatly increased the fresh air work of the various philanthropies. Parks and playgrounds temper the fierceness of the heat, and the establishment of baby tents on open spaces, whether vacant lots or playgrounds, brings good air to the hundreds of babies that are brought out from dark, foul-smelling tenements. The poor suffer from the lack of means to cool milk. Many of them cannot afford to buy ice, and the water is not suflSciently cool to serve the purpose. Free ice funds have, therefore, been established in some cities. Ice is frequently furnished to needy families, the preference always being given to those families in which sick children are in need of relief. METHODS OF PREVENTIVE WORK m 9. Reduction of Poverty and Vice. Poverty has an ultimate relation to infant mortality. Many underfed and emaciated children can be daily seen in our large hospitals, and many withered mothers are the victims of mal- nutrition ; soon their suckHng babes are stricken also. Poverty prevents parents from drawing on the community, which is rich in its resources and its capacity for coaxing children back to health. Poverty keeps the nurse and physician out of the home ; it houses the poor in dirty, dilapidated alley houses ; it prevents education ; it makes people helpless and causes them to aban- don hope. If poverty is self-inflicted, little can be done, and lazy, shiftless, and improvident parents may have themselves to blame. Still we do not know to what extent our methods of training and our social neglect are responsible for their fate. If poverty is due to circumstances over which individuals have no control, the burden rests flatly on the community. Poverty can be largely abolished, and it must be done for the sake of the children, but it must also be done to promote a better civilization. Vice cannot be overlooked. Drunken fathers neglect their families and waste their means, while vicious mothers are hard- ened to misery and shame. The immorality of many men and the consequent infliction of disease upon their offspring is re- sponsible for a growing proportion of infant and child deaths. Innocent women are frequent victims of such men, but the peril to children is perhaps the graver, because deformity or death is the frequent penalty. 10. Control of Midwifery. In the American cities about one-half of the births are attended by midwives ; the proportion in New York City is about 40 per cent ; in Chicago approximately 80 ; but in Boston it is very small, owing to the enormous extension of its obstetrical out- door hospital facilities. A large proportion of the midwives are ignorant women, with no knowledge of microorganisms and with no appreciation of the importance of absolute cleanliness. Many of them are old ; some are untidy in habits ; others lack a full equipment of instruments, and probably not more than 10 per cent are careful efficient workers. 112 PROBLEMS OF CHILD WELFARE To safeguard the life and health of the child and also of the mother the supervision of midwives has become necessary. Most European countries have adopted strict regulations, and American states and cities are slowly following, the state law applying to the city of New York being a good type of such reg- ulations. Among the provisions of the law are the following : Every midwife must have a permit from the Board of Health. This must be renewed annually. The applicant must be 21 years of age, literate, of good moral character, must have attended under the instruction of a licensed physician at least twenty cases of labor, and must appear in person at the Department of Health. No permit will be granted to an applicant guilty of criminal practice. A midwife may attend only certain cases of labor. If speci- fied conditions develop, a physician must be called. She must be scrupulously clean, must carry the prescribed articles in her equipment, and follow a certain course of pro- cedure. She must drop a i per cent solution of silver nitrate into the eyes of the newly born child, and summon a physician if the child develops certain injurious conditions. She must report still-births and also issue birth certificates. The law is enforced by the Division of Child Hygiene. Midwifery must gradually be subjected to the same program of control as the medical profession. Schools and training must be provided, and the right to practice must follow a proper examination of the applicant. Subsequent supervision, how- ever, must be rather complete because of the relatively inferior education of the midwife even though she takes a short train- ing course. In England midwives are not licensed unless they have graduated from an accredited training school, but in the United States facilities for training are meager, and a profes- sional course is not required. A system of state registration and control, and the adoption of a standard that would require special training, will simplify the midwife problem and develop a more efficient group of workers. METHODS OF PREVENTIVE WORK 113 II. Municipal Campaigns against Infant Mortality. What is the function of the municipality in connection with this problem? We have already seen that cities engage in cam- paigns for the reduction of infant death rates, but what are the Umits of activity which must not be exceeded? Will not individual responsibility perish under the threatened deluge of paternalism, and leave us weaker than before? The social worker thinks not. He believes that the city or state must insist on a pure nulk supply and that the individual is helpless in this respect. He also believes that the public must educate the ignorant. Take for example the splendid work recently carried on by the health officials of Chicago. Lectures on in- fant care were given to pupils in the higher grades of the ele- mentary schools, as well as to mothers. Moving pictures were exhibited; literature was distributed; placards filled with in- formation were conveniently posted; articles were circulated; special bulletins were prepared; a midwives' correspondence school was established ; nurses were sent from house to house ; demonstrations of care and hygiene were given; sick babies were discovered, and the aid of private philanthropy invoked if necessary; the mUk ordinances were enforced and housing conditions improved. The campaign was principally concerned with two problems — a better food supply, and better care of babies. To such work there can be no rational objection. One difficulty, however, remains — there is danger of en- croaching on the field of the private physician who imagines that his livelihood is being wrested from him. Yet private and public philanthropy also have jealously guarded the as- sumed rights of the private physician and do not try to displace him. Rather they try to gain his help and cooperation. On the other hand, health is a matter of public concern, and the trend of progress is inevitably in the direction of the pubhc physician. The same logic has given us the public school teacher. Some of the more intricate personal relations involved may well be left to private philanthropy. Especially is this true of relief cases, and others that do not lend themselves easily to a 114 PROBLEMS OF CHILD WELFARE definite routine of action. Public authority should, however, take the lead and allow private philanthropy to supplement its work, rather than the converse. Under its recent socialistic administration, Milwaukee began an interesting experiment in health promotion, when it estab- Ushed an " educational health center." This was a combination of milk station, prophylactic dispensary, settlement, social center, and district office of the charity organization society. The area served covered 33 blocks and ministered to 16,000 persons. Within this area virtually complete birth registration was secured; some prenatal care was given, and very careful postnatal work was done with good eSects; midwives were instructed, and the standards of physicians raised as well; mothers were persuaded to take time for education ; boarding homes were found for dependent babies, and other activities carried on. It was planned to establish similar centers through- out the city until all the people would be served. This ambition, however, has not been realized, owing to political changes. The work of other cities need not be detailed here. The illustrations given suffice to show how cities can by vigorous work reduce their infant mortality and promote the general health of their small children. Such work should be carried on during the hot weather especially, but should not, as has usually been the case, be confined to the summer months, be- cause the problem of care in the winter season also demands attention. The establishment of bureaus of child hygiene in departments of health, as has been done in a number of cities, is giving a remarkable impetus to systematic efforts to reduce infant mortality. Likewise prenatal work carried on by a branch of the municipal government, as recently begun in Boston, opens the way for a further extension of the work of our public agencies. 12. Cooperation among Preventive Agencies. The saving of child lives has become a question of such im- portance that a variety of organizations have entered the work. At once there is danger of much dupUcation of effort METHODS OF PREVENTIVE WORK 1 15 and waste of energy. Cooperation is necessary to facilitate well-directed work. New York City has an association of milk stations which in 19 11 included the seven different organizations that were operating such stations. This cooperation enabled them to work more efficiently, to prevent duplication and overlapping, to handle details more adequately, and to provide greater publicity than would otherwise have been possible. In 191 2 a Babies' Welfare Association was formed, and 27 agen- cies were represented. In Chicago close cooperation has existed among the principal agencies interested, such as the department of health, the United Charities, the Visiting Nurse Association, and the various settlements and sanatoria. In St. Louis the agencies interested in infant mortality are brought together in the Central Council of Social Agencies, where they perfect a plan of cooperation. In this city the duplication of nurse work because of overlapping has been one of the problems. If a proper coordination of the work of preventive agencies can be established, and if a maximum of efficiency can be secured so that all waste of effort will be avoided, then a rapid reduction in death rates should take place. PART II HEALTH AND PHYSIQUE CHAPTER I PHYSICAL CONDITIONS OF CHILDREN I. Standards of Physique. Next to life comes health. Without this no man can be industrially, mentally, and morally as capable as the normal man should be. The development of physique and vigor is therefore one of the great essentials of wholesome life, and every man should have the opportunity to acquire his highest physical possibility. It is not mere height and weight that count, but a normal development, for the tall Patagonian is not necessarily superior to the short Italian, nor a heavy race superior to one of lighter weight, but a man of normal stature is superior to the dwarfed specimen of his own race. So with strength and other characteristics. It is probable that the different races of the world each possess certain inherent normal proportions of physique, such as height, weight, lung power, shape of head, etc. The normal tends always to persist, but environmental influences may carry a people far from the origi- nal standard. However, when favorable conditions return, the people will rebound and the normal type again appear. Heredity gives us a standard for each race, environment causes the principal deviations therefrom. The social phase of this problem consists in surrounding each person with the forces which will insure to him the physique to which he is entitled, while the eugenic side consists of the problem of improving the standard. Recent studies and observations of the physical conditions of children and of certain adult groups have indicated certain laws of development, as well as the causes of physical degeneration. The boy baby weighs about eight ounces more at birth than the girl baby, but the death rate of male children is uniformly 119 I20 PROBLEMS OF CHILD WELFARE higher than that of females, and they are also more susceptible to certain diseases. Boys are superior in height and weight from birth until they are about 115 years old, but at that age the girls overtake them and exceed them in both respects for a period of from two to three years. Then boys grow so rapidly that they again outstrip the girls, and from that time on are taller and heavier than girls. The rapid growth of girls pre- cedes puberty by about two years, during which period of development many children grow as much as three inches in a single year. The boy of 14 if allowed to work, runs a great risk, for this is precisely the time of his most rapid growth. Before puberty the difference between boys and girls as to strength, pull, grip, and other physical powers is much less than after- wards. After this period the lines of development diverge, the male sex grows strong, but the female sex develops endurance, resistance, and the peculiar feminine powers at the expense of great physical strength. These several cycles of growth are most important in their relation to the permanent vigor and physique of the individuals. 2. Comparative Development of Social Classes. The physical conditions of the child of to-day are a pretty safe indication of the forces that are at work in his environment. Observations made many years ago by Quetelet were to the effect that wealthy children were larger than poor children. Roberts, in his study of English boys, compared the laboring class groups of the towns with the non-laboring classes in the schools and universities. He discovered a difference of 2.37 inches in height at the age of ten and of 1.09 inches at 20, both of course in favor of the well-to-do boy. On the other hand, while the poor boy was lighter in the earlier years, at 20 he was heavier than his wealthy cousin. Bowditch, in 1877, found the American-born pupils of selected schools in Boston both taller and heavier than the non-working English boy,' the difference in weight being greater, however, than that in height. He also showed that children of native parents were taller and heavier than those of foreign extraction. 1 Bowditch, The Growth of Children. PHYSICAL CONDITIONS OF CHILDREN 121 These differences he attributed partly to the greater prosperity of the old native stocks, partly to racial characteristics, but he also discovered that the children of native parents who were attending the higher schools were superior to the average chil- dren of the native classes. The chief difference was in height. He therefore concluded that lack of comfort was the principal factor responsible for this difference, and that poverty affected height more than weight. Porter, in his study of St. Louis children, divided them into two groups, the children of manual tradesmen, and those of merchants and professional men. Between the ages of 6 and 10 he found but little difference, but beyond this age the well-to-do child was decidedly superior, and at 17 he excelled in weight by 5.5 pounds. Porter concluded that material prosperity and social status are important influences, especially after the age of ID. His comparisons also indicate that successful children are larger than unsuccessful ones, the corollary of this being that poverty retards school progress. The more recent studies in Great Britain are perhaps of the greatest significance. Two somewhat limited investigations were made; one of children in schools attended by the well- to-do ; one of the inmates of the industrial schools, among whom both dependent and delinquent children would be included. At 10 the boys of the industrial schools were 10.64 pounds lighter and 3.31 inches shorter than the others, and at 14 the differ- ences were 21.85 pounds, and 6.65 inches, respectively. A study of children in Edinburgh also revealed striking condi- tions, but that of 72,857 children in Glasgow is of the greatest significance. Using the standard established by the Anthro- pometrical Committee of. the British Association, the figures for the poorest districts were compared with those for the better localities. At 10 the boys in the poor districts were 10.8 pounds and 2.9 inches below the standard, and at 13 the de- ficiency was II. I pounds and 3.1 inches respectively. The average for all the children up to the age of 14 was below the standard in both weight and stature, but the average stature of the children between 14 and 18 years was slightly above the 122 PROBLEMS OF CHILD WELFARE Standard. This is accounted for by the fact that practically no poor children attend school after the age of 14. Children were also classified according to the housing condition of the parents, being divided into groups living in one, two, three, or four-room apartments, with very important results, as shown in the following table : ^ Living in Weight (Podnds) Height (Inches) Boys Girls Boys Girls One-room houses . . Two-room houses . . Three-room houses . . Four-room houses . . 52.6 S6-I 60.6 64-3 Si-S 54-8 59-4 6S-S 46.6 48.1 SCO Si-3 46.3 47-3 49.6 SI.6 Although it would seem that the above differences would be slightly lessened by a comparison according to age distribution, similar results were shown by testing the above summary on measurements compared by age groups. Therefore the figures are substantially valid. They indicate an enormous physical difference between the inhabitants of one-room and those of four-room houses. The figures correspond very closely with those given for the other studies mentioned, and show that poverty very seriously depresses the physique of children. Rowntree came to similar conclusions after his study of poverty in York. Gershal tells us of the relative inferiority of dependent Jewish boys, and Boaz says that at 5 they are 1.6 inches below the normal; at 11, 3.4 inches, and that at 15-16 they are nearly 8 inches shorter. The evidence then seems adequate and conclusive. The effects of bad environment then are mainly two : First, we have physical deterioration and individual subnormality. The race standard does not necessarily suffer, but the aggregate strength of a nation is impaired. Porter says, " A prolonged strain on a growing child harms for life and leaves a mark which ' Report on the Physical Condition of Children attending the Public Schools, of the School Board of Glasgow, 1907. PHYSICAL CONDITIONS OF CHILDREN 123 can never be effaced," while Dr. Robert Hutchinson of Eng- land says that the child of 10 to 15 must have enough food or be stunted for life. Second, physical deterioration impedes mental and moral progress, strong children being relatively advanced in their studies. The young inmates of the John Worthy School — a juvenUe reformatory — of Chicago are inferior in height, weight, grip, endurance, and mental capacity. A relation between the physical and moral qualities is also evidenced by these facts. Causes of degeneration register their effects in adult life, and while the child recovers somewhat from his handicap he cannot be entirely restored. The Jewish people are comparatively short, — probably an inherent characteristic, — but Ripley says that a difference of three inches in stature has been noted between the wealthy West-end and the poverty-striken East- end Jew of London. Environmental causes probably account for the major portion of this difference. In Berlin the problem of physical fitness for the army is be- coming a serious one, and a very large proportion of rejections are being made. Rural East Prussia has fared much better, and here a high proportion are physically fit for military service. During the years 1893-1902, the British government examined 679,703 recruits, and rejected 234,9T4 outright — more than one-third — and about 20,000 later.' Whether higher or lower than formerly, this proportion of rejections when physical re- quirements are comparatively low indicates an unwelcome con- dition. Rejections were most numerous among volunteers from manufacturing centers such as Manchester. Lack of physical development, such as inferior chest measurement, and want of vital power were, the chief causes of rejection; but among students volunteering, the decay of teeth was the prin- cipal reason. The British Inter-Departmental Committee on Physical Deterioration, which investigated this subject in 1904, denied that deterioration had taken place, but very wisely yet inconsistently called attention to the many causes of degen- eration. It makes little difference, however, whether people ' Burke, Thomas, The Forum, Vol. 36. 124 PROBLEMS OF CHILD WELFARE have declined or have never reached their proper proportions. The effects are the same. 3. Causes of Deterioration. Inferior children and inferior adults call for an explanation. Among many causes, the Committee on Physical Deterioration gave the following : urbanization, the great majority of British people now living in cities where smoke and other unsanitary conditions such as bad housing prevail ; conditions of employ- ment, which bear heavily upon the people, especially upon the children, whose development is retarded thereby; alcoholism, a frightful expenditure of money for intoxicating liquors, imply- ing depleted physique ; poor food, much being of inferior quality, besides many people are suffering from insufficient food. In other words, poverty is a cause. Dr. Eichholz estimating that 16 per cent of the London school children were imderfed. These causes — - bad living conditions, unsanitary workshops, alco- holism, and malnutrition — stand out as the four chief reasons for physical inferiority. Disease is also a factor, especially epi- demics of disease that affect children between two and five years of age. The causes of deterioration abroad are apparently similar to those operating in the United States. They are largely factors of environment, and therefore if removed wUl allow the race to spring back to its natural physical condition. One of the reassuring conclusions of the English investigators was that the deterioration was not a degeneration, but only a temporary condition dependent upon unfortunate social and industrial relations. Here then is the great field for the social worker, who must so change the environment that the race may be enabled to reach its highest development. 4. Physical Defectiveness. Apart from the failure of certain classes and groups to develop a normal physique and the usual amount of strength, we find physical defects more or less grave existing among a large pro- portion of children. Among the more serious of these defects are : blindness, deaf-mutism, physical deformities, and tuber- cular tendencies. The relatively minor defects include adenoids, PHYSICAL CONDITIONS OF CHILDREN 125 enlarged tonsils, defective teeth, imperfect vision or hearing, and malnutrition. a. Blindness. There are probably about 100,000 blind in the United States, including those who are partially as well as those who are totally blind. Of the 64,763 blind tabulated by the federal govern- ment in 1904, 56,165, or about seven-eighths of the total number, were 20 years of age or over. This indicates that the vast majority are adults, although a very large proportion of the blind acquired their defect before they reached this age. Ac- cording to the federal statistics this number is 32 per cent, or nearly one-third. Furthermore, the congenitally blind and those acquiring blindness before they were two years old form two- fifths of the entire number of blind minors, more blindness ap- pearing during the first five years of life than during any sub- sequent five-year period. Special attention should therefore be directed to the causes responsible for these conditions. One of the principal causes of blindness is ophthalmia neo- natorum, — a disease which usually attacks children shortly after birth. It is a result of one of the social diseases. Out of 2549 pupUs in 22 schools for the blind in the United States in 1912, 27.9 per cent lost their eyesight from this disease, the proportion in the different schools ranging from 13.3 per cent to 39.1 per cent. The statistics for two schools for the blind in England attribute 41 and 45 per cent respectively to ophthalmia, and wherever careful examination is made a high percentage of cases is usually found to be due to this cause. On the basis of the proportions apparent in the schools, it is probable that from 10,000 to 15,000 persons in the United States owe their blindness to this disease. It is the most important cause of blindness among children. Sex immorality — usually of men — is responsible for the condition which makes this disease possible, but the carelessness of physicians and of mid- wives is responsible for its development, since a very simple treatment of the child at birth will entirely prevent all inflam- mation. Compulsory treatment of the eyes of the newly born, the compulsory reporting by midwives of all cases developing 126 I'ROBLEMS OF CHILD WELFARE under their care, and proper treatment of every such case should reduce the amount of blindness due to ophthalmia to a mini- mum. Danger of infection will of course remain so long as immorality and the social diseases continue to exist. Among the causes of blindness is the disease known as tra- choma. It is becoming increasingly prevalent, having taken root largely through its importation from Southern Europe. Immigrant children are spreading the disease in the schools, and the infection has been planted in various parts of the country. Congenital blindness or weakness of vision is also responsible for a large proportion of blindness, and accidents claim a con- siderable share. Failure to care properly for infected or injured eyes frequently causes blindness ; for example, crossed-eyes and defects of vision result in weakened eyesight and often culminate in blindness. Atrophy of the optic nerve, perhaps the most important cause of blindness, affects but few persons under 20 years of age, its chief incidence being in later life. A very large proportion of all blindness is absolutely preventable. b. Deafness. In 1900, 89,287 cases of deafness were reported for the United States — a proportion of approximately 1.2 per 1000 popula- tion. Of this number 42 per cent were totally deaf, and the remainder, or 58 per cent, suffered from partial deafness only. Should the same ratio hold for 1910, then the number of deaf persons in that year was over 112,000. Ninety per cent of the total deafness and 58.1 per cent of all deafness occurs before the age of 20, while 70 per cent of the total deafness occurs un- der five. Some of the causes of deafness appear in the table on page 127. Five causes are responsible for two-thirds of the total deaf- ness, but partial deafness apparently resulted from a great variety of conditions. Again congenital conditions produce 33 per cent — one-third — of the total deafness, but only 3 per cent of the partial deafness. Nerve diseases are respon- sible for more than four times as much deafness among the PHYSICAL CONDITIONS OF CHILDREN 127 former as among the latter group. Scarlet fever tends to pro- duce total deafness. Congenital causes, nerve diseases, and scarlet fever produce more than half of the deafness occurring among persons under 20 years of age. Total deafness imder five is usually accompanied by muteness. Percentage of Deafness erom Specified Causes 1 Causes All Deaf- ness TOTALIY 1 Deaf Partially Deaf Deafness UNDER 20 Congenital . . . . - 16 8 16 10 3 S3 33 II 4 18 66 3 6 23 4 6 42 28 Scarlet fever . . Catarrh and colds Nerve disease . . Old age ... . 13 6 15 Total specified . . 62 The statistics warrant the conclusion that heredity is an im- portant factor in causing deafness. Fay, in his extensive study of the deaf, discovered an astonishing rate of deafness among the children of parents having deafness in their families. The investigations of the United States government point to similar conclusions. Consanguinity represents one phase of this prob- lem, as is shown in the subjoined table. Congenital Deafness and Consanguinity of Parents^ Parents Cousins Parents not Cousins Degree or Deafness Number Deaf Percentage Congenitally Deaf Number Deaf Percentage Congenitally Deaf AUdeaf TotaUy deaf . . . . Partially deaf .... 406s 2525 1540 42.7 61.I 12.0 75,53° 31,560 43,97° IS-O 3I-I 3-4 ' United States Bureau of the Census, The Blind and the Deaf, 1Q06, pp. ii3 and 122. 'Ibid. p. 208 a. 128 PROBLEMS OF CHILD WELFARE The percentage of persons congenitally deaf is nearly three times as high among those whose parents are cousins as among those whose parents are not cousins. Among the totally deaf this proportion, however, is almost exactly two to one. Again, of the deaf born from consanguineous marriages, 53.4 per cent had blood relatives who were deaf, while of the remaining deaf only 29.9 per cent had deaf relatives. It is clear that hereditary weaknesses have been intensified by the intermar- riage of first cousins, and that an abnormal amount of deafness results therefrom. The influence of heredity is also indicated by the fact that 32.1 per cent of all the deaf had deaf relatives. In the case of those deaf from birth the proportion was 45.5 per cent, the pro- portion being larger, however, for the group which acquired deafness after the age of 20 than for those who acquired it be- fore that age. The evidence indicates that deafness due to catarrh, which is a chief cause of deafness among adults, is in part attributable to heredity. Thus heredity affects both children and adults, the former through congenital deafness, the latter through the effects of catarrh. Deaf parents have a much larger proportion of deaf children than has the community at large. The Bureau of the Census concludes on this point that " the tendency to deafness among the children of deaf persons is more than five and one-half times as great as in the case of the general population of the United States." c. Physical Deformities. No hard and fast dividing line can be drawn between cripples and normal children, as every stage from the slightly injured child to the hopeless cripple is represented in our population. Our interest, however, is largely confined to that group of cripples who are so helpless that they cannot, without undue pain and effort, attend school or care for themselves. It is this group which must receive special attention from the schools or from other social agencies. A few facts as to the origin of the cripple have been collected in foreign countries, and the following statistics will throw some light on the question. PHYSICAL CONDITIONS OF CHILDREN Causes of Deformities ' 129 Cause London Geeuany Number Per Cent Number Per Cent Tuberculosis .... Paralysis (including in- fantile) Congenital conditions Rickets Scoliosis Miscellaneous .... Total 1634 942 227 158 314 327s 49-9 28.7 7.0 4.8 9.6 lOO.O 11,303 ii,i6s 6,479 4,724 9,167 32,34s 75,183 IS.O 14.8 8.6 6-3 12.2 43-1 lOO.O The London cases cover the seriously crippled children only, while those for Germany include many children with very slight deformities. Tuberculosis is the principal cause of the serious deformities, causing nearly one-half of the crippled cases in London, and a larger proportion in Germany than any other cause. Paralysis, most of the cases being infantile paralysis, comes next in both places, and in Germany it almost rivals tuberculosis as a cause. The German statistics include the proportion suffering from scoliosis or curvature of the spine, which comprises about one-eighth of the total. Congenital malformations are relatively unimportant, being responsible for from 7 to 9 per cent of the cases. Rickets, usually a result of malnutrition, accounts for a considerable number, and the " Miscellaneous " cause is very large for Germany because of the inclusion of the minor deformities. In both countries, however, the principal causes follow in the same order of im- portance: tuberculosis, paralysis, congenital deformity, and rickets. It is apparent that disease through its various mani- festations causes the bulk of physical deformity, but behind disease He conditions which are ultimately responsible for the production of the cripple. Little information can be obtained concerning the crippled ' Report of the British Departmental Committee on Tuberculosis, igi3. Vol. II, p. 42. 130 PROBLEMS OF CHILD WELFARE children in the United States. Neither their number nor theii proportion can be obtained, and tables of causes are likewise unavailable. The efforts of schools and philanthropic bodies to provide educational advantages for every child promise to throw light on each of these questions in the near future ; crip- pled children will then be discovered, and the cause of their condition analyzed. d. Tubercular Tendencies. Recent investigation is demonstrating that a large number of children show evidence of tuberculosis. The studies made by Von Pirquet indicate that the majority of children respond positively to the tuberculin test, the proportion among chil- dren of 10 years rising as high as 70 per cent. In most cases the tuberculosis is latent, and the child never suffers actively from the disease, autopsies having disclosed the fact that many chil- dren dying from other diseases are also affected with tubercu- losis. Kelynack claims that 40 per cent of all children dying under 15 years of age show signs of tuberculosis, and that many children dying from measles, whooping cough, influenza, and other diseases reveal the presence of the tubercular germ. Physicians now admit the general prevalence of latent tuber- culosis. The problem of tuberculosis relates itself to those persons who suffer actively from the disease, whose lives are threatened, and who may infect others, but naturally the proportion of chil- dren in the group is comparatively small. A study made in Stockholm, Sweden, indicates that 1.6 per cent of the school children of that city were afflicted with tuberculosis and needed special attention. An examination of 543,594 English school children yielded more favorable results, only .67 of i per cent being apparently tubercular. Dr. Newman, however, has com- puted the proportion of tubercular children as approximately I per cent of the total number of children, not including the institution cases, which if added would yield a percentage sim- ilar to the estimate for Stockholm. The inspection of school children in the United States has not revealed so high a percen- tage, but examinations have not been thorough and many in- PHYSICAL CONDITIONS OF CHILDREN 131 fected children are unable to attend school. That tuberculosis in children is an important fact is indicated by the statistics of the registration area of the United States, which show that in 1911 18 per cent of all deaths from tuberculosis occurred among persons under 20 years of age. If 15 per cent of our school population is seriously tubercular, then about 300,000 school children should be given careful treatment and the con- ditions of their environment so modified as to insure their recovery. The great majority of tubercular children do not suffer sufficiently to cause much interference with their school duties or with their occupations if they have begun to work. Tuberculosis proceeds very slowly among children and usually does not manifest dangerous sjrmptoms until after the age of majority. Owing to this fact, it is difficult to estimate the number of tubercular children in any community. The careful examination of children has shown that the pulmonary form of tuberculosis is the most common one. The belief formerly held that among children the bones and joints were the chief objects of attack has been over- thrown. The lungs suffer most severely and most often, and it even appears that the infection of joints does not usually indicate localized trouble, but is one of the results of a generalized infection, the lungs being the primary seat of the disturbance. Constant exposure to infection is responsible for the large number of tubercular children. Dr. Wallace's study in New York of 443 children suffering from tuberculosis shows that 196 came from houses that were previously infected and 130 from tubercular families, indicating that nearly three-fourths of the children had been regularly exposed to the disease.^ Floyd and Bowditch in Boston found that out of 1000 children examined 679 had been directly exposed to tuberculosis in their homes. More than one-third of the entire number showed definite signs of pulmonary tuberculosis, and in two-thirds of the children some symptoms of the disease appeared.' Dr. ' Sixth International Congress on Tuberculosis, Vol. II, Section IV, p. 421. ^ Ibid., p. Ags. 132 PROBLEMS OF CHILD WELFARE Sachs has estimated that at least one-third of the small children in the families of the tubercular poor have been infected.^ e. Minor Physical Defects. Quite apart from the problems of physical deterioration and special handicaps is that of the minor physical defects of chil- dren. A near-sighted child may have ample food, and one suf- fering from adenoids live in a palace, but these defects will not be removed thereby. They will not only remain, but will severely handicap the children in their work and opportunities. Physical defects may also result in actual deterioration of phy- sique ; while on the contrary the removal of the defects opens new possibilities for the child and enables him to achieve greater progress along all lines. Therefore the problem must be solved. It is difficult to estimate the amount of physical defectiveness among children, since the medical inspections made in the United States have not covered a sufficient number of typical localities to enable us to make generalizations. It is quite worthless to say that, " i to 15 per cent suffer from skin dis- eases," ^ as it makes considerable difference whether it is i per cent or 15 times as much. On the other hand, a number of cities have examined so many children that their results must prove helpful in enabling us to arrive at some conclusions as to the magnitude of the problem in the cities. In the country districts little or nothing has been done: consequently we can make no estimates for more than one- half of the entire school population. Some defects, however, probably occur with an approximately equal degree of fre- quency in city and country alike, and partial statistics there- fore have considerable value. There are a large number of physical defects that should be discovered by the examining physician. Among the most important of these, aside from tuberculosis and deformities, are: defective eyesight, defective hearing, dental caries, ade- noids, difficult nasal breathing, enlarged tonsils, malnutrition, pediculosis, curvature of the spine, organic heart troubles, etc. ' Si3rth International Congress on Tuberculosis, Vol. 11, Section IV, p. 485. ' Quoted from a circular sent by a society dealing with school hygiene. PHYSICAL CONDITIONS OF CHILDREN 133 Each of these interferes either with the mental or the physical development of the child, and should be removed if possible. Gulick and Ayres have made the most extensive investiga- tion of the physical conditions of school children in the United States that has yet been made, they having studied the work of medical inspection as carried on in the principal American cities. Some of the results obtained are given in the following table, which is based on the examination of 559,863 children in nine cities ; nearly 40 per cent of the children, however, being from New York City. The percentages are based on the relation between the total number of children having specified defects and the entire number of children examined. Percentage op Children examined having SPECiriED Defects' Nature of Defect Percentage Defective teeth 46.6 Throat trouble 18.4 11.7 Defective eyesight 12.9 1.6 Defective hearing Other defects 8.3 1.04 According to these figures, nearly two-thirds of the children examined had defects sufficiently serious to require attention. As there was an average of slightly more than one defect per child, a large number of children must have suffered from two or more defects each. The most common defects are dental caries, from 29 to 50 per cent of the children suffering from this handicap. These variations indicate the need of a wider study to arrive at the average proportion of children needing dental treatment ; for example, an examination of nearly 15,000 school children in Cincinnati disclosed the fact that 82 per cent ' Giilick and Ayres, Medical Inspection of Schools, 1913, p. 38. Percentages computed from tables given in this book. 134 PROBLEMS OF CHILD WELFARE needed dental treatment. The difference among cities depends somewhat upon the degree of poverty among the children examined. In most cities medical examination began in the schools located in the poorer districts, and although it has been gradually extended, but few cities cover their entire school enrollment. Among the poor the proportion of children having defective teeth is highest, orphan asylums sometimes reporting a number exceeding go per cent, but if the entire body of school children were examined, the proportion would be much reduced. The proportion of children suffering from defective vision is entirely uncertain, but nearly 12 per cent of these half million children were affected. Defective eyesight was more common when medical inspection was first introduced. In Boston in 1907 it was found among 31.5 per cent of the public school chil- dren, but by 191 2 it had been reduced to 15 per cent. The congested districts of Cincinnati recently gave a proportion of 33.36 per cent. As in the case of the teeth, the care of chil- dren's eyes depends largely on the educational and economic condition of the parents. It has been estimated that 80 per cent of the eye troubles can be cured or overcome. Adenoids and other nasal troubles are found in various pro- portions, ranging in the nine cities tabulated by Gulick and Ayres from 4.8 to 18. i per cent. Adenoids were discovered in 28 per cent of 7102 children examined in Minneapolis, and the proportion of these children affected with enlarged tonsils was 35, although the average among the children in the nine cities was only 18.4 per cent. Both of these defects are ex- tremely common, but adenoids are especially to be feared be- cause they frequently result in weakened mentality, although enlarged tonsils also cause retardation. Medical inspection indicates that everywhere the most common forms of defects are : defective teeth, adenoids, enlarged tonsils, and defective vision. These four groups comprise the great bulk of all the physical defects. In most of the cities having systems of medical examination the total defects average at least one for every child, and usually less than one-third are PHYSICAL CONDITIONS OF CHILDREN 135 free from all serious defects, but these conclusions are based on data that are biased in favor of a large proportion of physi- cal defects. Adequate examination of well-to-do pupils and of the children of the country and. small towns remain to be made before accurate estimates can be made for the country at large. CHAPTER II CARE OF HEALTH AND PHYSIQUE The child has a right to be healthy, and society must recognize this claim by extending the opportunity. This right depends on two considerations : first, the child is too young to reaUze the permanent consequences of ill-health, and will therefore not guard himself against them ; second, ignorant parents often fail to care properly for their children and leave them handi- capped for life. Children are wards of the state and are sub- ject to state care and protection. The authority of the parent is no longer absolute ; he cannot treat his child as he will, but must defer to the social interest involved in rearing children. According to theory the child can be protected against serious delinquencies of parents, but society cannot force parents to build up the body and physique of their children so as to make them superior men and women. This task, however, is a worthy one and should not be neglected. The health interests of the child are of several varieties, viz., protection against disease, detection of physical defects, and their removal, and physical training and education. Not until children were congregated in schoolrooms did the danger from disease appear, and not until then were systems of medical in- spection of schools adopted. These, furthermore, have met with considerable objection because of the principles that were involved. I. The Problem of Medical Inspection. a. Theory of Inspection. The medical inspection of school children was first justified on the theory that it was a legitimate exercise of the police power of the state. The schoolroom is an ideal place for the diffusion of contagious diseases, and is a clearing house for the 136 CARE OF HEALTH AND PHYSIQUE 137 diseases of the community. If diseases can be checked at their source and an epidemic prevented, the public health is pro- tected. Medical inspection therefore depends on the same prin- ciples as quarantine laws, the establishment of pest-houses, and the refusal to permit unvaccinated children to enter school. The medical inspection of schools at first accorded with this theory, and was practically restricted to the detection of con- tagious diseases. In this work Europe led the way, for as early as 1867 a number of German cities adopted some system of inspection. They were followed by Austrian cities in 1873, Belgian cities in 1874, and French cities in 1884. In the United States the beginnings of inspection were made in Philadelphia in 1890, but were shortly abandoned. A few years afterwards — 1894 — Boston provided for limited inspection and was later copied by other cities. In New York City, inspection was at first limited to sixteen different diseases, but this was con- sidered too broad a work, so seven of the diseases were selected and inspection limited to the task of detecting them. Since then, of course, this policy has been reversed. Medical inspection has been extended on the theory that social progress requires such extension. Society is justified not only in defending itself against dangerous disease, but also ia fortifying the physique of its constituent members. To-day we feel justified in building for the next generation, and inter- fere with a condition that threatens to imperil the future social and economic welfare of the individual. Only in this way can misery and distress be prevented. Abnormal conditions are a burden to society and involve heavy costs, and since their prevention is regarded as legitimate work, medical inspection has been extended to include the detection of the minor diseases of the child and finally to examination for physical and mental defects. In some localities this still seems to be an unjustifi- able interference with personal liberty, but the people are rapidly refusing to be guided by sUly sentiment that retards the cause of social reform. Capacity for self-support is more desirable than freedom from the piercing eye of the physician. 138 PROBLEMS OF CHILD WELFARE b. The Scope of Inspection. The ground covered by inspection depends largely on the attitude of the board having control of the work. If guided by the old theory, inspection is limited to a few diseases ; if not, a physical examination of the child is made, and a program of physical improvement adopted. No system of inspection is complete unless the following points are covered. (i) Diseases of every description. Contagious diseases must be watched most closely, and no cases of disease should be overlooked. Children suffering from diphtheria, measles, scarlet fever, chickenpox, whooping cough, smallpox, mumps, and tuberculosis, and other general contagious diseases are usually excluded from the schools. In addition certain other diseases ordinarily exclude children from school xmless they receive prompt attention at home, the principal ones being acute cases of contagious skin or eye disease and of pediculosis. (2) Mental Defects. A careful mental classification of the children should be made, and this can be done by applying some of the recently devised mentality tests. The way will then be paved for appropriate handling of children in school as well as ior the introduction of ways of removing the remediable defects. (3) Physical Defects. Under this head should be included physical abnormalities, such as a crippled condition or physical deformities, and if possible the causes of such abnormalities should be unearthed. Special attention should be paid to the sense organs, since defec- tive eyesight is one of the most common hindrances to children in their work. Shortsightedness and focal inequalities — the two principal forms of eye trouble — must be cared for in order to avoid serious consequences. Pupils, if apprised of these defects, may seek relief, and parents should be informed of the needs. Delay is altogether too dangerous. Deafness should be detected. This often causes the teacher to misunderstand and even misuse the child, and it seriously retards his development. Adenoids and defective breathing CARE OF HEALTH AND PHYSIQUE 139 are equally important, for their eSect on mentality is so serious that prompt attention should be given. Enlarged tonsils are a prominent symptom of defectiveness, and their influence like- wise is harmful. Stammering, although not common, is a great handicap. Special classes for stammerers depend upon some plan for proper segregation. Malnutrition should be distin- guished from other defects so that its prompt removal may be effected. Weaknesses of the heart, tuberculosis, curvature of the spine, flatfoot, nervousness, and other defects should be noted. Although the most numerous of all defects, defective teeth have untE recently been considered of minor importance. They need special attention because they contribute to malnutrition, indigestion, and other ailments. Other defects of a less serious nature wUl be discovered. 2. Organization of Medical Inspection. The organization of a system of inspection is strongly influ- enced by the ground to be covered by the work. Medical in- spection to detect dangerous communicable disease has been followed so rapidly by examination for non-communicable diseases and for mere physical defects, that the problem of organization, formerly very simple, has become a more difficult one and has involved the authority of the schools. Whether medical inspection of the schools should be a function of the board of health or of the board of education has therefore become a mooted question. The health departments wish to obtain jurisdiction over the health of the school children in order to lessen disease, while boards of education claim that the work is only a special application of the functions of their department of hygiene. The detection of contagious diseases is a necessary part of the work of the health department, and the danger of epidemics makes watchfulness on its part absolutely necessary. Compulsory vaccination, effectual quarantine, and other pre- cautionary methods have been established by this department, and the logical development of its work carries it into the school to detect evidences of contagion there. The work has simply become positive and preventive, instead of remaining I40 PROBLEMS OF CHILD WELFARE negative, as it formerly was. Contagious disease can easily be eliminated if access to the probable agents of an epidemic can be gained in time. It seems therefore that the health bureau has a claim to the right to superintend the work of medical inspection of the schools. The board of education, on the other hand, contends that the health, cleanliness, and physical condition of the school child, apart from the presence of contagious disease, are closely bound up with his school work, and that therefore the best re- sults can be achieved only by placing the medical inspectors under its direction. The chief demands made upon the school physician are the adaptation of the pupU to the conditions of the school and the removal of minor defects. Contagious disease cases form a very small part of the total number of cases needing attention — probably not more than 4 to 5 per cent in most cities. The great proportion of the inspector's work is more closely allied to the natural functions of the teacher than to those of the representative of the bureau of health. Defec- tive vision, deafness, backwardness, adenoids, defective teeth, and subnormal physical development directly affect capacity for education and determine the methods of instruction that should be applied. The promotion of health means the pro- motion of education. Accordingly, the board of education con- siders medical inspection a mere extension of the work of its hygiene and physical exercise departments. Teachers and parents are a very necessary part of the system, and the entire building equipment of the schools is involved. In actual practice the cities in which medical inspection is of longest standing are doing the work under the guidance of their health departments. The system began owing to the presence of contagious disease in the schools. It was natural for the health ofl&cials to use this method of checking epidemics, and school boards did not consider inspection as one of their duties. But a foothold once established, the boards of health have been loath to relinquish it. In fact, they have increased their func- tions to include the detection of non-contagious defects. Of the first 10 cities of over 200,000 population in the United States, CARE OF HEALTH AND PHYSIQUE 141 9 began medical inspection as a branch of the health depart- ment. Several boards of health, notably those of New York City and Boston, have established bureaus of child hygiene which deal with this problem. Medical inspection, to have value, involves a readjustment of the child to the conditions in the school and the adaptation of the school to the needs of the pupils. These tasks belong principally to the educational agencies ; hence the school boards began to realize their duties and their opportunities. Accord- ingly they have introduced systems of medical inspection and examination of school children. The majority of large cities recently adopting a system of inspection have done so through their school boards, and the present tendency is clearly in the direction of enlarging the work of the departments of school hygiene to cover this work. In 191 1, out of 443 cities having systems of medical inspection, 337 administered the work through their boards of education.' On the whole, this devel- opment is a desirable one. In a few cities the work is done conjointly by the two boards, but this system tends to create confusion and endangers the efficiency of the inspection, and especially of the remedial work which follows and which gives value to the examination of the child. Joint reponsibility is not proving successful because of the friction which it engenders and the consequent impossi- bility of securing the best results. Most of the remedial work and the statistical tabulations, including the keeping of records, will in any case remain a part of the task of the school authori- ties. As the efficiency of physical examination increases, greater emphasis is placed on correlating school conditions with the physical status of the children, and less attention relatively is given to the cases of disease that may be discovered. 3. Methods of Examination. a. Medical Inspection. In most small towns systems of medical inspection are entirely absent. In some, the teachers on discovering a case of apparent sickness of serious character report the case, and the child is ' Gulick and Ayres, Medical Inspection of Schools, 1913, p. 145. 142 PROBLEMS OF CHILD WELFARE sent home or the physician comes to the school to make an examination. Under these conditions it is chiefly through the alertness of the teacher that contagious disease is checked. In larger cities medical inspection is often confined to a certain proportion of the schools, while the remainder are handled in a manner similar to that of the small towns. Again, all the schools may be covered for medical inspection ; that is, for the detection of a small number of contagious diseases, but only a part of the schools for the physical examination of the children. About one-half of the cities having medical inspection also include a program of physical examination for part or all of the school children. 1 Regardless of the department which under- takes the work, physicians must be used to make the actual inspections. Each inspector should have assigned to him a number of schools, all of which must be visited in the routine of his work. In New York City each inspector visits about seven schools, which have a registration of approximately 9000 pupUs. At stated intervals it should be the duty of the inspector to examine every chUd in each school, but usually the number of inspectors has not been sufficient to do the work acceptably. The daily visit to a school should be for the purpose of understanding the graver ailments of the child ; a clinic or examination room should be provided, and only such children should be sent to the inspector as require examination. The principal matters of interest should be : the detection of contagious diseases and the exclusion from school of the affected children ; the inspection of children who have returned to school after exclusion on account of disease or other cause ; also the examination of those who have been recently treated and of those who are plainly in need of treatment. Suspicious cases should always be referred to the inspector by the teacher or by the trained nurse, and parents should be notified or children be referred to appro- priate places for treatment. In some instances it will be necessary for the physician to follow the child into the home, but this task should usually ' Gulick and Ayres, Medical Inspection of Schools, 1Q13, p. 36. CARE OF HEALTH AND PHYSIQUE 143 belong to the school nurse. Treatment by the physician in the home will not be welcomed by the medical fraternity, which depends for its subsistence upon the fees received from private practice. It is well at the preseftt time not to interfere too seriously with the work of the practicing physician, although means must be provided for those who are imable to command the private services of a physician. On the other hand, health is a matter of public concern, and the public physician must sooner or later perform the regular task of giving medical attention to all. b. Physical Examination. If possible, a physical examination should be made of every child. Such examination should be thorough according to the method of several German cities. It should, in the first place, cover all minor defects ; then the general physical constitution, chest measurement, weight, height, condition of the skin, spine, eyelids, sense organs, etc., should be carefully noted and recorded. The information thus obtained would be useful for both imme- diate and comparative purposes, and should furnish the basis for a constructive program of physical development. It is probably more important at present to emphasize the so-called minor defects, such as defects of hearing, of vision, and of breathing, defective teeth, enlarged tonsils, tuberculosis, and malnutrition. An examination for general physical conditions, however, must eventually be correlated with a plan of physical training. In a city where the number of examinations is limited because of an inadequate force of physicians, three groups of children should receive special attention; children beginning school, those about to graduate or expecting to drop out, and special cases referred by the teachers or nurses because of apparent existence of injurious physical defects. Then if time allows, an examination of the remainder may be made. Every school child during the course of his elementary school career should undergo a number of physical examinations. Then only will he properly safeguard his body and physique. The results of examinations are recorded, and if serious defects 144 PROBLEMS OF CHILD WELFARE are disclosed, the parents are notified and requested to give the child proper treatment. If this recommendation is disregarded, a system of follow-up work is required to secure results. Many cities endeavor to procure the cooperation of parents so that the defects of the children may be corrected. c. Examinations hy Teachers. The function of the teachers in an examination of school chil- dren is hmited by some thinkers to the giving of information as to defects, and to the reporting of cases needing special exami- nation. Massachusetts, however, in 1906 invested the teachers with the power and duty of testing the children for sight and hearing. The law has proven a distinct success, and other states have begun to copy the plan. Teachers should be required to report findings of serious defects to the boards of health or other competent bodies, so as to prevent possible abuse. The train- ing of teachers in methods of testing sight and hearing is neces- sary to make the plan successful. Then it can be instituted in every school throughout a state — in rural districts and in cities alike — except where a system of medical inspection has been adopted. The beginnings of a state-wide system can well be made by requiring such examinations by the teachers. 4. The Removal of Defects. The removal of the minor defects of children depends primarily upon the efficiency of the school nurse. Briefly stated, her duties should consist of the following tasks : a. The treatment of the minor cases which the medical in- spector orders sent to her. These include numerous skin diseases, some of which may be contagious; cuts; sprains; certain a£fections of the eye, etc. b. Instruction in regard to pediculosis and the nature of the home treatment required. c. The detection of minor cases of disease among the pupils and the summary exclusion of cases showing symptoms of a serious contagious disease. In New York City beginning January, 191 2, the control of contagious diseases was placed in the nurses' hands so as to give physicians time to make physical examinations of the children. CARE OF HEALTH AND PHYSIQUE 145 d. Visits to the homes, so as to advise parents as to methods of treatment, and when necessary to impress upon them the need of medical attention. In some cities the nurses frequently attend the child to the hospital or dispensary. e. The keeping of records showing the physical condition of the child. Besides these general duties, subsidiary ones are common, such as the exclusion of children on account of unsatis- factory vaccination. Underfed and dirty children also receive the nurses' attention. School nurses frequently handle about five schools each, visit- ing each school every day, but they cannot make detailed examinations on every visit. The treatment of cases requires much time, and an enormous amount of work must be done. A nurse should not be required to minister to the needs of more than 2000 children, although at present most large cities assign to her the care of nearly twice this number. The school nurses have been most efficient in reducing the number of children excluded from school. By treating minor diseases they have removed the dangers of contagion and have prevented an enormous shrinkage in school attendance. The number of physical defects recorded from year to year is an indication of the success attained, both in discovering and in dealing with these defects. In considering results we must keep in mind the fact that treatments which involve operations are difficult to handle. As a general rule, such oper- ations are performed at some clinic or dispensary and not at the school. If the parents fail to take action either because of poverty or unwillingness, the health and education of the child may suffer severely. Permission must be secured from the parents to allow the operation, and if they object practically nothing can be done. The states are, however, beginning to consider compulsory measures. England has already done so, and it is probable that in the United States the term " neglected chUd " can be so expanded in meaning as to cover those cases of children suffering from serious physical defects whom parents refuse to have treated. In that case such children will come under the supervision of the courts and parents will be compelled 146 PROBLEMS OF CHILD WELFARE to attend to their needs or the state will perform the service directly. The school nurse, however, has proven a valuable substitute for law. The postal card notifications in New York City resulted in obtaining treatment for only about 6 per cent of the reported children, but this proportion rose to 83 per cent (care of defective teeth excluded) as a result of the system of home visits carried out by the school nurses. The following table gives the proportion of various defects found among children in New York City in the years 1909- 191 2 inclusive.' Proportion of Defects among Children in New York City, 1909-1912 Number examined . . . Percentage needing treatment Defects, percentage having Defective vision . . . Defective liearing . . . Defective teeth .... Defective nasal breathing Enlarged tonsils .... Malnutrition .... 1909 1910 1911 231,081 266,426 230,243 74.48 73-9 72-3 I3-I II. I 10.6 I.O .6 .6 S7-0 61.6 S8.7 18.7 iS-4 11.8 22.0 18.7 iS-o 3-1 3-3 2-S; 258,784 71.2 9.9 1.0 S3-8 10.8 14.0 3-7 These figures indicate that the proportion of children suffer- ing from specified defects has declined in nearly every case in spite of more careful examination each succeeding year. The proportion needing treatment has fallen constantly through- out the four years. Malnutrition alone shows a considerable increase, and this does not lend itself so easily to medical treat- ment. The reductions effected have been accomplished largely through the follow-up system that has been in operation. The New York City Committee on Physical Welfare in 1907 found that 31 per cent of the limited number of children it examined had defective eyesight, but the more extended exami- nations by the board of health show a much smaller percentage. ' The Division of Child Hygiene, Department of Health, City of New York, 1912, p. 78. CARE or HEALTH AND PHYSIQUE 147 This is being reduced by obtaining medical treatment and by persuading parents to provide glasses for their children if neces- sary. Cases of poverty are reported to relief organizations, the result being a steady decline in the proportion of children with defective vision. In many cases defective hearing has been remedied. While the figures for New York City show little change, Boston reports areductionfrom8.i3 to 3.09 per cent during the years 1907-1912. A somewhat similar decline in proportion of cases occurred throughout the state of Massachusetts. Defects of the teeth are more numerous than all the other physical defects combined, and but little advance has been made in reducing them. Among the important steps taken is instruc- tion of children in the proper care of teeth, such instruction being given in the schoolroom to the children having defective teeth and in the homes by the school nurses when engaged in follow- up work. Other methods of care or relief include extraction and filling of teeth. Provision to meet this need is a recent development and has come about through a better understand- ing of the relation of bad teeth to malnutrition, health, back- wardness, and retardation. For example, a study of the effects of dental service in Cleveland in 1909 indicated that the children treated gained 37 per cent in working efficiency. Systems of dental inspection and dental clinics are necessary to remedy actual defects of the teeth. Accordingly, some cities have supplemented the medical inspection with dental inspection carried on by dentists, and in 191 1, 89 cities had established a Umited amount of this work.* In most of the remaining cities making physical examinations of school children, the teeth are also examined, but this is done by the regular medical inspectors. Dental clinics have developed principally in connection with dental schools and dispensaries, and usually treat both children and adults. In some of these, teeth are extracted free and a small charge is made for fillings, but others are entirely free. In certain cases dentists do under-price work for children when recommended by the school nurses. Among the 19 free dental ' Gulick and Ayres, Medical Inspection of Schools^ i9i3» P- 122. 148 PROBLEMS OF CHILD WELFARE clinics of New York City is one maintained wholly for the treat- ment of school children, but this is supported by private philan- thropy. In a number of cities dental clinics have been es- tablished in the schools through public funds. Many schools are now furnished with such clinics, but in most cases the financial support is derived from private associations — usually the local dental societies. Since dental treatment is expensive, a large proportion of school children cannot afiord it, but on the other hand, the effects of bad teeth are so damaging that opportunity for dental treatment must be afforded to all. There- fore a system of school clinics seems desirable. Here children can have all service performed without charge and the cost of the material can be borne by the parents, or if necessary by private or public philanthropy. Among the minor diseases requiring considerable attention is pediculosis. In New York City in 1911, 152,045 cases occurred among a total of 248,771 cases of contagious eye and skin diseases, and in Boston it accounts for about two-thirds of the cases of these diseases. The more serious cases are ex- cluded from school, but the great majority are treated by the school nurse. In some cities notable success in reducing the amount of pediculosis has been achieved, as in Philadelphia, where the nurses in a short time reduced the number of cases by at least three-fourths. By teaching children to take intelli- gent care of themselves, by interesting them in hygiene and general cleanliness, and by teaching parents how to attend to affected children, the great majority of cases can be obviated. The New York City statistics on defective nasal breathing and enlarged tonsils show a most gratifying reduction in the number of cases. Adenoid cases are referred to parents for action, and the nurses press the necessity of treatment. In about 40 per cent of the cases in 1911 operative treatment was reported, and an almost equal number received other medical care. Four-fifths of the cases received some medical attention, although in a large number it was known to be inadequate. The percentage treated in 191 2 was much smaller. About two- thirds of the children having enlarged tonsils were treated. CARE OF HEALTH AND PHYSIQUE 149 The number operated on has steadily declined, and while the number receiving medical treatment in 1909 was 33,396, in 1911 it fell to 12,839. The prevalence of adenoids and enlarged tonsils can be, and has been, greatly reduced by medical inspec- tion and insistence on proper treatment of the children. The remaining defects of school children lend themselves in most cases to remedial care. Unfortunately the proportion of all defects needing treatment which actually receive it is com- paratively small. GuUck and Ayres estimate it at from 20 to 40 per cent of the cases. It appears therefore that the system of follow-up work must be made more effective, so that practi- cally all cases wiU be reached. The school needs the power to force parents to perform their proper obligations. It should also require philanthropic agencies to continue the task of im- proving and reconstructing social conditions. But the school, not private charity, is commissioned to develop mental and physical capacity in children ; consequently the time will come when it will be empowered and required to remove the obstacles which hinder children from attaining their fullest develop- ment. 5. .Progress of Medical Inspection. Philadelphia was the first American city to attempt any form of medical examination, by appointing several physicians to test children for vision. Objections arose, especially from par- ents, so the attempt was abandoned. Later Boston began the work of medical inspection under the control of the board of health. The schools were divided into 50 districts, and as the work has expanded, a corps of nurses, working under the direc- tion of the school authorities, has been created. Some cities began with the aid of private philanthropies, which furnished nurses and physicians. A complete system of inspection in the large cities requires an army of oflScials, and for this reason the system has not been extended so as to cover entire cities, but has been confined to the poorer sections, where the need is greatest. In 1 91 2, 443 cities had a system of medical inspection, and over 200 cities had some form of physical examination, the most 150 PROBLEMS OF CHILD WELFARE rapid progress having been made in the last few years.^ The states have also been falling into line. Connecticut began in 1899 by requiring tests for vision; other states followed, and two types of laws have developed. The one is mandatory, seven states now having such laws, although they may apply to the cities only. In ten states permissive laws have been enacted, but here the community remains dormant until it is aroused to the need of action. Medical inspection and physical examina- tions are still largely confined to the cities, the movement in the rural districts having made but little progress. State law alone can remedy this situation. ' Gulick and Ayres, Medical Inspection of Schools, 1913, p. 17. CHAPTER III CARE AND TRAINING OF PHYSICAL DEFECTIVES It is rapidly being conceded that the school authorities must educate the exceptional as well as the normal children. The blind or deaf child should not be educated by philanthropy but by the public schools. The education of these classes must not interfere with that of the normal children, but all are entitled to the advantage of an education, even though the labor ex- pended on one group exceed that expended on another. A thorough medical examination must precede the separation of children into groups or classes for special instruction. Those physically incapable of meeting the ordinary requirements of regular class work need to be segregated for special instruction, some to be educated by the local school board, some by the state. The better known groups are the blind and the deaf, but additional ones are the crippled, those having defective speech, and the anaemic and tubercular group. The last is the most numerous of all. I. The Blind. Every state should provide an institution for the education of its blind, and provision for the maintenance of the children in whole or in part must also be made. The state schools should enroll all blind children in the country districts and the smaller communities where the number of blind is not suflScient to make the establishment of classes for the blind possible. Education should be compulsory and a charge levied against the commu- nity so as not to discriminate against the locality that educates its blind directly. The state must make ample provision for the indigent blind and insist on educating them, and if necessary it must pay all expenses directly. It is far better to spend money on the education of blind children than to give permanent relief 152 PROBLEMS OF CHELD WELFARE in the form of pensions. The cities must establish independent facilities for educating this class. Although a number of the schools for the blind in the United States were established by private philanthropy, the duty of the public to perform this fimction is universally recognized. There are 53 state schools for the blind in the United States with an enrollment of nearly scxxs pupils, a large proportion of whom are over 14 years of age. In some of the large cities classes for the blind have been established by the local boards of education. Some experiments have also been made with the bUnd in classes with the seeing pupUs. In each of the four elementary schools for the blind in Chi- cago, special apparatus is provided and special teachers are placed in charge. The pupils are taught the BraUle system of print and are assisted in the preparation of their work. They divide their time between their special rooms and the regular classrooms; they recite with the regular classes in reading when they reach the third grade and thereafter ; they usually enter the classes for language and music from the beginning and wherever possible they are given the opportimity to redte with seeing pupils. In Cleveland the bUnd children redte in the regu- lar classes in the upper grades only. Such a program is carried out partly to reduce the cost of education and partly to bring the child in touch with the outside world and to make the seeing pupils more sympathetic. Most dties adhere to the old custom of educating the bhnd separately. In 1 91 2 New York City operated 12 dasses for the bUnd and had an enrollment of 125 pupUs ; Chicago enrolled 53, and other cities — 14 in all — made some special provision for the blind children. The preliminary education of the blind both in state and dty schools is similar to that of seeing children. It is naturally some- what slower, and the majority of children are in the lower grades. Reading is comparatively slow work, but the Braille system of print makes writing by the blind simpler than before, and relief maps are used, for the sense of touch must be substituted largely for that of sight. On the whole, the education of the blind must CARE AND TRAINING OF PHYSICAL DEFECTIVES 153 proceed along physical and industrial lines. Compelled to grope about, the bUnd lose their firm and erect posture, and unless carefully trained they suffer much physically; consequently systematic gymnastic exercises, athletic sports, and various recreations must be provided. Heart and lung action is im- proved thereby and a better posture is assured. Although the bhnd can acquire a considerable formal educa- tion because of their hearing, the problem of self-support is a difficult one because so little can be done without the eyesight. While the bhnd may rise to high intellectual levels, they are not easily made capable of self-support. They are restricted to a very small number of occupations, the principal ones being teaching music, piano-tuning, broom making, chair caning, weaving, and basket making. Each student must be thoroughly trained, or competition from seeing people makes self-support impossible. If the school cooperates with the home and stim- ulates interest in the blind children, parents become more hope- ful and better results can be achieved for the children. A serious problem in many schools for the blind is the proper segregation of boys and girls. It is difficult to prevent the bhnd from marry- ing the blind, yet nearly every instance of such marriage is a tragedy. The spirit of independence and the duty of self-sup- port must be religiously taught or frequent intermarriages among the blind will follow and the community be compelled to support a family of children, as very few of the bHnd can provide for more than one additional person. 2. The Deaf. Like the bhnd the deaf have been given a measure of care and training in state institutions. In the same way the work must continue for the sake of the children scattered over the state who would no doubt be neglected but for the facilities which a state can provide. Although the state instutitions are fun- damentally educational in character they must also minister to the needs of the indigent group. In the cities day schools for the deaf can easily be estabUshed because the deaf can reach them without assistance. The chil- dren can be brought to some convenient location and trained un- 1 54 PROBLEMS OF CHILD WELFARE der special teachers in day classes in a special building or even in a part of the regular school, but a centrally located building ofifers the better plan. If all of the deaf can be brought together, a system of grading is made possible, economies in equipment can be made, and adequate courses in industrial training be provided. The deaf cannot speak because they cannot hear themselves articulate, so they eventually become dumb. Formerly they were taught the sign language, using signs and gestures to ex- press themselves, but in recent years an oral method has been developed, and children now learn to articulate by means of " lip- reading." Many of the deaf acquire considerable power of speech, but in this respect the congenital cases are much inferior to the others, although hearing may have been destroyed within the first two years of life. The majority of children are now taught by the oral method, which enables them to converse with the hearing. The deaf exceed the blind in numbers, therefore both in the cities and throughout the states the student body is larger than that of the blind. In 191 1 the 57 state schools enrolled 10,740 pupils. There were also 55 public day schools, of which 21 were in Wisconsin and 14 in Michigan, while the private schools num- bered 20. The last two groups enrolled 2300 children. A com- parison of the deaf and the blind in state schools shows that while 6.1 per cent of the former were high school students and gradu- ates, the corresponding proportion among the blind was 18.5 per cent. The blind can master a formal education more rap- idly than can the deaf, and their scholastic attainments are much superior, but that eyesight is an invaluable asset for industrial efficiency is evidenced by the fact that few of the deaf receive charitable relief while many of the blind are so assisted. The majority of the deaf are physically subnormal, this con- dition being both cause and effect. An important eflfect is in- ferior lung and chest development, due in part to the failure to use the organs of speech. The oral method of communication will lessen the difficulty, but physical training is necessary to develop properly every part of the body that fails to receive suffi- CARE AND TRAINING OF PHYSICAL DEFECTIVES 155 cient exercise. The deaf shuffle their feet, walk awkwardly, and are poorly balanced. Industrial training is very important, and certain occupations are so adapted to the deaf that self-support is within the reach of all. The state schools especially, but some of the city schools as well, emphasize vocational training, — cook- ing, sewing, and household economy being taught the girls, while the boys do shopwork and learn sign-painting, bookbinding, pottery, and printing. In a limited number of occupations a sense of hearing is not necessary either for efficiency or for pro- tection against accident. Such occupations naturally become the field of work for the deaf. 3. Crippled Children. While institutional care must be provided for many crippled children, there are a large number who are simply in need of edu- cational facilities. Some must eventually become self-support- ing or become dependent upon the pubUc. An adaptable edu- cation is therefore necessary. Besides, the cripple misses the joy which comes from play, and exercise with an abundance of good cheer must be provided to keep him happy. In London excellent provision is made for crippled children, sixteen day schools having been established, with accommoda- tions for 1 100 children who are provided with meals, the public authorities furnishing nurses and paying half of the expense of the cooks, besides the building equipment. Parents are required to pay a small sum to help defray expenses and charitable funds supply the remainder. In the United States in 191 2 four cities — New York City, Chicago, Cleveland, and Detroit — made some provision for crippled children. New York City had 34 classes, with two additional ones contemplated and an enroll- ment of 560. These classes are made convenient to pupils, being usually on the first floor and close to play facilities, and the board of education operates a number of stages that convey the chil- dren to the schools, but private philanthropy assists in this work. In Chicago nearly all of the 180 crippled children in the schools were conveyed by the transportation facihties provided by the school authorities. This is as it should be, and is the most con- venient arrangement. Noon lunches are also provided gratis IS6 PROBLEMS OF CHILD WELFARE by the Chicago school board. Many crippled children need to be placed under orthopedic care, as their physical weakness fre- quently prevents heavy work in the schools. Consequently slow progress must be tolerated. Crippled children have usually been overlooked by the educa- tional authorities if they were found by the truant officers to be incapable of attending school unassisted. This discovery has been sufficient to permit continued non-attendance. The vari- ous social agencies that come in contact with the untaught crippled child in his home have given impetus to the movement among the schools to estabUsh special educational facUities for children too crippled to compete with the normal child. Since many of these children need orthopedic care, they have been con- sidered outside the proper jurisdiction of the school board. The new view, however, demands that education be provided, that appropriate equipment be obtained by the schools, that some system of transportation be provided, and that a plan of coopera- tion between the department of school hygiene and the private or public philanthropies providing orthopedic care be carefully followed. Where private institutional care is provided, ade- quate educational facilities are also necessary. A beginning has been made in the development of state schools for the crippled. In 1897 Minnesota appropriated a sum of money for the state care of crippled children, and in 1909 it gave additional funds for the establishment of permanent buildings. Two other states — New York and Massachusetts — have each established a state school or institution. This makes it possible to gather and educate the isolated cripples of school age through- out the states. 4. Tubercular and Anaemic Children. The schools must undertake to give every child a proper phys- ical training, and must attend to the body as well as to the mind. Medical inspection and physical examination of children are only the first steps toward an elaborate system of training which will develop each child and strengthen his subnormal organs as far as possible. To this end the anaemic and tubercular should be separated from the normal groups of children and should receive CARE AND TRAINING OF PHYSICAL DEFECTIVES 157 special care ; but, in addition, efforts should be made to keep children from becoming weak. Consequently the school must carefully guard the physique of its children, yet so far it has done but Uttle in this Hne. It is still too absorbed in its literary curriculum. Germany opened the way for the development of schools for the tubercular and pre-tubercular children. In 1904 an open air school was established in a pine forest near Charlottenburg — a suburb of Berlin. Shelters were erected to protect the children from inclement weather, but the major portion of the time was spent out in the open air invigorated by the odor of the pines. Weak and anaemic children and those touched as yet but lightly by disease were selected for the experiment, but acute tubercu- losis cases were not received, and in all, 107 children were ad- mitted. The school lasted for three months during the summer season. The routine consisted of breakfast, class instruction, light luncheon, physical exercises, rest, dinner, sleep, food, in- struction, and play, special emphasis being placed on good food. The periods of school work were made comparatively short, and adequate sleep and rest were provided. Remarkable results were soon noticeable : many children were cured ; most of them gained in weight ; they improved in general attention and temperament, and were remarkably successful in their school work. The school was enlarged until it included 250 pupils, and was operated for an eight months' term. Other schools were sub- sequently established, and in 191 1, 15 of these were in operation. London opened its first open air school in 1907, and at once achieved remarkable results similar to the effects observed in the German school. A number of such schools have been established in other parts of England, and several schools for active tuber- culosis cases are also being maintained by the educational au- thorities. The latter are closely allied to the hospital or sani- tarium schools in the United States. The London Charity Or- ganization Society has favored sending three classes of children to these schools : those returning from sanitaria ; those suffer- ing from tuberculosis ; and the children from tubercular homes. The distinction made between active cases and those predisposed 158 PROBLEMS OF CHILD WELFARE is apparently very loose. Both types of schools are making progress. The first American experiment with an open air school was made in Providence in 1908, but Boston and New York soon followed. In 191 1, 35 cities had established schools and 47 differ- ent schools were in operation.' Since then other cities have be- gun the work, and in the old centers the work has grown. New York City in 191 2 had seven open air classes, and six classes for tubercular children. This movement has had a very interesting history. Private societies have to a very considerable extent taken the initiative in the establishment of the schools ; then the assistance of the educational authorities has been secured. When once established, the school boards have gladly developed the system. Why in some cases the medical examiners dismissed children from school because they were a source of danger and the school authorities neglected such children entirely it is difficult to say. Anti- tuberculosis and charitable societies then coming in touch with such cases have agitated for the proper treatment and education of the children. The cities disagree as to an ideal site for the estabhshment of open air schools. Some use the regular school building by simply transforming part of it into an open air room, which can be done quite easily, thereby reducing the cost of equipment. Roofs have been used to some extent. It is an advantage to rise be- yond the murky air of the street, and good results have been se- cured in this way. In many cities special buildings are favored, and these may be of various kinds, some substantial, others a mere shelter. Undoubtedly much would be gained if the open air schools and classes could be located in healthful districts, where smoke and bad city odors cannot reach them, where the air is fresh, and where opportunity is given for the enjoyment of both sun and shade. Practical considerations often prevent this, and fairly good results can be obtained by out-door treat- ment imder ordinary conditions. • Ayres, L. P., Address on "Open Air Schools" before Seventh Annual Meeting iox the Study and Prevention of Tuberculosis. CARE AND TRAINING OF PHYSICAL DEFECTIVES 159 From the beginning difficulties over the distribution of the cost of maintenance have arisen between the cooperating parties. In about three-fourths of the cases some private philanthropy is assisting in financing the enterprise. The school board usu- ally pays for the building and its equipment and also for the teacher. Private associations pay for the cots, quilts, special clothing, nurses, cooks, and food. The question naturally rises where can a line be drawn between the obhgations of the educa- tional authorities, on the one hand, and those of philanthropy, on the other. The tendency is unquestionably in the direction of greater latitude among school boards and away from the obligations of private philanthropy. While some school boards defray the entire cost directly, others cooperate with the depart- ment of public charities. The restrictions placed on the use of educational funds have prevented many school boards from ven- turing as far as they otherwise would. On the other hand, many men consider these limitations just. The schools, how- ever, have gone far in the direction of maintaining certain groups temporarily, such as delinquent children in parental schools. Is not the maintenance of an open air school quite as justifiable ? However, there has been less opposition to the division of the expenditure between the school board and the department of pubhc charities. The physical and mental improvement of this class of children is of intense social importance, and the work must be done largely by the public, for enough work still re- mains for private philanthropy. The advent of the open air school is responsible for other de- velopments of a similar nature. Theoretically, the school is used for the pre-tubercular, but it constantly violates this principle, and training is now demanded for children actually infected with tuberculosis. The seven New York City classes for this group evidence this tendency. Unless such training is harmful to the child because of the advanced stage of the disease, it is quite justified. Again the movement in favor of fresh air classes for a larger group of children and finally for all has been stimulated. The open windows and low temperature rooms in Chicago and Boston are an answer to this demand. The ventilation of school l6o PROBLEMS OF CHILD WELFARE rooms must be improved if not revolutionized, as it is not enough to relieve the children from many hours of confinement with short periods of recess. Wholesome air must be suppUed at all times. Artificial methods of ventilation have not been entirely suc- cessful; only too often windows have remained closed, while fresh air has not been obtained. Children should be allowed from 1800 to 2100 cubic feet of fresh air per hour, but in actual practice, lack of ventilation or failure of ventilating systems fre- quently reduces this volume to very unhealthy proportions. Results in the United States have been similar to the ones mentioned in connection with the experience of Charlottenburg. In general, our fresh air schools have limited their membership to not more than 30 pupils each. Otherwise more than one nurse would be required in each school, and the teacher likewise would be overworked. After several months of training and expe- rience in an open air school children are usually ready to resume their places in the regular classes in the schools. They generally make more than normal progress in their studies, besides gaining in weight and in stature. The St. Louis Open Air School re- ported one gain of 23 pounds in five months ; also the comple- tion of two and three-fourths years of school work in 1 2 months. Though originally subnormal, the majority gain more rapidly than do ordinary children ; they acquire a better disposition and become more hopeful toward life ; they also learn of the curative value of fresh air and of sunshine, and become centers for the radiation of a fresh air doctrine. But frequently such children have no escape from their old environment, and when they re- turn to their homes may lose what they have gained. It has been amply shown from experience in several cities that children remaining away for several days from the open air school and living under old conditions have frequently lost in weight and in healthfulness. How serious then is the problem of the child dismissed from the open air school and compelled to go back for a considerable time to the disease-producing conditions that had previously depleted his physique. In such places it is often impossible to observe the precautions necessary for the main- CARE AND TRAINING OF PHYSICAL DEFECTIVES l6l tenance of health. When the schools have done their part, the great incubus of poverty, of slum conditions, of insanitary hous- ing, still remains. Until this is removed, the schools can only labor feebly with the results of conditions that will always pro- duce the same effects. Nevertheless, the experience with the pupil of the open air school points tmerringly to the causes of anaemia and tuberculosis, and will hasten the movement for the permanent improvement of social conditions. 5. Underfed School Children. A considerable number of school children are underfed, and many come to school without having had their breakfast. There is also a vast amount of misfeeding ; for example, inveterate coffee drinking among children has retarded their growth in weight and in stature and handicapped them in the develop- ment of strength. Malnutrition is frequently associated with other physical defects, and is often a consequence. Defective teeth, for example, often overburden the digestive system and cause the child to suffer. The problem therefore presents two phases: first, misfeeding due to physical defects, ill-prepared food, ignorance, or lack of self-control; second, underfeeding resulting from poverty or penuriousness. Malnutrition, so- called, may be of a primary or secondary character. If it is primary, the child needs more food or better food ; if secondary, the physical or mental causes of the malnutrition must be re- moved. In either case improper physical development results, and this causes dullness and interferes with educational ad- vancement. The New York City Department of Health classifies as mal- nutrition only those cases in which malnutrition is the primary condition. In 1911-1912 out of 258,784 school children examined by the department, 9734 cases, or 3.7 per cent, were reported as malnutrition cases. Since only about one-third of all the chil- dren were examined, the total number of cases throughout the city is much greater, although the children examined were largely from the schools in the poorer districts where malnutrition is frequent. The cases recorded, however, did not cover all cases of defective physique, as only the more patent ones were counted. l62 PROBLEMS OF CHILD WELFARE The number of underfed and misfed children is therefore much larger than 3.7 per cent, especially in the congested localities. In 1908 a committee of the board of education of Chicago, after an investigation of malnutrition among the school children, came to the conclusion that 5000 children in that city were suf- fering from underfeeding and that at least 15,000 came to school hungry. An examination of 15,184 school children in Kansas City in 191 1 disclosed the fact that 7.7 per cent were suffering from malnutrition. In every large city there are a considerable number of such cases among the school children, and it is for this reason that the feeding of school children has become a live question in many cities. In approaching this question, several propositions must be clearly understood: first, school lunches obtained at cost in- volve a different principle than does the free feeding of children ; second, hungry children imply hungry parents. The underfed child is therefore a mere symptom of a family problem. Third, the primary function of the school relates to the education of children, and physical care provided by schools is largely a means to that end; fourth, education includes a program of physi- cal development. A number of European countries have tried to solve the problem by providing free meals for the school children. For example, England in 1906 empowered the educational authorities of the cities to supply food to children at the expense of the school fund, and during the first year after the enactment of this law, fifty cities took advantage of its provisions. Many children had been given relief by the " destitution authorities," but the work seemed unsatisfactory, and in 1909 more than 100,000 children were provided with free meals by the boards of education. The public assumption of this work followed a previous plan of co- operation with private philanthropy. Free feeding of children was common before the enactment of the law of 1906, but the food was provided from voluntary donations. Most of the paid service, however, and the equipment, even some of the fuel, was paid for; from the school- funds. Then came the final step — ■ CARE AND TRAINING OF PHYSICAL DEFECTIVES 163 to provide the food. Continental countries have preceded Eng- land in radical legislation of this sort. In the United States the free feeding of children has found but Uttle favor, but the large number of the underfed has forced the problem on the public. Interesting experiments have been carried on in several cities, notably in Philadelphia and in New York. In 1910 in the former city a private committee was or- ganized among the citizens, five schools were secured, and one- cent and three-cent lunches were provided which were sold at the morning recess and at noon. Lunches were bought by 21 to 58 per cent of the children, dinners by 12 to 19 per cent; the penny lunch allowed the purchase of a single article only, but the three-cent lunch permitted a rather agreeable combina- tion. The committee made a study of the effects, and 40 children who regularly bought dinners for a period of three months were compared with 40 who did not patronize the lunches. The children were tested for weight, stature, grip, and lung capacity, and it was found that the children fed at school averaged better in every respect than those not fed. The former had gained 1.78 pounds each, the latter only .80, a difference of nearly one pound. The former also excelled in mental ability and in behavior. A group of philanthropic woriien began the work in New York City in 1909. There they have operated in seven schools, and all patrons of the lunch rooms are required to buy soup, which is served for one cent. The children may then select additional foods, each of which also costs a cent. A small number of chil- dren usually assist in serving the meal and receive free meal tickets in payment for service. In addition a few free tickets have been provided for children too poor to afford a meal or who suffered severely from malnutrition. The average price per meal has been approximately three cents, but the total cost, including administrative expenses, is nearly five. In three years 174,199 luncheons were served at a cost of $8640.'^ The regular cus- tomers of the lunch rooms have not been confined to the very poor, but the patronage has been rather general. Among the 'Fourteenth Annual Report of the Superintendent of Schools to the Board of Education of the City of New York, pp. 180 ff. 1 64 PROBLEMS OF CHILD WELFARE advantages claimed for the school lunch room are: improve- ment in physical condition, more alertness, greater energy, and better work ; besides the children have received instruction in cleanliness, cost value of foods, table manners, and taste in the arrangement and serving of foods. The school meals have not only improved physique and stimulated study, but have also served as object lessons in household economy. In Chicago the board of education instituted the plan of pro- viding penny lunches and at first bore the entire expense. Later it relinquished part of the burden to private philanthropy, but continued to furnish rooms, full equipment, janitor service, and the wages of one attendant. Meals costing one cent each are now being served in a number of schools located in the Italian and the Jewish districts. Again, effects physical and educational in character are observed. In other cities experi- ments are being made, but occasionally, as in St. Louis, the pat- ronage of the lunches in particular schools does not seem to jus- tify the continuation of the work. On the whole, however, the school lunch room is gaining in favor, and without doubt it will extend itself into the schools of the poorer districts of nearly every city in the near future and will doubtless invade the better sections. Whenever attempted in the United States, the feeding of school children has been conducted on a cost basis, but usually the price of the meals has been somewhat less than the actual cost of food and service. While the existence of a large amount of malnutrition is evi- dent, and the educational authorities are gradually introducing plans for the feeding of school chUdren, it does not follow that in the United States as in European countries the schools will assume the role of philanthropic agencies. They cannot under- take the difficult task of rehabilitating the families that are in poverty; they can inform parents and philanthropic agencies that certain children are sufiering from malnutrition and must be cared for; that is, they can cooperate in the solution of the problem. With the machinery of public and private relief organizations in actual operation, the schools cannot afford to become supplementary relief agencies. Accordingly the CARE AND TRAINING OF PHYSICAL DEFECTIVES 165 free feeding of school children in American schools would be a mistake, since the idea is contrary to sound principles of relief. The policy of providing poor school children with wholesome meals at cost is thoroughly sound and should be encouraged. Society caimot afford to neglect the child even though it cannot reconstruct and improve the parents; therefore, the school must do its part. This involves the improvement of physique and the promotion of mental and moral eflSciency. Instead of jeopardizing the self-respect of parents and of handicapping relief agencies in their work by the giving of free meals, the schools can indirectly educate parents by providing their chil- dren with meals at cost and can prepare the children more adequately for the tasks of the schoolroom. The work should be connected with the domestic service de- partments of schools, and be sufficiently systematized so that knowledge of the values of various foods, of the economy of buy- ing, and of the amenities of the dining-room may be acquired. Such knowledge possesses much educational value, and should become a part of the mental equipment of every child. Among the ignorant and poor such knowledge is not acquired except through the schools and the philanthropic agencies, and this burden should be borne by the schools. CHAPTER IV PLAY AND RECREATION Play and recreation have assumed a tremendous importance in the hfe of the nation. Play is common to man and the ani- mals of the higher orders, and the speculation concerning its origin and uses has resulted in the development of several theories, chief among which are the practice, surplus energy, and recreation theories. According to the first, play is a form of practice along the lines of future methods of conduct; for example, the cat plays with the mouse but enhances her effi- ciency for maintaining a livelihood at the same time. The surplus energy theory assumes that play is necessary to wear off the exuberance of the young, whether man or beast ; while the recreation theory claims that play is for purposes of relaxa- tion and recovery from the tiring effect of the monotony of life. That play is of inestimable value to animal life has long since been conceded ; but its usefulness to the human race has not been appreciated until within a few years. Play implies bodily movement and exercise in cooperation with others, and is a form of recreation popular with the children. Recreation consists of several forms that differ widely in effect. It has been classified by De Groot as follows : '■ Active — the use of muscular and nervous energy, such as baseball, swimming, etc. Passive — watching others in an exhibition or entertainment. Social — exchange of ideas and expressions of a joyous nature. Active recreation he further divides into manual, rhythmic, dramatic, and athletic play. It must be evident at once that active recreation produces different results than passive or social recreation, yet each has an important function. 1 Report of the South Park Commissioners of Chicago, igi2, p. 30. 166 PLAY AND RECREATION 167 I. Values of Recreation. a. Physical Values. Play, exercise, and recreation affect both body and mind, and the physical effects are very important. The total disuse of an organ tends to render it useless; for instance, a limb tightly bound for six months would lose its functions entirely or recover them with great diflSculty. Consequently a reasonable exer- cise of the various organs of the body is necessary. The spon- taneous play of children develops part, perhaps most, of the body, but no single game is adequate for the task. Fortunately the use of the same game becomes monotonous, and children vary their games because of the added pleasures which change affords. The effects are far-reaching, for the children bring a large variety of muscles into use, but a symmetrical develop- ment of the body hardly results from dependence on the spon- taneous play of children. Rightly planned, organized play is necessary to accomplish this result, for many organs and parts of the body do not develop sufficiently except through exercises that are specially adapted to them. One of the diseases which can be lessened by the organization of play is tuberculosis. A disease of filth, it will long remaia with us, and a development of resisting power in the individual is absolutely necessary. The play of growing children under good surroundings will, more than any other agency, prepare the child for the struggle with this disease. Although the greatest prevalence of tuberculosis is during the adult period of life, — notably between the thirtieth and fortieth years of life, — the time for preparation against the disease is during childhood. Proper development of the appropriate organs forms a splendid asset for the individual when he is later ex- posed to the tubercular germ. Play as a precautionary meas- ure cannot be too strongly urged, especially for weakly and subnormal children. b. Social Values. The social and moral influences of play produce indelible effects upon the child mind. Play is didactic, and leaves its trace for good or bad as the case may be. Unorganized and 1 68 PROBLEMS OF CHILD WELFARE spontaneous play often develops the bully and the coward; systematic play impresses the ideals taught by organization and cooperation. One of its initial values is the recognition of mutual rights, which are but little understood by the un- thinking chUd and, when brute force permits, are often entirely overthrown or perverted into a mere toleration of privileges. Few children are spontaneously generous; the majority are selfish and require companionship to soften their egoism. On the supervised playground, a new regime is put into operation. The right to the use of the sand pile cannot be monopolized by any ambitious player. All things are held in common, and every child must be granted an equal opportunity, so each learns that others have rights that must be respected. Our rapidly in- creasing density of population and the innumerable contacts involved demand a new limitation of rights and a recognition of the boundaries of the rights of the individual. Play there- fore becomes a most important school of citizenship, and the social results which follow are expressed in such ethical values as order, obedience, self-denial, and discipline. The self-repres- sion, not self-effacement, which develops from the influence of play makes obedience something more than unwilling subordi- nation. It becomes respect for authority as well as deference to the welfare of the group. The team work of play develops a characteristic most neces- sary for the success of our experiment in democratic govern- ment. This characteristic is the capacity for cooperation, which is the ideal of the democratic movement. Ability to cooperate means ability to excel, but absence of this power means ultimate disorganization and disorder. Practice in accomplishing a given task together impresses boys and girls with the immense value of concerted action. Things must be done in unison, and every one takes part ; thus the individual learns that he is necessary to the game and that without his sane cooperation neither he nor his associates will be able to enjoy themselves to the fullest extent. Thus, through practice and sheer necessity, capacity for cooperation develops. The citizen will not govern wisely until he learns the value of co- PLAY AND RECREATION 169 operation and until he feels himself a part of the government. If government is only partially successful, he must feel the humiliation ; if it fails, he must participate in the disgrace ; if it succeeds, he may rejoice in the accomplishment as he would if it were entirely his own. Good government depends upon a cooperation so intense that each accomplishment will inevi- tably reflect itself in the attitude of the individual. The suc- cessful adjustment of the individual characteristics to those of a group so as to make interrelations possible is a prime task of the playground and can nowhere else receive equal encourage- ment and development. Play will improve the good citizen- ship of a nation, and therefore become a safe and sane form of social insurance and a guarantee of better government. One possible influence of play is less reassuring ; unless it is carefully carried on, an imhealthful development of the gang spirit may result. The absence of complete democracy tends to segregate the children into antagonistic groups, among whom a spirit of intolerance may arise. Base leaders appear, and these dominate the actions of the gang, which panders to the baser instincts present on the playground. Unless hindered, the difiEering elements will form numerous gangs in which the spirit of true cooperation will fail and intrigue as well as enmity will control action. The principle of complete self-govern- ment cannot be successfully applied to immature minds, and play, in order to conserve its good efiects and to eliminate its evil propensities, must be properly supervised. c. Mental Values. The child cannot play without receiving mental influences of various kinds, since play is not only educational but stimulates the capacity for mental growth. The backward child through the influence of wisely planned play grows in intelligence and becomes capable of better work. The normal chUd adds new mental qualities, such as initiative, alertness, mental ability, and foresight. The need of alertness stimulates the chUd to activity, and the task of solving the problems which every game presents requires a fresh display of initiative for each added instance. The quality of leadership develops, and this involves 17° PROBLEMS OF CHILD WELFARE the use of the calculatmg faculties, and requires constant planning and the use of judgment. The advantages of properly conducted play have a value far in excess of the energy and cost required for competent supervision, therefore the playground movement is alive with tremendous social possibilities. 2. Recent Appreciation of Play. The majority of parents, and of teachers as well, have regarded the play of the child as a natural but somewhat useless activity. Parents often prevent their children, especially the older ones, from indulging in play because they do not understand its character-building qualities and believe it a mere waste of time. As a needed relief from the confinement and concentration of the schoolroom, its usefulness has, however, been generally ac- cepted. The physical effects of play received the first recog- nition, and its social and moral effects were unobserved until some of their necessary consequences became too patent to remain hidden from the view of the sociologist and the moralist. That some of the world's great teachers had long since recog- nized the uses of play is true, but the popular mind had not fol- lowed them, and the discovery had to be made anew. The present attitude toward play is a mark of the changing tendency in regard to our many social problems. The social reformer finds that play and the playground are powerful agen- cies, which, if carefully used, wUl accomplish much good. The potential criminal of the slums must be transformed into a law- abiding citizen, and the indifferent must become zealous in the cause of reform. The depleted physique of the children of the poor must be renewed, and their intellectual and moral im- provement required. The riotous child of the street and the gang of the dismal alley must be reclaimed and their energies directed toward nobler standards of living. To accomplish these results is the aim and hope of the advocates of the play- ground movement. The effects of the meager efforts that have been made to promote play have been most hopeful. The social attitude toward play is now a healthful and helpful one, but the problem is serious, owing to the difficulties which are naturally involved in furthering the playground movement. PLAY AND RECREATION 171 3. Facilities for Recreation. Ample facilities for play are needed. It has been estimated that every child should have approximately 30 square feet of play space. As the playground must be located where the child can reach it, playground facilities must be properly dis- tributed throughout the residential sections. The cost of ade- quate playgrounds and equipment is enormous, and this is partly due to the tardy recognition of the need of play space. In some cities even the school buildings are not all provided with play- grounds, and this is especially true in the slum sections where play space is most needed. Children therefore pour into the streets to organize their games and play them. Often the only open space consists of a few feet of ground immediately in front of the school building, but this, if paved with brick, becomes very unattractive, and the street is often more alluring. a. Roof and Basement Playgrounds. The insistent demand for play space has resulted in the use of the roof or the basement of schools for play purposes. In New York City, especially, where the tall tenement buildings have usurped so much space, much has been accomplished by transforming the roofs of school buildings into playgrounds. These roofs are covered with wire netting or at least surrounded by a strong fence so as to make mishaps impossible. Roof gardens frequently accompany the playgrounds and are used for the cultivation of flowers and vegetables. This method of providing play space has some advantages. In the crowded portions of cities, it is especially desirable that children come in touch with pure air and sunlight wherever possible. The atmospheric conditions on the roofs are notice- ably better than those in the narrow streets. The use of roofs for open air schools and the success that has attended this movement furnish ample proof of the healthfulness of the roof playground, and several cities have resorted to its use. However, it is often inconvenient to use the roof for play- ground purposes; and basements are frequently constructed to meet the need. Owing to the size of the buildings, such basements have a tremendous area and offer large opportunities 172 PROBLEMS OF CHILD WELFARE for play, but the air is not always good and sweet; it is fre- quently dark, and sunlight is almost entirely absent. Young children, especially the ones living in unfavorable homes, should not be required to remain in basement playgrounds. c. Streets and Vacant Lots. In the foreign sections of our large cities, where overcrowding is common, the streets are used to a large extent by pedestrians and also by children at play. Asphalt or well-paved streets are very well adapted for this purpose. In certain sections children are tolerated in the streets and the authorities do not drive the boys into the alleys. Wagon traffic tends to avoid streets used in this way, and this increases the safety of the children. Some progress has been made in the establishment of play zones, where at certain times of the day portions of the streets are roped off by the policemen and cannot then be used for traffic, but are turned into playgrounds for the children. This gives an opportunity for play and is far better than the alley, but the street lacks the salubrity of the park and is but a makeshift. In 1912, 10 cities increased their regular play space in this way. Many streets in the congested districts are so poorly paved that they are not serviceable for this purpose, so other methods of gaining play facilities must be found. The numerous vacant lots in many cities are temporarily turned into playgrounds by the boys of the neighborhood. In some cases the permission of the authorities is necessary before these places can be used for play purposes, but this is quite readily secured, and thus the playground room of a city can be enormously extended beyond the meager facilities directly xmder municipal and philanthropic control. Play under these condi- tions is not supervised and is conducted by the boys according to their own ideas, yet it relieves congestion and has done much good. Occasionally the city uses the lot directly and erects playground apparatus which remains during the summer months. Usually the equipment is intended for the small children, the larger ones being expected to attend the regixlar playgrounds. PLAY AND RECREATION 173 d. Public Recreation Centers. The major portion of a municipality's playground space consists of that secured exclusively for playground purposes and transformed into parks and formal playgrounds. Although the first playground space was furnished by the schools, the school authorities have not kept pace with the need of play space. They have not regarded recreation as a function of the school except as it is necessary to rest pupils from the monotony of their study and to make them more alert for their class work ; consequently the municipality has been forced to create separate playground areas. Unlike the use of streets and lots, the estab- lishment of playgrounds involves the expenditure of consider- able sums of money, and the needed recreation centers, if established at all, must be created in the localities where children can use them. In the crowded quarters of the city the cost of real estate is high, and very little vacant space can be found. How to secure ample funds to establish a system of playgroimds is a problem for nearly every city. A single block in New York City cost $1,811,127. 4. Types of Recreation Centers. There are various t3rpes of playgrounds, and some of them are intended for children of almost every age. The type of play- ground and the method of its control vary with the age group which is to be accommodated. The park for small children as found in many cities is a dis- tinct type. Some parks are divided into two parts; one for boys and the other for girls; often an entire playground is limited to the use of one sex. Special provision is sometimes made for the little children, who are given a small enclosed space into which the others may not come. Usually these playgrounds contain sand gardens, swings, teeterboards, and some additional apparatus, besides space for games of various kinds. In the middle of the sand garden is a covered enclosure containing the sand. The level of the sand pile is about two feet above that of the adjacent groimd, and the sand is accessible from all sides. Here small children are allowed to dig and are carefully watched by an attendant so that no accidents may 174 PROBLEMS OF CHILD WELFARE occur and that trouble among the children may be avoided. Some opportunity is also given for digging in the garden around the enclosed sand pile, and here the older children may enjoy themselves. The swings and teeterboards may be out in the open air or under a protecting roof, and some of the parks are provided with equipment of both kinds. In certain parts of the park seats are provided for the child's mother, who may rest there with her young charges. These parks usually open at nine o'clock in the morning and close about sunset, and are in use through the warmer months of the year only. Formerly many of them were mere vacation schools operating for ten or twelve weeks during the summer, but now a general extension of the time has been granted. A second t)rpe of playground accommodates children of all ages, and therefore contains a greater measure of provision for the older boy, who does not dig in the sand nor play baby games. In addition to provision for the small child, opportunities for physical exercise are given to both boys and girls, and appro- priate machinery for this purpose is furnished. The grounds contain poles, ladders, horizontal and parallel bars, play-horses, small merry-go-rounds, and other apparatus. However, the boys are usually better provided with the means of enjoyment than are the girls. This type of playground is not usually en- closed, and may be used whenever the condition of the weather allows. Accordingly on a bright winter day and frequently in the early spring these grounds may be seen covered with boys eager to use such apparatus as may be allowed to remain all winter, and in the summer months they are covered far into the night with enthusiastic children. The most notable variety of recreation center in the United States is the so-called civic center, which usually comprises a small park containing a finely equipped field house. The idea took form in Chicago in 1903, when the South Park Commission decided to establish a number of such centers on the south side of that city, and within four years ten such centers were created. A typical center is established at a cost of about $220,000, and the yearly cost of maintenance amounts to approximately PLAY AND RECREATION 175 $30,000. The centers comprise an area in some cases of ten acres each, being much larger than the ordinary playground. Furthermore, they do not confine their activities to the needs of children, and many adults participate in the advantages. They are located in regions badly in need of play facilities, and are therefore usually found in the poorer and more disagreeable parts of the city. In Chicago the groimds were secured by direct purchase of the land; buildings were removed and the parks and centers created. The grounds are enclosed, and contain various build- ings and an exceedingly good equipment. A typical field house consists of a large assembly hall, where entertainments of various kinds are continually held, and where dancing parties frequently convene ; a boys' gymnasium equipped for games, especially for basketball and for physical exercises ; and a girls' gymnasium in another part of the buUding, where the equipment is equally adequate. The building shelters one of the branches of the public library, and contains many clubrooms used by adults as well as by boys and girls. An indoor swimming pool is one of the valuable features of the equipment and a large outdoor pool is provided for summer use. This is used by males five days of the week, while on two days its use is limited to females. Ample shower baths are also provided. During the winter months there are facilities for indoor play, but when good weather approaches the outdoor equipment is more generally utilized. This includes provision for the little children, for a boys' ground, and for a girls' field. The portion allotted to the small child contains a wading pool absolutely safe, swings, teeterboards, and similar apparatus, as well as sand bins, and only children under ten years of age are allowed to use these groimds. Provision is also made for the caretakers, who are supplied with ample shade whUe they watch the little ones. Mothers may come with their children and remain to see them play. The boys' field is the largest area of the three divisions, but the patronage is also the largest; the field con- tains tennis grounds, a baseball diamond, an outdoor hand-ball court, outdoor gymnasium facilities, and apparatus adapted 175 PROBLEMS OF CHILD WELFARE to the larger boy. A running track is usually included, and con- tests are a part of the regular program. In a few instances small ball grounds have been set apart for the little boys, but the general rule is to admit all classes to the larger field. The girls' field has the usual outdoor equipment, with oppor- tunity for play and exercise. Even athletic contests for the girls and women have been inaugurated, and among the events are the rimning jump, traveling rings, fifty yard dash, etc. Girls also organize into league teams, and compete in many games, such as baseball, quoits, field hockey, relay races, and others. Hun- dreds of girls participate in these games, — a fact which attests their popularity. When false modesty has subsided, their utility will also be generally recognized. A portion of the grounds is used in common, or for certain definite purposes. In winter a part of the field is flooded and converted into a skating pond; and a little dressing room is provided in a corner of the park. A number of tennis courts are located on this common field where the sexes may mingle in their play. A variety of sports are allowed, baseball being the most popular. The outdoor fields are open from May to November, but the indoor gymnasia are open throughout the year. The ordinary city park is of limited service to the children of the poor, since they can draw little comfort from a park several miles away. For example, Fairmoimt Park in Philadelphia, with its 3000 acres of land, is hardly used by the poor chUd. It is so far away that only the well-to-do can afford the neces- sary carfares. The thousands of little children seen there are not the children of the poorer sections of the city; hence the park has a limited usefulness only. Even Central Park, on the narrow island of Manhattan, is but meager relief to the child of the East Side, and it can attract no children at all from the more distant slum sections. The larger and better equipped park is seldom visited by the poor except on those rare occasions which form distinct events in their lives. Playgrounds and parks for small children must be located within one-fourth mile, and for large children within one-half mile, of the chil- PLAY AND RECREATION 177 dren's homes. In spite of their many prohibitions, parks offer a large opportunity for play and sport. Games of many kinds can be played, but the chief advantage is for the larger boy and girl rather than for the small child. In New York and in a few additional cities recreation piers have been established, but these again cater to the older chil- dren and are not serviceable for the smaller ones. The chief source of enjoyment here consists of music, which is furnished free of charge by the cities, as is often done during the summer months in many of the parks. The evening recreation centers and the evening roof playgrounds of New York City are addi- tional methods of providing recreation for children. 5. Progress of the Playground Movement. The playground movement in the United States is a recent development. The idea seems to have been borrowed from the city of Berlin, where small sand piles had been scattered through- out the public parks for the purpose of giving the children an opportunity to play. Some citizens of Boston heard about this innovation, and in 1886 two religious societies of that city followed the Berlin plan. Various charitable and philanthropic societies, especially social settlements, then became interested in the idea and many playgrounds, established and conducted by private organizations, arose. The earlier playgrounds were mostly under private auspices, but the initiative of private enterprise soon awakened the cities to their need, and public playgrounds were established, but comparatively little was accomplished before 1900. Probably the greatest single impetus given to the movement was the convention of the National Playground Association in the summer of 1907. At a second convention the following year, twenty-nine states were represented, and the playground movement spread everywhere. To-day a nation-wide work of educational propaganda is carried on, and a magazine devoted to the cause is being published. Also pamphlet literature is widely disseminated. The small cities are being aroused to action by the systematic work of the playground leaders. In five years a tremendous amount of work has been accom- 178 PROBLEMS OF CHILD WELFARE plished. In 1907 only 66 cities had joined the playground movement ; in 1908 the number had increased to 185 ; in 1909, to 339 ; in 1913 the number having playgrounds or having begun to establish them had risen to 642.1 Of this number 342 cities, having a total of 2402 playgrounds, regularly supervised their recreation centers. In maaiy cities, however, the only centers were the school playgrounds, which received some supervision from the teachers. In 70 cities supervised playgrounds were opened for the first time in 1913, and altogether over |8,ooo,ooo was spent or aiuthorized for expenditure in this year — an enor- mous amount considering the recency of the playground move- ment. Among the large cities Chicago leads in provision for recrea- tional facilities. Its 14 large field houses and civic centers reg- istered an attendance in 1912 of more than 5,000,000 persons, and more than $11,000,000 has been spent by the city on its playgrounds. Seattle has also established a number of civic centers with excellent results. In addition to the work of its board of education. New York City has established many small playgrounds through its park department, and it has furnished music at its recreation piers and developed evening entertain- ments. Many of the cities are contemplating elaborate plans of work and have purchased considerable ground for the estab- lishment of a system of playgrounds. State governments are being interested in the playground movement. New Jersey, for example, has authorized a play- ground commission for each one of its larger cities, which selects sites, purchases land, and organizes the work. Some states have authorized park boards and commissions not amena- ble to municipal control to facilitate the establishment of play- grounds, and the wider use of school property for recreational purposes likewise increases the facilities for play. Measured by the standard requirements of play space per chUd, the play- ground movement, however, has only fairly begun, and in no city have adequate facilities been provided. The least advance has occurred in the country districts, although here certain ' The Playground, Vol. VII, No. lo, January, 1914. PLAY AND RECREATION 179 forms of recreation are qmte as necessary as in the cities, and their social values are of special importance. 6. Supervision. The importance of play, not as mere recreation, but as a vigorous formative influence on character and ideals, has been recognized, and so the question, how shall this influence be made most effective, naturally arises. Shall play be supervised or not? Wherever the park ideal of playground prevails very Httle supervision is possible. In the large park there is none, but in the small parks a system of limited supervision may exist. The results of the operation of the unsupervised playground have not been sufficiently encouraging to gain much support for this method. In fact, the experience of the school play- ground contains a note of warning against this system ; conse- quently the recent tendency has been toward the supervised playground. In the latter the bully and the gang cannot rule and destroy the ethical values of play, nor can the larger boys monopolize opportunity to the detriment of the smaller child. Unquestionably the supervised playground is superior in its capacity to develop the character and the social ideals of the child. The quality of the supervision is likewise a matter of utmost importance, especially to the boys. Children under 10 should have women instructors, but boys over 10 should be in charge of men. The success of supervision depends upon the tact and general efficiency of the play leaders, therefore the need of professional playground workers is being rapidly recognized. The 285 cities with supervised playgrounds in 1912 reported 5320 such workers — nearly 20 per city, and 63 employed an average of 10 each throughout the year. In many cities classes for the training and instruction of the play leaders have been organized, as training is the chief essential to success. This can be given in the physical education departments of normal schools, in the various schools of social work, or in classes organized espe- cially for instruction in the subject. Leaders should understand the meaning of the playground movement in its larger and theoretical aspects, and in its relation to commercial recreation. l8o PROBLEMS OF CHILD WELFARE They should be especially conversant with the practical phases of the problem; be thoroughly acquainted with playground and recreation equipment ; have a large repertoire of appropriate games ; understand such special activities as those of the boy scout or camp fire girl ; and have some capacity for story-tell- ing, for the manual arts, for athletics, and for similar accom- plishments. They should be imbued with the spirit of com- munity service and should endeavor to make their work count as genuine social service. The public school teacher who presides on the playground is in special need of training in the social aspects of play and recreation. Too often she approaches the task from the stand- point of the pedagogue instead of that of the social worker. She thinks of order and discipline rather than of constructive character building. Play facilities should be accessible throughout the year. The rigor of northern climates, however, makes the use of out- door playgrounds impossible during the harsh winter months, unless it be for skating. Nevertheless, playgrounds should be open as long as weather conditions allow, and provision for adaptation to winter sports should be made. Instead of a season of about seven months, as in many American cities, play- grounds can be put to better service. During the summer they should be open all day ; and, after school has begim, they should be accessible before and after school hours. Field houses, such as those in Chicago, with their magnificent indoor equipment, make ample provision for all classes during the winter months with the exception of the small children. We have not fully recognized as yet the need of outdoor exercise in the brisk winter days, but this is especially important for the children of the slums, confined to small, stuffy, and unsanitary rooms. In 1913 more than half of the recreation centers were open during July and August only. In a few cities a season of nine or ten months prevailed, while there is a tendency in favor of longer seasons and of the all-year playground where that is climatically possible. In 68 cities 337 centers were open throughout the year. PLAY AND RECREATION l8l 7. Administration. The control of public recreation is a matter of great impor- tance. The public acts through the school authorities and the park and recreation departments of cities, or boards established by the states. The control of these activities must gradually be centralized, and with the increasing magnitude of the problem, the task will become more serious. Opinion seems to be crys- tallizing in favor of placing the various recreation centers, swimming pools, public baths, municipal dance halls, and the recreational activities carried on in parks, in the hands of some special bureau or department of the municipality. It is im- possible to separate the work for children from that for adults, therefore objection is made to placing the supervision of all recreational agencies in the hands of the school authorities. The functions of recreation centers are so varied that it is un- certain how far they fall within the scope of the work of a board of education. Some separate municipal department would be free to carry on every enterprise according to social needs and requirements, and would not be handicapped by educational straitjackets. On the other hand, the argument made for the educational authorities cannot easily be brushed aside, since it is conceded that play is essentially educational in character. Schools are deferring to individuals of every age who want training and education, and recreation is extended to many not enrolled in regular classes. There is an identity of interest between ed- ucation and recreation which should be safeguarded, and this can best be done by the extension of the administrative functions of the school board to cover recreational facilities. At all events, the educational authorities will retain control of the school playgroxmds, but if they are limited to this a complete system of centralization is not possible. By an extension of authority, the recreational activities can be correlated and made efiEec- tive. Furthermore, a propaganda supported and pushed by the department of education carries more weight and is more likely to succeed than if advanced by the branches of the mu- nicipal government. The confidence of the people in their edu- lS>2 PROBLEMS OF CHILD WELFARE cational system is largely responsible for this. As the appre- ciation of the social aspects of education increases, the functions of the board of education must materially expand. In actual practice, the various cities differ widely as to the method of work. The splendid recreation centers of Chicago are supervised by a park commission, but in Gary, Indiana, the schoolhouses are the social centers. In Boston the school board has charge of the playgrounds both in the parks and in the school yards, and in New York City the school board has greatly enlarged its functions, but the principal recreation centers are controlled by another municipal department. In St. Louis recreation centers are controlled by a bureau of the park depart- ment, while in Kansas City part of the control lies with the board of public welfare. In many cities several bodies cooper- ate to manage the playgrounds. In smaller cities private play- ground associations are required to do much of the work, and here also the school boards frequently take charge of the play- grounds. In the large cities the park boards and recreation commissions are the principal controlling authorities. The school boards, however, retain control of the school playgrounds, often operating them during the summer months or arranging for their use under the immediate supervision of the department in charge of the recreation centers. It is not likely that the school boards will extend their operations to cover the entire field, but it is very probable that the work wUl be largely concen- trated in some other municipal department. The future super- vision of moving picture shows, dance halls, pool rooms, and other commercial amusements wUl make this development necessary. Educational authorities do not wish to be burdened with this task, but it will easily harmonize with the work of a recreation commission. 8. Special Outdoor Activities. A number of specialized forms of outdoor recreation have grad- ually developed. Among these are the summer camps and excur- sions of boys and girls under the direction of our Young Men's and Young Women's Associations. The Boy Scouts and Camp Fire Girls represent a recent development of allied activities. PLAY AND RECREATION 183 The Boy Scout movement is of English origin, and at first exhibited many military aspects, but after its importation to the United States it was largely modified and lost its former tendency to stimulate a desire for war. The boys are stUI organized in troops, wear uniforms, and receive a certain amount of military drill, but emphasis is placed on their aims and duties. Their chief tasks and pleasures are summed up in the term "Scoutcraft." This includes "instruction in first- aid, life saving, tracking, signaling, cycling, nature study, seamanship, campcraft, woodcraft, chivalry, patriotism, and other subjects." ^ Boy scouts may be in one of three classes, and each boy must pass certain tests before he can be promoted to the next higher class. The scout law is a set of principles which should regulate the conduct of the boys. It consists of 12 resolutions, each of which represents some important virtue. Merit badges are given to "first class" scouts who pass certain tests in such sub- jects as athletics, bee fanning, camping, firemanship, handcraft, pioneering, signaling, path finding, marksmanship, and others. The boy scout is benefited in several ways: usually his pleasures take him into the coimtry where the air is fresh and wholesome. He is physically improved by these excursions and becomes more capable of withstanding the bad effects of city life. Contact with nature, with flowers, trees, birds, and animals, profoundly affects his character, and also has great educational value. Again organization and discipline, in addition to the observance of scout law, develop important mental and moral characteristics. Boys become more active and alert ; they gain self-control; they become more mannerly and chivalrous; they acquire much practical knowledge, such as the art of swimming, life-saving, etc.; and they are stunulated to the task of self-improvement. The Young Men's Christian Associations were formerly the chief agents of the boy scout movement, but other agencies have interested themselves, and at present patrols and troops are formed in connection with the associations of the different 1 Boy Scouts oj America, The official Handbook for Boys, p. 3. 184 PROBLEMS OF CHILD WELFARE religious denominations, the Sunday Schools, settlements, and other organizations. In many cities the boy scouts make use of the recreation centers for their work. The total number of boys enrolled in the organization in 1912 is estimated at 500,000. The Camp Fire Girls are organized according to plans similar to those governing the Boy Scouts. They also aim to accomplish similar results, but have adapted their program suf&ciently to include the acquisition of much needed knowledge relating to affairs of house and home. The recreational activities are prominent features, and outdoor life is exalted. The physical and moral effects derived from the movement should be very similar to the gains achieved by the Boy Scout movement. Comparatively few girls have as yet been organized into camps, the total enrollment in the United States in 1912 probably not exceeding 40,000. The summer camp is accessible to a rather small proportion of the children in need of outings, but fresh air camps often specialize on weak and sickly children, giving them an outing lasting from one to four weeks. Remarkable results have been obtained, and frequently tubercular children have regained en- tirely their former strength and energy. The class of children which is forced back into unsanitary parts of the city make little permanent gain, however, and they must have regular access to healthful playgrounds in order to conserve their health. The effect on the mind of a short summer outing is being for- cibly demonstrated by the short vacation schools, conducted in the summer camps by the Young Men's Christian Associa- tions. The boys often gain from three to six months' work in regular schools because of the stimulus received in these camps. 9. Commercial Recreations. A large proportion of recreational facilities are provided by commercial agencies, and many cheap modern amusements are being furnished. Naturally they draw a heavy patronage and are fraught with good or ill according to their character. Among these recreations are motion pictures, cheap theaters, dance halls, pool rooms, skating rinks, and penny arcades. The motion picture has for the first time brought a valuable PLAY AND RECREATION 185 recreation and amusement within the reach of the masses of the people. Although the great majority of the patrons are adults, it has been estimated that 400,000 children in the United States visit the picture shows and cheap theaters daily. From one- fifth to one-fourth of the average audience is composed of children. Few children in any city are not within reach of some picture show, but on account of the uncertain nature of the business, in some cities the nxunber of establishments fluctuates greatly from time to time. In the cities a large proportion of the shows cost five cents a performance ; in the smaller towns the usual charge is ten cents . Picture films now embrace nearly every variety of subject, — historical, geographical, industrial, scientific, sociological, fanciful, and mythical, and afford not only entertainment but instruction as well. It is therefore very important that the character of the films shall have an uplifting effect on the spectators. The committee organized in New York City for the purpose of censoring moving picture shows passes on from 80 to 90 per cent of the film subjects used in the United States. The stand- ards of nickelodeons have therefore been greatly raised, and in many cities few distinctly objectionable films are presented. On the other hand, uncensored films are often widely exploited. Usually the demoralizing film is the only one of its kind in a single exhibition, the remainder being entirely innocent, but this one destroys the social value of the performance. Other films of doubtful quality are frequently produced, and many of the scenes, especially the more dramatic exhibitions, such as robberies, burglaries, and thrilling episodes, although they do not directly teach vice and crime, inflame the imagination of the chQd, cause him to reenact the story or tragedy, and often lead to the direct commission of crime. The great majority of juvenile delinquents frequent the five- cent show and the cheap theater. Although causal connections can be established only in a limited number of cases, there can be no doubt that many children are demoralized in this way. Standards should be raised, and all vicious subjects be forced out, either through public opinion or a higher grade of film cen- 1 86 PROBLEMS OF CHILD WELFARE sorship. Among the particularly objectionable features of many motion picture shows are the cheap and disgusting vaudeville presentations. The moving picture show can be made a wholesome amuse- ment for children. Philanthropic and municipal activity should provide high class amusements consisting of moving pictures and lantern slide exhibitions, which can be given in the school- houses, churches, and other public buUdings. The recreational need of the child can thus be partially met and elevating forces be granted an opportunity to exert an unconscious influence over the boy and girl. The increased use by our public schools of appropriate pictures and scenes in the study of history, geog- raphy, literature, and other subjects will also serve as a whole- some substitute for inferior commercial recreations. The public censorship of motion pictures is desirable, and the cities should each provide for a proper system of inspection. The cheap theaters add the vaudeville and the burlesque to the motion pictures, and are therefore more objectionable. The cost of admission being higher, the proportion of children attend- ing is much smaller. Every large city, and many smaller ones, have a number of cheap theaters where melodrama flourishes, demoralizing shows are presented, suggestive dances are given, and vulgar vaudevUle features are common. From the moral standpoint these shows are in special need of censorship, but the difficulty of eliminating everything objectionable is so great that every means should be encouraged to substitute a higher grade of amusement in their place. The dance hall offers a specially serious problem for the young girl. Few boys under sixteen attend the public dance hall, but many girls but slightly above the age of fourteen may be found there, and a large proportion of both boys and girls learn to dance at the public dancing academy. A study of a limited number of children in New York City disclosed the fact that 56 per cent of the boys and 31 per cent of the girls acquired the art at these institutions, and nearly three-fourths of the boys and one-half of the girls frequented them.' The parents of these ' Davis, M. M., The Exploitation of Pleasure, pp. 12 and 13. PLAY AND RECREATION 187 children were largely people belonging to the laboring and clerical sections of the community. Dance halls are numerous in the cities. Chicago has more than 250, St. Louis approximately 150, and Cleveland about 100. Many of the halls operate in connection with the saloons, some become a recruiting groimd for the white slaver, and many are regularly visited by prostitutes. Much vile and de- grading language is common, and frequently suggestive and indecent dances are allowed. Strangers often dance with each other either without introduction or after having met through the mediation of an ofl&cial introducer, and dances frequently continue imtil the early morning hours. The first step in providing proper dancing facilities for yoxmg people consists in the strict regulation and control of dance haUs. All halls should be properly licensed and be divorced from saloons and places where intoxicants are sold, a suitable closing hour should be provided, disorderly dances should be forbidden, and the police or inspectors authorized to close such dances summarily. No persons under 18 should be admitted, unless properly chaperoned by parent or guardian, adequate closet and cloak room facilities should be provided, and finally a well-qualified force of inspectors to supervise the dance halls should be established. Well-meaning men have instituted model dance halls and have hoped to preserve so high a plane of conduct that all objectionable features would be eliminated. It is doubtful, however, whether the commercial dance hall, no matter how well managed or supervised, can afford entirely wholesome amusement and recreation for young people. Recreation is so vital that it must be socialized, as education has been. It cannot remain a commercialized activity ; therefore our phil- anthropic and public agencies must provide the means. The schools should be opened as recreation centers where amuse- ments of various kinds, including a limited amount of dancing, are provided, and if necessary additional facilities can be pro- vided by the city, as in the case of the field houses of Chicago. Dances at such centers would in all cases be carefully super- l88 PROBLEMS OF CHILD WELFARE vised ; there would be neighborhood activities ; the demoralizing elements could be eliminated; and other forms of amusement could be introduced so as to vary the recreations afforded. An adequate program of socialized recreation wUl rob the commer- cial dance halls of the best of their patrons and will drive many such halls out of existence. Dancing cannot and should not be eliminated, but its evU results must be removed. Pool rooms, skating rinks, and penny arcades are minor forms of amusement so far as children are concerned. Boys imder certain ages should not be permitted in pool rooms because of the demoralizing elements encountered there. The skating rink often offers opportunities for leading girls astray, and needs public supervision to lessen the danger. The penny arcade is gradually dying out. In spite of the fact that the subject titles are usually worse than the scenes presented — a scheme to attract the curious — the arcade is giving way to the motion picture show, which is so much cheaper and more satisfactory, so that the dangers involved are not so serious. CHAPTER V WIDER USES OF THE SCHOOLS According to the old-fashioned notion school property was consecrated to use by children for what were called educational purposes. A school yard was a concession to youth, but an infraction of the principle. Debating societies and literary clubs were presumptuous in asking for shelter in schoolhouses, but often could not be refused. The growing recognition that schoolhouses are public property dedicated to public use for various purposes has resulted in the expanded use of the school. The term educational is likewise receiving a broader inter- pretation. I. School Playgrounds. An extension of the use of school property consists in the admission of children to the school playgrounds outside of school hours. New York City furnishes an excellent example of work done, since during the summer of 191 2 its board of edu- cation operated 112 indoor playgrounds, 78 grounds for mothers and babies, 13 open air grounds, 7 kindergarten centers, and 12 evening roof playgrounds, — a total of 222 playgrounds. The board makes a special feature of vacation playgrounds, thus adding materially to the playground space of the city. The equipment is meager, but the management is good and the at- tendance is large. In Boston the schools are granted the use of public play- grounds, and children are organized into class and school teams, and at the appropriate times of the year track events, baseball, football, hockey, etc., are enjoyed. A large corps of instructors is employed by the school board to supervise this athletic work. In Newark, New Jersey, the summer playgrounds have good apparatus for the boys, games for the enjoyment of aU are 189 1 90 PROBLEMS OF CHILD WELFARE carried on, folk dancing is taught, and hand-work is pro- vided. The movement in favor of the wider use of the school play- ground is rapidly spreading, and the above illustrations merely indicate the type of work done. Playgrounds should be open before and after school hours, on Saturdays, and during the summer vacation months. Such a policy would add largely to the available playground space in every city, and if it could be relied on, the city would not establish playgrounds in the vicinity of schoolhouses. In too many cities we find the curious anomaly of a school yard and playground side by side, indicating that the agencies have not correlated their work in the slightest degree. In many cities the playgrounds are managed by the school boards. This is frequently the condition in the smaller towns, where the school playgrounds are used for general purposes. Some apparatus is placed on the grounds, and the control and management of the activities naturally remain with the school authorities. 2. Evening Centers. Many public school buildings are open in the evenings. The term "social center" is usually applied to such a school if the activities are varied and largely confined to adults, but if the activities are open especially to children, then the term "recrea- tion center" is used. How far public school buUdings should be used for other than educational purposes has been a mooted question, but the right to use the building is being rapidly conceded. There is no consensus of opinion, however, as to who shall bear the cost of operation. The Boston school committee, for example, holds that the buUdings should be used, but claims that the cost should not be assessed against the school funds. On the other hand. New York City, Chicago, and Los Angeles are examples of cities spending money directly through their educational departments for this work. Among the activities prevailing at evening recreation centers are the following : literary, debating, dramatic, athletic, choral, violin, and civic clubs; folk and social dancing, gymnastics, games, baths, swimming, parents' associations, Boy Scouts, WIDER USES OF THE SCHOOLS 191 moving pictures, monologues, lectures, concerts, library facili- ties, formal study, and class work. The evening recreation work of New York City is so well developed that the entire subject can best be illustrated by a short account of its principal features. In 1912, 48 centers were in existence, presided over by 299 teachers, and the aggre- gate attendance was 2,657,880 or 20,020 per night. The centers are open from two to six nights per week, most of them every week-day evening, and they operate for eight months of the year. The total number of clubs and classes formed in these centers was 778, of which number 462 belonged to the "junior" division; that is, consisted of persons under 16 years of age. Many interesting forms of work were carried on ; for example, study rooms were set aside for the children who do not have good facilities at home for the preparation of their lessons. These rooms were nearly always filled, and the children in attendance profited greatly because of these opportunities. Although this class of children does not represent the highest type of mentality, less than 4 per cent of those attending failed of promotion. Baths were operated in 12 recreation centers, and swimming classes were conducted in one of them. The game rooms have been very popular, and here chess, checkers, parchesi, authors, and similar games were allowed and enjoyed. Classes in gymnastics and athletic drUls formed a feature of the work, and considerable ability is being developed among many of the class members. Folk dancing is a common form of recreation as well as a beautiful diversion. Mixed or social dancing has also been introduced, although many consider this objectionable. One evening a week was allowed for such dancing in fifteen recreation centers conducted for the girls and women, and the young men who attended were carefully selected, being usually members of clubs in neighboring centers. The teachers insisted on repressing the degrading features of certain dances, and in this way have developed better manners and more self-respect among the boys and young men. Insistence on order and decorum has also resulted in better behavior. 192 PROBLEMS OF CHILD WELFARE The work in dramatics has aroused a large amount of interest, and the classes in singiag have enjoyed much popularity, especially the classes for girls. Beginnings were also made in instrumental music, a number of bands and orchestras having been organized. In these centers moving pictures were at- tempted, and they proved very successful. Large crowds were attracted, as the exhibitions were free, but the success of the enterprise developed sentiment in favor of paid admissions so as to provide means for securing a high grade of films. The subjects presented were historical, literary, dramatic, and geo- graphical, and lacked the sensational features so common in the commercial moving pictures. Among other groups were the Boy Scouts, and social and civic clubs. Chicago and Cincinnati follow New York in the number of schools used as evening recreation centers, but in no city are many of the schools used for such purposes. In 1912, 114 cities had taken steps in this direction and were using 357 school- houses in this way — an average of only three schoolhouses per city. The amount of money expended is stUl comparatively small, and in many of these cities private philanthropies of various kinds have borne the cost of heat, light, and janitor service, but in about 70 per cent of the cities this cost is now paid by the school board. The number of workers is usually too small, the majority of them are volunteers and lack training for systematic service. StUl, paid workers were reported in 44 cities in 191 2, but in only 19 of these was the cost borne wholly or in part by the boards of education. Evening recreation centers must become a permanent feature of our social activities ; the cost must eventually be borne by the school board and the work be carried on by paid officials selected because of their capacity to do the work. Such workers must be trained social workers if the highest degree of efficiency is to be attained. 3. Social Centers. Allied to the evening recreation center is the so-called social center, which performs the functions of a recreation center, but in addition ministers to the various needs of a neighbor- WIDER USES OF THE SCHOOLS 193 hood. It includes both chUdren and adults, and operates outside of school hours during the day and at night. The social center movement received its first impetus from the publicity which it gained through the origin and develop- ment of the social centers in Rochester, New York, where it began in 1907. In that year one school was specially equipped for the various activities of the social center and the work en- joyed a distinct success. Provisions were made for gynmasium facilities and baths, also for various innocent table games ; library and reading room privileges were provided, and arrange- ments were made for lectures and entertainments. The build- ing was also thrown open for the discussion of public questions. The activities were carried on largely through the various clubs that were organized. Boys' and girls' clubs were formed for debating, exercises, and entertainment, and one men's and two women's clubs were formed the first year. These devoted their time largely to the discussion of political questions, with occasional social evenings, but the gymnastic work for men and boys excited the greatest interest. Three evenings each week the gymnasium was open to them; two evenings it was used by the girls and women. It was interesting to note that many elderly women participated in the exercise. The traveling library located at the building was used to great advantage, and the weekly entertainment was patronized by a large number of people. Occasional dances and dinners were also provided. The initial success of the Rochester experiment resulted in a rapid expansion of the work, and many cities began to imitate and develop similar activities. Political and other diflSculties, however, have beset the movement in Rochester, and progress in the work there has been greatly impeded. On the other hand, the impetus which this city gave to the movement has continued, so that a large number of cities using the schools as recreation centers are also carrying on the wider community or social center work. In many of these cities paid workers have charge of the activities — a fact which indicates the reasonable permanency of the work. Among the cities in which the schools are used for general 194 PROBLEMS OF CHILD WELFARE purposes is Gary, Indiana. In the following table the work of a school in Gary is contrasted with that of ii small parks in Chicago.^ Population served Maintenance (annual) Annual attendance Indoor gymnasium Shower bath . . Outdoor gymnasium Swimming pool . . Assembly hall . . Club rooms . . Reading rooms . . Lunch rooms . . Chicago Parks Gary Schooi, 800,000 20,000 $440,000 $100,000 310,000 1,000,000 1,325,000 500,000 2,000,000 2,000,000 725,000 300,000 270,000 1,000,000 70,000 50,000 600,000 1,000,000 520,000 20,000 This table indicates that the Gary school is used almost continuously. Facilities of many kinds are provided, and the children are taught to use them without hesitation or distrust. The plan is to utilize the entire building all of the time, and the result is not only more recreation but also more manual and industrial training. Furthermore, the school becomes a neigh- borhood center. The most rapid development of social center work is taking place in Wisconsin. Here the state university has undertaken to stimulate interest in the wider use of school buUdings as well as to organize the work directly. Allied to this work is the plan of conducting lyceum courses in the small towns and cities. As a result, about 50 cities have begun the use of the public school as a social center, and a very large number of towns have accepted the lyceum courses planned by the university. The inevitable consequence will be the opening of schools in these cities for community purposes. In social centers the gymnasium becomes the most attractive feature. Boys, girls, men, and women — all take advantage of the ^ Wirt, William, National Conference of Charities and Correction, 1912, p. 61. Figures given in round numbers but approximately accurate. WIDER USES OF THE SCHOOLS 195 opportunities which it affords ; therefore gymnasium facilities must receive special attention. Many schools are now being provided with them for the training of the school children. These schools if conveniently located are accordingly best adapted for neighborhood uses. An important development is the school bath. Shower baths are being introduced in many cities in the schools used especially for recreation centers, although other schools are also favored. In the congested sections every school should be equipped with bathing facilities. While the use of a bathing equipment can- not be made compulsory, it can be so encouraged by teachers that its use will become practically tmiversal. The cleanliness of children will be greatly promoted thexeby. During the sum- mer months the school baths should be open to the public, in order to supplement the municipal baths which are usually un- able to meet the demands. The public school swimming pool, formerly limited almost exclusively to the high school, is gradu- ally being added to the equipment of the elementary school building. It will increase the popularity of bathing and make measures of compulsion less necessary. The school serves admirably as a deposit station for books circulating from the public library. Many books should be sent to the schools for reference use, so the children may then read the books either in school or at home. Usually these class room libraries are small, consisting of not more than 50 or 75 books each, but these are repeatedly changed so as to make the outside work correspond with the class work. Schools used as deposit stations receive a larger collection of books. For these a library attendant may be furnished to take charge of the work, but the school must provide the housing accommodations. In this way library facilities can be extended to remote parts of the city with little additional cost. In a number of cities, especially New York, St. Louis, and Cleveland, good beginnings have been made in using the schools to promote the circulation of good books. In some cities and states the laws practically forbid the use of school buildings and school funds for other than purely edu- cational purposes. It therefore requires an elastic interpreta- 196 PROBLEMS OF CHILD WELFARE tion of the laws or new legislation to make our extensive public school equipment available for the education, upliftment, and general social betterment of the entire community. In some cases the proportion of the taxes devoted to the school fund is definitely limited, and expenditures other than those now author- ized involve hardships and retard the progress of work already carried on. These dif&culties are being met in two ways : first, by laws empowering the proper authorities to establish social centers ; second, by the appropriation of money for social center work. Under the stimulus of the workers in Wisconsin, that state in 191 1 enacted a law which granted comprehensive powers to the school authorities in cities of the first, second, and third classes. The school directors are authorized to establish evening schools, vacation schools, reading rooms, library stations, debating clubs, gymnasiums, public playgrounds, and public baths. These facil- ities are to accommodate both children and adults, and are to be provided free of charge. With the cooperation of the boards managing other forms of public property, such as libraries, parks, etc., the school directors may provide the instruction and supervision necessary to carry on educational or recreational activities in such buildings or parks. If necessary, the initiative may be invoked by 10 per cent of the voters, and if the proposi- tion carries, the school board must establish social centers as demanded by the people.' A number of states have empowered their school boards to make a limited use of the school buildings for social center pur- poses. Massachusetts has appropriated money directly for use by the Boston schools for the development of evening recreation centers. In Indiana a recent state law authorizes small cities to construct and equip swimming pools, playgrounds, and social centers. In this way, either through the school boards or through the direct action of the city, the states are authorizing the es- tablishment of social centers. In some states the removal of the age limits within which free education is allowed, will give addi- tional impetus to the wider use of the schools. ' Perry, Clarence A., A Survey of School Social Centres, p. 15. WIDER USES OF THE SCHOOLS 1 97 4. Physical Training. It is a comparatively new idea for the schools to give atten- tion to physique. The physical training of children has been a function of private agencies, or the work has remained entirely undone. Physical training aims not only to remove defects, but to guard against them as well, and to develop general physique. Although it has been a prominent feature of the German school curriculum for many years, its use in the United States is still very limited. The physical training afforded in the Francis W. Parker School of Chicago — a private school — is one of the most noteworthy examples of the nature of the work. At the beginning of the year each child is measured and thoroughly examined. If de- fects are discovered which demand special corrective exercises, the children affected take the exercises imder the direction of an instructor. The children are examined again at the end of the year in order to learn of their physical development and their relation to the normal measurements of a child of the same age. Careful adjustments of chairs and desks are made as well as careful seating in regard to light and ventilation. Correct standing and sitting postures are required. A complete course in physical training is given to the children. This course is graded so as to meet the requirements of each grade of children, and from the fifth grade on, and in the high school grades, the work of the boys and girls is differentiated. Each sex has its own classes and is given appropriate work. The girls acquire strength, elasticity, poise, and grace, while the boys develop strength, endurance, skill, and courage, and both are taught exercises that have hygienic value. The school has ac- complished remarkable results with its boys and girls. Recently some of the public school systems have introduced courses in physical training. In Boston in 1907 a department of school hygiene was formed to promote the physical develop- ment of the pupils. Courses were introduced which included games, plays, and folk dancing, and each grade was given lessons in healthful exercises. The kindergarten and first three grades were limited principally to games and plays, but in the higher igS PROBLEMS OF CHILD WELFARE grades formal gymnastics and organized graded exercises were given. In New York City a department of physical training was begun in 1903. At first the program of work was re- garded as artificial, but its real importance has gradually been recognized by both teacher and pupils. One feature of the work consists of the organization of the recess periods for physical training, and tests such as the following are applied : Do the children play more than half the time ? Are they happy ? Can the teacher secure prompt attention ? The plan followed in recess work depends upon the answers to these tests. Special attention is given to the problem of acquir- ing good posture, because of the frequency of spinal curvature and similar ailments which are frequently induced by the lax habits of children in the schoolroom. Two-minute exercises are required of all children three times a day, and gymnastic drills are made to include as many pupils as possible instead of drilling a few to perfection. The use of apparatus has developed the need of a gymnasium in nearly every school building in our cities. This equipment is being added but slowly, although Chicago is progressing very rapidly along this line. The work of male instructors is largely limited to the supervision of the boys in the gymnasium, while the women conduct exercises for the girls. In 191 2 there was only one instructor for every 10,000 pupils — a condition typi- cal of other cities as well. In Chicago separate attention is given to training the crippled and the blind, but in no city has a complete system of physical training for all been adopted. Usu- ally the work is limited to certain schools or to certain groups of children, since supervision is regularly inadequate, teachers are too few, and many of these are untrained. In many cities the schools have introduced athletic sports, such as baseball, basket ball, soccer football, track and field work ; while in the high schools football is also allowed. The movement is distinctly in the direction of extensive athletics as contrasted with intensive work, which benefits a few people only. Such exercises as jumping and running can be enjoyed by the WIDER USES OF THE SCHOOLS 199 great majority of boys. The individual school meets draw in a large proportion of the older boys, while the inter-school contests develop intensive training. In some schools all boys physically capable of doing so engage in athletic training, and instead of allowing them to specialize on one form of exercise, the instruc- tors require the boys to compete in a variety of exercises so as to enable them to develop diEEerent groups of muscles. The es- tablishment of minimum and maximum standards prevents both indifference and overexercise. The participation of boys in athletics according to such rules tends to produce a symmetri- cal muscular development ; and it is this which athletic exer- cises should encourage. Organized efforts to give athletics a definite place in public school life have resulted in the establish- ment of public school athletic leagues in more than a hundred cities in the United States. Such efforts tend to promote an ideal of physical training and education. In a search for suitable exercises for girls the New York City schools selected folk dancing, but added a number of games and exercises that permitted a more vigorous use of the body. The teachers have been trained in special classes to enable them to organize the girls in the schools and to conduct the exercises. In view of the general failure to develop the physique of girls, and of the former tendency of civilization to encourage delicate- ness and physical incapability, the movement in favor of the proper athletic training of girls needs special encouragement. If the schools succeed in a rational program of physical de- velopment for girls, then their efforts to promote physical edu- cation will obtain ample justification. In recognition of the demands that will inevitably be made on our public school buildings, it will be necessary to recognize the need of anew type of building — one equipped to serve as a recrea- tion center. It must have a complete gymnasium, with facilities for bathing, so that every variety of athletic exercise can be carried on. It must be provided with kitchen and cooking utensils, with suitable assembly rooms, and moving picture ap- paratus ; certain rooms must be adapted for club purposes, mothers' meetings, and similar gatherings ; the outdoor equip- 200 PROBLEMS OF CHILD WELFARE ment must be equally complete and include the necessary gym- nastic apparatus, while playground space must be ample and the grounds be made suitable for play purposes. In addition school buUdings must have cold air rooms, and be so constructed as to make atmospheric conditions within their walls as nearly like the wholesome out-of-doors as possible. 5. Vacation Schools. During the summer months many school buildings can be used for the work of the vacation schools. The schools are established to keep children out of mischief, to give retarded children an opportunity to study, to develop manual skUl, and to carry on continuation work. New York City leads in this work, and in 191 2 operated 33 vacation schools with an enrollment of over 28,000 children. The term lasted six weeks, and the work was limited to forenoon hours. Among the classes of children en- rolling were pupils who had not been promoted, pupils who ex- pected to skip a grade, children who wished to insure their proper promotion the following year, and children compelled to attend school because they could not otherwise secure working cer- tificates. Class work consisted almost exclusively of various forms of handicraft. Basketry was the most popular subject, but chair caning was also an important branch. The industrial work for boys included elementary and advanced bench work and Vene- tian iron work, forms of training that appeal especially to the boys of the lower grades. The girls received lessons in cooking and housekeeping, also in such domestic arts as sewing, dress- making, millinery, embroidery, knitting, and crocheting. Most girls make a number of useful articles for personal use and thereby gain the incentive to perform a creditable piece of work. Lessons in nursing adapted to both boys and girls were given, personal cleanliness being especially emphasized. Kinder- garten classes were maintained for the little children. Although attendance is not compulsory, the average attend- ance in 191 2 was 91 per cent of the enrollment — a fact which indicates that the pupils were drawn to the schools by the inter- esting character of the curriculum. WIDER USES OF THE SCHOOLS 20I The work in the vacation schools of New York City is typical of these schools in other cities, although many minor deviations occur elsewhere. In Chicago special vacation classes have been provided for crippled children, the deaf, and the tubercular. Here also considerable time is spent in nature study, and the parks are used for outdoor work. Since 191 1 an opportunity has been given to pupils who failed of promotion to review the studies in which they failed. On the whole, the vacation school emphasizes the recreative features and limits itself to those forms of work that supply the play spirit with an opportunity to express itself. Many of its activities closely resemble those carried out on the playground, and to some extent it is substi- tuted for additional playgrounds. It lacks several important characteristics of the playgroimd, however, and is no real sub- stitute. The vacation school has gained a wide foothold and is constantly receiving greater appreciation. 6. School Gardens. In some cities experiments have been made in conducting school gardens. The typical plan of work is as follows : Each garden is divided into small individual plots or class plots ; these plots are used for the growing of plants and vegetables, each child or class attending to its particular plot. A specified time is set aside for the children to cultivate and care for their little gardens, the work being under the guidance of a teacher who is advised by a gardener in respect to certain of the details. Neglectful children lose the right to their plot. The produce raised belongs to the children and may be used by them. They are required to be diligent in their work, keep their plots in good condition, and attend regularly to the instruction given them. The work begins in the spring months, lasts during the summer, and closes in the early fall. The experience with school gardens has been varied, but under skillful guidance children become interested in nature, in plant life ; they develop powers of observation, and capacity for sus- tained effort. On the other hand, if the children are not carefully controlled, the system degenerates into a wasteful expenditure of time. The Germans have been conspicuously successful in 202 PROBLEMS OF CHILD WELFARE school gardening, but American cities have enjoyed a rather limited success. Further experimentation is, however, desir- able. In the coxmtry districts and the small towns practical farming can be taught by the laboratory method and should become successful as soon as competent teachers can be secured. The experiment stations which have been established by many country schools are, however, something more than school gardens. There is no doubt about the advisability of extending and developing them. PART III TRAINING AND EDUCATION CHAPTER I THE MENTAL CLASSIFICATION OF CHILDREN I. Mental Types. The mental classification of children is becoming increasingly important from the educational and psychological point of view. The need of such classification has resulted in intensive studies of the mentality of various groups of children with very valuable results. In consequence we are revising estimates as to the number of feeble-minded and backward children in the United States. The word "feeble-minded" is a generic term and is generally used to include those individuals who are too feeble mentally to be capable of self-support. A wide range of mental types is covered — from the high grade imbecile to the hopeless idiot. The following grades and classes are recognized by Dr. Barr : * 1. The imbecile trainable in three grades; low, middle, and high. 2. The moral imbecile found in all of these grades; trainable only under rigid custodial care. 3. The idio-imbecUe ; improvable as regards cleanly living, and trainable in a very limited degree. 4. The idiot ; except in rare cases and by expensive methods, absolutely imimprovable. The high grade imbecile in this classification is made practi- cally synonymous with the term "backward children" as now defined. The moral imbecile is found principally among the higher types of the feeble-minded and is practically a born crim- inal, but the number in this group is comparatively small. The idiot often cannot stand or sit alone, usually he cannot speak, but • Barr, Mental Defectives, p. go. 205 •2o6 PROBLEMS OF CHILD WELFARE merely mutters some inhuman and unintelligible sounds. A rough classification of the mentally feeble into idiots, imbeciles, morons, and backward children is ample for sociological pur- poses. At a recent meeting of experts in the problem of feeble- mindedness these groups were graded in the following manner : the term "idiot" was made applicable to persons with a mind no more developed than that of a normal two-year-old child; the word "imbecile" was defined as a person with a mind re- sembling that of a normal child between two and seven years of age ; the " moron " was made to include persons whose mentality was equal to that of children from seven to twelve years of age. The moron denotes the highest grade of feeble-mindedness ■ — a type that under proper training can become self-supporting. Above this group is another, known as "atypical" or "backward" but which is not usually included under the term "feeble- minded." It includes all children who are four or more years below their normal grade in school but whose mental capacity is not limited to that of the moron. Some authorities set the limit at three or more years below normal grade. A census of the feeble-minded is very desirable, as the present number in the United States is unknown. The emmieration of 1890 gave 9S,ooo — undoubtedly considerably less than the actual number. In 1904 the Bureau of the Census estimated that there were 150,000 feeble-minded in the United States. The recent application of definite tests so as to make possible a more rigid classification of the various grades of mentality indicates a larger percentage of feeble-mindedness than was formerly conceded. It appears that the natural mentality of individuals is distributed according to an almost regular frequency curve, the great major- ity of individuals being concentrated at a point which, in virtue of this fact, is called normal. Some are above the normal, but very few are found at that point which marks the genius. Below the normal we find first a considerable number of retarded, then the backward, finally the feeble-minded, the least numerous of which are the idiots. Since the causes of retardation and back- wardness are more active than the causes of mental superiority, more persons are below than above the normal.' Goddard esti- THE MENTAL CLASSIFICATION OF CHILDREN 207 mates that there are 300,000 feeble-minded in the United States.' A recent census of the feeble-minded in New Jersey showed 6063 cases — but the census was probably not entirely complete. But at the same rate there would be approximately 225,000 in the United States. Perhaps the proportion of feeble-minded in the relatively new communities is somewhat less than that in the remainder of the United States, yet there can be no doubt but that the total number is considerably above 200,000. Even if this conservative figure is not exceeded, an enormous burden is being placed on the American people. Backward children form a very numerous group. Some of the older studies of subnormal children yielded rather alarming figures. Professor Monroe of Stanford University gathered particulars of 10,000 school children in California and claims to have found about 3 per cent feeble-minded and 10 per cent dull or backward. Dr. Francis Warner, investigating for the English Government, concluded that 7 per cent of the 100,000 school children studied were dull, and that 1.6 per cent were feeble-minded. A recent test by Goddard of 1 547 children in the first six grades of the public schools of a small city disclosed the fact that the mental advancement of the children was repre- sented by a slightly asymmetrical curve: the shorter upper wing indicating exceptional types, and the somewhat larger lower wing, the backward and feeble-minded. The test showed that 15 per cent were from two to three years behind grade and that 3.3 per cent were four or more years behind.^ These results were secured by applying the Binet test and are more definite as well as more conservative than those of the two other investigators. A less scientific investigation made in Philadel- phia by a committee on backward children revealed the fact that about i per cent of the school children were backward. Figures for Cleveland show that 1.4 per cent of the school chil- dren are retarded four or more years. The wide variations shown above indicate the need of addi- tional investigation with the use of accurate tests. The results ' The Survey, March 2, 191 2. ' Report of the National Education Assodation, 1911, p. 871. 2o8 PROBLEMS OF CHILD WELFARE obtained by Goddard are the best indication of the probable number of backward children. A rate of 3 per cent apphed to the school population of the United States indicates that there are about 600,000 backward children. This assumes that the number who dropped out of school because they could not enter the two highest grades maintain a proportion similar to that of the backwardness disclosed in the first six grades. Sociologically these figures imply that this number of children should be given special instruction in separate groups. The magnitude of the problem is at once evident. A more numerous group than the backward children are the retarded. These, however, do not represent a mental type different from the so-called normal children. Their retardation is due largely to social causes. Together with the normal group they constitute the bulk of all children. They are not taught in special schools or in special classes, so the discussion of their problems will be reserved for a later chapter. Another special group consists of the rapid progress type or the exceptionally gifted children. They have received less at- tention than the subnormal groups, so we have but little in- formation in regard to their number. The tests by Goddard to which we have already referred showed that 4 per cent of the children were two or more years ahead of normal grade.^ Fig- ures by the United States Bureau of Education also show that in one-half of the cities studied, 4 per cent of the children were under age. Furthermore, our methods of education reduce the number of children who would otherwise make more than normal progress. In spite of this fact, however, we must expect to find a larger proportion of children below normal than above it. The underaged are not all exceptionally gifted, and the proportion who are distinctly defective is larger than the distinctly gifted class. But we do not know what percentage should be classed as exceptional. It must fall within the number who are above normal grade. Ward estimated the number of talented individ- uals in society as one out of 500, but believed that a proper system of education for women would increase the proportion to • United States Bureau of Education, Bulletin, 1911, No. s, p. 103. THE MENTAL CLASSIFICATION OF CHILDREN 209 one out of every 300.1 jf opportunities are given to all, the num- ber of gifted will apparently increase. Although some of the great leaders of the nation have been ordinary boys while in the public school, it stands to reason that the brightest children, if unhampered, should develop into the able men and women of the next generation. The duty of giving them a chance to do extra work is quite as important as that of favoring the sub- normal. Probably it is far more important. More harm than good is accomplished by blasting the career of one genius and bringing five retarded children up to normal grade. The genius is worth many retarded children, but neither group need be sac- rificed. We need a higher level of intellectual ability and must encourage the children of promise. 2. Causes of Mental Abnormality. Additional study is necessary to determine the comparative iniportance of heredity and of environment as causes of mental subnormality. Roughly speaking, however, the relative influ- ence of heredity and environment varies inversely as the child departs from the normal ; for example, the boy one year behind grade may be entirely the victim of environment, but the boy six years behind is kept back largely by hereditary defect. Conse- quently we may expect heredity to be a much more important cause of feeble-mindedness than of mere retardation. a. Feeble-mindedness, How Caused. The recent studies of the family histories of feeble-minded individuals have disclosed an amazing amoimt of abnormality in their families. In one city a family was found in which had appeared insanity, feeble-mindedness, epilepsy, alcoholism, criminality, and illegitimacy. No doubt but that heredity was a chief cause of these conditions. Older studies, such as that made of the Jukes, do not separate the environmental from the heredi- tary factors, and are no strong proof of the influence of heredity. The cumulative evidence, however, of a large number of cases of feeble-mindedness has great value as an indication of the causes. Dr. Barr has tabulated 4050 such cases, and finds the causes of their feeble-mindedness to be as foUows : ' Applied Sociology, p. 232. 2IO PROBLEMS OF CHILD WELFARE Causes acting Before Birth 65.45 per cent Family History of Idiocy and Imbecility 25.43 per cent Family History of Phthisis 7.60 per cent Family History of Insanity 6.91 per cent Family History of Intemperance . . . 5.75 per cent Other Causes 19-76 per cent Causes acting at Birth 4.59 per cent Causes acting after Birth 29.96 per cent With the exception of 8.89 per cent of the causes, which were classed as abnormal condition of mother during gestation, the causes acting before birth are hereditary influences. The in- fluence of heredity is especially marked in the cases showing a family history of mental defect and abnormality. Undoubt- edly the hereditary factor is also involved in a small proportion of the causes acting at birth and after birth. These statistics therefore indicate that from 60 to 65 per cent of feeble-minded- ness is chargeable to hereditary weakness. An investigation by the Indiana State Board of Charities of 3048 persons comprising 803 families in which feeble-minded- ness occurred in one or more generations, corroborates this con- clusion. Of the entire group 52.3 per cent were distinctly feeble- minded, and an additional 9.4 per cent were defective either mentally or physically. Only 38.3 per cent were normal. The hereditary tendencies are, however, more marked in the families in which feeble-mindedness has appeared in two or more genera- tions. There were 312 such families in the group. Among them inherited defect was apparent in 61.2 per cent of the cases.'- Recent English figures indicate even larger proportions, about 70 per cent of feeble-mindedness being charged to hered- itary causes. The study of the Kallikak family by Goddard furnishes remarkable evidence of a similar nature. The causes acting at birth are of minor importance. Careless physicians, physiological maladjustments, and instrumental deliveries are partly to blame. Feeble-mindedness from these ' Butler, Amos, The Burden oj Feeble-mindedness, National Conference of Charities and Correction, 1907, p. 8. THE MENTAL CLASSIFICATION OF CHILDREN 21 1 sources can be reduced. The causes acting after birth are very important. They are responsible for nearly 30 per cent of the cases of feeble-mindedness. Malnutrition, falls, injuries, and disease are among the causes. To a large extent they are en- vironmental. Attempts must be made to remove them directly, since a program of negative eugenics wUl not afiEect the propor- tion of feeble-mindedness due to other than hereditary causes. b. Causes of Backwardness. Coming to the backward children we find that powerful causes must have operated to retard persons four or more years. Brain defect is undoubtedly an important cause, but this is aggravated by the conditions under which children live and by the physical defects which have been developed by them. Important causes of mental dullness are defective eyesight, defective hear- ing, adenoids, and throat disorders. The defects that increase with the age of the child also aggravate the retardation. Among these are poor eyesight and hearing. In Germany, Dr. Cohn found that 22 per cent of the children in the lower grades had defective eyesight and 58 per cent in the upper grades. Ad- vance in education becomes increasingly difficult under such conditions. In Sweden, Axel Key found a similar problem. At eleven years of age, 6 per cent of the children had defective eye- sight, but at 20 the proportion rose to 37. Among American school children, the proportion is about one-fourth. Much backwardness must be due to this cause, for eye strain and over- taxed attention act directly on the nervous system and make it incapable of producing normal mental activity. The nose and throat affections are powerful causes of back- wardness. They are often accompanied by other defects, so that the results become cumulative. Adenoids often affect the mind and produce a mental sluggishness that leaves the child severely retarded. Their removal has in many instances relieved the brain and accelerated mental activity. The operation, however, must be performed in time or the mind becomes in- capable of recovering from its depression. A physical examination of backward children throws some light on the causes of their retardation. The compilation of the de- 212 PROBLEMS OF CHILD WELFARE fects of 2230 children examined in New York City in 1911-1912 shows that 79.6 per cent had defective eyesight ; the hearing of 70.1 per cent was affected ; 65.4 per cent had defective teeth ; 48.2 per cent had throat trouble; 41.5 per cent suffered from defective speech ; and 39 per cent had adenoids. In all, these 2230 children had over 11,000 defects — - nearly 5 per chUd — as contrasted with an average of about i per chUd among normal school children. A large number also suffered from malnutri- tion. Of the atypical children examined in 1908, 60 per cent were misfed. The large number of physical defects from which backward children suffer are, no doubt, responsible for a con- siderable share of their retardation. Even the child with a normal mind and brain could not withstand the onslaught of so many physical defects. And the clinic has demonstrated the close connection between dullness and defects. Such illustra- tions as the following corroborate this fact : a boy brought to the psychological clinic conducted by Dr. Witmer was thought to be feeble-minded. He was found to be badly in need of dental care; certain teeth were extracted, and a wonderful improvement followed. Another boy was burdened with deafness and adenoids. He was relieved and improved at once. Dullness also results from a feeble condition of the nervous system, and many causes operate to affect the nerves. Among them are malnutrition, excitement, overwork, etc. Dr. Francis Warner claims that 9 per cent of 50,000 London school children whom he studied showed abnormal nerve conditions. Such conditions are, however, themselves effects and we must search farther to ascertain the ultimate causes responsible for arrested mental development. Poor physical conditions easily affect the mind, therefore causes of physical deterioration are causes of mental retardation. Poverty is no doubt an important factor. A cause of continued defect is the discouragement that comes when slightly deficient children try to keep up with brighter schoolmates and fail. Since they cannot receive special atten- tion, they lose courage and fall farther behind. Absence from THE MENTAL CLASSIFICATION OF CHILDREN 213 school for whatever reason is probably the most common cause of retardation, and while this is not strictly backwardness, it often appears so, and when sufficiently pronounced amounts to the same thing, because the child lacking early training is not so apt and active in mind as is the normal child. Hereditary weakness is responsible for much backwardness. Especially is this true of the more serious cases. But physical defects and the unfavorable conditions under which many children live bear so heavily upon them that the slightest in- herited defect has cumulative consequences. Passing over the normal groups or the great majority of chil- dren, we come to that small proportion possessing exceptional mental characteristics. These children owe their advantages to one or more of the following causes : (i) Hereditary Influences. (2) Variations from Parental Types. (3) Training. Investigation has shown that exceptional ability frequently runs in families. This fact, however, does not make heredity the sole factor responsible for the advantage. The social en- vironment has no doubt operated to produce good results. The genius has not yet been explained. Frequently his ofEspring are most mediocre ; seldom do they rise to his level of mentaUty. He seems rather to be an accidental variation — a departure from the expected distribution of mentality in a family. If so, his progeny tend to revert to the ancestral type. From the eugenic standpoint, therefore, we cannot hope for a more rapid mental improvement of the race through the children of the genius than through the remainder of the group possessing exceptional natural ability. In fact, the progressive variation from a type is more likely to reproduce an equally capable ofispring than is the radical and fickle variation, which has found no rational ex- planation. The latter often produces a genius in one generation and defectives in the next. The environment of very young children often develops a precocity which makes their mental age exceed their physical age, but this exceptional condition is not inherent and cannot be made permanent except by subject- 214 PROBLEMS OF CHILD WELFARE ing each generation to similar influences. Racially no gain has been made, but if a continuously favorable environment is as- sured the results are quite as secure. Without doubt the great majority of exceptional school children have been affected by both hereditary and environmental influences. CHAPTER II EDUCATION OF EXCEPTIONAL CHILDREN I. Need of Classification of Children. The first step in a program of education for the mentally subnormal groups consists in testing and grading the mentality of the children. In this way the mental age of a child will be discovered and the plan for his education will be simplified. Such tests should be made of all backward and defective chUdren coming under the notice of the school authorities, of the children sent to institutions for defectives, and of all delinquents brought into the juvenile courts. A special test should be made of those sent to reformatorj' institutions. A wide-awake attendance department of the local school system will discover every child of school age regardless of mentality, and each doubtful case will then be referred to the proper school officials for examination. If the Binet test or some similar test is applied, the child will be properly classified as to mentality, and steps can then be taken to assign him to the institution or t3fpe of school to which he belongs, if suitable facilities for such disposition are available. The work of the educational authorities of Cleveland serves as an illustration : In 1912, 1281 chUdren of doubtful classification were examined by a psychological expert. Of this number 469 or 36.5 per cent were foimd to be feeble-minded, 281 or 22 per cent were back- ward, while the remainder were slightly retarded or normal. In Chicago the Department of ChUd Study and Educational Re- search, organized in 1899, carries on similar work, but includes other defective groups. Many cities have made a beginning in the study and examination of their backward and defective children. Adequate facilities for mental tests in the cities wiU result in the development of educational provision for the group that can be successfully handled by the school authorities. 21S 2l6 PROBLEMS OF CHILD WELFARE Bulletin, 1911, number 14 of the United States Bureau of Education classifies exceptional children in respect to adminis- trative oversight, education, and care.^ Although both the physically and the mentally defective are classified by the Bureau, only the latter group will be included in the classifica- tion that follows : Institutional cases, to be dismissed from care and oversight of school authorities; insane and demented children, feeble- minded, below middle grade imbeciles, high grade moral im- beciles, and epileptics. Cases for special instruction in schools ; backward but capable of restoration to normal grade, dull, retarded through physical defects, and the gifted. Uncertain classification ; high grade imbeciles, feeble-minded above this grade, and mild cases of epilepsy. From the administrative point of view these groups contain three definite types of children : first, the untrainable ; second, those trainable to some degree, but needing constant super- vision and oversight ; third, the group capable of considerable training and of partial or even complete self-support, and not needing institutional care. The duty of the public school and of the state directly to these groups is determined largely by the conditions which underlie this classification ; that is, the grade of mentality. The state is justified in supporting individuals if necessary, and also providing training ; the schools give institu- tional care only to groups that can be restored to normal condi- tions, such as truants and delinquents. 2. Care of the Idiot. Beginning with the lowest groups we have the idiots and other untrainable classes which need institutional care and protection. Accordingly it is not the function of the school to deal with this class of defectives, but it is the duty of the state to place them under custodial care. For this purpose every state needs one or more institutions. According to the best estimates only a small proportion — perhaps one-third — of the feeble-minded are in institutions at the present time, although the percentage ' Pp. 21-22. EDUCATION OF EXCEPTIONAL CHILDREN 217 of idiots given custodial care may be larger because of their helplessness and the trouble they cause in private homes. Since they are incapable of self-support, cannot be trained, and may become a public menace, they should be permanently committed to a state institution for the feeble-minded. This applies es- pecially to women, who otherwise frequently become the mothers of illegitimate and feeble-minded children. 3. Education of the Feeble-minded. The trainable groups should be educated as far as their capacity allows. If, however, they cannot become self-sup- porting, they will also need institutional care. Furthermore, they are a greater racial menace than the idiots, because they are more likely to indulge in sex irregularities. They are very pro- lific, and the women are the constant prey of the immoral men of the communities in which they live. For this group, again, the state must make provision. Colonies for the feeble-minded should be established, and training provided for every inmate capable of making advance. The first attempts to educate the feeble-minded were made in France by the physician, Itard, and the physician and educator, Seguin. The latter experimented for many years, and finally in 1842 he began to train a small class of feeble-minded children. His method was given to the world, and in a few years training schools for the feeble-minded were established in various coun- tries. These schools also provided institutional care, but de- tention was not made permanent. Massachusetts was the first American state to establish a school, which dates from 1849. The larger and more populous states have estabhshed similar institutions, several of them each having more than one, but in 1912, 24 of the 49 states were still without public institutions of this kind. In all there were 33 state schools and 20 private schools, some of the latter being in states making no public provision for the feeble-minded. In all of these institutions children are divided into two groups : the trainable and the un- trainable. In 1912 the state schools reported 21,357 inmates, 62 per cent of which were neither in school nor in kindergarten ; that is, were incapable of literary instruction. Many of these, 2l8 PROBLEMS OF CHILD WELFARE however, were being trained in the industrial departments of the school. A very small percentage of all the children attained the equivalent of a fifth grade education. The private institutions are very small, and in 191 2 contained only 749 inmates, and they are therefore of but little aid in the training of the feeble-minded, but the majority of their inmates belong to the trainable class. Nineteen states have neither public nor private provision for the feeble-minded, who, if given any care at all, are confined in alms- houses, asylums, children's institutions, etc., where they re- ceive no training adapted to their needs. In attempting to educate the trainable imbeciles and morons, several principles are observed. Careful attention is given to the amount and quality of food consumed by the inmates, since the development of the body reacts profoundly on the mind. Adequate medical care is provided so as to enable every organ of the body to function to the best advantage. Exercise and outdoor recreation are used as a physical and mental tonic. Fresh air invigorates and stimulates. Manual training and the correlation of hand and brain, or the development of the brain through the hand, furnish the best methods of education. Industrial classes are considered the best supplement to manual training. The development of individual aptitudes and of capacity along the lines of least resistance is the most promising ideal of train- ing. Class work is imgraded, so as to allow every inmate to progress as rapidly as he can. The inability of the state to provide institutional facilities for all of its feeble-minded necessitates an extension of the work of the public schools to include the education of the most ad- vanced children of the moron type. Such children can be gathered at the most convenient centers for individual instruc- tion in day schools. Many can come to the schools unattended and can go about without danger to themselves. The only hope of educating the bulk of these subnormal children under EDUCATION OF EXCEPTIONAL CHILDREN 219 present conditions lies in the widening functions of the schools. In many cities where special provision has been made for back- ward children, some provision is also made for children of this lower type of mentality. In 1911, out of 898 cities reporting to the United States Bureau of Education, 94 maintained schools or classes for defective children, most of these cities being lo- cated in the North Atlantic and North Central states. Unless eugenic considerations forbid, the public schools can well supple- ment the work of the state. 4. Education of Backward Children. The education of the backward children is a problem of special importance because of the large number of children involved. It is distinctly a question to be solved by the public school, for these children have an undoubted right to an education. a. Methods of Providing for Education. Backward children can be handled in several ways. In the first place they may receive individual help from teachers em- ployed for this special purpose. The ordinary teacher has not time to devote to children who cannot remain abreast of their grade, because of the volume of work that devolves upon her. Consequently many children, when once retarded, fall farther and farther behind. This difl&culty can be met, in part, by a plan of individual instruction and help such as the so-caUed "Bataviaplan," which consists of the employment of additional teachers to assist the backward pupils. Under certain conditions this plan has been successful, but its application has been largely limited to assistance for the retarded rather than the backward. The latter group really require a different variety of instruction from that given in the regular classroom ; special aid in school work, therefore, does not solve the problem. In a number of cities, however, special teachers for this purpose are placed ki the schools where individual instruction is most necessary. The second method of care is through the special class for backward children. Instruction adapted to the children can be provided, and teachers specially trained for such work can be secured. The plan does not involve the expenditure of money for a building equipment and the playgrounds can be used by all. 220 PROBLEMS OF CHILD WELFARE Furthermore, classes can be established whenever needed, and it is claimed that parents are less reluctant to send their children to special classes than to special schools. Besides, the children enjoy the advantages which come from association with normal children, while the latter probably do not sufier from the con- tacts. On the other hand, children soon learn the distinctions involved in the establishment of special classes. Accordingly the backward will sufEer from the taunts and gibes to which they will be continually subjected. Such treatment tends to dis- courage and to demoralize them or to arouse resentment. New York City adheres strongly to this plan, but conditions differ widely from those obtaining in smaller and less congested cities. The third method consists of the establishment of special schools. This plan is the most expensive, because it necessitates special buUding and playground equipment, and the schools are also less accessible to children. This frequently involves car- fare, the cost of which in some cases is borne by the school authorities. Furthermore, many parents do not want their children to attend these schools. On the other hand, this plan results in the most satisfactory adaptation of the work to the needs of the pupUs, since the special school exists for one purpose only — the education of backward children. The problem is therefore likely to receive more attention than if some other plan is followed. The associations of the children are whole- some, and they compete with each other for advancement; classes are purposely kept small, and individual instruction is given. This plan of education for backward children is most in favor at the present time. b. History and Extent of the Movement. On account of the large number of backward children, the development of special provisions for their training is particularly important. . As usual, the work began abroad, special classes for mentally deficient children being established in Germany in 1867, while Norway followed in 1874, and England, Switzerland, and Austria in 1892. In Prussia since 1880 special schools or classes for defectives have been required in all cities having a population of 20,000 or more. EDUCATION OF EXCEPTIONAL CHILDREN 221 The German system is not uniform, some cities having special schools, others contenting themselves with special classes for these children. The first special class in England was opened in 1892. A low tj^e of backward children were allowed to enter, so the results have been far from satisfactory. Nevertheless, the large English cities have established special schools for the care of this class of chUdren. • The laws of 1899 and 1902 required the local educational authorities to provide for the mentally defective children. Many children are therefore maintained as well as educated. In igo8 the Royal Commission on the Feeble- minded recommended that the school authorities give up the plan of providing for mentally defective children, and that the responsibility for the defective of all grades and of all ages be centralized in a separate body. This signifies opposition to con- trol by the schools over the lower grades of defectives, but the best grade of backward children are not affected, and for them special provision by the schools is gaining ground. In 1908 London operated 27 centers for their training. In the United States, Providence, Rhode Island, first took up the work for backward children. In 1893 three schools for special discipline and instruction were organized and made a part of the public school system. Backward children were tried in these disciplinary schools, but it was soon discovered that treatment suited to mischievous boys was not suited to slow- minded children. Accordingly, in 1896 a special class for the latter was opened. Others have been added since, and marked success has been achieved in the training of the children. The first special class in Boston was organized in 1899 and furnished the impetus for the work there. Only improvable children are accepted, and cases recommended by school prin- cipals are examined by a medical expert before admission. Each school district also maintains an ungraded class, which, however, is practically limited to retarded or immigrant children. The work in Philadelphia was prompted by the activity of local social agencies through whose efiorts a private school for the educa- tion of backward children was organized. In 1901, however, a special class was established in one of the public schools. For 222 PROBLEMS OF CHILD WELFARE some years the backward and incorrigible were taught in the same buildings, although they were placed in separate classes. A complete differentiation has finally taken place. In New York City considerable attention has been given to the dull and backward children, and special classes, but not spe- cial schools, have been established for them. Eack year the doubtful cases are referred by the school principals to the exam- ining physicians who ascertain their mental condition, and also the physical defects from which they may be suffering. Certain grades and types are then assigned to the special or imgraded class. In 191 2 the city had authorized 142 special classes with a membership of 2253 children. Three-fifths of the schools have proposed children for the special classes, and according to the present policy of the Board of Education such classes will even- tually be provided for all schools needing them. The schools proposing children have averaged 11.8 persons per school — a class of convenient size. St. Louis has established 13 special schools for the backward. These schools are ordinary two-story residences rented for the purpose and located at the points of greatest convenience. Transportation is furnished to children living at a distance. These examples of provision for backward children sufficiently illustrate the method of development. In the following table is summarized the extent of such provision in American cities in 1911.' Ahea Cities Reporting Cities having Classes for Backward Children Number Per Cent United States North Atlantic South Atlantic South Central North Central Western 898 370 60 90 322 S6 220 97 IS 18 70 20 24-S 26.2 25.0 20.0 21.7 35-7 1 United States Bureau of Education, Bulletin, igii, No. 14. Provision for Exceptional Children in Public Schools, pp. 32, 34. EDUCATION OF EXCEPTIONAL CHILDREN 223 These figures show that the various geographical sections do not vary widely from each other in regard to the proportion of cities making special provision for backward children, with the exception of the Western cities, which rank highest. Less than one-fourth of all the cities reporting have made any provision whatsoever. Probably in no large city have adequate facihties been provided as yet for this unfortxmate class of children. c. Principles of Care and Training. The first generally accepted step in the handling of backward children is their separation from the normal group ; otherwise the education of the normal classes is greatly handicapped. Teachers are usually kept busy with their regular work, so the subnormal child is neglected. He is soon discouraged and drops out of school with no preparation for life and with little or no capacity for self-support. The removal of the chUd from his grade should follow one or two failures, provided, of course, that there has not been some valid reason for his defection. Germany has a wise system of admission to special classes. If after several trials children faU to advance with the regular grades, they are visited in their homes and then sent to the special classes on trial. After a few weeks a committee, consisting of inspector, school doctor, and teacher pass upon their fitness to remain. If after a fair chance, backward children fail to respond to special class instruction, they should be placed in institutions and their places given to others who might profit by the opportunity. Just as the dull chUd must be taken from the regular grades, so the feeble-minded child must be taken from the special classes. He is the same menace there that the backward child is in the ordinary schoolroom. In the second place, medical attention is most urgent. Be- sides the initial medical examination to detect defects, regular in- spection must be made. Physical defects are so often the primary or contributory causes of backwardness that their removal would at once stimulate the child to vigorous mental develop- ment. Wholesome nutrition should also be required, as mis- feeding is an important factor, and nurses should be assigned to these classes or schools to attend to the hygienic and medical 224 PROBLEMS OF CHILD WELFARE needs of the children. Good results have been accomplished by such methods, but, on the other hand, the value of medical care is often exaggerated. A study of 600 backward children in London indicated that only 16 per cent were retarded because of physical defects or ill health, and in a small proportion of additional cases the defects were regarded as contributory causes.^ Ungraded work and individual instruction are necessary here, as in the case of the feeble-minded. Classes should be limited to 15, and no school shoidd contain more than three or four classes. Such an arrangement brings together a sufficient number of children to allow an economical use of material equip- ment and to reduce to reasonable limits the per capita cost of maintaining the building. A corps of trained teachers for this work is specially necessary, the training gained by teaching in schools for the feeble-minded being exceptionally valuable. Kind, patient, optimistic women probably excel in this service. The German plan of employing men is not regarded as so satis- factory. The class work is based on the theory that the training of the hand arouses action in the brain. Accordingly, emphasis is placed on sloyd, clay modeling, basket weaving, sewing, and raffia work, and in addition, for the girls, various branches of domestic science. Games are emphasized, and children are taught to play. Nature study is a valuable part of the curricu- lum in some of the New York schools. On the whole, the work of these classes must be such that it will invigorate the body and stimulate the mind so as to awaken the dormant faculties. d. Results. WhUe attempts to train backward children have resulted in their improvement in a large proportion of cases, the develop- ment of capacity for self-support is more doubtful. German experience has shown that about 83 per cent of these children are able at the end of school age to secure employment requiring little skUl, and can in time become partly self-supporting. Some will be able to maintain themselves. The care of the remaining ' Hogarth, A. H., Medical Inspection of Schools, p. 51. EDUCATION OF EXCEPTIONAL CHILDREN 225 17 per cent is more of a problem, and without doubt the majority should eventually be transferred to institutions. In Birming- ham, England, where an after-care committee has kept careful record of pupils of special classes, about one-third of the cases followed have been reported as wage-earners, but only a smaU. percentage of them were self-supporting. About 38 per cent seemed to require permanent protection and at least partial sup- port. Many of the children in the English special schools, how- ever, belong to the moron type. No American statistics relating to the economic efEects of special training are available. The figures for a number of cities show that a small proportion can be returned to regular classes ; for example, in 1912 Chicago returned 10 per cent of the children from its subnormal divisions, and New York promoted 8.6 per cent of the children in the ungraded classes. Usually when the pupUs become 16 years of age they drop out of school and are lost to the school authorities, and while a small proportion enter industry, little is known of the remainder. "After-care com- mittees" are needed to assist them and counsel with them so as to increase their opportunities. e. The Montessori Method. The Montessori method of educating children was developed by Madame Montessori, an Italian physician, through her ob- servations and experiences in educating backward children. She adapted many of the principles developed by Seguin and by Froebel. She believes in the education of the senses, with es- pecial attention to the sense of touch, which she believes has been neglected. She trains children to do the hosts of ordinary tasks of daily life in a scientific way. This leads to early control of the muscles and to symmetrical physical education. She would do away with repression and irksome discipline, thinks children should not be restrained except when their activities interfere with the rights of others, and believes much in individual initia- tive. She lets her pupils sit or lie or assume any comfortable position to do their self-selected tasks. Self-expression and in- dividuality are encouraged, and the rather complete sets of ap- paratus used in the Montessori schools are designed to teach, Q 226 PROBLEMS OF CHILD WELFARE through practice in doing well, the ordinary duties and tasks. For example, through working with their sets of buttoning and lacing flaps, children learn to dress and undress themselves and younger brothers and sisters. In order to teach chUdren these very elementary things they enter the schools at a very tender age. In short, the Montessori method directs the play impulse to useful activity ; develops the sense organs, thereby stimulat- ing the brain ; adapts the principles of home life to school life ; permits the child to follow his own inclinations ; and employs the prosaic duties of life for educational purposes. 5. Facilities for the Gifted. It is imfair to the exceptionally gifted to hold them back by the ironclad classifications of the ordinary grade schools. The psychological effects on children of lingering in grades that they have outgrown is distinctly bad, and opportunities must be given them to make special progress. In an efiEort to meet this need, 54 cities in the United States in 191 1 had developed some plans for the advancement of this group of children. Most of these cities were located in the North Atlantic and North Central states. This work is new and unsettled in character, but follows several general lines, of which the following are representative : first, flexible grading, reported by Baltimore, Cleveland, and other cities, by means of which pupils of like ability are placed together in slow and fast grades. The fast classes are larger, do more extensive work, and cover a wider range of facts. Second, many schools divide the year into three or four parts, and the especially gifted are able to skip an occasional part year. A third plan is that of organizing special classes at the beginning of the seventh or eighth grades to take up high school work. Indianapolis has a scheme of this sort by means of which chUdren strong in mathematics and language, for example, may exchange their eighth grade work in these branches for high school algebra and Latin, thereby securing a half year's credit in advance of their grade. Lincoln, Nebraska ; Rochester, New York ; Worcester, Massachusetts, etc., report work of this kind. This work though quite as important as the work for backward children does not EDUCATION OF EXCEPTIONAL CHILDREN 227 constitute so grave a problem because gifted pupils are easily taught and are not in such need of special methods and unusually trained teachers. They usually need merely to be put in advanced classes and kept busy. It is most important, however, that this slight and inexpensive provision be made for them. CHAPTER III SOME SOCIAL ASPECTS OF EDUCATION I. School Attendance. The need of an education is now regarded as fundamental ; accordingly, most children of proper ages attend school. In the United States the public school system has enjoyed a wide de- velopment and has been a tremendous factor in the training of the youth of the land. It has no equal as an educational insti- tution, although it has shortcomings and must be improved. The rapid trend toward compulsory attendance laws means a larger task for the schools as well as improved education. In 1910 there were in the United States 27,750,599 persons between the ages of 6 and 20 years, inclusive, and of this number 62.3 per cent, or nearly two-thirds, attended school. In all of the states, except 10 Southern states and Arizona, the percent- age exceeded 60. School attendance is much heavier among children from 6 to 14 years of age than at any other time. The distribution of school attendance according to various age groups for the years 1909-1911 is shown in the following table.^ School Attendance in the United States Percentage of Children Attending School All Classes White Colored All Classes Under 6 years .... 3-1 6-20 years .... 62.3 64-5 47-3 68.0 6-9 years .... 73-S 77-2 49-3 80.1 10-14 years .... 88.2 91. 1 68.6 96.1 15-17 years .... SI. 2 52.4 4I-S SS-8 18-20 years .... 15-2 iS-7 II. 7 16.6 ^ Thirteenth Census of the United States. Abstract. * Report of the Commissioner of Education, 1912, Vol. II, p. xiv. 228 SOME SOCIAL ASPECTS OF EDUCATION 229 These figures show that the very highest percentage of school attendance occurs among the 10-14 year group, and they also indicate that the percentage of school attendance is much higher for 191 1 than for the preceding year — a fact no doubt due to better compulsory attendance laws. More than 90 per cent of the children of the age 10-14 years are in school. A smaller pro- portion of the yoimger children attend school, since many do not begin imtU they are seven or eight years old and compulsory attendance laws usually fix the lower limit at the seventh or eighth year. In most states or cities where education is com- pulsory the law applies to the children until they reach 14. At 14 many children enter industry, and only slightly more than one-half of those from 15 to 17 years old attend school. Of those from 18 to 20 about one out of six still attends school. The situation is much better for the white children than for the colored, this being due partly to the absence of compulsory attendance in many parts of the South and partly to the meager attention paid the negro child. In 1910 of all children aged 6 to 14 years, 81.4 per cent attended school, but the proportions for colored were only 59.7. In such states as Massachusetts, New York, and Illinois, however, negro children showed a per- centage almost as high as that for white children, but in the Southern states the relative proportion was much lower. And yet the percentage of attendance has been gratifying, and indicates progress. In regard to nativity it appears that the maximum attendance of children 6 to 14 years of age occurred among native whites of foreign parentage, followed by native whites of native parent- age, and then by the foreign born. The order is not imiform in the various states, however, in some the highest proportion of attendance being found among those of .native extraction. Again for each of these groups the Southern states show the least promising results. Of the fifty cities having 100,000 population or more, 23 had a higher proportion of attendance from children of native than of foreign extraction ; in 27 the converse was the case ; and in 4 the foreign born excelled the native group. Rural and urban districts showed little difference in respect 230 PROBLEMS OF CHILD WELFARE to the proportion attending school, when the entire population from 6 to 20 years is considered. The subgroups, however, are very unlike. Considering the entire group, it appears that in 1910 in the rural districts 62.9 per cent attended school; in the cities 61.6 per cent. For children 6 to 9 years of age, the pro- portionate attendance in cities was 13 per cent higher than in the rural districts but for children from 15 to 20 the proportion for the rural districts was 10.5 per cent higher than for the cities. Cities predominate in sending small children to school; the rural districts, in sending larger ones. These figures, however, do not relate to the average length of attendance, but only to the number of children who have attended school at some time during the year. The average number of days that children attend school during the year furnishes an indication of their actual educa- tional advantages. In 191 1 the average length of the school term was 156.8 days — a decrease of 1.7 days from the preceding year. The figures for the different states vary widely, from 92.8 days in South Carolina to 194 days in Rhode Island. If 180 days be accepted as the standard length of a school term, then only six states and the District of Columbia exceeded the stand- ard. The Commissioner of Education regards 1620 days of school attendance by the child during the years from 6 to 16 as a reasonable requirement ; that is, 90 per cent of the possible attendance for ten years on the basis of the standard school term.' Measured by the actual attendance of children in 1911, the children of South Carolina received only 34. i per cent of the needed education. In 12 states they receive less than one-half, and in no state does the average attain the standard, but in 17 the attendance exceeds 1200 days. These facts indicate the ex- istence of two very serious evils ; an unduly short school year, and a large proportion of non-attendance. In spite therefore of the high proportion of children attending school, unless the average period of attendance is considerably longer, children are not being adequately prepared for the problems and duties of life. Some of the low averages do not even reveal the worst ' Op. cit., pp. xix-xxi. SOME SOCIAL ASPECTS OF EDUCATION 231 conditions, because the cities raise the average for a state, the school year in the rural districts being usually shorter than in the cities. 2. Illiteracy. The test of our educational system depends primarily upon the degree of education actually imparted, not upon the proportion of children attending school nor upon the average number of days attended. A considerable group of children evade our schools entirely and remain illiterate. They indicate the extent to which American public opinion fails to support the minimum standard. The success and failure in meeting this low ideal are best measured by the actual illiteracy among our native white population over 10 years of age. Many adult foreigners are illiterate, and they should of course be excluded from our com- putation. So with the negro. In the following table are pre- sented rates of illiteracy for persons 10 years of age and over, for children 10 to 14, and for urban and rural districts."^ Percentage of Persons 10 Years of Age Children 10-14. Persons 10 AND OVER. Percent- Percentage Years of Age Class of Population age Illiterate Illiterate AND over Illit- erate, 1910 1910 1900 1890 1910 1900 Urban Rural Total 7-7 10.7 13-3 4.1 7-1 S-i lO.I White S-o 6.2 7-7 1.8 3-S 4.2 ,S-8 Native white of native parents 3-0 S-7 7-S 2.2 4.4 0.9 S-4 Native white of foreign parents I.I 1.6 2.2 0.6 0.9 0.7 1.9 Foreign born . . 12.7 12.9 I3-I 3-5 S-6 12.6 13.2 Negro 30-4 44-S S7-I 18.9 30.1 17.6 36.1 Illiteracy is being gradually reduced, every class of the popu- lation participating in this gain; yet 5,516,163 UUterates were enumerated in 19 10 in the United States. More than 3,000,000 were whites, of which slightly more than half were of foreign birth. Native whites of foreign or mixed parentage yielded the ' Abstract o{ the Thirteenth Census of the United States, pp. 239 £E. 232 PROBLEMS OF CHILD WELFARE lowest percentage of illiteracy in both age groups as represented above, and in urban and rural districts as well. This superiority of the native born of foreign extraction is largely apparent, being due to their location in cities and states where compulsory edu- cation laws are in force. Many persons of native parentage live in localities not reached by such laws. In the cities the difference in the proportions between persons of native extrac- tion and those of native birth but foreign parentage is reduced to two-tenths of one per cent. In the rural districts the dif- ferences are greater, due in part to the absence of educational opportunities in the South, and to the poverty of certain parts of the section where the population is almost exclusively of na- tive extraction. A comparison of the proportion of illiterate males 21 years of age and over in the 50 cities having 100,000 inhabitants or more in 1910 shows that in 28 the native whites of native parents had a lower percentage of illiteracy than did those of foreign parent- age ; in 1 5 the rate is lower for the latter ; and in 7 the propor- tions are equal. In most cases the differences were very slight. The figures indicate that local conditions rather than race or nationality are principally responsible for these differences. Five per cent of the white population 10 years of age and over are illiterate. The rate in rural districts for whites is slightly higher than in cities, but the census enumeration shows that the rate for native whites in the cities is only one-sixth as high as it is in the rural districts. The high percentage of ilHteracy among the foreign born tends to equalize the rates between country and town. Among the negroes, however, rates are very high in the country, due largely to the absence of schools and of compulsory attendance. The comparatively high rate for the native whites in rural districts is caused principally by heavy illiteracy among the moxmtain people of the Southern states, where from 15 to 19 per cent of the rural population are illiterate. In the Central West the rates are approximately 3 per cent, and in a number of states the illiteracy of native whites of native parentage 10 years of age and over is less than one-half of i per cent, but in Louisi- ana and New Mexico it rises to 15 per cent. Taking all classes SOME SOCIAL ASPECTS OF EDUCATION 233 of the population, the smallest percentage of illiteracy is found in the following states : Iowa, Nebraska, and Oregon. In these states it is less than 2 per cent. The very low rates of illiteracy among children 10 to 14 years of age in the East and North indicate that good laws can almost eliminate illiteracy. The rather high rates for the United States as a whole depend upon three groups of our population : first, the foreign born, a large proportion of whom are illiterate adults who do not acquire an education after arriving in the United States ; second, the native whites of the backward and moun- tainous regions of the South, where educational facilities are in- adequate and the people are poor ; third, the negroes, who re- ceive less attention than do the whites and who have little oppor- tunity for education in many of the states. Most of the North European countries excel the United States in the reduction of their illiteracy. This is especially true in Germany, where the army recruits number only 11 illiterates per 1000 soldiers, but in South and East Europe an enormous amount of illiteracy prevails. The race composition of the American people makes comparison with foreign countries un- fair. 3. Distribution of Children in Grades. It is impossible to secure data in regard to the actual grade attainment of American school children. Therefore we do not know the average degree of education acquired. Even though our illiteracy be small, unless the literate can make practical use of their education, the gain is not great. On the following page is presented the estimated grade distribution of school children in 1911, for the United States and for a number of selected cities.* The estimates for the United States as a whole show a remark- able shrinkage in the proportion of children in the higher grades. This is due to the larger number of children in the lower age groups, to the elimination of children by death, to retardation, and to the gradual dropping out of school by the older children. • Report Commissioner of Education, 1912, Vol. I, p. xv, also United States Bureau of Education, Bulletin, rgii, No. 5. Age and Grade Census of Schools and Colleges. Percentages for cities computed from tables. 234 PROBLEMS OF CHILD WELFARE Estimated Grade Distribution of School Children in 191 i Estimate Grade roE United Minne- apolis Si. Loins Toledo Spokane States Per cent Per cent Per cent Per cent Per cent First 24.9 17.8 18.4 I7-S 18.1 Second . 14.9 12.8 16.2 14.4 14.0 Third . I4-S 12.4 lS-4 ^3-9 13.2 Fourth . 14.0 12.9 IS-O 14-3 13-3 Fifth . II.9 12.8 12.3 13.2 12.8 Sixth . 8.2 11.6 9.4 II.o 1 1.4 Seventh 6.3 10.4 7-4 8.8 9.6 Eighth . 5-3 8.6 S-7 6.7 7.6 The differences in the grade distribution among the various cities as shown above indicate that these influences act with varying intensity in the different localities. They also indicate that, in spite of the natural reduction in the higher grades through death, retardation, and dropping out of school, there are other important causes of these conditions. Professor Thorn- dyke made the following computation in regard to elimination. Out of 100 children entering school, 90 remain to grade 4. 81 remain to grade 5. 68 remain to grade 6. 54 remain to grade 7. 40 remain to grade 8. 27 remain to first year high school. 17 remain to second year high school. 12 remain to third year high school. 8 remain to fourth year high school. He foimd the widest differences among cities, however. According to his computation 47 per cent of the Boston school children entered the eighth grade, and 14.4 per cent did so in Baltimore.' Ayres in his study of 58 cities finds a smaller ' Thomdyke, E., Elimination of Pupils from School (United States Bureau of Education, Bulletin, 1907, No. 4). SOME SOCIAL ASPECTS OF EDUCATION 235 amount of elimination, but his percentages are computed from a base consisting of the average yearly memberships for children 7 to 12 years of age. Strayer claims that there is but little elimination during the first four grades, but a considerable amount afterwards. Omit- ting the repeaters, the percentage of boys in cities of 25,000 and over who enter the sixth grade is represented by a median of 73 per cent ; that is, in one-half of the cities less than this per- centage enter the sixth grade, while in the remaining half the percentage is larger. The figures for those entering the seventh grade are represented by a median of 55 per cent, and for the eighth grade by 42 per cent."^ If the median and simple average tend to coincide, then Thorndyke and Strayer show very similar results. The study of a ten-year period in Cleveland indicates that 48.23 per cent of the children enrolled in the first grade reached the sixth, 36.29 per cent reached the seventh, and 25 per cent the eighth.^ The results show a higher proportion of elimina- tion than that given in the foregoing figures. During the federal investigation of woman and child labor in 1907-1908 a study was made of the retardation and elimination of school children in six selected cities. In the following table is given the percentage of children leaving school before reaching the fifth grade in the five cities for which these specific facts were obtained, also the percentage of the total enrollment who gradu- ated from the grammar school.^ Cities Percentage of THE Enrollment Graduated Pawtucket, R.I. . . . Columbus, Ga. . . . Columbia, S.C. . . . Plymouth, Pemisylvania Hazleton, Pennsylvania . 3-1 S-3 4-3 1.6 5-8 1 Strayer, G. D., Age and Grade Census of Schools and Colleges (United States Bureau of Education, Bulletin, igii. No. s), p. 136. 2 Report of Cleveland Board of Education, igio, p. 41. ' Woman and Child Wage Earners in the United States, Vol. VII, pp. 300-302. 236 PROBLEMS OF CHILD WELFARE In these cities less than one-half of the children entered the fifth grade, and many dropped out before reaching the age of 14. Serious elimination is also indicated by the fact that so small a proportion of the children enrolled were graduated. Better en- forcement of attendance laws has no doubt reduced the elimina- tion of pupils since this investigation occurred. In the larger cities likewise the conditions are probably considerably better; still an enormous number of children drop out of school after the fifth grade. In many cities the number of eighth-grade pupils equals about one-twentieth of the total enrollment, thus indi- cating an enormous shrinkage in the student population. 4. Retarded and Underaged Children. Children who are not more than three years behind their nor- mal grade are retarded, but are not usually considered backward. Children who are in advance of their normal grade, on the other hand, are not considered gifted unless they are exceptionally bright. In every city we find a considerable percentage of the children varying from the normal either favorably or unfavor- ably. Strayer summarizes the extensive study of retardation made by the Bureau of Education with the table on the following page, which covers 133 cities of 25,000 population and over and 186 cities of less than 25,000 population.* These figures indicate that more than one-third of the children are retarded but only about 4 per cent are above normal grade. More than half of the retardation, however, is found in the group who are not more than one year over age. Still retardation is many times as heavy as rapid promotion. The percentage of retardation varies from less than 10 per cent in certain Massachu- setts cities where children begin school at five or six, to more than ^ Age and Grade Census of Schools and Colleges (United States Bureau of Educa- tion, Bulletin, 1911, No. 5), p. 103. Normal Grade as used above may be described as follows : a child of six or seven should be in the first grade, of seven to eight in the second, etc.. Median Percentage signifies that in one-half of the cities studied the proportions were less than the figures given and that in the remaining half they were higher ; for example, in one-half of the cities of the first group there were less than 56 per cent of the boys in the normal age group and in the remaining half there were more than this proportion. SOME SOCIAL ASPECTS OF EDUCATION 237 Median Percentages for Normal Aged, Overaged, and Underaged Children Cities or over 2S,ooo Cities of less than 25,000 Boys Girls Boys Girls Normal 1 year over age 2 years over age 3 years over age 4 years over age Total over age Total under age S6 20 10 S 2 38 4 60 18 9 3 I 32 4 S4 20 II 4 2 38 4 S8 18 8 3 I 36 S 60 per cent in some of the Southern cities. The proportion of children retarded one year shows wide differences which range from 3 to 33 per cent for boys among the smaller cities ; those retarded two years rise as high as 22 per cent ; for three years to 15 per cent. It is evident that a great disparity of conditions obtains among the American cities. Influences of great impor- tance are operating to produce these results. The amount of retardation is somewhat affected by the pro- portion of the various race elements in our population. An intensive study of 46,836 children 8 years of age and over by the Immigration Commission shows that 36.6 per cent of the children were retarded, and that the rates of retardation among certain racial groups were as f oUows : '■ — Native bom 30.3 per cent White 28.1 per cent Negro 66.8 per cent Indian 47.8 per cent Foreign born 40.4 per cent English speaking races 27.3 per cent Non-English speaking races .... 43.4 per cent Among the white children the non-English speaking races show the highest proportion of retardation, the Polish Jews ranking first with 66.9 per cent, the South Italians following with ' Report of Immigration Commission, Vol. II, p. 36. 238 PROBLEMS OF CHILD WELFARE 63.6 per cent, while the Swedes show the lowest percentage, 15.5. These differences indicate the importance of ascertaining the causes of retardation. Another condition affecting the problem is the percentage of repeaters.^ In its effort to study the causes of retardation the federal government learned that the proportion of repeaters among the boys ranged from 9.8 to 14.5 per cent ; among the girls, from 8.4 to 10.9 per cent — figures which correspond roughly to those mentioned by Strayer. His estimate was that the number of repeaters in the sixth, seventh, and eighth grades would be 12 per cent of the total number in the grade for the sixth grade, 10 per cent for the seventh, and 8 per cent for the eighth. It also appears that a very large proportion of the repe- titions occurs among children in the 7 to 8 and in the 12 and 13 year groups. The variation among the grades is not pronounced, although the fifth grade perhaps contains more than its propor- tional share. 5. Causes of Retardation and Elimination. Children who are not more than three years behind normal grade are, as has been said, retarded. The causes of this retar- dation are somewhat elusive. The most comprehensive state- ment that has yet been made was presented by a special com- mittee directed by the New York City Board of Education to study the subject. This committee after a careful study pre- sented a report in which they designated the following causes of retardation. Irregular attendance. Truancy due to the lack of support by the courts in the enforce- ment of law, and to failure of parents to cooperate. Insufi&cient number of truant ofiicers. Ignorance of the English language. Late entrance to school. Transferrals to other schools. Physical defects. Sluggish mentality. •By "repeaters" is meant children who fail of promotion and must repeat a grade. SOME SOCIAL ASPECTS OF EDUCATION 239 Oversized classes. Absence of teachers. Part time attendance at school. Varying standards of rating pupils. Insufficient teaching. Improper methods of promotion. This list of causes can be classified under four heads: a majority of them relate definitely to defects in the school system ; a number indicate negligence by other forms of public authority ; the home is charged with some responsibility ; and some children are clearly defective. With the exception of some physical defects, many of these causes may be removed, although great changes are thereby involved. The federal government presents the following table based on investigations involving 1042 boys and 804 girls, who were com- pelled to repeat their work in the grades.^ Percentages Boys Girls Irregular attendance or absence . . . Lack of ability, slowness, dullness, or immaturity Lack of interest or application . . . Poor health and physical defects . . Lack of English Other 29.7 20.0 24.1 12.9 6.3 7.0 34-1 21.2 16.2 14-9 , 8.2 S-4 Some of the causes named in the above table are merely pre- cipitating causes, so the ultimate conditions imderlying retarda- tion still remain obscure. However, the proportions given have value. Irregular attendance is a compound consisting of dis- like of school, poor health, moving, and other conditions, and accounts for nearly one-third of the repetitions. It is significant that the proportion due to lack of interest is higher among boys than among girls, indicating that our schools fail somewhat in making school work appear practical to boys. One-fifth of the 1 Woman and Child Wage Earners in the United States, Vol. VII, p. 281. 240 PROBLEMS OF CHILD WELFARE children repeating are apparently incapable of normal progress. Feeble mentality, poor health, malnutrition, and physical defects are the principal causes of these conditions, but their propor- tionate importance can only be guessed at. At aU events slow progress appears to be largely controllable. The reasons why children leave school are closely related to the child labor problem, and the subject must necessarily receive attention in a later chapter. At this point, however, the chief reasons may be briefly discussed. The causes are in part stated by the city of Cleveland, which ascertained the facts for 2032 children leaving school in the year 1909-1910. The proportions are as follows: 55 per cent went to work; 15 per cent were suffering from illness; 11 per cent left the city; 5.6 per cent withdrew because of poverty, and the remainder were handi- capped by physical defect or were indifferent to school work. The children who went to work were, however, not all impelled to do so by poverty. According to various investigations, about one-third of the children leave school because of economic neces- sity. The chief cause is undoubtedly dislike for school work, which depends upon a complex of causes, including inef&cient teaching, unsatisfactory curriculum, and lack of ambition on the part of the child. Ill-health accounts for about one-sixth of the cases. 6. Compulsory Education. Although compulsory attendance laws do not solve the prob- lem of education they are a very important factor. Compulsory attendance does not secure compulsory education ; compulsory education does not secure compulsory eflSciency. However, if children are required to attend school, they gain the opportunity of achieving such education as the school actually affords. The movement in favor of compulsory education laws, though very young, has made rapid strides within the last two decades. A large majority of the states have such laws applying to children under 14 years of age, but in many cases the necessary annual attendance is limited to 12 weeks. If children over 14 remain unemployed, many states require their school attendance xmtil the age of 16. The New York law, for example, requires attend- ance for the entire school year of all children under the age of 14, SOME SOCIAL ASPECTS OF EDUCATION 241 and for the entire school year of all unemployed children between 14 and 16. The South has been tardy in the enactment of com- pulsory education laws, yet in several Southern states such laws apply to particular counties or cities, while others have enacted state-wide laws. In most of them some restrictions have been placed upon the employment of illiterate children. Since com- pulsory education is the proper complement of child labor laws, these restrictions which tend to keep children in school should be required for the entire school year of all children who have not reached the working age or are not regularly employed, unless physical or mental defects interfere. Provisions of this sort are in operation in about half of the states. Unwise exemptions from the operation of compulsory attend- ance laws are frequently made. Chief among these is the pov- erty exemption, according to which children too poor to dress adequately may be excused from attending school — precisely the group of children who can least afiord to forego the advan- tages of an education. A community is most unsocial indeed if it fails to supply such children with the clothes necessary for appearance in school. Poverty exemptions are frequently ac- companied by permission to engage in gainful work, and children of tender years are allowed to enter factories and workshops. Further exemptions are made for children who are diseased and a source of contagion, for crippled or deformed or feeble-minded children, and for those who live too far away from the school buildings to attend. Compulsory attendance laws should contain the following requirements : — (i) School attendance until a specified grade and age have been reached. (2) Attendance throughout the school year. (3) Compulsory attendance of children of working age unless regularly employed. (4) An exception for pupils unable to advance in the grades, (s) Such restrictions as will supplement the child labor laws. (6) Application of the laws to the entire state. (7) Machinery of enforcement. 242 PROBLEMS OF CHILD WELFARE 7. Truancy. Compulsory education laws have suffered much, from non- enforcement. In the first place, the number of attendance or truancy ofl&cers has been totally insuflScient. In the rural dis- tricts and small towns there is often no provision whatsoever for law enforcement, and unless public opinion condemns the practice, non-attendance becomes altogether too frequent. Again, truant oflScers are often incompetent, many times because they are not socially trained, while truancy is often a mere symp- tom of family maladjustments and cannot be cured by police activity. In such cases constructive work with the family is necessary. It is difficult to prevent temporary absences from school, especially if regular attendance does not constitute tru- ancy as defined by the school authorities. More ofl&cials, more efl&ciency, and better attention to irregular attendance would greatly lessen truancy. The greatest proportion of truancy among boys occurs in the thirteenth year and among girls in the twelfth year. Fig- ures from Chicago show that more truants come from the fourth grade than from any other grade, also that the smallest percent- age of truancy occurs in the grades offering manual training. A limited study of the causes of truancy in New York City specially emphasized the following : ^ — Gang influences. Moving picture shows. Indifferent, ignorant, and depraved parents. Mercenary parents. Insufi&cient guardianship. Faulty teaching or methods of discipline. Backwardness. Lack of interest because of unjustified retardation. Physical weakness. Oversize. Opportunities for employment. 1 Report of the City Superintendent of Schools to the Board of Education of New York City, 191 2, p. 245 S. SOME SOCIAL ASPECTS OF EDUCATION 243 Most of these causes are of such a nature that improvement of home or school conditions would remove them. Irregular attendance differs somewhat from truancy, especially in regard to causes. In Chicago it has been discovered that over one-third is due to illness, more than one-sixth to request of parents, one-seventh is caused by indifference and truancy, while the remainder is due to various causes. About four-fifths of the temporary absences are excusable. Irregular attendance is, next to incapacity, the greatest cause of non-promotion in the grades, and therefore constitutes a serious social problem. CHAPTER IV INDUSTRIAL EDUCATION I. The Adaptation of Education. The purpose of education should be to fit the chDd for life. He must be taught to adapt himself to the conditions of his environment, to enjoy the higher pleasures, and to take his right- ful place in society. It is obvious at once that no school can give the child a complete education, and that this is obtained slowly, if at all, through the lessons learned from activity in the world as well as through those taught in the classroom. The predomi- nant interests of society vary from time to time, therefore the most important elements in education will also vary. Literary education formerly received a very proper emphasis, and met popular needs quite eflEectually. It is still a most necessary form of training preparatory to successful citizenship, but it is now generally admitted that literary education alone is inade- quate, since it does not train the hand, although the vast major- ity of all persons become manual laborers. Both brain and hand should be educated, each in proportion to the demands of later life. Consequently certain forms of industrial education must be provided in order to fit children for success in later life. The most successful education not only affords the proper variety of training for the chUd but also sustains his interest un- til the essentials have been gained. In an industrial era book learning is so plainly inadequate that many practical-minded children lose interest in their work and drop out of school. One of two possible consequences may then occur; the child may become a truant and eventually a delinquent, or he may enter some gainful occupation and swell the ranks of chUd laborers. It is of utmost importance for our educational authorities to consider this problem and to work out a solution. If it cannot 244 INDUSTRIAL EDUCATION 245 be done directly through the public schools, private philanthropy must be called on for assistance. 2. The Untrained Child in Industry. Thousands of children enter industry without having obtained any industrial education, sometimes without even finishing their primary education. No children who drop out of school at the end of the fifth or sixth grades can hope to have acquired direct training for any occupation which they may enter ; the seventh and eighth grade children may acquire a little manual dexterity. The consequence of the early exodus from school is an army of untrained workers who usually enter the first available occupa- tion. This is almost uniformly some undesirable trade that affords but little compensation. It has been estimated that about 90 per cent of the working children enter unskilled oc- cupations ; about 7 per cent skilled occupations of a low grade ; perhaps 3 per cent enter high grade occupations which promise a future. About 3 per cent, then, of the working children begin at once to prepare for a trade, but it frequently happens that in- stead of being taught a trade, the child apprentice is merely used as a handy boy, and learns his trade, if at all, by absorp- tion. No special efiort is made to instruct him, and unless he is ambitious and aggressive, he wiU be retarded in his efforts to acquire definite trade knowledge. The great majority of children who leave the public school for gainful occupations necessarily lack in stabiHty of mind and persistence in work. They, therefore, have no definite aims, have no particular trade in view, are willing to experiment with many forms of occupation, and, being without proper guidance, are not taught the needs of earnest concentration of energy. As a result, they quickly drift from one occupation to another, and since these occupations are usually very different, the experi- ence of the child has no cumulative value. Our system of child care which allows children who are almost illiterate to leave the schools and to enter industry is sadly at fault. A compulsory education law which applies only to per- sons below a certain age is better than no law at all, but at the same time it establishes artificial and illogical boimdary lines. 246 PROBLEMS OF CHILD WELFARE If at 14 the boy is not prepared for life, but is mentally and physi- cally capable of adequate preparation, the state is not justified in allowing him to waste several years of time in unskilled occu- pations, but should insist on his continumg in school until he has acquired the necessary preparation. The fixing of arbitrary ages for compulsory education overlooks the entire problem of industrial efl5ciency, and emphasizes time instead of accomplish- ment. Child labor laws should so supplement our educational requirements as to prevent the employment of all children not properly trained in the schools. 3. Vocational Guidance. In an effort to meet the problem of the Untrained chUd, a Vocation Bureau was established in Boston in 1908 for the pur- pose of developing a form of work which has been caUed voca- tional guidance. The aims of this bureau are as follows : ' — To study the waste attending the passing of untrained children into industry. To assist in the choice of, and preparation for, a life work. To develop a plan of cooperation between schools and occu- pations. To publish material relating to the requirements and possi- bilities of various occupations. To train individuals for vocational guidance service. To act as a bureau of information. One of the most important of the bureau's activities has been the publication of short pamphlets on particular occupations such as those of the machinist, the baker, the grocer, etc. A typical pamphlet deals with the divisions of a trade, its handi- caps, its possibilities, the compensation paid, the opportunities in the trade, the conditions of apprenticeship, and related ques- tions that make it possible to decide more wisely in the choice of an occupation. Although the bureau publishes information relating to different occupations and gives advice to inquirers, it is not an employment bureau and does not try to place children in specific occupations. This limitation on its work is probably wise, since finding jobs for children would only slightly improve ^ Record of the Vocation Bureau of Bostoiij 1913, p. 3. INDUSTRIAL EDUCATION 247 the present maladjustments in industry, while the larger prob- lems to be faced might be forgotten. Through the efforts of the bureau the Boston public schools have introduced a plan of vocational guidance, and in 1913 a department was established to carry on this work. In 1910 the school authorities appointed a considerable number of teachers to act as vocational counselors, whose chief duties consisted of serving as bureaus of information and advice, of conferring with employers, and of discussing the vocational problems of the chil- dren. The completed plan is to put the work on a systematic basis, in order that the practical interest of the school children can be thoroughly aroused. Boston has proceeded farther with this form of work than any other city. New York, after a short study of vocational gviidance by its board of education, decided against the establishment of a vocation bureau, on the ground that practically all occupations that could be entered by children vmder 16 were imdesirable. This conclusion, however, seems to have been based on the sup- position that the functions of such a bureau were those of an employment agency rather than those of a department created to give advice and awake interest in the need of industrial training. Vocational guidance has definite limitations : it has but little value as an employment bureau, and its chief service consists in the knowledge of different trades which it brings to light and in the advice which it gives to children and to parents, as well as in its capacity for promoting industrial education. 4. Preparation for Industrial Training. a. Manual Training. If the child can be provided with purposeful manual training, his real inclinations will probably be aroused. Although manual training is gradually filtering down through the grades and reaching the younger children, it has not been sufficiently di- rected toward immediately useful ends. Gradually the purpose of manual training is being diverted from that of making the hands skillful to that of training them for skill in the making of something useful. Manual training should be organized from a vocational point of view, so that it may bear directly on the 248 PROBLEMS OF CHILD WELFARE industrial eflBiciency of children. Shop work for all boys 12 years of age or over, and the practical use of tools employed in woodworking and metal working are necessary to reach the great majority of boys. In a similar way cooking, sewing, and household economy should be taught all girls in the seventh and eighth grades. So many children leave school at the end of the fifth grade that a large number of girls would still escape the needed courses in domestic science. Literary instruction, however, cannot be displaced, and the adaptation to our new needs must not be at the expense of the social and cultural in- terests so necessary to successful citizenship. The introduction of useful manual training in the seventh and eighth grades is proceeding rapidly among the schools in our larger cities, and the reorganization of the work will prove of immense value to our prospective working population. In 1910, 41 of the 50 prin- cipal cities in the United States provided some form of manual training, 21 of them carrying the work from the first grade throughout the elementary school years.' In all of the 41 cities sewing was taught in some grade and in 32 cooking also received some attention. b. Pre-vocational Schools. In order to reach a certain class of children the need of intro- ducing an intensified form of manual training is being recog- nized. The Boston pre-vocational center represents an efiort to meet this need. The purpose of such a center is to influence boys to remain in school irntU they are 14 ; to enable them to graduate earlier than they otherwise would ; to develop a desire for industrial education ; and to give some definite training to boys who actually enter industry at 14. Boston has estabhshed a number of these centers, in each of which a little more than one-half of the day is devoted to academic work, while the remainder of the time is occupied with shop work of a practical nature. The elementary industrial school opened by the city of Cleve- land in 1908 is of a similar nature. At first it was used espe- cially for the duller pupils, but later others applied. A two-year !• Report of Cleveland Board of Education, 1910, p. 38. INDUSTRIAL EDUCATION 249 course is provided, and the boys and girls are taught separately. Here again one-half of the time is devoted to the academic department and the other half to industrial work or domestic science, and gymnasium practice. The boys do not learn a trade, but are given excellent elementary instruction in woodwork- ing, pattern-making, and the like. In Chicago the industrial classes for truants have been operating on the same principle, while in other cities plans for the establishment of pre-vocational work have been adopted. 5. Forms of Industrial Training. a. Apprenticeship Schools. Formerly the method of training consisted of apprenticeship work, but recently the system has suffered a serious decline, the reason therefor having been stated by the federal Bureau of Labor as follows : ^ (i) The decline of personal relations between master and apprentice. (2) The extensive use of machinery and the subdivision of labor. (3) The disinclination of employers to use apprentices. (4) The unwillingness of journeymen to instruct apprentices. (5) The unwillingness of boys to become apprentices. Manufacturers have been loath to grant apprentices the broad training necessary for their permanent welfare. The speed required in modern industry and the extreme sub- division of labor have prompted the employer to attempt to limit the work of apprentices to some particular occupation in order that they may speedily acquire skUl therein. This unsocial attitude is opposed by both the apprentice and the labor unions. The latter demand an extensive training of apprentices, and also frequently insist upon a limitation of their nvunbers. Another objection to the present method of employ- ing apprentices is based on the practice of using them in the more unskilled forms of labor at lower rates of compensation than those paid to journeymen. They can be supervised by a 1 Charities and Commons, Vol. XIX, p. 814. Quoted in article by Ralph Al- bertson. 250 PROBLEMS OF CHILD WELFARE competent journeyman, will do fairly satisfactory work, and will lessen the cost of production for the employer. The decline of the apprenticeship system is based largely on the conditions existing in unregulated industries and cannot be considered as permanent. In recent years many industrial establishments have again created a system of apprenticeships, frequently with very good effects, especially where the train- ing has been conducted wisely and for the benefit of appren- tices. The system has inherent qualities of strength which cannot be supplied by industrial schools and is therefore likely to reestablish itself at least in part and in those industries where a broad training is of advantage to both employer and employee. The development of continuation schools and of protective child labor legislation also tends to make the apprenticeship system more feasible imder a regime of machine industry than has been supposed. The rejuvenated apprenticeship system has in many instances been made a part of a plan of instruction through apprentice- ship schools. A number of the large railroad corporations have established special schools for the training of their apprentices in practical work as well as in such branches as mathematics, mechanical drawing, and elementary physics.^ At the comple- tion of the apprenticeship time the boys are usually given a small bonus and their tools. Meanwhile they have been receiving a regular rate of pay which is usually advanced every six months, no deduction being made for the time spent in school, which is usually about two days per week. Apprenticeship schools are also gaining in favor among manufacturing concerns which are devoting special attention to the training of machin- ists. The plan of indenture is similar to that adopted by the railroad corporations, but the curriculum covered for machin- ists is very comprehensive and, if completed, trains boys for very successful technical work. In 1912 nearly 4000 per- sons attended the schools maintained by these two groups of industries. ' Senate Document, 62d Congress, 2d Session, No. 936. Industrial Education, pp. 57-58- INDUSTRIAL EDUCATION 251 b. Continuation Schools. A very practical form of industrial education is that afforded by the continuation school. Such schools have been popular in Germany, but have only recently been introduced into the United States. In a typical continuation school the pupils receive instruction for only a few hours each week, the remainder of the time being spent in actual work in some industrial estab- lishment. The aim of the school is to coordinate the training received in the shop with theoretical subject matter, a knowl- edge of which is necessary for the development of efficient workmen. These schools usually operate during the daytime, and the pupils attend without deduction of pay. The actual shop work under the direction of foremen and shop managers serves as most valuable laboratory work which carries with it nothing artificial in character. The Boston continuation school established and maintained by the school authorities is an example of this new develop- ment. Qualified persons from 14 to 18 yearsof age are admitted, and are instructed in classes that meet twice a week for two hours at each meeting, the term lasting for thirty weeks. The students are, without exception, regularly employed at paid work in a wide range of trades and occupations. Among the subjects taught in the school are the following : banking ; the dry-goods, shoe and leather, and clothing industries ; business organization ; salesmanship of various kinds ; cooking ; sewing ; household arts ; and EngHsh for non-English speaking students. Another good illustration of such schools is the Cincinnati continuation school, established for the purpose of giving boys who were employed by the members of the Metal Trades Asso- ciation an opportunity to supplement their shop work with class instruction. The school is maintained by the board of education and accepts apprentices 16 years of age or over. It enrolls about 250 apprentices and has a considerable waiting list because of the recognized value of the training. The Ranken Trade School of St. Louis, in addition to its regular courses of instruction, provides part-time work for employees of certain industrial establishments with which it 2 52 PROBLEMS OF CHILD WELFARE has an agreement that in case of strikes, pupils shall not be used to fill the places of strikers. Other continuation schools have recently been established, some under philanthropic agencies, others under public auspices. c. Trade Schools. The pre-vocational or intermediate industrial schools should give children an opportunity to test their inclinations and capac- ities. The door of the trade school should then be open if this will best meet the needs of the children. Several principles must be observed in the organization of trade schools.' Pupils should enter the school with the definite purpose of learning some trade which they expect to make their life-work. The curriculum must practically exclude the liberal arts courses, although mathematics, science, and economics should be included. The methods of teaching must conform largely to the labora- tory plan. Classes must be small and individual instruction be afforded. Hours in trade schools must be made to approximate those in workshops. There is a great need for trade schools, although at the present time a large number of industrial operations do not require skilled tradesmen. The widespread trade training of our youth will be of the most value only as occupations become skilled — that is, become trades — or as each unskilled occupation is made to stand in some apprenticeship relation to a trade. Apart from technical schools for advanced students, many trade schools have been established in recent years. Typical private schools of this class are the New York Trade School, the Williamson Free Trade School in Pennsylvania, and the Wilmerding School of Industrial Arts in San Francisco. The pubUc trade schools of Boston, Milwaukee, and New York City typify the schools operated by boards of education. These schools vary in the length of their course and in the amount of training afforded. In some schools the courses are less than one year in length, in others they cover two or three years. ' Op cit., pp. 67-72. INDUSTRIAL EDUCATION 253 The New York Trade School provides a short term training, and teaches such branches as plumbing, carpentry, electrical work, bricklajdng, sign-painting, house and fresco painting, sheet-metal and cornice work, plastering, steam and hot water fitting, blacksmithing, printing, and drawing. The William- son School, as an example of the type with a longer curriculum, covers such trades as carpentry, bricklaying — including range, furnace, and boiler setting — pattern and cabinet mak- ing, machine trade with its many details, steam and electrical engineering, steam-fitting, etc. Each pupil is required to take a preliminary course in wood carving and mechanical drawing, and a well-developed academic department supplements the industrial training with courses in science and literatiu-e. The Milwaukee public trade school furnishes a two years' course, the trades taught being pattern making, tool making, carpentry, woodworking, plumbing, gas fitting, and the machin- ist's trade. On the other hand, the public trade school in Philadelphia offers a three years' course with some additional lines of work. A number of trade schools operate three separate departments, — a day school, an evening school, and a coopera- tive or continuation school. Evening trade schools have met with less resistance than have the day schools, and have in numerous cases been estab- lished by boards of education. The trade training offered, however, usually represents only one phase of the work done in the public evening schools. Young workers are frequently compelled to work during the day and have little time for study except at night. The evening trade schools therefore minister to this particular need best, although it is usually a considerable hardship to work during the day and study in the evening, especially for growing children. For all children under 16 or 17 years of age day instruction should be made compulsory on the part-time plan, but for the older people the evening school may very properly be supplied. Hundreds of commercial schools have arisen to teach boys and girls some particular trade or occupation, such as stenography, tjrpewriting, bookkeeping, plumbing, sewing and millinery. 2 54 PROBLEMS OF CHILD WELFARE These institutions frequently have no minimum entrance re- quirements, and many of their graduates are therefore very poorly equipped for their work. Usually the course of instruc- tion is too short, and the required literary training too inade- quate. Schools operated for profit cannot have the best ideals and should be displaced by public or private endowed schools. Education cannot be commercialized, but must be definitely socialized in order to insure the best variety of training for all. 6. Plans for Vocational Education. A plan of vocational education which will cover the needs of modern industry is most difficult to outline, but many experts in this line have given their best thoughts to the problem. The plan advocated by Professor E. G. Cooley is most comprehen- sive and illustrates the trend of modem thought. The plan is as follows: ^ — Vocational schools of two types for youths of 14 years and over. (i) Schools for students compelled to give most of their time to actual work. (a) Part-time schools supported by the state, the children being employed half of the time and in school the remainder. (b) Continuation schools providing from 6 to 10 hours of instruction per week. (c) Continuation schools for persons over 18 years of age, providing training in either day or evening schools. (2) Schools for students who are able to give some time to training before entering industry, and which pro- vide full time instruction in a two years' course, (o) Elementary schools for those too immature to become apprentices. (b) Vocational schools for children from 14 to 16. (c) Schools providing commercial courses. (d) Schools for home making. (e) Agricultural winter schools. ' Report of the Superintendent of Schools to the Board of Education of New York City, 1912, p. 164 fE. INDUSTRIAL EDUCATION 255 Cooley's plan makes room for both the publicly supported and the privately maintained institution. At present the respective fields of public and private enterprise are not defi- nitely outlined. Some object to a public system of industrial education on the ground that it accentuates class differences and denotes an acceptance of undemocratic principles. Others object on the ground that public education should be preparatory for citizenship and should provide children for a large outlook on life but must not deal with such prosaic questions as making a living. On the other hand, it is urged that public moneys are used for the training of professional men and women, and in order to make education democratic the public should also pro- vide industrial training. The American Federation of Labor favors the establishment of schools in connection with the public school system for the industrial training of children from 14 to 16 years of age, but opposes the narrowly specialized train- ing sometimes given under private auspices, because of the antagonism to the position of organized labor often created by such training. An extension of our public provisions for industrial training seems desirable, but such training should be provided first for such trades as carpentry, sign making, decorating, and others that are pursued apart from large industrial establishments. The public school cannot become a mere appendage of the local manufacturing concerns, but must insist that these concerns carry their part of the burden. Public continuation schools are, no doubt, also in line with correct public policy. Private philanthropy, if it proves fair to organized labor, should extend its operations in the field of industrial training. 7. History and Development of Industrial Education. The first steps in industrial training were taken by private individuals who estabhshed and endowed trade and technical schools. A number of these schools, such as the school in Mil- waukee, and the Manhattan Trade School for Girls, have been made a part of the system of public instruction. Many cities have established one or more of the various forms of industrial education, and state laws are stimulating the work. In a num- iS^ PROBLEMS OP CHILD WELFARE ber of states, systems of state aid to vocational education are being devised. The Indiana law provides for state aid for training in industries, agriculture, and domestic science through the establishment of continuation, part-time, evening, and aU day schools. The plant and equipment must be provided by each local community, and if the work is approved by the state board of education, the local authorities are reimbursed to the extent of two-thirds of the salaries of the teachers handling vocational subjects. New York in 1910, and Massachusetts in 191 1, made provi- sion for state aid to vocational schools. According to the New York plan, the amount of state aid will equal about 29 per cent of the operating expenses in the larger cities and 39 per cent in rural communities. The Wisconsin law of 1911 requires children between 14 and 16 who have not graduated from the elementary schools but have entered industry to attend part-time or continuation schools. This law will necessitate the establishment of voca- tional schools. In Connecticut several schools have been estab- lished by the state directly, and in other states this method of solving the problem is being agitated. The friends of indus- trial education have also attempted to secure federal legislation. Bills relating to vocational training have passed one house of Congress, but have never succeeded in passing both. On the whole, public provision for industrial education has made rapid strides and the subject is receiving much attention. CHAPTER V MORAL AND SEX EDUCATION The subject of sex education is one of fimdamental impor- tance and is rapidly pressing forward for consideration. The awful results of sex irregularity, about which we are constantly learning, force attention to the problem. The cry for sex edu- cation is an outcome of the search for preventive methods, and depends upon the realization of the natural consequences of the present failure to cope successfully with the problem of illicit sexual indulgence. I. Causes of Sex Irregularities. The first step in a program of sex education is an tmderstand- ing of the causes of illicit sex relations, and the results that follow. Without doubt ignorance is an important cause, and many boys and girls are contaminated for this reason. Illus- trations continually occur of young girls who were apparently ignorant of the probable results of sex irregularity and who become diseased or pregnant through their Ulicit relations with men. In many communities bad men and boys can be foimd who win prey upon the ignorance of young girls ; on the other hand, the immoral girl frequently demoralizes an entire company of boys, who are seduced largely through ignorance. A large proportion of the school girls who become pregnant yield be- cause they are ignorant of the probable consequences of their missteps. There is something incongruous about an educational system that provides a girl with a ready knowledge of Latin, Geometry, and Ancient History, and denies her instruction about her own physical possibilities that will protect her against dis- honor and disease. It is difl&cult to believe that very many children are altogether ignorant of the impropriety of sex irregularities, even though s 2S7 25^ PROBLEMS OF CHILD WELFARE they may know nothing of the consequences. There are but few children who have not been taught the rudiments of modesty, consequently it is clear that illicit sex relations among such children must represent a low standard of morals and a false sense of modesty. Parents have probably exhibited low stand- ards of morals in the presence of their children and have either failed to teach higher standards or have deliberately allowed their children to accept low ideals. In a sense, children are not responsible for their standards, and parents, not children, must be blamed when moral standards are low. The absence of confidential relations between parents and children on sex matters often renders the children helpless in times of moral danger. Parents do not always advise girls to compel respect from boys and young men, and girls shrink from discussing such subjects with their mothers ; consequently familiarities are permitted, which later lead to positive immo- rality. With the approach of puberty comes sex passion, and neither the boy nor the girl fully understands its significance ; both are prompted by curiosity, and both may become its victims. Coupled with ignorance and low standards we find weak minds and weak wills. Young girls are frequently ensnared by men because they do not have sufficient wUl power to resist evil. As will be shown in the study of juvenUe delinquency, a close connection exists between low mentality and low moral- ity ; that is, many girls do not know how to protect themselves or are too weak-willed to do so, and thereby lose their virtue. It is clear that many boys deliberately indulge in wrong-doing and know that they are engaging in immoral practices. They have been influenced by evil associations and have come to con- sider illicit sex relations as an accepted form of pleasure. They therefore seduce young girls, especially those belonging to some lower social stratum, who are less resistant to boys or men sup- posed to come from a higher class. In addition the older boys begin to frequent houses of Ul-fame. The causes of wrong sex relations among adults are practi- cally the causes of prostitution, and include lack of proper MORAL AND SEX EDUCATION 259 moral and ethical instruction, low wages, double standards of morals, immoral associations, the lust of men, greed, unwhole- some amusements, and overcrowding. 2. Results of Illicit Relations. Naturally it is impossible to secure adequate data concerning the effects of sex irregularities, but many estimates have been made. In the first place the statistics of our schools for the blind show that about one-third of the blind children owe their blindness to ophthalmia neonatorum, which is an affection resulting from one of the venereal diseases. This proportion, it should be specially noted, relates to blind children and not to aU blind, as the great majority of the blind acquire their blindness after they become of age. Another result of sex immorality is venereal disease. The number of men who have or have had gonorrhoea is almost un- believable, the estimate having been placed by some physicians at 80 per cent of all unmarried men reaching the age of 30. The estimates, however, are based on limited observations in the large cities and do not give due weight to the wide differences that may exist between the rural communities and the large cities, nor between the native and the foreign born population. We must have more information and more statistics on this subject before we will be able to make any generalizations of value about the prevalence of gonorrhoea. It is very probable that the high estimates now made are partly the result of the desire to arouse the people against the dangers of immorality and are therefore exaggerations. Again, a large amount of sterility is caused by gonorrhoea, estimates placing the figure at about two-thirds of all sterility. Although in most cases it is the wife who is made sterile through infection from her husband, in a small proportion of cases the man loses his virility directly from the action of the disease. An allied effect is the sterility of the wife after the birth of a baby — a condition due to the fact that a pregnancy frequently precedes the action of the disease germ in destroying the fer- tility of the woman. ^^ \. "'x One of the most serious results of vice is S5rphilis, wjiich infects 26o PROBLEMS OF CHILD WELFARE the blood and befouls the entire body. According to some esti- mates as many as i8 per cent of the men become aflSicted with this disease, whUe others place the figure at not more than 5 per cent. The effects of syphilis on the race however, regard- less of the exact proportion of men afflicted, are most disastrous because of the death-dealing consequences to both women and children. It has been shown, for example, that more than 50 per cent of the syphilitic children die in infancy, and that most of the remainder grow up weak and sickly. Furthermore, the stigmata of the disease may be transmitted to the third genera- tion. Many miscarriages and abortions also result from syphilitic infection. Again, a large proportion of all the abdominal operations on women, especially married women, have been made necessary because of infection from gonorrhcea or syphUis. Likewise, a majority of the deaths from inflammatory diseases peculiar to women are a result of venereal disease. That syphilis shortens life is also indicated by the records of life insurance companies, some of which require extra payments from syphilitic persons. Furthermore, the disease is a frequent cause of general paralysis, locomotor ataxia, apoplexy, insanity, and other ailments. Both gonorrhoea and syphilis are infectious and contagious diseases that can be transmitted by means of the discharge from sores on the fingers, lips, and other parts of the body and by means of contamination from kissing, from clothing, pipes, towels, and other articles of daily use. Finally, illicit sex relations give us the unmarried mother and the illegitimate chUd; and only too often young girls are compelled to bear the burden of motherhood. The accumula- tion of evidence indicating the terrible ravages of venereal disease and the sad consequences of vice and ignorance have led to the promotion of efforts to protect society from these evils. 3. Measures of Prevention. a. Societies of Social Hygiene. The older organizations dealing with the problem of sexual vice confined themselves largely to methods of attacking the MORAL AND SEX EDUCATION 261 so-called social evil or commercial prostitution. In recent years, however, the need of education relating to sex life has been recognized, with the result that a considerable number of societies of social or sex hygiene have been established. In 1912 there were at least 25 state or local societies of this char- acter, besides several national organizations engaged in allied work. The original object of many of these societies was simply to lessen the spread of venereal disease, and they did not con- cern themselves to any profound degree with the question of morals. This attitude was the result of the interest of the physician in preventive medicine, for it was he who first appre- hended the dangers of social disease to civilization, but he failed to see the broader relation of lax morals to the inevitable con- sequences of immorality. Gradually, however, the truth has been driven home, and the various societies have greatly ex- panded their fimctions. Societies of social hygiene now carry on their work along several significant lines of work. Circulars of information are distributed to men and women, and in some cases even to children. The pamphlets intended for the older persons usually point out the dangers of sexual vice, such as the contracting of venereal affections, and the contamination of wives and chil- dren, while the pamphlets intended for yoimg women also em- phasize the possibilities of pregnancy. Many circulars discuss sex physiology so as to enable young persons to understand themselves better. An efiEort has been made to furnish circu- lars suited to young boys and girls, but great caution has been exercised in giving information to children through the printed leaflet. Lectures on social and moral hygiene form an important part of the educational work. Women physicians frequently address assemblages of young women, while opportunities to address groups of men are very common. Many men and women are being reached in this way, and are told the essential facts of sex and social hygiene. It is believed that good results are ob- tained by instructing parents, who in turn wUl be able to instruct their children. 262 PROBLEMS OF CHILD WELFARE The use of the drama to fight the venereal peril and to develop higher morals is comparatively recent, but a number of problem plays have been attempted in order to represent the dangers of ignorance and vice. Whether these graphic representations are productive of good is a mooted question. b. Public Educational and Preventive Work. In a number of states the boards of health have begxm to attempt methods of education, usually through the judicious distribution of pamphlet literature. These boards usually place special stress on the dangers of venereal disease and sub- ordinate other considerations. On the other hand, the fallacy of a system of double morals and of the theory of sex necessity is taught, as well as the need of higher moral standards. The public health authorities have in some instances attempted to gain a better control of the spread of venereal disease, and in at least one state the law provides for the compulsory report- ing of such diseases to the board of health. The extension of this form of legislation to all the states would be desirable; also an improved system of control of the venereal diseases when they threaten to become a public menace. A number of states have passed laws requiring persons con- templating marriage to present a physician's certificate declar- ing their freedom from venereal diseases. The older laws have not been enforced, while the recent laws of Wisconsin and several other states have not yet been adequately tested. The efficacy of such laws remains a matter of experiment, and their success probably depends upon the development of public opinion. c. Sex Education in the Schools. It is well known that both boys and girls obtain information and misinformation about sexual matters at a very early age, and frequently their minds are besmirched thereby. It is not therefore a question of whether children shall be instructed or remain in ignorance, but a question of how best to instruct them so that their attitude shall be reverential and the subject of sex be invested with the nobility which it deserves. Granting the need of instruction, who shall be the guide? Shall it be the MORAL AND SEX EDUCATION 263 parent, the physician, the teacher in the schools or in the Sunday schools, or some other agency ? This question is receiving the most serious consideration, but the widest divergence of opinion still exists. One point of view has been expressed by the American Feder- ation for Sex Hygiene through one of its special committees.^ Because of its importance the proposed plan of education is sum- marized as follows : Sex instruction is regarded as a practical measure, its aim being both hygienic and ethical. It must not awaken curiosity, and should keep sex consciousness and sex emotions at a mini- mum; consequently the details of human anatomy should be avoided in the elementary schools. Here the basis of instruc- tion is nature study, in the secondary schools biology and hygiene become the basis of work, and all scientific instruction should be supplemented by ethical teaching. The committee divides the life of pupils into four periods : from I to 6; from 6 to 12; from 12 to 16; and from 16 to maturity. Children in the first age period need chiefly the care of the mother, but the next group are to receive lessons on repro- duction in plants and lower animal forms. The mind of the child is to be prepared for reproduction in man, but the question is not discussed, although allusions to it are made. Children between 12 and 16 may study reproduction among mammals, and finally apply the facts to man ; they should learn the sig- nificance of sexual morality, and be made to understand the physical and psychical changes through which they are passing. Children of 16 and over are to be instructed in heredity, the relation of sexual morality to future generations, and the dangers of venereal disease. The committee does not favor separate lessons in sex educa- tion, but would make the instruction a part of courses in nature study, biology, hygiene, and ethics. Instruction involving re- production among men is to be given in separate classes for each sex with a person of that sex for instructor. The regular ' The American Federation fcr Sex Hygiene, " The Matter and Methods of Sex Education. " 264 PROBLEMS OF CHILD WELFARE teachers rather than a sex specialist is favored, but courses in sex hygiene are recommended for normal schools and colleges so as to train teachers along the line of instructing the young. It is also recommended that sex instruction be given in the evening schools so as to reach many children who have dropped out of the elementary grades. Systematic lectures at public expense are to be given to parents, and courses in sex instruc- tion should be organized by various types of social agencies. Children in the upper grades of the elementary schools who are over-aged and who have contracted injurious sex habits are in need of private instruction, and girls should be taught at an earlier age than boys. The committee states finally that sex instruction should not be introduced prematurely, but only so fast as competent teachers can be found and trained, and so fast as public sentiment will support it. The dangers attending sex instruction should not be over-emphasized, because the pernicious teachings from clan- destine sources from which so many children now suffer cause vastly more harm than would an occasional mistake in the method of treatment in the schools. Contrasted with the attitude of the committee, whose pro- gram has just been outlined, is that of those who oppose aU sex instruction in the schools. Some of this opposition is based on the theory that if adequate moral instruction is given, sex education is unnecessary. This attitude, however, utterly divorces health from morals — a position inconsistent with the modern theory of how habits and morals are developed. There is no doubt but that the dangers attending sexual immorality must be emphasized as well as the advantages of right living. The tendency to "sow wild oats" must be overcome by showing its terrible consequences, as well as by moral teaching. Another argument against sex education in the schools rests on the assumption that undue attention wUl be given by chil- dren to sex life and activity, with the consequence that they will brood over these problems instead of keeping them in the background. Again a group of children taught this subject may treat it in a frivolous manner, jest about it, and perhaps MORAL AND SEX EDUCATION 265 fail utterly to gain the good results expected. It makes consid- erable difference as to the psychological effects of certain forms of education whether a child is taught individually, or whether children are handled ia groups. It is also urged that the teacher does not hold the confidential relations to children that are held by the parent or perhaps the physician, and that therefore he cannot guide or instruct chil- dren so successfully on this very delicate subject. Some claim that it is not at all the function of the school to provide sex education, even though it might be done successfully, but that this work belongs exclusively to the home and to the church. The ravages of venereal disease both among adults and chil- dren and the past failure of both parents and churches to deal adequately with the subject have driven many persons to the advocacy of sex instruction in the schools. In a few localities beginnings in this work have been made, but because of the general incompetence of teachers to handle the subject wisely and correctly, courses on sex hygiene have been introduced in a number of the state normal schools, and in the state of Wash- ington such instruction is made compulsory. Whether or not the public schools shall give instruction in sex hygiene depends largely upon the success attained by the state normal schools in preparing competent teachers for this work. An experiment in the teaching of sex hygiene in the public schools has been conducted in the city of Chicago. Here classes were formed in the high schools, the sexes being separated and taught by physicians. Attendance at classes was not compulsory, and parents were given special opportunity to withdraw their children from these classes if they desired to do so. In actual practice, only a very small proportion of the high school chil- dren eligible to the classes were prohibited by their parents from attending them. The lack of unanimity among the members of the board of education has resulted in the dis- continuation of the classes — a most unfortimate action, since time had not been given to test the experiment. No other city has made a systematic attempt to provide sex education, although 266 PROBLEMS OF CHILD WELFARE individual teachers in many schools have instructed their pupils on this subject. The test of the success of sex education in the schools will have to be made in the grade schools, however, not in the high schools. There is little reason why sex instruction cannot be given to boys and girls of high school age, but grave difficulties attend similar instruction intended for children in the sixth seventh, and eighth grades. On the other hand, children should be properly instructed in sex hygiene before they reach the high school, since it is not the wisest economy to wait until their minds have been contaminated with pernicious ideas. It is well known that most children of ten and over have received considerable information about sex subjects, and if they are to be safeguarded morally, they should be guided as soon as the need becomes apparent. It is not a settled conclusion, however, that the task of sex instruction shall fall to the schools. It more properly belongs to the home, and parents should be fitted for this work. Mean- while, some experimentation by well-operated schools would do no harm and might throw much light on the best method of handling this most delicate subject. d. Education of Parents. In the great majority of cases parents do not discuss the subject of sex with their children. The inevitable query, "Where does the baby come from?" is met with an evasion or a positive misstatement of fact ; consequently the boy receives his first lesson in the barnyard or the alley. The fact is that parents do not properly dignify sex and sex relations, and hence are incapable of presenting these subjects to their chil- dren. The confidential relations between parents and children are or ought to be such that if the former have the right attitude of mind they can best inform the children on sex matters. It is therefore incumbent upon societies of social hygiene and other interested bodies to educate parents for this most important work by means of lectures, pamphlets, approved books, and personal advice and constdtation. There is no doubt that much good also can be done by reaching young people before they MORAL AND SEX EDUCATION 267 become parents and providing them with the proper sex infor- mation. A considerable efiort is being made to educate parents, so they may shoulder the burden of sex education. Here the aid and resources of the educational authorities should be accepted without qualification. The schools can well afford to give room to lectures to parents on this subject and even to provide lec- turers and teachers. It should be remembered that the general attitude on this question, which has remained substantially the same throughout the ages, cannot be revolutionized in a day; so it is worth while to be patient and to attempt to buUd our new ideas on a solid foundation. The education of parents through appropriate means is therefore essential and should proceed as rapidly as possible. Little can be expected from the physician directly as far as sex instruction of children is concerned. The great majority of fam- ilies do not stand in a sufficiently close relation with a physician to be able to use him for the education of their children. There- fore other methods of handling the problem must be devised. e. The Church and Sex Education. The church cannot avoid the subject of sex education, inas- much as the development of austere moral standards is at least one-half of the problem. The church has not performed its part of the great work of ennobling and spiritualizing the men and women of to-day with the degree of success that should be expected. The failure is due in part to the antiquated methods still in vogue in a large number of Sunday schools and to an undue emphasis on doctrine at the expense of practical religion. Sunday schools will not be successful until actual efficiency tests are applied and reforms inaugurated such as the employment of qualified teachers, the standardization of teaching, the grading of pupils, the introduction of graded work, and the shifting of emphasis from dogmatic theology to the problems of applied religion. Such reforms will open the way for a rational treat- ment of sex problems, and for such timely advice and instruction as wUl raise the morals of children and young people as weU as promote healthful living. 268 PROBLEMS OF CHILD WELFARE The church is in danger of limiting its work to the abstract teaching of morals without direct application to sex life, and of forgetting that the hygienic side of the problem of sex edu- cation cannot be avoided. If a reasonable balance is main- tained, the church can become one of the chief factors in the solution of this question. PART IV CHILD LABOR CHAPTER I CAUSES OF CHILD LABOR The causes of child labor are so complicated that the precise influence of each cause cannot be weighed. The contributing factors are so interdependent that if one of the causes should suddenly be removed, the others would become largely inactive ; at least much of their power would have disappeared. But the factors do not work with equal force in different localities. In some regions, for example, poverty is a powerful compelling force; in another, low ideals among parents; in a third, the greed of employers. To these facts is largely due the hetero- geneous nature of the child labor problem. I. Greed of Parents. That the greed of parents is often an important cause of the employment of children is an imdeniable fact. Even to-day many parents still consider their growing children as capital or economic assets on which they hope to declare dividends at the first opportunity. Formerly, when education was not compulsory, and factory labor was still in its infancy, the large family was regarded as an economic advantage because the cost of maintenance was comparatively low and children could be employed at very early ages. Among the farming population thousands of children are at present engaged in gainful occu- pations. The use of the child in farm labor as soon as he is physically able is a very natural condition. If the parents have low ideals, children are exploited and overworked, but usually they attend school during most of the school year, and are still able to give considerable assistance at home. By performing certain light tasks, the coimtry child inculcates a habit of industry which is invaluable to him in later life. If such work is required principally for the sake of training, it is most useful, 271 272 PROBLEMS OF CHILD WELFARE but if it degenerates into drudgery, and prevents education and legitimate leisure time, it is most harmful. It often happens that the farmer's son is deprived of a sufficient education to become efficient in any occupation other than that of farming. The small boy compelled to hire out to another farmer is usually exploited, and represents a most unhappy form of chUd labor. The greed of parents presents its darkest aspects in the atti- tude of the ignorant classes of native Americans and of a large proportion of newly arrived immigrants, who send their children to factories and workshops, where the extenuating conditions that exist on the farm do not obtain. In fact, the child labor question is in some sections closely allied to the problem of immigration. Children are exploited for two principal reasons : first, in order to increase the family income ; second, to enable parents to withdraw from work and live upon the earnings which the children provide. Fall River, Massachusetts, furnishes a good example of the tendency to use the entire family as an income-gaining agency. In addition to husband and wife, the children of the foreign born enter the mills as soon as the laws of the state permit. Investigation has shown that parents often send their children to work as soon as the fourteenth birthday has been reached, despite the deficiency in education which may exist. Hundreds of children drop out of school in the midst of their school year, and are expected to become wholly, or in part, self-supporting. In 191 1, one-seventh of the working children of Chicago entered the gainful occupations the day after their fourteenth birthday. Factory inspectors frequently find that children do not give their age correctly and claim to be above the required working age, no matter how small or underaged they may appear. Usually the children have been instigated to such untruthfulness by their parents, who are also frequently guilty of perjury in regard to the ages of their children. Such low ideals were formerly very common in the anthracite regions of Pennsylvania. Child labor is especially prevalent in large families. Limited investigation in St. Louis shows that working children come from families averaging more than six persons each. In 70 CAUSES OF CHILD LABOR 273 per cent of 1085 families studied, three persons, or half of the members of the family, were engaged in gainful work. The feeling prevails that as soon as the child is old enough he ought to foUow the example of his older brothers and sisters and become gainfully employed. Parents think they cannot afEord to allow children of working age to remain in school. Fre- quently, however, the youngest child escapes from this tyranny of procedure and gains additional education. Studies in several localities, for example, in New York City, indicate that the majority of families could live decently without the income from the working child. The second cause of exploitation finds a less common expres- sion, but is not absent. The child labor problem in New Eng- land before 1820 was somewhat intensified by the desire of parents to retire as soon as their children were able to obtain sufficient wages to maintain the entire family. Many parents hold that since their children are dependent on them for so many years, it is entirely proper for the children to bear the burdens of the family as soon as possible. They owe this to their parents, regardless of the handicap to themselves in later life. Indolent and shiftless parents especially rely on such support. An extreme case of this kind is afforded in the following illus- tration : A young foreigner not many years in the United States, having married early, found that at the age of 34 his children were able to support him, and that the family could be main- tained without his aid. He therefore retired, and began to spend his days in idleness and pleasure. In the South many families move from the mountains to the cotton mill districts in order to enable the young children to earn a wage even though it be a mere pittance. Cases have been cited of fathers whose chief occupation was that of carrying lunches and dinners to their children in the factories ! Much child labor is due to the indifference of parents. Chil- dren manifest their dislike for school work, and parents, instead of insisting that they continue to study, permit them to decide as they please. If under these conditions some slight economic gain should result, parents remain entirely apathetic. The 274 PROBLEMS OF CHILD WELFARE New York vocational survey declares that the most striking thing discovered in the investigation was the apathy of both parents and children ; three-fourths of the former, and two-thirds of the latter, had no conviction that it was worth while to con- tinue school work; it seemed a sacrifice to remain and much would be gained by beginning to work. It appears that many parents do not consider education practical and are glad to see that their children are anxious to enter industry, but conditions in this respect are not uniform throughout the United States. In places where the tradition of education is strong, parents are loath to allow their children to drop out of school, but in other sections the opposite is true. The Massachusetts investi- gations indicate that the majority of parents prefer that the child should remain in school, other conditions being favorable, and experience in Chicago and St. Louis indicate apathy among the majority of the parents. The investigation by the federal government shows that parents wanted their children to enter industry in 27.9 per cent of the cases, although the labor was not necessary. Probably the real apathy, however, is much larger than this figure. 2. Poverty. Although a large number of parents whose children work enjoy a reasonable standard of living, and push their children into industry in order to add to the family comforts and con- veniences, a considerable proportion also suffer from economic pressure. Some light on the influence of poverty as a cause of child labor appears from the results of the federal investigation of child wage earners. The statistics are presented in the fol- lowing table : ^ Causes or Child Labor Causes Percentage Necessity Help desired but not necessary Dissatisfaction with school Child prefers to work ... 30.0 27.9 26.6 9.8 S-7 ^ Woman and Child Wage Earners in the United States, Vol. VII, p. 46. CAUSES OF CHILD LABOR 275 Poverty accounts directly for less than one-third of the child labor, but the desire for economic improvement is responsible for slightly more than half. More than one-fifth of the chil- dren are discontented with school and turn to industry, many of them because they are anxious to work. A study of 302 children applying for working papers in New York City indicates that not more than 33 per cent of the chil- dren entered industry because of poverty. The average monthly rent paid was slightly over Si 5. 00 and on the whole the standard of living was fair.' In St. Louis, 19 per cent of the children studied began to work because of grave economic pressure, but in an indefinite number of additional cases poverty was un- doubtedly a cause. The results of the various studies indicate that poverty is the primary cause of child labor in approxi- mately one-third of the cases. Poverty is, however, both a cause and an effect. It is such an insinuating influence and is so interwoven with the other causes that an estimate of its actual magnitude as a factor is most difficult. For example, the attitude of parent or child often depends upon the poverty in the home ; employers often encourage child labor because they believe that poverty will be alleviated thereby ; and state laws permit exemptions to allow children of less than the standard working age to be gainfully employed, in order to help maintain dependent members of the family. Poverty is too often one segment of a vicious circle, for : poverty causes child labor ; child labor prevents opportunity for industrial training and results in low wages in later life; low wages in turn mean poverty. Consequently poverty seems to run in famUies, when the real cause is a succession of condi- tions that naturally follow each other, and that will not change until broken at the most vulnerable point. Poverty, or, more accurately, a low plane of living, requires an increase of income, whatever be the sources. Some children work to aid their widowed mothers but, contrary to popular belief, the proportion of such cases is remarkably small. Others ' Report of City Superintendent of Schools to Board of Education of New York City, 1912, p. 390. 276 PROBLEMS OF CHILD WELFARE are expected to add to the family income to make higher stand- ards possible, especially if the family lives on the subsistence level and every increase in income is so much gain. If parents have low ideals, poverty acts more easily as an apparent cause than otherwise. 3. The Attitude of the Child. The child's attitude is a very important factor in the problem and involves two considerations — dissatisfaction with school, and the desire to work. A large proportion of the children dropping out of school leave on their own initiative, many of them in spite of protests from parents. They do not fully under- stand the value of the education which they are receiving or they fail to advance; so they refuse to continue after they have passed the age of compulsory attendance. The majority of children who leave school do not intend to remain idle, but naturally turn to some gainful occupation to absorb their time, and to earn a little money. Children, especially boys, develop a spirit of independence and become anxious to demonstrate their working capacity. The impulse grows because most chil- dren have friends who are earning money. Nothing thrills a young boy more than the first wages he receives. His first gainful employment develops his pride and self-reliance; be- sides, he is earning money which he could not otherwise enjoy, and in turning from the monotony of school to the drudgery of work, he does not realize what the step will cost him. The limited studies which have been made of the causes of child labor throw some light on the proportion of blame borne by the child directly. Out of 612 children considered by the federal government, two-fifths left school and entered industry of their own choice, many of them against the expressed wishes of their parents. Over 22 per cent of the 1085 St. Louis school children studied were anxious to begin working, while the major- ity of all these children secured their first positions through their own efforts. These examples indicate that a large proportion of the working children deliberately enter industry of their own accord but this could, of course, be prevented in many cases except for the indifference of the parents. The gravity of this CAUSES OF CHILD LABOR 277 condition points most clearly to the need of such reformation in our educational system as will change the attitude of both child and parent. Furthermore, the parents need to learn that child labor ordinarily obstructs the promise of a future and leads to unskilled labor and a low plane of living. A better school and better parents are necessary to guide the child and to prevent him from ruining his material prospects. 4. Demand for Child Labor. The attitude of employers of labor is responsible for much of the child labor of the United States. The culpabiHty of the employer in this respect is twofold : first, he makes the entrance of the child into industry possible by employing children who are pressed into service by their parents or who deliberately decide to enter on their own initiative. By accepting children he encourages the tendency of parents and chUd workers to continue the evil of child labor. Frequently employers receive children who should not have been granted work certificates, but they refuse to accept responsibility for this because they are operating a business concern, not a moral hospital ! In the second place, many employers directly encourage and de- mand child labor in order to enhance their profits. The pres- sure of parents would be of no avail if employers did not offer inducements to children. Wages indeed are poor, but other considerations play a part. When the child, discouraged on account of unsatisfactory school work, turns to the factory or the mill, he often finds a cordial welcome in industry instead of finding the doors closed against him. An increasing number of employers, influenced by both human kindness and long- sighted business considerations, have reduced the amount of child labor in their employ, but a large contingent still favor the employment of children and do not consider the influence of such employment upon the future prospects of the child. Progressive employers have sometimes voluntarily refused to encourage child labor. In the South this attitude has taken the form of temporary agreements not to employ children below a certain age. Competitive conditions, however, usually prevent such agreements from becoming permanent. 278 PROBLEMS OF CHILD WELFARE The attitude of the dominating faction in industry is indicated by the character of the laws in those states in which certain industries are largely localized. The canning and preserving industry, for example, has endeavored to prevent wholesome child labor legislation. In nearly every state in which the industry is economically important, it has been wholly or par- tially exempt from the operation of child labor laws, and the severest struggle has been necessary to secure adequate legis- lation. The exemption is based on the supposed necessity of working long and irregular hours in order to save perishable products. An additional illustration of the attitude of some employers is furnished by Delaware, which not only exempts the canning industry from the child labor law but even exempts the manu- facture of fruit and berry baskets from the operation of the law, although there is no question concerning the perishability of the product. The employers who do not want the law to apply to their industry have been sufficiently powerful to prevent its extension. In this tendency lies the danger of allowing exemp- tions, since most products are perishable in time, and if one industry is exempted a second one will demand a similar exemp- tion, and so we pass from the product which is physically perish- able to the one perishable in a commercial sense and open the way for a complete collapse of child labor laws. The canners are, however, the most persistent opponents of good child labor laws to be found among the enemies of such legislation. The long-continued fight in Pennsylvania to prohibit the night work of boys in the glass houses of that state illustrates the power of the glass manufacturers. At present boys of fourteen and over may work in the glass mills on night shifts under cer- tain provisions. In every state where the glass industry has a foothold, this problem has been faced, but in most instances night work of children has been prohibited. Ever5rwhere it has been done against the protests of a large proportion of the glass manufacturers, yet the employment of boys fourteen to sixteen years of age on night shifts is so flagrant an evil that it should have no apologists or supporters. The opposition has CAUSES OF CHILD LABOR 279 been based on the theory that perishable goods are being handled, and nothing must be done to interfere with their immediate manufacture. The physical and moral welfare of boys is considered of less importance ! Failure to restrict night work, the low minimum age limit, and the absence of efficient systems of inspection and enforce- ment — all indicate that economic conditions and the influence of mUl owners are too powerful to permit reasonable child labor legislation. Quite singularly also some of the strongest oppo- nents of progressive legislation are Northern men who have invested in Southern cotton mills and who are credited with wilhng conformity to the more advanced laws of New England. It must not be forgotten that many Southern mill owners are strong supporters of moderate child labor laws, and that manufacturers frequently maintain schools for the mUl chil- dren, who, in their old homes, received no education whatsoever. In fact, chUd labor in the South is condoned by others than manufacturers on the ground that it makes a better use of the child's time as well as gives many children educational facilities which would otherwise have been denied them. The newsboy has enjoyed greater immunity from the law than any other class of working children. Many newspapers, al- though they advocate suitable chUd labor laws for other indus- tries, are opposed to legislation which will curtaU the operations of the vendor of their own wares. This opposition arises from two causes : the belief that the newsboy conduces to a larger circulation of the paper, and sympathy for the boy in his present desires rather than in his future needs. Sentiment for the boy, commendable at the right time but not wise in this connection, aids him in the development of bad habits. It is probable that the four industries mentioned represent the most aggressive form of opposition by employers to child labor legislation. Much of the appeal of the employer in favor of chUd labor is based on two arguments : first, eco- nomic necessity. Intense solicitude is manifested for the famUy income ! What wUl become of the widows if their chUdren may not help to support them? Although the general faUacy of 28o PROBLEMS OF CHILD WELFARE this argument has been clearly shown, legislators are still influenced thereby. The second argument relates to the evils of child idleness. If the boy does not work, he will be idle and engaged in mischief ; therefore it is better to allow child labor. Child idleness is, however, not the logical alternative for child labor, and little progress is made by substituting one evil for another. 5. Modern Industrial Conditions. Modern industrial conditions have made room for both woman and chUd labor in several ways : first, by the use of improved machinery ; and second, by such a minute subdivision of labor as to separate lighter forms of work from the more difficult operations ; third, women and children can be secured for such work at comparatively low wages. Children are in many cases able to operate a machine because modern improvements have made it so nearly automatic. The machinist must be continued, but the adult operators can be dismissed in favor of the young boy or girl. When the work does not require special skUl or strength, the tendency is especially marked. The chief advantage which accrues to the employer from this substitution is the use of poorly paid child labor instead of adult labor. Nor is output decreased by this change, as the worn-out boy can soon be replaced by another eager to obtain his paltry earnings. In certain factories young girls from four- teen to sixteen years of age are taking the place of men in the operation of machines, but are receiving wages no higher than those usually paid to girls of that age. Much work which requires time and running to and fro is apportioned to the little boy or girl. In the cotton mills the children are very largely used for this kind of work; for ex- ample, the doflers, bobbin boys, and spool boys. In fact, a large proportion of the older boys drop out of the cotton mills be- cause they have outgrown their work. The glasshouses use boys in a similar way, and elsewhere in industry niches for the employment of the child have been made by the convenience aSorded by the helper and the apprentice. A particular occu- pation may be isolated from the series of processes necessary CAUSES OF CHILD LABOR 281 to complete an article, and if only a single act of skill is re- quired, a child can become proficient in a short time. In the clothing trade such minor occupations become a department in which chUdren are frequently employed. The tasks allotted to small girls in the manufacture of artificial flowers require little skill; all processes requiring much care and attention are performed by skilled hands, but much can be left to the work of the untried employee. The comparative facility with which a large proportion of the occupations in many mills can be performed tends directly toward the use of the child wherever he can be secured for the carrying on of these occupations. Modern competition is an additional factor which often para- lyzes the efforts of progressive manufacturers. The margin of profit is frequently so narrow that legislation may become a menace. Natural advantages and child labor in some states also operate to encourage the use of child labor in other states. The competitive conditions over which employers have no imme- diate control are often responsible for the antagonistic attitude of employers toward the abolition of child labor. If conditions could be equalized throughout the United States, much of the opposition to good legislation would disappear. The objection to uniform state laws is comparatively slight because changes in the cost of production would then be distributed equally among competitors whether they lived in the same or some other state. 6. IndiSerence of the Public. The public must bear a large share of the responsibility for the existence of child labor, as it can eliminate much of the evil by seriously opposing the practice. The culpability of the public takes several forms : direct preference for the goods or wares peddled by the child ; a willingness to allow child labor for the purposes of self-support or the support of dependent parents ; inability to recognize the ultimate results of premature child labor ; the desire to purchase goods at the lowest possible cost regardless of the child labor which may be involved ; and finally, utter indiSerence to the social problem itself. The public encourages child labor by its willful patronage of the 2 82 PROBLEMS OF CHILD WELFARE small boy. The newsboy seated on the doorstep of the public building gets the major portion of the business without exertion on his part, while the adult worker strives in vain to secure his share of the sales. The same principle obtains with the child working elsewhere; sympathy for the child blinds reason and foresight, and thus the child is allowed to continue his work. The public must learn that it is not efficient kindness to pur- chase the goods that are made by chUd labor under bad con- ditions, nor to purchase the small child's wares even when he begs piteously. Poverty exemptions indicate social lethargy. A chUd under fourteen should not be compelled to bear the economic burdens of supporting a family, yet children of tender years are often exploited and compelled to labor for hire. Even our relief societies, which supposedly are actuated by the most prudential and farsighted motives, will, on occasion, endanger the pros- pects of a child by insisting that upon his arriving at the age when he can legally be employed he shall immediately enter some gainful occupation in order to relieve the public of the support of dependent parents. This has been done in spite of the child's immaturity and lack of preparation for industry. Such action means gross neglect of duty, and no charity has a right to a moment's existence which strives to rehabilitate a family by means of injurious child labor. Many men of prominence fail to realize that the new industrial conditions require special preparation on the child's part. Because many men began work as mere boys and succeeded, is no argument against wholesome legislation at the present time. Successful men frequently oppose good laws because they them- selves have not faUed and have withstood the disadvantages of premature toU. They do not usually realize, however, that child labor involves risks and handicaps to-day which are far more serious than the consequences in a former decade when cities were smaller, machinery less complex, and work less rapid. They have become blinded to the evil effects of child labor, and are often bitter enemies of the real interests of the child of to-day. The farming class likewise fails to understand CAUSES OF CHILD LABOR 283 the dangers of child labor in the cities and in industrial centers, because farmers are prone to judge the results of all forms of labor by the effects of labor on the farm. In our legislatures such men are easily influenced to oppose needed legislation. It thus appears that while the specific causes of child labor are numerous, the chief factors are reducible to six heads : the attitude of the parents; poverty; the ambition of the chUd; the greed of employers ; modern industrial conditions ; and the indifference of the public. The relative importance of some of these factors can be approximated in a superficial way, but in most instances they cooperate closely to produce the evil in question, and each one of these causes is an essential factor in the problem. The more fundamental positive causes, how- ever, are limited to two : poverty, or low plane of living ; and the absence of ideals due to ignorance and indifference. As a preventive of progressive legislation, the opposition of the employer undoubtedly stands foremost, but the elimination of child labor depends especially upon improved economic and moral conditions and better educational facilities. Poverty usually prevents the acquirement of educational advantages. A lack of these results in low ideals. Accordingly, children want to work, and parents encourage the idea. By remaining unskilled workers, chUd laborers cannot reach a high plane of living where child labor can be entirely abolished. CHAPTER II FACTORS OF THE CHILD LABOR PROBLEM I. Occupations of Children. The occupational distribution of the workers is an important factor in the chUd labor problem. The character of the work affects the health, while the type of employment may affect the industrial opportunities of the laborers. Certain forms of work also tend to demoralize children. The exact occupa- tional distribution of child workers in the United States is not known, as the statistics gathered in 1910 have not yet been published.' The broader classifications, however, do not vary radically from year to year. The proportion of working chUdren engaged in agriculture, according to the Twelfth Census, was nearly 60 per cent ; in domestic and personal service, 16 per cent ; and in manufactur- ing and mechanical pursuits, 16 per cent. Less than 7 per cent were employed in trade and transportation, while less than one out of every six hundred was engaged in professional service. As the enactment and enforcement of child labor laws has taken place largely since 1900, these proportions have undoubt- edly changed. The laws have usually exempted agriculture and domestic service, therefore it is reasonable to expect that the proportion of all child workers in these occupations has risen, with a consequent decline in the remaining occupations. Whether the aggregate amount of child labor has increased, the forthcoming figures alone can tell. Some data concerning child labor in manufacturing industries for the year 1910 are available, and they probably throw light on the comparative effectiveness of child labor legislation. ' May, 1914. 284 FACTORS OF THE CHILD LABOR PROBLEM 285 According to these figures, the number of children under 16 engaged in manufacturing industries in 1909 was not quite 1000 more than in 1899, while the proportion of the total num- ber of workers who were children had fallen from 3.4 to 2.4 per cent, which represents a marked decline. But in a number of industries a considerable amount of child labor still prevails, as is shown in the following table.^ Industry Percentage op Workers UNDER 16 Years or Age All industries Cotton goods Hosiery and knit goods . . . Silk and silk goods .... Canning and preserving . . . Confectionery Woolen, worsted, and felt goods Boots and shoes Boxes, paper The table shows that the proportion of children has declined in such important child-employing industries as the manufac- ture of cotton, hosiery, and silk, but in spite of the decline, more than 40,000 children were employed in the cotton mills. Canning and preserving shows a considerable increase in the proportion of child labor — a fact due to the failure of the states to enact stringent legislation covering this industry, and here women have also been employed in increasing proportions. An increase in chUd labor is apparent in the confectionery, paper box, and boot and shoe establishments, but these indus- tries include many minor occupations regarded as suitable for children, and in the first two the great majority of all workers are women. Out of 61 industries listed by the Bureau of the Census, 22 employed a larger proportion of children in 1909 than in 1899, most of these, however, being of little importance. In the majority of industries a considerable reduction has • Thirteenth Census o£ the United States, Abstract, p. 458. 286 PROBLEMS OF CHILD WELFARE occurred. Legislation is probably responsible for most of this decline. The relative progress of the different geographical divisions in reducing child labor in manufacturing has considerable significance, as is shown by the fact that the New England states have remained almost stationary, whUe a decline has occurred in every other section of the coimtry. The least pro- portions are found in the Western and North Central states ; the highest in the South — those for the South Atlantic states being two times that of any other group. North Carolina, with 1 1.3 per cent and South Carolina with 12.9 per cent of their factory workers under 16 represent one extreme; Oregon and Montana, each with .3 of i per cent represent the other. Never- theless, these two Southern states have made creditable prog- ress in reducing chUd labor, while Massachusetts and Connec- ticut have actually increased their proportions. Pennsylvania has more children employed in its factories than has any other state, being credited with 29,102 ; next foUow Massachusetts and North Carolina, but New York, credited with less than 8,000 workers, is said by the New York State Factory Investi- gating Commission to employ nearly 14,000 children between 14 and 16 years of age in its factories. The fact that the extensive employment of children is largely confined to a few states is due, of course, to the presence in those states of industries in which many light and unskilled forms of labor abound. These industries are situated as follows: the cotton industry is largely localized in New England, the Caro- linas, and Georgia; the glass mills are found especially in Pennsylvania, New Jersey, and West Virginia ; candy making is carried on throughout the United States, but the chief seat of the industry is in Massachusetts and New York, and silk man- ufacturing is carried on principally in New Jersey and Pennsyl- vania. Pennsylvania is also noted for its woolen factories and for its coal production. The boot and shoe industry flourishes in Massachusetts and Missouri, whUe canning and preserving are carried on extensively in at least fifteen states. The localization of industries in certain states accounts partly FACTORS OF, THE CHILD LABOR PROBLEM 287 for the difficulty of securing progressive legislation in those states. Although agriculture claims the great majority of all child laborers, it does not seriously injure the child, since outdoor work on the farm will not produce bad physical effects. Again, about four-fifths of the children are members of farmers' families and are simply assisting their parents, who in most cases will safeguard the physical interests of their children. No harm will result from the ordinary forms of farm work, if a compul- sory education law is enforced and the children work only outside of school hours and during the vacation season. Domestic and personal service furnish a real chUd labor prob- lem. In this group of occupations, children of foreign parentage and negroes form a large proportion of the workers, and as a result business rather than personal ties obtain in the relation- ship between employer and employee, since most of the em- ployers are native whites. About one-half of these workers are mere servants and waiters and are forced at once to recog- nize class differences. Much of the work is of a menial and degrading character, while the routine of work and the lack of opportunities for self-expression produce serious moral effects. Trade and transportation has offered an apparently inviting field for a large number of children. Mercantile establishments draw heavily on children for the simpler occupations, such as bundle wrappers, cash boys and girls, and delivery boys, while the carrying of bundles and packages has developed enormous proportions. Offices demand boys to do the odds and ends that must be done. The street trades form another branch of this group, newspaper selling, messenger service, boot blacking, selUng of gum, flowers, etc., and distributing bills. The most important numerically is newspaper selling, and the newsboy is found in every city where daily papers are sold, and even in smaller towns. Complete statistics of numbers are not avail- able, but New York City has approximately 5000, while Boston, Chicago, and Philadelphia have about 3000 each, and there are at least ten other cities each of which has 1500 or more news- boys. When unrestricted by law small boys may often be seen 288 PROBLEMS OF CHILD WELFARE engaged in this occupation, but the majority of boys begin when about nine or ten years of age. They remain in the service for about three years, then drop out and search for some new occupation. Although statistics on the subject are not available, there are still a large number of messenger boys, but because of their unreUabihty the younger boys are being dropped and an increas- ing number of the boys employed are over i6 years of age. The boy bootblack is also being driven out of his occupation, and the remaining street trades employ but few children. This group of occupations really unfits children for regular work; consequently the state must endeavor to reduce the number engaged in the street trades. . The recent child labor laws are making special provisions for the control of these occupations, but are not usually applying the same restrictions as those limiting factory work. A small group of children are employed in professional serv- ice, many of whom sing, act, or practice contortions in mov- ing picture shows, vaudeville, and cheap theaters. The environ- ment in which they work is frequently most demoralizing, and they usually are without proper chaperonage. Furthermore, they are deprived of the means of education. Very few chil- dren under i6 years of age can engage in any profession in which the influences are uplifting and educational. In the coal mining industry the employment of boys under 14 has almost ceased, while the number of boys from 14 to 16 has been reduced, and the great majority of these boys are work- ing above ground. In many industries a limited amount of work is sent to indi- vidual homes to be completed there. This results in one of the phases of the sweating system. Among these industries are the manufacture of men's ready-made clothing, women's and children's underwear, hosiery, dolls' clothes, artificial flowers, shirts, cuffs and collars, leather goods, paper boxes, brush making, hand embroidery, and nut picking. A large proportion of the home work is carried on in tenements in the large cities, where the work is usually done by the mothers and FACTORS OF THE CHILD LABOR PROBLEM 289 the children. The children of school age cannot assist during school hours, but help in the mornings and evenings. Small children may be required to work all day, and it is not unusual for all the children and female members of a family to engage in home work until the late hours of the evening. The inves- tigation of child labor conditions made by the federal govern- ment discovered children five years of age and upward employed in the making of men's clothing, and agents for the state of New York likewise found children of these ages actively engaged in work. The principal nationalities represented were the Bohe- mians, Italians, and Russian Jews. In some states licenses are required before individuals may manufacture goods in their homes, but it has been impossible heretofore to enforce license laws satisfactorily, consequently we have no adequate knowledge of the amount of home work that is still carried on. Even when a system of inspection is in operation, it is difficult to learn about child labor and the hours of work. Without doubt a considerable number of children are employed in the home sweatshops and are coihpelled to work as many hours per day as their parents may require. In New York City alone over 10,000 Hcenses are held, but sweating is largely localized in a few large cities. In estimating the magnitude and seriousness of the child labor problem most agricultural laborers should be excluded from consideration. Again the proportion of children in manufacturing, which increased tremendously during the decade 1890-1900, has suffered a remarkable reduction since that time, although many children remain. Children likewise do not prove very acceptable in domestic service; they rebel against its exactions and are gradually being displaced. The heavy increase during the ten years ending in 1900 in the number of children engaged in trade and transportation is being met by the recent drastic legislation, which will gradually reduce the proportion of child workers in this group of occupations. 2. Age of Children. In 1900, 62 per cent of all the working children were 14 years of age or over, and the constant tendency to raise the 290 PROBLEMS OF CHILD WELFARE age limits has no doubt resulted in increasing this proportion. Although the majority of agricultural child workers are under 14, the danger here is of slight importance. But great harm follows the employment of children under 14 in manufactxu-ing, mining, trade and transportation, and home work. The presence of children under 14 in factories is largely confined to the South, where the age limits have not been raised to the accepted standard, and to the canning industry elsewhere. Many children under 10 have been discovered in the cotton mills, some of whom are carried directly on the pay rolls. Com- paratively few children under 14 are found in domestic service. The New York State Factory Investigating Commission in 1912 discovered that 141 of the 1259 children found working in the cannery sheds of that state were under 10 years of age, and 502 were under 12.^ The Commission learned that the small children present were all expected to work, that many of the children were kept in the sheds late at night, and that tru- ancy was being aggravated by these forms of child labor. It is also significant that when an inspector arrived at a certain cannery at 5.30 a.m. nearly 200 children were hurried away so that records of their ages could not be made. In home work, as has just been shown, many small children are employed. The street trades have until the recent legisla- tion in many states commanded a large number of boys under 12 and a considerable number under 10; for example, before the enactment of the Missouri law, one-seventh of the newsboys of St. Louis were under 10 years of age and about one-half were either 11 or 12. The federal government, in its study 'of seven selected locaUties, discovered that the average age of the children when they entered industry ranged from 12.4 to 14.4 years. The lower figures represented Southern conditions, but the average for one Pennsylvania town, in spite of a fourteen-year limit imposed by the law of that state, was only 13.5 years ! But in the larger cities the average age is somewhat higher. According to a brief vocational guidance survey in New York City the median 1 Second Report, New York State Factory Investigating Commission, Vol. I, p. 132. FACTORS OF THE CHILD LABOR PROBLEM 291 age of the children studied was 14 years and 5 months — a figure that corresponds exactly with the results of a similar investigation in Chicago. These figures are probably typical of the large cities, while those gathered by the federal govern- ment represent conditions in the country as a whole, outside of metropolitan centers. 3. Literacy and Education. No statistics are available in regard to the comparative liter- acy of working children in the United States, but without doubt the proportion of illiteracy is higher among working than among non-working children. In the Northern states the amount of illiteracy among the general population is small, but in the South the percentage is comparatively high. Here the chil- dren in the mills are largely recruited from the ignorant people coming from the mountains, and therefore a high rate of illiter- acy prevails among them. The following statistics gathered by the federal government corroborates this conclusion.^ Illiteracy of Children in Cotton Mills compared with that of THE General Population States Percentage or Illiteeacy among Working Children under 14 Working Children 14-15 Native Whites of Native Parents, lo years and over (1910) Virginia . . North Carolina South Carolina Georgia . . Alabama . . Mississippi 70.4 53-8 S0.3 42.7 6S-S 44.0 S7.8 39-8 31-9 28.2 46.S 22.0 8.2 12.3 lo.s 8.0 lO.I S-3 These figures, although based on a limited nimiber of cases, are a vigorous commentary on the prevalence of illiteracy among the children employed in the cotton mills. In four of the six states mentioned more than one-half of the children studied who were under 14 were illiterate. The percentage of illiteracy among the older group of children is considerably lower, how- ' Woman and Chili Wage Earners, Vol. I, p. 244. 292 PROBLEMS OF CHILD WELFARE ever, due in part to the habit of allowing some of the children of the family to work during one year while the remainder are at school, and then alternating the next year by sending the children who had worked to school, and those who had attended school to the mills. A comparison of the illiteracy in 1910 of native whites of native parents in these states with that of the cotton mill employees shows that the proportion of illiteracy among the working children under 14 is more than five times as great; that of the group between 14 and 16 is from three to four times as large. The foreign-born child also affects the percentage of illiteracy among working children. Among this group the proportion unable to read and write is comparatively high, and at the same time a larger percentage than among the native born are en- gaged in gainful employment. The age of children on coming to the United States likewise affects the problem, for the older children often do not attend school at all. Negro children suffer from inferior educational advantages, so a high rate of illiteracy naturally prevails among them. A literacy test does not afford much information concerning the amount of education acquired by child workers. It is easy to classify as literate if the smallest amount of education has been secured, but it is difficult to make satisfactory progress in the schools. A large proportion of working children have a mere smattering of knowledge, and are not able to use their education for practical and gainful purposes. The recent ob- servations of school authorities in the large cities have disclosed the fact that children applying for work certificates have reached an average grade attainment of a little beyond the beginning of the sixth grade. Usually a larger number drop out of the sixth and seventh grades than from any other. Out of 497 children studied in Chicago, more than one-half left school while in these grades.' A large proportion of the working children — from one-third to one-half in the metropolitan cities — leave school for work before they have reached the sixth grade. This group ' Talbert, E. L., Opportunities in School and Industry for Children 0/ the Stock- yards District, p. 12. FACTORS OF THE CHILD LABOR PROBLEM 293 can make but little if any use of their school training, and must limit themselves to unskilled manual work almost exclu- sively. The efficiency of the truant departments in such cities raises the average grade attendance of the working child, but cities less influenced by this factor show somewhat different results. The following figures presented by the federal government give the average grade of the children studied in the localities designated. Average Grade of Working Children ^ LOCAUTY Average Grade on Leaving School 4.1 3.6 4.0 3-1 2.9 4.0 S-o Woonsocket Columbus, Georgia; Georgia and Alabama counties . . . Columbia, South Carolina Plymouth, Pennsylvania Hazelton, Pennsylvania These figures show a comparatively low grade attainment — the highest average being only five. It also appears that nearly one-half of the children left before entering the fifth grade and three-fourths before reaching the seventh. If these facts are typical for the child labor in the smaller cities and towns, it indicates a most grievous condition, and emphasizes the need of including definite educational requirements in every child labor law and the rigid enforcement of these provisions. 4. Wages and Wage Advancement. The wages of employed children suggest at least three impor- ant propositions : the relation of wages to degree of education, the relation of wages to age, and the opportunities for wage advancement. A study of 770 children in St. Louis who left school from the fifth, sixth, seventh, and eighth grades indi- cated that the wages of the child with a fifth-grade preparation on entering industry were practically the same as those of the ' Woman and Child Wage Earners in the United States, Vol. VII, p. 132. 294 PROBLEMS OF CHILD WELFARE child from the eighth grade.* These observations have been corroborated by studies in other cities. It appears therefore that the training of the upper grades of the elementary schools does not materially enhance the immediate wage-earning capacity of the children; and this is especially true of those who enter the manual and mechanical pursuits. It also accounts for part of the apathy of parents toward the schools and the education of their children. Education is a much larger factor in determining the character of positions for boys and girls who are over i6, as a greater variety of occupations are open to them. Intellectual ability will then imply promotion and progress. Age likewise does not guarantee superior positions, since the younger boys earn practically the same wage as the older ones and the minor differences are to a large extent accidental. It is only as age is a measure of physical capacity or endurance that it may gain a slight advantage. Boys in transferring from one position to another find as wide a difference in the wages paid as between those of the younger and the older boys. The fourteen-year old boy has practically the same opportunities in industry as has the child who is nearly i6; consequently he sees no advantage in remaining at school after he has reached the age of 14. Age and grade, within limits, are factors of minor importance in determining the opportunities of children. A factor of grave importance consists of the limited field of employment for children, as the positions open are, on the whole, undesir- able, afford few opportunities, and pay low wages. The major- ity of girls in manufacturing and mercantile establishments receive initial wages that range from three to four dollars per week; but boys usually receive from $3.50 to $4.50. Little actual advancement occurs during the first two years of work. The wages of newsboys in the great majority of cases approxi- mate twenty-five or thirty cents per day, or about $2.00 per week, the Sunday newspaper proving somewhat more profitable 1 Washington University Studies, Vol. I, Part II, No. i, October, 1913. Indus- rial Opportunities of Children in St. Louis, p. 80. FACTORS OF THE CHILD LABOR PROBLEM 295 than the daily paper. These returns, however, represent an average of not more than three hours of work per day. An occasional newsboy earns as much as $10.00 per week. Although adult home workers acquire considerable speed and, may therefore earn fair wages, the rate of pay for home work is almost uniformly less than that paid in the factory. This im- poses a double hardship on the children engaged in the sweated trades, for they work slowly, and if they receive a low rate of compensation their earnings are pitifuUy small. Consequently a child working from four to six hours per day usually earns not more than twenty cents, and many children actually fall far below this limit. The wages of child workers are one of the best indications of a present social maladjustment. 5. Night Work and Overtime. Night work for children is rapidly dying out. ' Night shifts in manufacturing establishments do not usually include children, but several exceptions occur, such as the night shifts in the glass- houses of Pennsylvania and the night work for older children in the Southern cotton mills. The evils more to be feared are long hours, or overtime, the principal occupations in which they persistently remain being the seasonal trades. On account of the necessity of doing the major portion of the year's work with- in a comparatively short time, these industries engage in over- time during a part of the year and operate on short time dur- ing the remainder. Among the trades in which children are largely represented and compelled to work overtime are : the paper-box industry, the confectionery trade, the canning and preserving of fruits and vegetables, artificial flower making, toy making, and, to a limited extent, the making of cotton and woolen goods. The period of overtime extends from a few days, as in some of the mercantile establishments, to three months, as in many candy factories. The amount of overtime is often excessive, and frequently children are employed 13 or 14 hours per day for three or four days per week. The majority of factories engaging in overtime limit themselves to not more than four 296 PROBLEMS OF CHILD WELFARE nights per week. Although factories sometimes operate till 10 o'clock, and in some instances on Sunday as well, the usual closing time for overtime work is at or before nine p.m. In the cheaper stores in some cities the doors are not closed in the pre-Christmas season until very late in the evening. Here the workers may be employed for at least 14 consecutive hours. CHAPTER III GENERAL EFFECTS OF CHILD LABOR I. Introduction. The original opposition to child labor was largely based on hxunanitarian motives. The horrible conditions which formerly prevailed finally determined sympathetic men to abolish the atrocious system. Shaftesbury, Dickens, and the philanthro- pists developed the public opinion that investigated the evils of child labor, but the economists at first opposed its abolition on account of the reputed detriment to the industries affected, although later they discovered an economic justification for such legislation. This evolution first took place in England, but in the United States an almost similar development occurred. Here the original attitude toward child labor was the exact opposite of the one held to-day. In estimating the productive capacity of a nation, statesmen such as Hamilton included the labor of children, since this was regarded as entirely legitimate. Why should they not add to the wealth of the country? Further- more, they would earn a wage that would partly compensate parents for having brought them into existence ! When our manufacturing enterprises began to spring up in the Eastern states, it was generally believed that industry could be made more productive and children more useful by their employment in gainful occupations, especially in the manu- facture of textiles. The cotton and woolen mills therefore soon began to swarm with little children called from the farms and small towns of New England. The wages received were absurdly low, but this very fact made the business more profit- able to the capitalist ! In 1 812 many children were employed at less than a half dollar per week, but by 1832 boys in the cotton mills commonly received $1.75 for a week's work. Our legis- 297 298 PROBLEMS OF CHILD WELFARE lators, however, were not interested in the wages of children, their chief concern being with the development of industry. Child labor was a mere means to a justifiable end. Child labor under the old domestic system had differed essentially from labor in the factory or in the tenements, but this contrast was not appreciated by the early economists or the American statesman of the beginning of the nineteenth century. There were no vital statistics to indicate the general unhealthfulness of cities and industrial centers. There was little knowledge of average trade life or the inju- rious effects of premature toil. The requisites for economic survival then were likewise different from those of to-day and child labor was less detrimental to society. A strong impetus was therefore given to the employment of children wherever they could be used. Compulsory education had not yet dawned, and women were denied the opportunity of acquiring any con- siderable degree of learning, nor was the social necessity of education apparent. Consequently, no impelling motive existed to prevent the child from entering some gainful occupation. Changing social standards have now awakened the American people to the seriousness of the child labor problem. 2. Economic Cost of Child Labor. The economic disadvantages of child labor are almost self- evident, but the results need to be briefly stated. One of the direct economic effects of child labor is a shortening of the period of trade life, owing to the physical depletion which results from premature labor in factories and workshops. The pres- ent conditions of industry are such that the boy who begins to work at an early age will be unable to endure the strain of indus- try as long as the child not subjected to such labor. Child labor therefore is to be regarded as a cause of inferior physique, and this naturally results in poverty. It is important that such precautionary measures be taken as will offer the greatest oppor- tunity for an extension of each individual's industrial career. Again, child labor draws prematurely upon our economic assets, and thus diminishes the amount of available labor power. By employing labor before it is mature an earlier GENERAL EFFECTS OF CHILD LABOR 299 yield upon the investment will be realized, but the human being will be exhausted so much sooner that great harm will have been done and the total trade life will be actually shorter. The eco- nomic loss caused by this handicap depends upon two results : the death of the child or the worker in middle life ; or his loss of earning power either in childhood or in later life through accidental or physical breakdown. The mortahty of children in a number of industries, such as cotton and glass manufacture, is too high, and obviously is caused in part by their employment, although precise statistics on the subject have not yet been gathered. The economic loss due to a higher mortality cannot be replaced. The physiological effects of child labor all oper- ate to lessen the general efi&ciency of a nation. Where the im- mediate result to the individual is deformity, stunted physique, or incapacity for hard work, the final effect is uniform — a reduced productive power. Accident as an economic cost is receiving greater attention as the appaUing loss of human life in industry is becoming better known. The child is more prone to accidents than the adult, and will suffer even in industries regarded as comparatively safe, since young boys and girls are naturally careless. Children cannot concentrate their attention on their work, and are therefore frequently the victims of accidents which maim them for life and lessen or destroy their economic capacity. The accident rate for girls has been shown to be especially high. Children are allowed or compelled to tend machines requiring the utmost care of the adult operator ; therefore serious injury becomes almost inevitable, and the danger is often the greatest for the very class least capable of declining to accept hazardous employment. In the recent federal investigation of conditions in the cotton mills it was found that children were generally employed in the less hazardous occupations and were not required to handle very dangerous machines ; still the accident rate in the South- em cotton mills was 48 per cent higher for persons 14 and 15 years of age than for those 16 and over.' The accident rate for ' Wrnian and Chili Wage Earners in the United States, Vol. I, pp. 385-386. 300 PROBLEMS OF CHILD WELFARE these children, working among shafts, belts, and gears, was 133 per cent higher than for the older group, and in gear accidents the rate was three and one-third times as high for the younger group ! In a similar way a high rate of accidents for children was discovered in a metal trade establishment which employed young boys at the machinery. Many states have recently enacted laws forbidding the em- ployment of children in certain occupations in which danger from accidents is considerable. Some states have general laws prohibiting the employment of children in dangerous occupa- tions, but do not specify these occupations. Unless the indus- tries are detailed, such laws have but little value. Child labor prevents the development of eflSciency in the worker, owing to his failure to receive proper training and education. The child necessarily enters industry without hav- ing acquired a trade education. He therefore joins the ranks of unskilled laborers, and remains the victim of low wages throughout his industrial career. He may be required to per- form the routine work of a very simple occupation in which he may acquire remarkable skill and dexterity, and if he has patience, and the monotony is not too oppressive, he may be successful for a time, but his speciaHzation is so extreme that no other employments except those of unskilled labor are open to him in case of sudden dismissal from his occupation. Child labor therefore promotes a division of labor which under our present system has already been carried too far for the best interests of the working classes. Child labor also means unstable labor. Monotonous work and extreme specialization are inherently contrary to the natural and spontaneous activities of the child, so unless some superior coercive force — a parent's insistence, the absolute needs of the chUd, or some similar force — compels him he wiU not remain in the same position for more than a very short period. The young child belongs to the floating class of workers, and this is especially true of the boy : yet his need of a definite trade is more urgent than that of the young girl, whose entire industrial career, owing to marriage and subsequent retirement GENERAL EFFECTS OF CHILD LABOR 301 from industry, is limited to about five years. A large .propor- tion of children enter "blind alley" occupations; that is, enter positions that are short-lived and do not lead to promotion. In the large cities and industrial centers a large proportion of the boys enter the factories ; next comes the errand and delivery service of the mercantile establishments, and other minor occu- pations. A small nxmiber of children — less than 10 per cent — enter the skilled occupations, the remainder are variously divided between the low-grade and the unskilled industries. A remarkable percentage of the boys, no matter what the in- dustry they may have entered, are required to begin work as mere delivery boys, or they carry bundles, packages, and boxes either from the establishment to the destination or are required to carry them about within the building. This work consists of the merest routine ; it does not prepare for any definite trade, and frequently there is no opportunity for an increase of wages, so the child leaves his position for another, usually in the same general industry. This proves to be of the same variety, so he wanders from one job to another. At first he struggles for better conditions, but eventually he becomes discouraged and indulges in long periods of idleness. A habit of irregularity is formed, and unemployment — forced, then voluntary — is a frequent result. This checkered career of the child leads to the conclusion that the years from 14 to 16 as spent in industry are wasted years. Only a limited number of occupations are open to the child with working papers and most of these lead no- where. The occupations with possibilities ahead are reserved for older workers and persons with experience or training. Employers frequently establish minimum wage limits for their workers, this being especially true of establishments that demand skilled labor, where in many cases the apprentice must be 16 before he is accepted. Two years of irregular work in industry result principally in instability and indecision. The untrained child cannot know his own mind and he knows little of opportunities in industry, so he simply drifts along until dire necessity forces him to begin to concentrate his efforts on a aingle industry. Meanwhile he has lost several years of time, 302 PROBLEMS OF CHILD WELFARE and his opportunity for an education is gone. In fact, when the child has once dropped out of school it is almost impossible to persuade him to return. He soon reaches the limit of his earn- ing capacity and cannot contribute to society the values which would be expected from him if he were trained. Investigations in Massachusetts and also in several large cities indicate that the untrained child suffers an enormous handicap. Although for a short time he may outstrip his trained associate in earning power, this advantage is quickly lost. The latter may gain an indefinite increase of wages or salary, but the former must al- ways remain among the wage-earning class. The net result of the entrance of children into industry is a positive curtail- ment of the wealth-producing power of the nation. Without doubt child labor reduces the wages of adults, as boys frequently displace men, and girls displace women. Often there is little or no difference in the character of the work performed, yet the children receive lower wages. The standard rate of wages paid in a certain position is thereby re- duced, and in a short time adults competing for these positions are forced to accept reduced wages. In this way families grad- ually sink below the poverty line, and little children are again driven into the mills to help eke out the family income. It has been shown that in a community in which child labor is prevalent, the family income is not essentially larger than in a locality in which the burden of support rests principally upon the economic head of the family. 3. Social Costs. The social costs of premature employment cannot be measured quantitatively, but are nevertheless a serious menace to our national welfare. Child labor hardens the boy who has chanced to be successful to the evils of the system. He says it is merely a case of the survival of the fittest, and if so why should not this principle be given an opportunity to separate the worthy from the unworthy ? The fallacy lies in a mistaken impression of what constitutes fitness. Accordingly the very men who should be strongest in their advocacy of progressive laws are precisely the men who look backward and do not GENERAL EFFECTS OF CHILD LABOR 303 struggle for the interests of the child of to-day. Prominent railroad officials fail to see the harm ia child labor in the mes- senger service; newspaper men oppose interference with the modern newsboy. Society suffers because the individuals subjected to child labor cannot realize the full amplitude of their powers. Not only is the loss occasioned an economic disadvantage, but race deterio- ration is threatened. In addition, the child has no opportimity to develop his full mental powers. A loss results to him in the limitation of his social opportunities, and to society in its failure to receive the best contribution of which the child would have been capable. Child labor debars the child from acquiring an adequate edu- cation, and thus handicaps him in his efficiency as a citizen, as has been shown. Many working children are illiterate ; others have so little education that almost no advantage can result. The demands of the state are becoming increasingly urgent, and every reasonable effort should be made to equip every boy and girl for the duties of citizenship. Successful citizenship requires intelligent application of the powers which education develops in the individual, but child labor is a serious bar to this achieve- ment. Unfitness for the social and political life of to-day fol- lows in the wake of child labor, and the citizenship of our country is thereby endangered. Though a small number of children are able to overcome the handicaps of premature child labor and thereby become natural leaders, comparatively few child workers ever attain to positions of prominence or become factors in directing our civilization, and this will become increas- ingly true from year to year. The failure to develop capacity means a great social waste. The curtailment of the earning power of the individual on account of the handicap which child labor imposes results in a relative incapacity to rise in the scale of living. Thus the prob- lem of poverty is accentuated, standards of living fail to rise, and the dependent classes increase in numbers. Without the needed moral, industrial, and trade education, the young worker likewise is unable to use adequate foresight, he cannot cooperate 304 PROBLEMS OF CHILD WELFARE SO successfully with others, and the benefits accruing from or- ganized labor cannot be fully realized. In this connection it is interesting to note that some men have maintained that child labor in the South is a blessing. It is claimed that disease has been lessened and death rates reduced because children have gained the service of physicians in factory towns, whereas medical care in the mountains from which the families migrated was very ineffective. Likewise, the social life of the town is superior to that of the backwoods and a modern mill is much better than the average mountain home. The younger children also can attend school instead of growing up illiterate. This argument is utterly fallacious. We do not right a wrong by substituting one evil condition for another. Furthermore, we create an additional evil — child labor — and blind men to the causes of the conditions in the mountains, while we content ourselves with dealing with a few of the effects, for only a small proportion of the children actually enter the cotton mills. The real upliftment of the people of the mountains is thereby delayed for many years. 4. Moral Effects. Many of the effects of child labor are demoralizing. Among the occupations in which special temptations abound are news- paper selling, errand and delivery work, and the messenger serv- ice. The small boy selling papers on the street easily degene- rates into the beggar, especially if he plies his trade at night, when his artifices meet with a greater degree of success. Practice in begging and in methods of deceit tend to demoralize him and prepare him for the juvenile court. Social workers have long since declaimed against the moral effects of child labor, and have produced evidence relating especially to several occupations which will be discussed later. The federal government has in a more comprehensive manner gathered the data presented in the following table which show the proportion of delinquents among working and non-working children.^ ' Woman and Child Wage Earners in the United States, Vol. VIII, p. 37. GENERAL EFFECTS OF CHILD LABOR 305 Cities Proportion of Boys Delinquent Working Non- Working Proportion of Girls Delinquent Working Non- Working Indianapolis Baltimore . Boston Newark . Philadelphia Pittsburg 6.67 2.87 15-71 3-74 1.66 6.56 .66 1.46 .89 •55 1-54 1. 41 •51 1.36 .28 ■34 2.47 ■31 .02 .08 .04 .04 .14 These figures have value only in so far as working and non- working delinquents are compared with each other in the same city, since the varying administrations of the juvenile courts make comparisons among cities impossible. A glance at the table shows that in every instance the proportion among the working boys is from two to ten times as high as among the non- working boys. Among the girls the disproportion is still more startling, but the number of girl delinquents is so small that the ratios are less reliable than those for boys. However, the in- vestigation showed that, although the number of working girls was less in each of these cities than the number of non- working girls, in every city except Indianapolis the majority of the de- linquent girls came from the working group. In fact, for both sexes, taking the cities as a whole, the working children furnished both absolutely and relatively more delinquents than the non- working group. Little difference was indicated in regard to the gravity of the offenses, but it appears that the working group inclines to the more serious offenses, and also contributes the larger proportion of repeating offenders. The relative dehnquency of the two groups is affected by other considerations which may modify the disproportions somewhat. For example, it was shown that broken homes are relatively more numerous among working than among non-working chil- dren, yet home environment was superior among the former group, while nationality, nativity, and age were influences of doubtful tendency. The fact of work seems to predominate 306 PROBLEMS OF CHILD WELFARE decidedly in producing the differences — a conclusion especially indicated from the proportion of offenders engaged in certain occupations. Investigation has shown that a vast majority of the newsboys are not compelled to enter industry to maintain livelihood, but do so because of the attractions and adventures of the business, and for the sake of the spending money acquired. In many cities the newsboy does not hesitate to enter saloons in the pur- suit of his trade, and frequently he visits the haunts of vice and himself becomes infected with serious disease. He becomes ac- quainted with bad women, is made callous to degrading sights, and is often thoroughly prepared for a career of vice and crime, so that many vicious young men acquire their bad habits from their experience as newsboys. In a large industrial school it was ascertained that of the newsboys who were inmates, one-third were suffering from disease caused by immorality, and that the newsboys were considerably below the normal standards of stat- ure and weight. In another large institution for delinquent children, the newsboys form 40 per cent of all the boys who had previously been gainfully employed. A recent canvass of the Lyman School for Boys in Massachusetts shows that nearly one- half of the inmates have been newsboys. Employees in the messenger service are specially subject to the pernicious influences of the immoral districts of the city. They are often compelled to deliver messages at unreasonable hours and in localities which are clearly demoralizing and they therefore form close associations with vice. There is a large percentage of juvenile delinquency among the members of the messenger service, and in many reformatories for boys the rep- resentatives of this occupation are altogether too numerous. The girl employed in this service suffers from the greatest moral temptations, but the recognition of this fact has prompted some of the states to prohibit the employment of girls as messengers unless they are at least 18 years of age. In several states similar attempts to save the boys have been made by prohibiting them from entering any questionable resort to which they may be compelled to carry messages — provisions, however, that have GENERAL EFFECTS OF CHILD LABOR 307 but little deterring power. Conditions are being somewhat im- proved by prohibiting persons under 21 years of age from working in the messenger service at night. Some of the street trades also lend themselves to the oppor- tunity for gaming, and as the newsboy and the bootblack enjoy a large amount of leisure, they become active participants in these questionable games. Shooting craps, throwing dice, and other games develop the gambling instinct in the boys of the street, and as a consequence the pennies earned through the work of the day are often lost again through the petty gambhng in which they engage. This loss, however, is less serious than the permanent injury to their character and the inculcation of the baser instincts. The errand and delivery boys are engaged in very irregular work, which frequently involves excellent opportunities for stealing small articles or money, and the associations are also Ukely to be demoralizing. As in the case of the street trades, the boys are not subject to regular supervision — a fact which conduces to their downfall. Domestic service provides the largest percentage of delinquent working girls, this being due partly to the opportunity for petty larceny which this occupation provides and partly to the lack of protection against immorality. Frequently members of the family are the guUty parties, but more often the girls are led astray by the men they meet in their search for pleasure and recreation. The domestic suffers from loneliness and lacks opportunities for companionship and for making friends. Con- sequently she seeks pleasure in doubtful places; hence the large amoimt of immorality. The figures presented by the federal government throw much light on the importance of various occupations as causative factors of juvenile delinquency. The following table based on statistics for 1466 working boys and 202 working girls shows the percentage of each sex engaged in the occupations furnishing the largest number of delinquents.' ' Woman and Child Wage Earners in the United Slates, Vol. Vin, p. 9 fif. 3o8 PROBLEMS OF CHILD WELFARE Percentage of Working Delinquents engaged in SPECiriED OCCDPATIONS Industry or Occupation Pee Cent of Total Delinquent Work- ing Boys Industry or Occupation Per Cent op Total Delinquent Work- ing Girls Newsboys 21.83 Domestic service 53-95 Errand boys 17.80 Textile, Hosiery, and knit goods 12.36 Drivers and Stores and helpers 7.30 markets 5-44 Stores and Clothing makers 4.9s markets 4.23 Messengers 2-59 Candy 4-45 Bootblacks 1.77 Laundry 1.98 Other occupations 44.48 Other occupations 16.87 A further study of 2416 delinquent boys showed that 11 76, or 48.6 per cent, when last employed were engaged in one of six occupations, which ranked in importance as follows: Delivery and errand boys 20.3 per cent Newsboys and bootblacks 18.6 per cent Office boys i.g per cent Street vendors 2.7 per cent Telegraph messengers 3.0 per cent Amusement resorts 2.1 per cent The large proportion of errand boys is due to the numbers in this occupation, but the actual rate of delinquency is much higher among the newsboys. It is further shown that 58.6 per cent of the working delinquents under 12 come from the ranks of the newsboys, and that four-fifths of this group have been engaged in one of these six occupations, although the entire number of working delinquents has been drawn from over fifty occupations. Yet these are precisely the occupations which re- cruit a large proportion of the boys when they enter industry. While they do not remain, is it not possible that they are pro- foundly influenced thereby? In conclusion it is evident that those occupations which do not admit of easy supervision by employers are responsible for the largest proportion of juvenile GENERAL EFFECTS OF CHILD LABOR 309 delinquency. Working children will not develop morally and spiritually unless subjected to wholesome discipline, and if they are inclined to be wayward, the street trades and deUvery service will prove specially demoralizing. In this respect the boy or girl in factory or workshop has an immense advantage because the restraints imposed by employers are rigid and cer- tainly tend to induce regularity, industry, and obedience. Night work in factories has several important moral conse- quences : for example, the discipline of the factory or of the store tends to greater leniency at night, and therefore the children wUl be given to greater excesses. The long hours of the child make him restless, and the different conditions at night urge him to throw ofi restraints, and hence demoralizing tendencies follow. Night work in the glasshouses undoubtedly has an injurious effect upon the boys. Contact with adult workers tends to be- come demoralizing, but the tendency is more marked at night. Smoking and drinking habits are formed by the boys, and pro- fanity is acquired. The chUd on the street at midnight, whether a newsboy or a factory employee on his way to or from work, can hardly escape moral degradation. The moral danger of night work to girls consists chiefly in the pernicious contacts with the baser elements of the street. The sensibilities are easUy blunted by the environment which the street creates for the working girl. Insults are common, even to the girls who are quietly re- turning to their homes, and in the early morning the young girl must run the gantlet of curious eyes and provoking farmliar- ities. In this way the moral fiber of girls is weakened; they become sophisticated, and finally lose their reserve. Girls need to be saved from this danger of the street, but the con- tinuation of overtime or the use of night work renders this quite impossible. In extenuation of the evil effects of child labor it can justly be urged that in some cases at least, the child has been taken from a bad street environment or has come from a most degraded home in the movmtains, and has been placed \mder discipline in the factory. Child labor is a school of training to the extent that it may occasionally place a child in a situation where de- 3IO PROBLEMS OF CHILD WELFARE grading influences are less aggressive than they would otherwise be. Even this slight extenuation cannot in any sense apply to the street trades. Society should not allow either the opportunity for mischiev- ous associations or the child labor which sometimes becomes • the substitute. More education, more parks and playgrounds and better homes, not more child labor, are the remedies for the bad influences of the street. S. Physiological Aspects of Child Labor. a. Need of Good Physique. The bad effect upon bodily growth and physical development is one of the most important objections to child labor. Society must attempt to make the individual capable of self-support, and cannot afford to incapacitate him by forcing him into pre- mature employruent. Should he break down, he becomes a public charge, and the state must expend its energies to main- tain him. The interests of society therefore demand men and women of physical vigor, capable of a normal trade life, and every effort should be made to develop the chUd into a strong, healthy person. In chfldhood the foundation is laid for strength, vigor, and general healthfulness. Activity is the keynote of this develop- ment, but this does not imply that the work of the factory will furnish the needed exercise. On the contrary, this is exactly what the factory fails to accomplish, for the reason that the op- erations are of such a character that a one-sided development is produced and the work is not usually carried on under the best conditions. The vigorous man requires a symmetrical development, and this can be secured only by combining the use of all the five hundred muscles of the body. The self-chosen activities of the child are a better means of providing the neces- sary exercise than are the monotonous operations of the factory, and whatever interferes with his needed play-time, be it work, school, or sickness, handicaps him in his proper development. By means of play, exercise, outdoor sports, and other similar activities, the chUd develops brain, nerves, and muscles, pro- motes a good circulation of the blood, and compels nature to GENERAL EFFECTS OF CHILD LABOR 31 1 provide a strong and adequate physical structure. Industrial capacity depends upon this development. The need of strong men and women in industry is greater than ever before because the domestic system did not sap the ener- gies of men as does the strain of modern labor. Certain dis- eases, such as apoplexy, heart disease, and Bright's disease, are increasing their proportion of fatalities, and extreme longevity is becoming less common. Furthermore, the stress of the fac- tory and workshop shortens the trade life of thousands of labor- ers, and provision must be made for them in their old age. After the age of forty-five the individual who has not established himself, or who loses his position, has extreme diflSculty in again adjusting himself favorably in the industrial system. Some firms will not engage the services of any new man who has at- tained this age, although they will retain their own employees indefinitely. Voluntary pension systems are springing up to care for many in their old age, but in not a few cases the aged are asked to resign. A significant movement has recently taken place in teaching circles, and several large universities have made sixty-five the age limit for their professors, at which age they are expected to resign. The trade life of the ordinary worker is, however, much shorter than that of those engaged in profes- sional work, and the average child worker may be expected to join the former class of laborers. There is a large group of con- fessedly dangerous trades, besides many others which slowly undermine the strength and vitality of the worker. So many industrial operations are carried on under abnormal conditions that physical vigor is necessary to counteract the effects. Formerly outdoor work preponderated ; to-day a large amount of all work is carried on indoors, where atmospheric conditions are almost inevitably devitalizing. Great powers of endurance are necessary to withstand the consequences of work in our iron and steel foundries, smelting works, machine-making factories, and workshops of similar character. Unless workers are physi- cally stronger than men formerly were, they cannot remain at work as many years. The occupational disease laws that are being enacted in many states are a recognition of the fact that 312 PROBLEMS OF CHILD WELFARE the sanitary conditions of many of our industrial establishments need radical improvement and that workers are suffering from the lead dust, the chemicals, poisons, gases, and the various in- jurious dusts that they encounter. Important as is the need of insisting on wholesome and sanitary workshops, it is still more important to prepare each person with a physique capable of withstanding the conditions of factory life. The newly arrived foreigner is physically incapable of perform- ing the work done by the American laborer. Not until he be- comes accustomed to the muscle-producing food used here, can he compete with native-born laborers. Although European people differ among themselves as to the amount of work per- formed in a given day, this difference largely disappears when representatives of these races consume similar quantities and the same quality of American foods. b. Effect of Premature Employment. During the period of its growth the body of the child is more or less plastic. Susceptibility to external impressions, and the long years of plasticity, make the highest development possible, but under untoward circumstances may cause the individual's ruin. At the age of puberty the body undergoes a considerable transformation, and injuries often leave permanent effects. The boy is harmed through improper development, but the girl suffers more severely from the effects of unnatural activities at this period, and overstrain is especially dangerous. The muscles are easily affected at about the thirteenth year, as it is the period of their hardening, and excessive strain may produce a tension which win prove permanently injurious. The child may become dwarfed or stunted; if so, almost unlimited effort will be re- quired to induce development in later years. As indicated in a previous chapter, the physical decline of large numbers of the English people is in part due to child labor. The working child tends to become ansemic, and the various organs of his body re- ceive insufficient nourishment. Muscles in certain parts of the body are overdeveloped, while others, owing to their weakness and lack of exercise, fail to develop. Child labor does not occasion a symmetrical development of the body, but leads to physical de- GENERAL EFFECTS OF CHILD LABOR 313 formity because of the excessive use of certain organs. An abnormal amount of nervousness exists among young women workers, due largely to premature overstrain. Work, as carried on in modern industry, cannot perform the beneficent function of play. c. Incidental Results of Child Labor. Certain specific conditions of child labor are specially harm- ful, such as the constant standing to which many children are subjected. And in some industries girls are compelled to stand for hours at a time — a tension which frequently is the cause of much harm, in that it produces lateral curvature of the spine as well as flat foot and varicose veins. An abnormal strain is also placed on certain muscles, and many girls become victims of pelvic disorders which interfere with their capacity for mater- nity. In the candy and paper box factories, as well as in many textile mills, standing is common, while in stores small girls are almost invariably on their feet, although moving to and fro. The bundle wrappers often stand in one spot all day. Some observations among employees in mercantile establishments have brought out the fact that varicose veins are most common among the girls, and that this is especially true of the ones that have been employed for a considerable time. Constant sitting is nearly as laborious and tiresome as standing, and it frequently involves a cramped position which injures the lungs and prevents the full and free development of the chest. The workers sub- jected to these conditions are very susceptible to the various lung diseases, and especially to tuberculosis. The cramped posi- tion which constant sitting necessitates also tends to deform the growing child ; in fact, a constant position of any kind is very tiresome, and a change rests the overworked muscles and brings a new set into play. In this way the fatigue resulting from work can be reduced to a minimum. d. Unkealtkful Occupations. Some occupations are by nature injurious to the worker, and especially to the plastic child. These are usually found in in- dustries in which a large amount of dust is formed. The boys working in the breakers of our coal mines are continually com- 314 PROBLEMS OF CHILD WELFARE pelled to breathe the black dust in which they are enveloped. In a short time their lungs are so filled with dust that they turn completely black, and the constant presence of this foreign sub- stance undoubtedly interferes with the free function of the lungs and retards the full development of the child. Many stunted and unreasonably small boys are found at work in the coal re- gions of Pennsylvania. In the textile mills, Unt and dust are continually flying about, and the best estabhshments cannot entirely escape the presence of these substances. Artificial methods of allaying the dust and of minimizing the diffusion of lint throughout the air have ac- complished much toward producing an unpolluted atmosphere. The cotton lint may be indiscernible in the air, but its presence is indicated by a deposit of the substance upon stationary objects. The air is breathed by the children, the lint penetrates to the lungs, and can with difficulty be thrown off by them, and there- fore the child is bound to suffer physically from this admittedly injurious substance. The weakening of the lungs renders these children specially liable to attacks of tuberculosis. The initial processes in the manufacture of goods from flax and hemp occa- sion a vast quantity of dust, and much of the preliminary work is done by children. Often the workers are surrounded by a cloud of dust which irritates the throat and bronchial tubes. The wool dust is especially harmful, but recent industrial im- provements in the better grade of mills have greatly diminished its deleterious consequences. The dust of the tobacco leaf is injurious, because it contains a poisonous substance. A large number of children are found in tobacco factories in the North and the South, and the work usu- ally requires the constant breathing of this poisonous fume. The principal effects of the dust on the child are the develop- ment of nervous affections and of nausea, the latter condition resulting more frequently among girls than among boys. A pre- disposition to disease is also developed, and even adults suffer from the effects of work in tobacco factories, many of which are most unsanitary, this being especially true of the smaller shops, where the underaged child is so frequently found. Injurious GENERAL EFFECTS OF CHILD LABOR 315 dusts are common in mills of various kinds, and in all cases the child sufEers more severely than the adult worker because of phys- ical immaturity. The constant inhalation of dust or poisonous substances is insidious in its effects, and many persons finally suc- cumb to diseases that have been induced or contracted thereby. Rapid variations in temperature produce baneful consequences. Such changes are common in the glasshouses in which boys are frequently employed, some of whom work close by the fur- naces, and are continually subjected to the fierce heat, while others run to and fro, and thus alternate between currents of hot and moderate air. The excessive heat, the cooler air, and the drafts combine to undermine the health of the boys. In some factories, such as confectionery establishments, certain rooms are heated or cooled to specific temperatures, and the child does his work at that constant temperature. The cool rooms are the more unhealthful, as the girl employed does not usually exercise the necessary precautions required to protect her against the cold, and the change from one level of temperature to another is likewise fraught with dangers. Many textile mills are over- heated and produce debilitating effects, and the majority of laundries are necessarily warmer than the outside air. Children cannot escape the heat of the laundry, and the dislike of many employees to allow the drafts to handicap them in their work often results in insufficient ventilation. In the summer months frequent faintings occur on account of the heat, both children and young women sufiering from this misfortune, but fans and ventilators in the better class of laundries now diminish the harmful effects of excessive heat. Over-exertion in the heat of glasshouses or laundries is an especial danger of the summer months, yet many laundries operate a longer day during the summer than during the cooler months. Moisture is another cause of physical discomfort. Dr. SewaU, in her investigations, found barefooted girls in some of the flax- spinning rooms, while in others the girls wore rubbers to protect themselves from the wet floors. ' In bleacheries, half-naked ' United States Buieau of Labor, Bulletin No. 52. " Child Labor in the United States." 3l6 PROBLEMS OF CHILD WELFARE boys were trampling cloth in deep vats, and in the bottling de- partment of one brewery the boys wore rubber boots, while in another wooden shoes were used. In some laundries the mois- ture is drawn off by means of hoods, and thus the bad effect of steam is mitigated. Aside from the tobacco industry, few children are engaged in occupations bringing them in contact with very poisonous sub- stances. The extreme susceptibility of the child to such sub- stances has generally kept child labor from these industries. Boys are occasionally found in dyehouses or in establishments where dyeing forms one of the occupations. Various kinds of coloring matter are used in making artificial flowers, also in cer- tain processes in textile mills. In some enameling works the use of lead is an unhealthful element ; in others varnish and paint combine to injure the young child. In many trades children suffer severely from accidents resulting from their natural care- lessness. It is true that many times children do not appear to be injured from factory life, but are nevertheless physically affected and later reap the results. The children who engage in the street trades lead a very irregular life, with injurious conse- quences to body and physique, and because of the early hours when newspapers are sold, boys begin their work without break- fasts. Again, they are found on the streets in the late afternoon and evening. Consequently these boys are irregular in their meals, while many of them subsist on inferior foods and confec- tions bought while they are at work. The late hours of work in many cities are an additional cause of the physical depletion of the boys. Failure to grow and to acquire proper strength are among the observed consequences, as well as anaemia and indigestion. The physical effects of home or sweatshop work cannot be distinguished from the consequences of life in the unsanitary homes in which much of the work is carried on. Nevertheless, by toiling away for hours and late into the evening the children making artificial flowers, white underwear, men's clothing, and paper boxes consume the time allotted for play and recreation and lose their opportunities for proper physical development. GENERAL EFFECTS OF CHILD LABOR 317 e. Effect of Night Work. The physiological disadvantage of night work is far greater than that of employment during the day. Whatever may be urged against day work applies with greater emphasis to night work, — this being particularly true in regard to indoor occupa- tions. The night work which takes the form of overtime is harmful because of the long hours which are usually involved. In this case the injurious effects are serious because recovery from extreme exhaustion is proportionally more difficult than from ordinary weariness. The bad effect of long hours is cumu- lative. The first obstacle which the night worker encounters is the difficulty of habituating himself to the change, night work not being in accordance with the wish of nature. The individual profits most by using the night for purposes of sleep, as daylight does not lend itself to effective rest, for the air is fuU of noises, and boys cannot entirely isolate themselves from aU disturbing influences. Because they cannot sleep they are out again by noon, engaged in play or sport. Some time must elapse before the child can train himself to sleep sufficiently during the day to meet his needs, and where the same child alternates weekly between day and night shifts, as he is usually required to do, time is not given to adjust himself to the ever-changing condi- tions. Therefore his physical energy is slowly sapped, and in- jurious results follow. Night work also invariably involves the use of artificial Kght, and confinement to its use is measurably harmful. The custom in some factories of operating only part of the night results in turning the factory hands out in the very middle of the night, and the change for the young boys is often distinctly unfavorable. The child who works at night is gener- ally less efficient than the child who works an equal number of hours during the daytime. This inefficiency is a sign of the physical handicaps of such work. The abandonment of night work by many manufacturing estabhshments is in part due to the recognition of its inherent disadvantages, and the enactment of laws forbidding child labor in the factories at night is a further indication of this point of view. 3l8 PROBLEMS OF CHILD WELFARE /. Summary. The emphasis which is being increasingly placed upon good physique, and the growing need of this qualification, demon- strate the importance of the consideration of the physiological effects of child labor. For in this phase of the problem lies much of the rationale of stringent child labor laws. Premature employment during the day or employment at night paves the way for those physical disabOities which result in an early in- capacity for self-support, or in excesses of divers kinds which hasten the breakdown of the individual. The conservation of energy and the production of the best types of physical vigor are inexorably necessary in the complicated civilization of to-day. Both economic and social conditions require high standards of physique, and a vigorous manhood and womanhood must be maintained at all hazards. The prohibition of child labor is one important step in this direction. CHAPTER IV CHILD LABOR REFORM Two lines of attack are necessary if child labor is to be abol- ished : first, constructive work to eliminate the causes ; second, repressive legislation. In actual practice it has been easier to pass laws than to remove the root causes of child labor. Unless this is done, however, the laws cannot be entirely effectual. Consequently the positive side of the problem must receive more attention than heretofore. The child labor reformers, both in England and in the United States, have spent the bulk of their efforts in obtaining legislation, largely because no other way of solving the problem was in evidence. Recently, however, they have begun to emphasize the constructive movements which if successful will make child labor unnecessary. I. Constructive Effort. Possibly the most important form of positive legislation is compulsory education, which has by some been called the best child labor law. Keep children in school until they are 14 and they cannot work at the same time except as newsboys and in the minor occupations. Besides being required to attend school the child should have the opportunity to acquire a really useful education — one that will fit him for his life work. Again so- ciety has emphasized the less essential thing — compulsory education — and has not given adequate thought to compulsory training for social efficiency. One reason for this is that we do not know what constitutes the best educational program and are still groping about for information. If schools can give children systematic instruction which will save several years of wasted time in industry as well as offer a definite line of work, school life wUl become more interesting, children will want to attend, and parents will be less ready to withdraw their children 319 320 PROBLEMS OF CHILD WELFARE from school. A very important consideration then in solving the child labor problem is to provide adequate educational facilities and require children to attend school. In fact, a pro- gram which will train the chUd adequately for his life work will probably consume his time up to the sixteenth year and thus eliminate child labor by simply crowding it out of existence. In the second place poverty must be attacked with additional vigor. The children of the well-to-do are not found in industry ; only those enter who are poor or ia moderate circumstances. As long as poverty pinches so long the child of 14 will be forced into the gainful occupations. A precarious plane of living with many conveniences and comforts almost within reach is a great inducement to child labor. The efficiency and wages of adult labor must be increased so as to allow a reasonable surplus of income over expenditure and yet make decent living possible. Not only poverty but near-poverty must be reduced to eliminate child labor. The development of ideals is a third consideration. Parents must become more foresighted and more anxious to prepare their children for life. They need to learn that the future, not the present, should dominate their attitude toward the chUd. Igno- rance is a frequent cause of the failure of parents to do justice to their children. Tradition and custom are powerful factors as well as a feeling of irresponsibility for the family obligations incurred. Finally, the selfishness of parents, which leads them to sacrifice their children for the sake of their own comfort and pleasure, is a far-reaching evil. When parents feed on the pro- ceeds earned by their underaged and untrained children, new ideals are necessary. How best to teach parents to safeguard the permanent interests of their children is an unsolved question, but unless they have better hopes and higher ideals than had their forefathers, no progress will have been made. 2. Legislation. A perfect child labor law is not even a theoretical possibility, for in a dynamic society no absolute adjustment to conditions can be made. The prevailing standard age limit is an arbitrary one; for example, in England children from 14 to 16 are in- CHlLi) LABOR REFORM 32i eluded among "young persons." A law must therefore be suit- ably revised from time to time to meet the new conditions that arise. The recent industrial history of Europe and of the United States illustrates this fact, for the laws of to-day are so radical that they could not even have been considered fifty years ago. Yet few, if any, American child labor laws are really socially adequate at the present time. The increasing complexity of our social relations, the changing requisites for social and industrial survival, and the ethical necessity of adapting ourselves to the needs of the day demand a rapid evolution in appropriate legislation. Existing laws will probably be con- sidered quite inadequate within a shorter time than has elapsed since the first serious attempts to enact child labor laws were made. a. Agencies supporting Legislation. The majority of the recent child labor laws of the different states have been enacted since 1895. Before that time the prin- cipal legislation against the employment of children related to certain dangerous and immoral occupations. In point of time we have lagged far behind Great Britain, but our progress has been more rapid, and some of our states have excellent laws that are far superior to those of Great Britain. The rapid develop- ment of industry has accentuated the problem, consequently private organizations have advocated a program of remedial legislation and with favorable results. The most efficient so- cieties of this kind have been the child labor committees. The National Child Labor Committee was organized in 1904 and has carried its propaganda into every state in which the problem has needed attention. Its work consists of investigating the conditions of child labor, of educating the public through pam- phlets, public addresses, etc., and of trying to secure child labor legislation, especially in the states most in need of better laws. It has therefore redoubled its efforts in the Southern states. In many of the states local child labor committees assist the national organization in its vmtiring fight for better legislation, much of the recent progress being due to the efforts of these pri- vate societies. Y 32 2 PROBLEMS OF CHILD WELFARE Good legislation has been fostered by other agencies, notably labor unions, women's trade union leagues, consumers' leagues, women's clubs of various kinds, miscellaneous associations, and state labor bureaus. The consumers' leagues of the United States, through their method of organizmg consumers and of insisting on the manufacture and sale of products under good labor conditions, can be made a powerful factor in raising the standards of public opinion. In fact, the National Consumers' League has been a most influential agency in obtaining better laws for children and women. State labor bureaus have in a number of instances drafted bills for presentation to the state legislatures, and have had considerable success in securing their passage. Unfortunately they have not always stood for the best and most modern legislation, and therefore the results of their efforts have not been suflaciently favorable. Even the manu- facturers have in several cases passed resolutions favoring some restrictions on child labor, and have thus imposed higher stand- ards upon themselves. The creation of sentiment and the enact- ment of satisfactory child labor laws depend largely upon the work of special organizations. b. Uniformity of Laws. A serious handicap to adequate legislation in the United States is the right of each state to enact its own child labor laws. As a natural consequence we find a variety of laws, a condition which enables the employers affected by proposed legislation to threaten to abandon the states in which their establishments are located and to continue business elsewhere. State selfish- ness and the desire to build up local interests are forces of such magnitude that the state hesitates to enact legislation which may drive capital from within its borders. With free trade among our states, uniform laws are necessary to render industry stable. So far each state has acted independently, hence child labor laws have not been highly effective. Our states' rights in this respect are very unfortunate. Most European countries are able to legislate for the entire nation, therefore the various sections have little excuse for opposing proposed legislation. In the United States there is no possibility CHILD LABOR REFORM 323 of uniform laws through separate state action, for no matter how often representatives of the various states may meet and decide upon a standard child labor bill, the states will each enact a law modified to meet the wishes of the dominating forces in that state. Furthermore, the reform forces will not have exactly the same program in each state and the proportionate emphasis on child labor laws will not be uniform. The formulation of a standard bill has, however, tended to unify the efforts of friends, of reform and wUl do much toward securing uniformity in the laws. The federal government, which ought to establish standards, has been negligent in its legislation against child labor. Al- though it has supreme control of the District of Columbia, it is only after many years of effort that a good child labor law has been enacted. The government should long since have passed a model law which the states could have advantageously copied. Uniformity of law can best be secured by a federal enactment applying to the entire United States, and a bill introduced iu the fifty-ninth Congress provided that interstate commerce in prod- ucts in the manufacture of which children under 14 years of age participated, should be illegal. President Roosevelt labored to secure the passage of this biU, but in vain. The op- position manifested itself largely under the guise of unconstitu- tionality, whUe the friends of the measure defended its legality on the grounds of the right of the federal government to regu- late interstate commerce. Had this measure passed and been sustained by our courts as constitutional, it would at once have secured a large degree of uniformity of child labor conditions throughout the United States, and the backward states would have been compelled to raise their age limits for the employment of children. c. A Standard Law. A model Child labor law for all time cannot be proposed. Every law should be subject to revision when occasion demands, and no piece of legislation must be allowed to become sacred. Several important requisites, however, are fundamental in an acceptable law. Among these are: first, the law must 324 PROBLEMS OF CHILD WELFARE be clear and distinct in its meaning, so as to permit of but one interpretation ; confusion in this respect is often a ground for its non-enforcement ; second, it must be enforceable and ma- chinery of enforcement must be provided; unless the law can be applied in an expedient manner and properly enforced, its very presence on the statute books may prove harmful ; third, the law must conform to the requirements of the social interests which are involved. A new plane of ideals will have been es- tablished, and the ethical progress evidenced in the law can then be generalized. A standard child labor bill has been drawn up by the Na- tional Child Labor Committee, with the hope that it will crystallize public opinion and result in an approach to uniform laws. The principal provisions of this bill are, in brief, as fol- lows : ' Child labor under 14 years is prohibited in practically every occupation except agriculture, domestic service, and the street trades. Child labor under 16 is prohibited in trades dangerous to life and limb ; and the trades must be specified, with power in the state board of health to add other trades ; a similar prohibi- tion is established against specified trades injurious to health and to morals. Children under 18 are not allowed to enter certain dangerous occupations and the board of health has power as in previous cases. Persons under 21 are prohibited from engaging in night work in connection with the messenger service in the large cities. Boys under 16 and girls under 18 must not work at night nor more than 8 hours per day or 48 hours per week. Employment certificates shall not be granted until proof is given that the child is 14 or over, in good health, of normal development, able to do the work expected, and has completed the fifth grade as well as attended school for a full term pre- vious to application for certificate. Employers must have on file date of birth, or of baptism, an ' National Child Labor Committee. Child Labor Laws in all States, 1Q12. CHILD LABOR REFORM 325 affidavit of the parent as to the child's age, the school record, and an official statement that the child's application was ap- proved. Records at the factory must be open to inspection by the desig- nated authorities. Employers must post schedule of hours and time of employ- ment in every room where boys under 18 or girls under 21 are employed. Persons xmder 21 are prohibited from working in connection with any saloon. Boys under 12 and girls under 16 are not allowed to sell papers in cities of the first and the second class. Boys under 16 must secure badge to engage in selling of news- papers, or work as bootblack, or in other occupations performed in the street. Badge cannot be given until satisfactory evidence of age, school attendance, and physical fitness for the employ- ment is given. Badge must be worn conspicuously by the child and a new one of different color issued each year. No child under 16 shall engage in the street trades between 8 P.M. and 6 a.m., nor during school hours. A child violating the street trades regulations shall be deemed a delinquent. A penalty shall be imposed on the employer for violating the law. Provision is made for the inspection of workshops, and the detection of violations of law. This standard bill does not set an unattainable ideal. It is intensely practical, and in several states certain provisions of law are already more drastic than the ones given in the standard bill. The most advanced child labor laws in the United States occur in the North and West, while the weakest and most unsatis- factory are found in the Southern cotton mill states. Several Northern states, however, have been compelled to fight bitterly for progressive laws, chief among which is Pennsylvania, which still permits the night work of boys of 14 and over in the glass mills. On the whole, the states with advanced laws have had a long history of industrial development, or they have been swept by 326 PROBLEMS OF CHILD WELFARE a wave of reform and have enacted such legislation largely as a preventive measure. d. Age Limits. One of the most important considerations in a child labor law is the age Umit below which work is prohibited. Reformers at first had to face the problem of tiny children at work and when England began to concern itself with child labor reform, five year old children were found working in the factories, and slightly older ones had been thrust into the mines. In the United States the worst forms of abuse have never existed, but nevertheless serious conditions have come to light. In certain canning factories in New York children six or seven years of age have been employed in preparatory work, such as stringing beans, sorting plums, and similar work, but were not carried on the pay rolls. In the South a few children of seven have been discovered in the cotton mills and children of no greater age have worked in the oyster industry. The newsboy of five was until recently a very common sight. Age limits are raised gradually and the presence of small children in industry usually prevents drastic legislation, consequently supplementary laws must be passed from time to time. The proper minimum age limit varies with changing social and industrial conditions. In the United States the fourteenth birthday has become an accepted age limit. Although age does not determine physical and industrial efl&ciencyand the proper educational requirements, it has become a convenient method of guessing at the qualifica- tions of a child for gainful employment. Age is not so funda- mental as fitness, but the diflSculty of developing refined methods of measuring the latter has made the establishment of the age limit the most important provision of a child labor law. In igi2, 32 states had adopted a 14 year limit for employment in factories and mines ; 6 had a qualified 14 year limit ; 7 states fixed the age at 12 ; 2 had a qualified 15 year limit; one had practically no restriction ; the remaining state fixed the age at 13. In some states these age limits are not made to apply to labor in mercantile establishments, although the tendency is distinctly in the direction of the more sweeping laws. In some CHILD LABOR REFORM 327 states children of 12 are allowed to work in certain occupations during the summer vacations, but this practice needs to be care- fvilly watched. In several Southern states poverty exemptions for children under 12 are allowed, and a few other states make similar provision for children between 12 and 14. The street trades are generally being subjected to regulation, but they will be discussed in a later section. A regular provision of law usu- ally requires an employment certificate for children under 16 who are allowed to work. This guards against the introduction of persons under the minimum age limit and protects the child who enters some emplojrment. e. Physical Qualifications. Education and physical development should determine the eligibility for an emplo3rment certificate. These are basic con- ditions, since the physical effects of premature child labor form one of the chief arguments against the system. No child should be allowed to work unless he can meet the standard physical re- quirements, and if children are not of normal weight and stature careful medical examination should determine whether they are likely to suffer because of physical incapacity. Standards must be developed so comparisons can be made. So far state laws have not designated any standards, contenting themselves with the usually meaningless provision that children must be physi- cally fit. Actual physical examination is now required by the laws of New York and of Rhode Island, while in some states the official granting the employment certificates is authorized to ask for the physical examination of the applicant if he considers him of doubtful health and strength. Systematic health inspection is, however, confined to a few cities in the United States. The City of New York, through its department of health, ex- emplifies the examination of applicants for work certificates. It has established a standard of four feet, eight inches in height, and eighty pounds in weight, but exceptions are made in the case of several short immigrant races if after careful examination the child is found to be normally developed. More than 40,000 ap- plicants are passed on every year. In 1908, in children were rejected, but in 1911, 539 were refused work certificates — about 328 PROBLEMS OF CHILD WELFARE one case in eighty. Many untreated physical defects are dis- covered, and if these threaten the health of the child, the depart- ment insists that steps to remove the defects be taken. Accord- ingly thousands of children are benefited by this procedure. In Boston the Bureau of Child Hygiene cooperates with the school committee, which grants the certificates, and the Bureau examines all children desiring working papers. The child must be in good health, but the physician instead of measuring cases by established standards decides them on their apparent merits. In igii, out of 2445 examinations 363 children were found de- fective, but only 30 were refused certificates. Defects of the eye and throat comprised over five-sixths of the total number. In the large cities two agencies are available for the examina- tion of applicants — the health bureaus and the boards of educa- tion. If the working papers are granted by the educational au- thorities, and they make medical and physical examinations of the school children, then they should also apply the physical tests to the applicants for working papers. Under other con- ditions it will be better to require the bureau of health to do the work, and in the smaller towns the task will undoubtedly fall upon the health authorities. /. Educational Requirements. The step from the school to the mill is seldom retraced, and the child gains his later knowledge entirely in the school of experi- ence. Compulsory education until the child may enter the gainful occupations is, of course, necessary, but this again is not the vital point involved. The child does not need the record of a certain number of years in school, he does need a record of at- tainment or of work accomplished. The usual type of educa- tional requirement simply demands compulsory education and perhaps a record of a full year of school attendance immediately previous to the application for working papers. But even such wholesome legislation does not guarantee that a child will have completed the fourth or the eighth grade. In some states the nimiber of weeks of attendance required is deplorably small, and where poverty exemptions are allowed the child is neces- sarily excused from school attendance. CHILD LABOR REFORM 329 A second type of legislative provision requires all children before they enter industry to have acquired a certain amount of education. The state of Washington, for example, permits children of 14 to work on condition that they have completed the eighth grade of school work ; otherwise education is compul- sory until the fifteenth year. Theoretically this is only a con- ditional educational requirement, as it does not reach the re- tarded children who are fifteen years of age or over. New Jersey requires compulsory attendance up to the sixteenth birthday ex- cept for the mentally and physically incapacitated and for chil- dren over 14 who have been granted a schooling certificate by the school officials. The New York law of 1913 provides that children must have completed the sixth grade before they may receive working papers. Ohio has made a definite fifth grade requirement, and in prac- tice if not in law, many of the states hold to this standard. While it involves a familiarity with the operations of arithmetic up to and including fractions, this is altogether too meager a knowledge of the subject. So with the other common branches. It is difficult to see how anything less than the completion of the eighth grade work is sufficient to meet the ordinary needs of to-day. A child with less education has but few opportunities for advance. A common requirement in state law consists of the provision that children above the compulsory attendance limit but imder 16 shall attend school, if they are not regularly employed ; that is, they are not allowed to remain idle. Although this is a whole- some feature, little attention has been paid to its enforcement. When working papers have been secured the child is usually forgotten by the school authorities, and he may not even be- gin work. In some of the large cities, however, methods of keep- ing in touch with chOdren of working age are being devised. An additional attempt to provide a certain amount of actual train- ing for the child consists in the requirement that boys holding work certificates shall attend night school. This is a feature of the New York law, applying to cities of the first and second class. 33° PROBLEMS OF CHILD WELFARE This law was amended in 1913 so that work in part-time or continuation courses may be substituted. In fact, where such courses are estabKshed, the board of education may require such attendance on the part of working children. The classes are conducted during the daytime and the work in school is taken out of regular working time. The most significant child labor legislation of 1913 dealt with requirements for attendance at continuation schools, five states passing such laws. The plan of compelling working children to supplement their education by attending evening schools has proven a hardship to many children who could not undergo the strain that work both during the day and at night involved. The continuation school is proving a superior substitute, because it does not increase the hours of work and it does enable the child to pursue studies which will en- hance his working efiiciency. g. Hours of Labor. The shorter working day is making rapid strides in the United States. In 1912, 21 states had an eight hour day for children in factories, and some of them also apply the same limit to work in stores and in mines. The remaining states allow a longer day, most of them adhering to a ten hour limit, but five still allow this to be exceeded. In some states, especially in New England, the number of hours allowed per week requires a shorter day on Sat- urday or a shortening of the regular working day. For example, Massachusetts allows ten hours per day but not more than 54 per week in factories, which amounts to an average of nine per day. The present tendency is distinctly in favor of substituting the eight hour day and 48 hour week for the ten hour day. Many of the states now fix the limits within which the day's work must be done. In New York, for example, with an eight hour day in factory work, the hours of the children must fall between 8 a.m. and 5 p.m. and time for dinner must also be al- lowed. Children found at work outside of these hours are con- sidered to be violating the law regardless of the number of hours they have been employed. Such regulations facilitate the en- forcement of law, but give the employer no opportunity to adapt the labor to his needs. Illinois is an example of another method. CHn.D LABOR REFORM 33 1 Here the day's work of eight hours may be done between 7 a.m. and 7 P.M. When leeway such as this is allowed, the enforce- ment of law becomes more difficult, in spite of the requirement that employers post the schedule of hours and furnish a copy to the bureau of factory inspection. Few factories observe this requirement in full, and the number of inspectors is usually insufficient to detect the violations. An eight hour day is quite reasonable, and it should be applied to every form of child labor, mercantile establishments needing the restriction quite as much as factories. Underground work, however, requires the most stringent regulations. h. Night Work. Night work is injurious to the child and should be prevented. In the industries frequently exempted from child labor laws, such as the canning and preserving industry, a considerable amount of night work prevails. Legislation limiting the work of children to daylight hours is a powerful factor in the preven- tion of night work for all. The dangers of late hours are being so rapidly recognized that laws on this subject are becoming popular, and 37 states now have some regulations affecting night work. Of this number 12 prohibit work after 7 p.m. by children under 16 and two by children under 14 ; ten states have fixed the hour at 6 p.m. ; the others have adopted a later hour or have no fixed limits of any kind. As will be seen, very few of the states have established the limit required by the standard child labor bill. In a number of states where night work is still al- lowed, powerful employing interests have prevented legislation on the subject, this being especially true of Pennsylvania, where the glass interests are the chief factor, whUe in several Southern states the prohibition applies only to children under 14. New York has enacted an advanced law which prohibits all persons under 21 years of age from engaging in carrying messages between the hours of 10 p.m. and 5 a.m. In addition to laws pro- hibiting the night work of children in this industry, higher age limits for entering it are also being demanded. i. Working Papers. The purpose of requiring all children between 14 and 16 years 332 PROBLEMS OF CHILD WELFARE of age to obtain working papers is to guard against the admission of applicants who are not suitably equipped to begin a career as wage earners. A permit when granted should contain satisfac- tory evidence in regard to the age, education, and physical con- dition of the child. Proof of age should depend largely upon certificates of birth and baptism, supplemented by the records of the school which the applicant has attended. The statement of the parent is not sufficient in itself, as perjury is not uncommon in the localities where only the affidavit of parents is necessary to obtain certificates. In such places a sort of traffic in working papers is carried on and often the same paper descends from one member of the family to another. Children frequently He about their age ; for no matter how small the boy or how tiny the girl, on inquiry the interrogator learns that the child is 14 years of age ! In eleven states the affivadivit of the parents is accepted as suffi- cient evidence of the age of the child. North Carolina merely provides that the parent shall furnish the establishment with a written statement of the age of the child and a certificate of school attendance. Tennessee only requires the employer to keep on file the sworn statement of parent or guardian as to the age of the child, and Texas does not require a certificate of any kind. Under such conditions, it is self-evident that child labor laws are practically meaningless. Apart from the affidavit system, several methods of granting working papers are in operation in the different states. The certificates may be granted by the school authorities, by factory inspectors, by boards of health, or by judges of county, munici- pal, or juvenile courts. Most of the states which require written proof of the age of the child place the duty of granting certffi- cates in the hands of the school authorities. The very efficient laws of Illinois and Massachusetts make this provision. School records are usually faithful and reliable sources of information, although the direct record of the birth of the child, if that can be procured, is a still safer proof of age. In New York the papers must be signed by an official of the board of health, who shaU not approve them unless a properly signed school record of the child has been filed, as well as a record of his birth or baptism. CHILD LABOR REFORM 333 In default of the latter the affidavit of the parent must accom- pany the evidence. The school record must show a specified amount of school attendance during the fourteenth year of the child and a certain educational standing. A certificate of physi- cal fitness is required, and the child must appear in person before the officer granting the working papers. This complex system makes the issuing of papers to underaged children ahnost im- possible. In several states the factory inspectors were formerly author- ized to issue the certificates. In Wisconsin this right has been transferred to the Industrial Commission and to local judges; in Missouri to the school authorities. Few states now cling to the old method. In a number of states local judges and magis- trates are empowered to grant papers, and when this is the case the affidavit of the parent is usually the only information re- quired. For this reason considerable objection has been made to this policy, which is now being superseded by vesting the power in the school authorities. Much depends on the method used in granting working papers. The application desk is the place where the first sifting occurs, and if well done many children will be rejected and required to improve their minds and bodies before they venture into the gain- ful occupations. The consensus of opinion now favors placing the task upon the board of education, because more intensive work will be done and fewer unqualified children allowed to re- ceive certificates. j. Dangerous Trades. Some industries are relatively more dangerous than others, and from these in many states children are excluded by law. No child under i6 years of age should be allowed to enter any occupation which is dangerous to the life, limb, health, or morals of such child. The moral and physiological plasticity of the child is a source of danger when exposure to bad conditions takes place, and certain trades should therefore be specifically forbidden to all persons below the age indicated. Among such trades are the following groups : first, occupations in which dangerous machin- ery is used, for the young boy or girl is much more liable to seri- 334 PROBLEMS OF CHILD WELFARE ous accident on account of the absence of caution and judg- ment. Second, occupations which require the use of poisonous acids, paints, colors, or injurious chemicals, such as white lead, phosphorus, and others. Third, occupations which place the safety and security of others in the hands of the worker; for ex- ample, the operation of passenger elevators, and equally impor- tant occupations connected with the mining industry. Fourth, occupations which are likely to affect the morals of the child, such as the liquor trade, occupations which occasion contact with houses of ill fame, and the manufacture of goods produced for immoral purposes. Fifth, occupations which are considered unheal thful. A limit of i8 years should be established for cer- tain extremely dangerous industries, — dangerous either to the worker or to the public that is served. This age limit should also be applied to all persons connected with the manufacture or sale of intoxicating liquors. The ordinary blanket laws which refer to dangerous and un- healthful occupations, without specifying the particular occupa- tion or industry, have no value whatsoever, and are not enforced. Our legislation should therefore be patterned after the English law, which places power in the hands of the proper officials to determine whether an occupation is dangerous or not. Our states have begun this method of procedure. In Massachusetts the state board of health is authorized to investigate occupa- tions and declare them dangerous or injurious, and persons under 1 8 may be prohibited from employment in these occupations. In Oklahoma the commissioner of labor may determine what occupations not forbidden by statute may be open to children between 14 and 16, while in Missouri this may be done by the state factory inspector. The better plan, no doubt, is that of empowering and requiring the board of health to pass upon the doubtful and unclassified occupations, and this is especially true in respect to the dangerous and unhealthful forms of work. Furthermore, each state should provide one or more medical in- spectors whose chief duty should be to ascertain the sanitary conditions existing in selected varieties of industries and to sug- gest methods of improvement. Probably the number of un- CHILD LABOR REFORM 335 healthful occupations could in this way be reduced, and undoubt- edly it would be of great value to working children, because the best of laws are too lenient. k. Industries Exempted. Usually child labor laws have not been applied to certain industries of which, owing to its peculiar conditions, agriculture is the most conspicuous example. The reasons for its exemption are so valid that they need no further discussion. Domestic service is also usually excluded, although the argument in favor of this policy is hardly tenable, since many abuses have arisen in connection with this occupation, and some form of regulation has become desirable. A most serious factor in industry is the problem of perishable goods. These includevariousfruits and vegetables in preparation for preserving and canning, certain kinds of confectionery, fresh oysters, and other products of minor importance. The canning and preserving industry, however, is the chief manufacturing industry which in some states is granted exemption from the provisions of the law. The exemptions are of several varieties : the absolute exemption of the industry from the operation of the child labor law ; the right to use child labor in the sheds where no machinery is used, on the theory that this is quasi- agricultural labor; and the waiving of the regular age limit for children during the vacation season, or, as in Indiana, for four full months. These exemptions are allowed partly because of the close relation of the industry to agriculture, but largely because of the reputed perishable nature of the product. English experience shows that insistence on the regulation of seasonal industries has resulted in a most remarkable degree of conformity to the limitations imposed. Many of the long hours and much of the night work were found unnecessary. In the United States, likewise, many industries formerly very irregular in their operations have become standardized and reduced to definite hours of work. A large group of industries are more or less seasonal in their nature, and the goods produced are commercially perishable if not subject to physical deterioration. Straw hats of a certain 336 PROBLEMS OF CHILD WELFARE style cannot be carried over much longer than goods that are physically perishable; Christinas novelties are valueless after the holidays, etc. The exemption of one industry will tend to open the way for the escape of another, and in a short time our entire code of labor laws will be in jeopardy. Himian values are more important than mere property, and should therefore receive proper recognition. Many of the states do not include retail stores among the in- dustries in which child labor is prohibited. In the small towns this is hardly a problem, but in the large cities much exploita- tion of children is possible if restraining laws do not exist. Many stores are open one or more evenings per week, and consequently children are forced to work long hours on certain days, especially on Saturdays and throughout the pre-holiday season in Decem- ber. The states which regulate work in these establishments do not all insist on conformity to the laws throughout the year, but several of them allow overtime or late hours for a definite period shortly before Christmas ; that is, make exemptions for the Christmas season. The number of days on which the law was suspended formerly varied from 4 to 20 but exemptions are now usually limited to one week. This is precisely the time of the year when children in mercantile establishments are subjected to the most exhausting work and are in special need of shorter hours. Many young girls collapse during this season, and con- sequently lose a portion of their working time. Under no conditions should the child labor law be suspended during the holiday season. The health of the child is too valuable to be sacrificed ; furthermore, early shopping should make long hours during the rush season unnecessary. I. Street Trades Legislation. It is considered necessary to legislate separately in regard to the street trades since the ordinary law does not apply to them. Newsboys are, by some, considered as merchants instead of em- ployees. Until recently they practically escaped legislation, but in 1913 fourteen states had regulations applying to all or part of the state. The New York law applies to cities of the first, second, and third class, and excludes boys under le and girls under 16 CHILD LABOR REFORM 337 from the street trades. Boys under 14 are required to secure a license or permit, which is issued by the school authorities. It must show that the boy is able to work as a newsboy, is regular in school attendance, and of the required age. A badge, which he is ejqjected to wear, is also given when the permit is granted. The enforcement of the law rests with the police and the truant officers, and parents may be punished for contributing to the de- linquency of their children. Massachusetts authorizes its local school boards to control the employment of children under 14 in the cities. In Boston no boys under 12 may sell papers, nor may boys under 14 sell after 8 P.M. The school committee has developed an elaborate set of rules pertaining to the wearing of a badge, showing badge to officer, surrender on demand of officer, regular school attendance, etc. The law is enforced by the supervisor of street trades, who is under the direction of the school authorities. This method has operated very successfully. The Wisconsin law applying to Milwaukee prohibits news- paper selUng by boys under 12 and girls under 18. The issuance of permits was transferred in 191 3 from the state factory in- spector to the board of education. Applications for permits must be signed by the parent or guardian of the child. A number of cities handle the problem through municipal action or ordinance; for example, in St. Louis girls under 16 were prohibited from selling papers by police order. If the regu- lations are made by the cities, state officials cannot be used to enforce the law. This, however, is hardly a handicap, inasmuch as enforcement wiU in any case rest with one or all of three groups of officials ; the police, attendance officers, and probation officers, but on the whole, street trade laws — state or municipal — have suffered from non-enforcement. Unless boys who violate the law are considered delinquent, and neglectful parents are penahzed and some body of officials is definitely instructed to enforce the law, it will do little good to enact legislation on the subject. Best results are secured by placing the administration of the law in the hands of the school officials. Regulations re- lating to bootblacks have been made very similar to those affect- 338 PROBLEMS OF CHILD WELFARE ing newsboys, but there is a tendency to impose a higher age limit. m. Minimum Wage Legislation. The development of minimum wage legislation will no doubt affect both the standards of family life and the amount and eflSciency of child labor. In 191 2 and 1913 several states passed such legislation, the laws being made to apply to women and to minors in eight states, but in the ninth "females" only are af- fected. In other states the problem is being studied with a view to the enactment of similar laws. It is evident that the wages of child workers will become one of the important matters of consideration by the various minimum wage boards or commis- sions, and that the pitifully small wages will be raised. In fact, many establishments have already, under the pressure of the publicity connected with the recent investigations, voluntarily increased the wages of the children in their employ. Such ac- tion will increase the desire of children to enter industry. The more likely result, however, of the establishment of minimum wage rates will be a reduction in the number of child workers and the substitution of adults. Such a readjustment is emi- nently desirable and will force upon the child the necessity of preparing himself sufficiently to enable him to earn the minimum rate fixed for the different industries. 3. Enforcement of Law. In regard to the enforcement of child labor laws a wide diver- sity of method prevails. The principal agencies intrusted with this task are : departments of labor, bureaus of factory inspec- tion, the police, and boards of health. In addition truant and attendance officers, and sometimes probation ofiicers, aid in en- forcing the law. In the more populous manufacturing states the departments of labor are usually composed of subdivisions, of which the bureau of factory inspection forms one branch, but sometimes the latter is made a separate department. In either case, the enforcement of law rests with the factory inspection organization. New York is an example of the former type, and Ilhnois of the latter. The states are gradually merging the bureaus that are closely CHILD LABOR REFORM 339 allied in their work. In the industrial states the tendency to- ward division of labor has operated to create a special department of factory inspection, but New York has returned to the plan of subordinating the bureau of factory inspection to the depart- ment of labor. In Massachusetts the inspectors are under the direction of the district police. A separate body of inspectors is, however, detailed by the department, and these resemble in qualifications the inspectors of the other two systems. In each of the states mentioned a high degree of efficiency in the enforce- ment of law has been achieved. Maryland has a separate corps of child labor inspectors working under its Bureau of Statistics and Information, but the plan has not proven entirely successful. Two states have a board of inspection of child labor. Until recently, child labor in mercantile establishments in New York was controlled entirely by the boards of health. The results were unsatisfactory, and the work of inspection in cities of the first class has been transferred to the departments of labor, but elsewhere the old law still holds. This condition is anomalous, and the task of inspection should be transferred to the factory inspection department. A few states empower the school officials to enforce the law against child labor, and in a considerable number of states truant officers are authorized to assist the other inspectors. These officials, however, aim primarily to compel school attend- ance rather than to prevent child labor. In several Southern states, especially those in which the child labor problem is a serious one, the provisions for law enforcement are extremely inadequate. In Alabama the inspector may prosecute violators of the law if ordered to do so by the governor ! Georgia and the CaroUnas have practically no law-enforcing machinery. With extensive violations of law in the states where enforcement is most successful, what must be the condition in a state having absolutely no means of enforcing the law ! Few if any of the states possess an adequate corps of inspec- tors. New York in 191 2 added largely to its corps of factory and mercantile inspectors and now has a force of 135. Even this large body has been declared entirely inadequate by the 340 PROBLEMS OF CHILD WELFARE prominent social workers of the state, and a recent investigation of conditions in New York justified this conclusion. Pennsyl- vania has 41 inspectors ; Ohio has 32 general inspectors besides several men who limit themselves to special industries ; Illinois has but 18. So with the remaining states ; they make but httle effort to proportion carefully the number of their factory inspec- tors to the amount of work to be done. A number of states now require a limited number of women on their inspection force, many persons holding that women will detect certain violations more easily than men and are more efficient in observing condi- tions relating to the employment of children ; also that a higher quality of woman than of man can be secured for the salary paid. Medical inspection, which is needed so badly, is still in its infancy, although New York and Massachusetts have made a beginning, the former through its factory inspection depart- ment, the latter through its board of health. With insufficient inspectors the law is violated. In many states four or five years are necessary for the inspectors to cover every, establishment once, and in no state are there enough in- spectors to visit all factories and workshops more than once during the year. Yet adequate inspection requires at least two visits, and probably more. Again the enforcement of child labor laws is usually only one of many functions performed by the inspector. Frequently this portion of his task is passed over hurriedly, and sometimes the neglect is intentional. The author knows of an establishment employing a large force of children which was not inspected for an entire year, although the firm was suspected of violating the law. Efficient inspection depends in part upon the good faith and ideals of the chief factory inspector, and the energy with which violations of the law are prosecuted. Such prosecutions must become deterrent influences. In those states in which the cost [ to the employer of a violation of the law has been inconsiderable, efficient enforcement has been difficult or impossible. Fre- quently the employer has reduced his policy to a financial basis. Having discovered that he can violate law for a certain time at a very moderate cost and that the advantage to him of the vio- CHILD LABOR REFORM 34I lation is greater than the cost in fines, he defies the factory inspectors and refuses to obey the law. In some cases coopera- tion between the employer and the factory inspectors for the enforcement of the law has been followed by the refusal to prose- cute firms for the illegal employment of children, on the promise that the violation would not be repeated. This method can be successful only when a real interest is evinced by the employer of child labor and when failure to comply with the demands of the inspector is followed by prosecution. The courts also are a considerable factor, since in some localities it is almost impos- sible to persuade the judge that violations should be punished. Unsocial courts and judges are a great handicap to the enforce- ment of factory laws. Competent officials selected through civil service examinations are badly needed, and the lack of these has been a severe setback to real progress. The chief offices are usually pohtical pliuns, and frequently the men appointed know as much about their duties as they do of domestic science. Factory inspection must be rescued from partisan politics and placed on a merit basis, but good officials cannot be procured unless an adequate salary is paid for their services and a professional career is opened to them as is the case in Germany. Strong men caimot afford to accept poorly paid and uncertain positions. In formulating child labor laws, legislators should be guarded by the fundamental principles which are involved. The social interests demand that such a protection of children be assured as to guarantee to an oncoming generation a physical, mental, and moral capacity which wiU enable it to meet successfully all social and industrial conditions. PART V JUVENILE DELINQUENCY CHAPTER I CAUSES AND NATURE OF JUVENILE DELINQUENCY I. Evolution of the "Juvenile Delinquent." The attitude of society toward the juvenile delinquent has undergone a fundamental change within a few decades. Part of this change is due to revulsion against the treatment formerly accorded to children, who were not fully responsible for the offenses which they committed. The court trial in Philadelphia of a little child of eight years was the beginning of the juvenile court movement in that city. A few years ago a boy of eleven in the state of Iowa was sentenced to imprisonment for life on the charge of murder ! Hundreds of little children have been thrown into jail in company with vile adult criminals, and in England little children were formerly sentenced to death for offenses too petty even to justify the mildest forms of pro- bationary treatment at the present time. In 1833 a boy of nine was sentenced to death for stealing a Httle paint. The penalty was not inflicted but the principle remains the same. In Chicago boys were confined with the men, and as late as 1899 boys were sent to the John Worthy School to work out fines at fifty cents per day. The delinquent child suffered from the older or classical theory of crime. A particular offense, quite apart from the motives that prompted it, was punishable with a definite penalty, and individuals were punished for the crime they committed, not because they were criminals. At first no discrimination was made between persons guilty of similar offenses, but later ex- tenuating circumstances were recognized. Furthermore, it was held that every person, regardless of age, was fully respon- sible morally for the offense committed. The little child had, 345 346 PROBLEMS OF CHILD WELFARE it was thought, as keen a sense of right and wrong as had the adult — an equal knowledge of what constitutes an infraction of the law. This atrocious doctrine has been entirely over- thrown, for recent child psychology clearly demonstrates that the morals of children are a development. Parents, home, and community are each partly responsible for their children's morals. Children are plastic in mind and body and their moral standards are changeable. It is difi&cult to determine the exact age when full moral responsibility should be demanded. In fact, this should depend upon mental rather than physiological age. The boy of twenty with the mind of a boy of twelve should not be treated as an adult, yet in the face of this psychological principle, juvenile delinquency refers legally to individuals under a certain age. Until recently no adequate psychological test has been avail- able. The age limit now established differs among the various states, but in the majority of cases it is sixteen years, although a number of states have raised it to 17, and in several the limit for girls has been fixed at 18. The term "delinquent" has been slowly expanding in mean- ing so as to include not only dehberate acts which would be punished if committed by adults, but also wayward tendencies of a serious character. Delinquency should refer to an attitude of mind and of morals rather than to the commission of some particular offense. It is necessary to reach the embryo delin- quent — the prospective criminal — and in many cases it is al- ready too late when the boy is brought into the juvenile coiu^t. Accordingly, we find laws such as the Colorado law which includes under "delinquents" persons of certain age who are guilty of such offenses as the following : violation of any law of the state or any city or village ordinance ; incorrigibility ; asso- ciation with immoral persons ; knowingly visiting houses of ill repute, or gambUng houses of any description ; visiting saloons ; wandering aimlessly about the streets at night or about railway yards ; the use of vile and obscene language ; immoral conduct ; jumping on moving trains, etc. This law covers almost every species of conduct which is likely to result in law-breaking and CAUSES AND NATURE OF JUVENILE DELINQUENCY 347 criminality, and it can be used to exercise preventive control over the child. In this way it is possible to reach him before he actually becomes so wayward that reform is impossible. Although in some cases the legal meaning of delinquency is still confined to direct violation of law, the more progressive states in the revision of their juvenile court laws or in the enact- ment of new laws are quite universally following the pattern of law described above. Effective work depends upon the legal right to direct and control the prospective ofiender. 2. Moral Classification of Children. The juvenile court idea depends upon the recently developed consciousness that the child is less in need of reformation than he is of the formation and fixation of character. A little habit forming is much better than much character reforming. The teachings of recent psychology and ethics have forced the accept- ance of the theory that conscience is developmental ; therefore, the problem of the child becomes one of constructive effort, not of repression after vicious tendencies have developed. Youthful misdeeds are recognized to be largely the result of the environmental influences which continually impress them- selves upon the child. The development of the child divides itself into three quite distinct periods. The first eight years of life form one period, and many children of this age, if not immoral, are at least unsocial, but their delinquency is almost wholly due to the neglect of their moral education by their parents, and they should be treated as neglected persons. The delinquent chUd at this age is no worse in his fundamental proclivities than the child who is merely neglected, and there- fore different treatment is not necessary. A full knowledge of the underlying causes of the difficulty will shift the burden of the blame to the parents. There is but little difference between the delinquent and the neglected child of this age. During the age period ■ — nine to thirteen years — several characteristic traits of childhood appear. Many of the instinc- tive actions of earlier life have vanished. The child, however, has not yet learned to correlate cause and effect. He is still deficient in prudence and foresight, and to a large degree uncon- 348 PROBLEMS OF CHILD WELFARE scious of the effects of his acts on others. He is self-centered, his morals are still in process of development, and he is very- susceptible to external impressions. The formation of habit proceeds at a very rapid pace during this period, and the moral habits are of special importance because they later develop into the morals peculiar to adolescence. The reUgious bias is also imparted during this period and the child becomes more truthful. The period of life including the years from 12 or 13 to 17 is marked by the practical completion of habit formation, and trains the child for success or failure. This period witnesses the culmination of fundamental physiological and psychological changes while the child arrives at puberty and endures many physical and emotional disturbances. It is significant that the religious impulse is strongest in this period, and that conversions are most numerous. Starbuck has well shown the incidence of emotionalism both for boys and girls, and his observations suggest the importance of properly harnessing this psychical energy. The religious impulse also has its counterpart in the wayward and criminal instincts of the boy. Many boys manifest an incorrigibility which, unless properly directed, will lead to absolute criminality. Rapid growth and the failure of the child to understand himself lead to moral aberrations which require the most careful treatment, affect the mental equi- librium of the youth, and influence the attitude of the two sexes toward each other. 3. Conditions underlying Juvenile Delinquency. a. Changing Social Conditions. A fruitful cause of juvenile delinquency consists of the chang- ing social conditions which make individual acts, harmless in themselves, a menace to society. The exuberant spirits of the boy must find expression in activity and excitement, and sup- pression is not possible. The numerous contacts of the city require a limitation of individual activity, since thoughtless acts which are entirely justifiable and even desirable in the country districts may be a constant danger to property in the city. Accordingly, a series of city ordinances have been enacted which condemn and prohibit such acts. Playing ball is not CAUSES AND NATURE OF JUVENILE DELINQUENCY 349 inherently a punishable offense, but to obstruct the streets or to endanger other persons who are using the street is distinctly anti-social, and is therefore prohibited by city ordinances. Persons may be injured, windows broken, and runaways caused by such sports conducted on the streets. Many boys are brought into some juvenile courts for offenses not more serious than playing ball. The highly valued bonfire belongs to the same category. Few boys can restrain themselves at the sight of a fire, and an even greater thrill follows their participation in a bonfire scene. The social needs of to-day therefore inter- dict acts which boys have for centuries been allowed to do, and as boy nature has not changed, many offenses are committed which the self-centered and thoughtless boy does without malice or deliberation. The Philadelphia girl of eight who set fire to a house did so to see the fire and the fire engines, not to commit arson. If children, instead of being cooped up in treeless and flowerless slums, had opportunities of touching nature and of using up their pent-up energies in parks and playgrounds and in other wholesome ways, they would not insist on committing acts that jeopardize the public. The boy who uses the streets for play is not more criminal than the community which declines to furnish him with proper play facilities. Change of law does not change child nature, but changed conditions require new adjustments. b. Home Conditions. The incompetency of parents is a prolific source of juvenile delinquency, for the home environment is the most potent factor contributing to the formation of character and habit. The force of social heredity, comprising the ideals, morals, religious impulses, teaching, discipline, order, personal habits, and super- stition of the parents, overpowers the child by its almost irre- sistible momentum. Profane parents have profane children. If the father lies, the son will not be truthful. If the mother is not moral, how can we expect the daughter to be ! Parents who are irreligious will find that their children scoff at religion. Slovenly parents raise careless children. A large proportion of the child's habits are formed before he is ten, and during this 35° PROBLEMS OF CHILD WELFARE time the one constant factor in his training is the environment of the home. A recent development in the home, especially the native American home, is the too liberal abandonment of the discipline and subordination of the child. We are not ready for any prin- ciple of self-control which allows the child to decide according to his own likes and dislikes, to obey or disobey, as he chooses, to work out his moral code on the basis of his own personal experience. The brutal corporal punishment of old has given way in many cases to soft effeminate indulgence by parents of the idlest humors of their children. Thus selfish and imperious instincts develop at the expense of altruism and obedience, and parents are unable to develop appropriate moral and social traits in their children. The children dominate and subdue instead of being molded into moral shape by their parents. If they were mentally mature, they should be permitted to enjoy complete self-direction ; but they are not, and unless subjected to the proper restrictions and discipline, they will fail to reach the full level of human moral attainment. Why should not the experiences of parents be used to guide and limit the tend- encies of children? Corporal punishment, although often undesirable, cannot be totally abandoned either in the home or in the school, except at the cost of moral development. The growing protest against its total abolition is not without sig- nificance. Is it not surprising that native-born children of native-born parents should form so large a percentage of the total delinquency in our large cities ? We are not yet ready for exclusive control by moral suasion. Another striking instance of the importance of discipline in the home is furnished by the high rate of juvenile delinquency among the native-born chil- dren of immigrants. These children are sent to our public schools, where they learn English and mingle with American children. In a short time they have become somewhat veneered with American civilization. Then they suddenly awake to the apparent discrepancy between the culture of their parents and that of the native American. A break then occurs in the home because the parents have lost control over their children. They CAUSES AND NATURE OF JUVENILE DELINQUENCY 351 are considered mere ignoramuses and are practically without influence. The environment of the street soon weakens the morals of the child, who finally is brought into the juvenile court. With the discipline of the home gone, the child easily succumbs to the other influences that surround him. Parents are also to blame for their failure to recognize that the life of to-day requires different treatment of the child than did the conditions of their own youth. What may have been permissible then is anti-social now. The energy of the child must be allowed to express itself, but this does not authorize unbridled and ruthless methods which are a menace to life and property. The great majority of children expend their enthu- siasm in harmless ways, and yet reap all the advantages which such excesses afford. Too many parents have so little regard for the rights of others that it is little wonder that young boys become ruffians and bullies. While conditions have changed, so have parents. When properly taught, children will exhibit a marvelous amount of respect, but it is easy to make them incorrigible. Fathers are, in many instances, actually or ap- parently so busy that they do not have time, or take time, to make friends and comrades of their sons, although a little effort expended in this direction profoundly affects the boy, who is ready to make a hero of his father, if he is only given the oppor- tunity. That dishonesty and petty larceny is a result of the failure of parents to provide their children with a reasonable amount of spending money is amply demonstrated. Boys engaged in the street trades usually enjoy small sums of money, but this is often spent in improper ways. The difficulty of entering street Hfe without money tempts the boy to steal and dispose of the goods. The first step taken, stealing becomes a habit, and can with difficulty be checked. Many boys who have entered some gainful occupation are compelled to bring home the entire wage and are denied the use of the smallest portion. Investigations have shown that a large percentage of boys do not report to their parents the increase in wages which they receive. The differ- ence between the original and the later wage represents the boy's 352 PROBLEMS OF CHILD WELFARE spending money. Dishonest habits are thus ingrained in the moral fiber of the young boy ; yet such habits are the natural result of the parents' failure to allow him any spending money from his hard-earned wage. The broken home is probably the most important single proxi- mate cause of delinquency. There is convincing evidence of the need of the refining and chastening influence of the home. Homes are broken up in many ways, of which the most important are the death of one or both parents, desertion, and divorce. The last two causes are also results and imply delinquencies among parents, and these furnish additional reasons for the waywardness of children. Many homes are broken by death, and orphan children often are left without adequate care, many being brought into courts — a much larger number than their pro- portion in the community. The half-orphans are more mmier- ous, however. A majority of these have lost their fathers, while the mothers are still alive. In many cases the surviving parent marries again, but the step-parent cannot take the place of the deceased. Accordingly, the children in such a home frequently suffer from neglect and drift into delinquency. The following figures are very significant : Out of 1307 delinquent children concerning whom the parental conditions were known, and who entered the St. Louis courts during the years 1908- 1909, 48 per cent had both parents living together, 21.9 per cent had parents separated or divorced, 18.9 per cent were orphans or haH-orphans, and the remainder, or 11.2 per cent, lived in homes where step-parents had been introduced. In all, 52 per cent of the children did not live in normal homes. More cases of delinquency were reported from homes where the child lived with the surviving mother than where the father had survived. Probably the control of the father is superior to that of the mother. On the other hand, widows are more numerous than widowers. The federal government, in its investigation of child wage- earners, throws additional light on this problem, as shown in the following statistics : ^ ' Woman and Child Wage Earners in the United States, Vol. VIII, p. 53. CAUSES AND NATURE OF JUVENILE DELINQUENCY 353 Parental Condition of Delinquent Children Paeentai. Conditions Percentage of DELINQnENT BOVS Percentage of Delinqttent girls Working Non- Working Total Working Non- Working Total Normal Half-orphan Step-parents One or both parents living away, orphaned, or deserted 54-6 25.2 9.2 II.O 61.I 23.2 7-5 8.2 S7-S 24-3 8-5 9-7 32.2 28.8 11.7 27-3 37-7 26.5 17.2 18.6 34-2 27.9 13.6 24-3 Total number 2412 1852 4264 3SI 204 SSS It will be noticed that but little more than one-third of the girls came from normal homes and that a very large proportion were orphaned or deserted. On the other hand, the table shows that out of 4264 delinquent boys, 57.5 per cent came from normal homes and only 42.5 per cent from homes broken by death, desertion, or separation. But for both boys and girls the proportion living under abnormal home conditions is so large that the magnitude of the problem can hardly be overestimated. Homes broken by divorce or separation lose much of their moral control. According to EUwood, out of a total of 7575 children in reformatories in the United States, 29.6 per cent came from homes broken by one of these causes.' The propor- tion varies among the different training schools, the usual range being from 25 to 35 per cent. These figures pertain to a class of serious offenders, and the average among all delinquent chil- dren is much lower. A very unfortimate form of incomplete home is that of the illegitimate child. The father is generally absent and the child Uves with the mother, or with relatives or strangers. The usual environment of the illegitimate child conduces directly to criminahty. Drahms says that of the 4838 juvenile male popu- lation in the reformatories of France in 1896, only 517 were of legitimate birth, and 4321, or 89.34 per cent were illegitimate ' Sociology and Modern Social ProUems, p. 158. 354 PROBLEMS OF CHILD WELFARE and born out of wedlock.* Of the 1095 girls, 246 were legiti- mate, and 849, or 77.53 per cent, were illegitimate. The Ameri- can rates, however, are very low compared with these. Neglect of the home is a frequent result of the drinking habit or of the indolence and indifference of the father. These attri- butes are easily transmitted to the child, whose vagrant instincts need only the slightest encouragement. Parental begging and stealing leave intricate traces on the minds of children, and confirm them in a life of idleness and crime. The child caught in an environment of this sort and accustomed to wrong and debased standards can with difficulty recover from the coercion of social heredity. Vicious homes are also important factors. A large number of fathers are intemperate and set a bad example for their chil- dren; also many are brutal and beat other members of the family. The boys in the home become rough, xmriily, revenge- ful, and cruel, while many run away from home and become Bohemian in habit, and incorrigible in morals. The criminal father practically forces his child into crime. Many men are irregular in their work and consequently do not provide ade- quately for the family wants. Children soon absorb their parents' faults, and if mothers are immoral, daughters must be handled by the courts. When children acquire bad habits and commit petty offenses, frequently parents overlook or encourage the delinquency, so when the boy steals coal, the parents burn it ; and when the child begs, the father does not interfere. Boys frequently organize marauding expeditions and are ac- tually encouraged by their parents, and thus a career of crime is begun. Cruel forms of punishment produce dehnquencies. Vicious whippings of the young child harden him and keep him from responding properly to the chastening effects of properly ad- ministered punishment. Many immigrant parents in this way develop a spirit of defiance in their children. A bad home environment will produce criminal tendencies which are often falsely considered instinctive, but which are really due to ' Drahms, The Criminal, p. 285. CAUSES AND NATURE OF JUVENILE DELINQUENCY 355 cruelty and abuse. Deliberate neglect throws the child on his own responsibility, and his undeveloped moral sense leads to his downfall. The native child of the immigrant also suffers from the inability of his parents to guide him aright. They do not understand America and its temptations and possibilities of crime and corruption, so they cannot protect their children from demoralizing influences. In Indianapolis a study of the apparent causes of delinquency credited lack of parental care with 42 per cent, bad associations with 20, criminal tendency with 5, and miscellaneous causes with the remainder. Usually, of course, several causes cooperate to produce the results. c. Environment and Associations. The environment of the boy outside of the home and the character of his associates leave their definite prints upon his moral nature, and are a large factor in producing delinquents. The child who must spend a considerable portion of his time upon the streets faces many temptations. His parents have not sufficiently warned him against the pitfalls to be encoun- tered, and the child, because of lack of self-restraint, speedily succumbs to the influence of his bad associations. More than three-fourths of all ofi^enses are committed in the evening before eleven o'clock. Darkness and evil companions may complete the demoralization of a boy, and one plotter or mischief-maker will ruin an entire "gang." It is here that the pickpocket develops and the petty thief. It is owing to his street associa- tions that the boy's actions degenerate into disorderly conduct, disturbance of the peace, and often into the ruthless and wanton destruction of property. The ba,d boy is ever present, and degrades his less resolute associates. The opportimities for legitimate sport are meager; hence a greater readiness to in- dulge in the forbidden pleasures. The energies of the boy result in spontaneous boys' clubs conducted in forbidden places and under most unwholesome conditions. Such clubs are the natural development of the organization of the street gang, and their work is equally wanton and mischievous. The many fruitless attempts of court officers to reform boys placed 3S6 PROBLEMS OF CHILD WELFARE on probation in their natural surroundings are an eloquent wit- ness to the inexorable influence of a bad environment. The native instincts of the boy, molded by the environ- ment of the home, resvilt in several classes of delinquent chil- dren after exposure to the associations outside the home. There are the morally weak who easily yield to temptation but who had no initial bias to do wrong. Their minds are open to sug- gestions of good or evil, and easily yield to vicious influences, but in another environment they would have escaped all moral taint. Another group of children are in the heroic age; for example, the vagrant child who glories in remaining away from home and in sleeping in box cars and sheds. He delights in the joy of numerous escapades, but he is becoming the criminal of adventure. His roving nature transforms him into the pro- fessional tramp. He willfully throws stones with injurious intent ; he attempts to derail cars and play pranks of a serious nature ; and he outwits the teacher and the attendance oflScer. If his adventure could be made wholesome, if his hero worship could be made inspiring, then all this wasted energy would be used in developing the boy. Again we find children vicious and impulsive, strong minded and incorrigible, demoralized at home and made criminal by the unrestrained associations elsewhere. They are the ones who will commit serious offenses, organize gangs of delinquents, and begin a career of crime. It is most difiScult to reform them because criminal tendencies have become so deep-rooted. In the cities many boys frequent the saloons ; some learn to drink, and all are contaminated. Besides, the use of tobacco is almost universal among delinquent boys. This habit has usually been acquired on the streets, and helps to undermine the child's morals. The opportunity for gambling and the playing of vicious games also frequently presents itself, and thus the boy rapidly becomes incorrigible. The environment of the girl is more wholesome, but the insid- ious influences that undermine her are more thorough and leave very serious consequences. Partly because of low morals in the home, but largely because of ignorance and low ideals taught CAUSES AND NATURE OF JUVENILE DELINQUENCY 357 elsewhere, most delinquent girls are also sexually immoral. For example, out of 224 girls sent in two years to the Massa- chusetts State Industrial School, 154, or nearly all of those under 17, were immoral, and of these more than one-half were prosti- tutes. d. Criminal Tendencies. In spite of the theory that the child of the juvenile courts is in need of formation instead of reformation, it is plainly apparent that a considerable nimiber of children have acquired criminal tendencies. To what extent these are due to natural and inherited traits and instincts and what importance shaU be attached to the contagion of an early vicious environment are still unsolved questions. Instances of moral perverts are sufficiently numerous. Persons are born with the innate tendency to develop into full-fledged criminals. Boys who have not suffered from the slightest suggestion of larceny have degenerated into thieves, thus indicating that their criminality was instinctive. Many children commit serious crimes such as murder, assault, and arson, with no compunction of conscience, the manner of committing the crimes being usually suggested by some experiences of their lives. It is probable, however, but scientifically undetermined, that the majority of apparently degenerate children are indebted for their delinquency to the influence of parents and the vicious surroundings of their earliest youth. Many of these children are precocious, and form habits and tendencies sooner than is usual. It has been estimated that physical heredity is responsible for about 10 per cent of all delinquents. e. Retardation and Defectiveness. Many delinquent boys are seriously retarded in their educa- tion. The inmates of the John Worthy School in Chicago range in age from 12 to 18 years, but about 80 per cent are not above the fourth grade. Out of 1020 delinquents handled by the juvenile court of Indianapolis in the years 1910-1912, only 354 had reached the sixth grade, whUe in the Massachusetts State Industrial School, only 38 per cent of the girls have reached the sixth grade or passed beyond. The great majority of juve- 3S8 PROBLEMS OF CHILD WELFARE nile delinquents have little practical education, and most of them have not learned to appreciate the meaning of education and therefore are more easily swayed by sinister influences. The application of the recently developed Binet test promises to give good results as to the backwardness of delinquents. One such test indicates that out of 107 delinquents, 53 were apparently normal ; that is, not more than three years behind the grade which their age justifies, and that 54 were four or more years behind, almost exactly one-half of the total number being seriously defective. Mental defectiveness is a prominent cause of delinquency among girls, but this must not be confused with hereditary criminality. The defective girl has a very immature mind, and easily becomes the prey of immoral men ; neverthe- less it is not criminal tendency but mental weakness that is re- sponsible for this misfortune. How much of this retardation and defectiveness is due to innate defects, and how much to ante- quated and impractical methods of education, remains to be learned. At any rate, mental defectiveness does not imply moral defectiveness, but the weak-minded child is easily influenced by an imfavorable environment. Physical defects also play a part. Especially is this true of adenoids, which is very common, being found among more than 10 per cent of the children in the public schools. It afiects the brain, causing the mind to become sluggish and inactive, and frequently perverting the morals. The removal of adenoids has in many instances resulted in the reclamation of a boy gone wrong. Other defects also, such as those of eye and ear, some- times affect the disposition of children. Their removal would undoubtedly lessen the amount of juvenile delinquency. /. Child Labor. Although to some extent a result of poverty, broken homes, and other conditions, child labor is itself a cause of juvemle delinquency. The federal ^ government in its report says, "working children showed a marked excess over non-working children both of delinquency and recidivism, and that this appeared in offenses of every grade." "The proportionate ' Woman and Chili Wage Earners in the United States, Vol. VIII, p. 62. CAUSES AND NATURE OF JUVENILE DELINQUENCY 359 excess of workers is large, varying from two to nine times the ratio of non-workers." As other factors affecting delinquency were found insuf&cient to account for these conditions, it be- came evident that child labor must be one of the direct causes. It was discovered that "the largest number of delin- quent boys were foimd in those occupations or industries in which the nature of the employment does not permit of super- vision." The principal occupations of this nature are news- paper selling, errand and delivery boys, and the messenger service. A large proportion of the delinquent girls were en- gaged in domestic service. That the street trades conduce to delinquency is well known. Being without supervision or restraint, boys abandon themselves to the constant contacts of the street, with their hardening influ- ences. Newsboys and errand boys furnish a large proportion of each class of offenders, but the messenger boys seem to lead in immoral conduct and assault and battery, while bootblacks lead in gambling, and oflSce boys in larceny. Occupational conditions are responsible in part for the tendency to commit certain crimes, but the environment of the workers helps to demoralize them. g. Poverty. The factor of poverty cannot be accxurately weighed, but its importance is evident. The bulk of delinquent children come from the ranks of those who are either below the poverty line or are resting rather insecurely above it. The poor and very poor are the chief victims, and children especially are sufferers. Adults are often responsible for their poverty, but children are not to blame. The statistics ^ of juvenile delinquency in Chi- cago for the years 1903-1904 show that out of 584 boys 76.1 per cent came from the lowest and next lowest group of families, and out of 157 girls, 89.8 per cent came from the same groups. The lowest class furnished 38 per cent of the boys and 69 per cent of the girls. Poverty means inferior homes, bad housing, inade- quate recreation, and other disadvantages. The resulting lack of opportunities for children is registered in increased delinquency. ' Breckinridge and Abbott, The Delinquent Child and the Borne, pp. 73-74- 360 PROBLEMS OF CHILD WELFARE The causes of delinquency are many, but without doubt the principal underlying conditions are broken homes, incompe- tency of parents, neglect and vice, environmental associations, retardation, defectiveness, physical defect, and poverty. 4. Offenses of Delinquents. If delinquency is largely an expression of wrong relations in the home and on the street, the offense committed by the child is of secondary importance. In some courts the chUd is simply charged with delinquency, no special offense being designated or recorded. This is an extreme application of the theory of the non-responsibility of the child. Furthermore, it obscures somewhat the causes of the delinquency, for without exact knowledge of results, causes cannot be accurately diagnosed. Certain offenses, however, are the result of like conditions, and no harm will follow if they are classified together. On the other hand, the major groups of offenses should be given, but certain minor classifications may be omitted. The juvenUe courts are far from uniform in the presentation of their statistics, so no general statements are possible in regard to the proportions among the various offenses, but partial facts, such as the following, are of interest. The table given below shows the classification by offenses of probation cases in New York for the year 191 1 and for nine months of 191 2, and of children committed to institutions in the United States during the year 1904. The leading offense among the boys is larceny. This seems to be almost universally true, and applies to the more serious institution cases as well as to the probation cases. More than one-fourth commit this offense, and in some localities the pro- portion is still higher. In its special investigation of juvenile delinquency in six selected cities the federal government dis- covered that in 1908 out of 8069 offenses committed, 35.19 per cent were larceny. In 1911, 43 per cent of the boys committed to the Lyman School for Boys in Massachusetts were guilty of larceny. IncorrigibiHty frequently comes second. Among boys this offense, together with disorderly conduct, often includes acts of CAUSES AND NATURE OF JUVENILE DELINQUENCY 36 1 Offenses of Juvenile Delinquents ' Ottenses Percentage Among Children Com- mitted TO In- stitutions, 1904 Boys Girls Probation Cases in New York Boys 1911 1912 Gills 1911 1912 Against the person . Against property . . Burglary .... Larceny .... Other .... Against society . . Incorrigibility . . Disorderly conduct Truancy .... Other Improper guardianship Other Number of persons . 3-6 37-2 8-5 26.8 1.9 47-3 17.6 6.S ii-S 11.7 6.3 5-6 "•3 o.S 10.4 •9 6S-3 3S-7 8.2 3-4 18.0 134 9-3 3-3 42.9 12.8 30.1 39-7 15.0 10.7 14.0 S-4 8.7 3-8 36-7 10.8 2S'9 12.0 13.6 S-7 16.7 11.4 .0 11.9 3S-I 26.2 .0 8.9 29.6 22.7 1.4 6.4 1.9 4-S 20.7 19.4 i.o 6.3 49.9 iS-6 10,137 1657 2187 435 3347 571 the same nature, so the classification is somewhat arbitrary. In some cities truancy ranks second, but this is principally due to the absence of a well-developed system of enforcing the attendance laws. The offenses committed by girls differ widely from the pro- portions obtaining among the boys, the principal offense being incorrigibility or waywardness. In the case of girls this usually implies immorality. A very large percentage of girls are also charged with improper guardianship. While this seems to indi- cate neglect on the part of parents, in actual fact a considerable proportion of these girls have also become immoral. In fact, no matter what the specific charge against the delinquent girl may be, the majority of such girls have practiced immorality. A study of delinquent girls in Chicago showed that 18 per cent were aflBicted with venereal disease. Out of 500 consecutive admissions to the IlHnois School for Girls at Geneva, 74 per •Bureau of the Census, Prisoners and Juvenile Delinquents, p. 241. Figures for New York, from Fifth and Sixth Annual Reports of the Probation Commission. 362 riiOBLEMS OF CHILD WELFARE cent were similarly afflicted. This list, however, included a large number of girls 17 years of age or older. ^ 5. Number of Delinquents. The number of children in the United States delinquent at any one time cannot be ascertained, but the number in reform- atories has been tabulated by the Federal Bureau of Education. According to its report, 115 institutions in the United States in 1910-1911 enrolled 51,387 persons, of whom 77.8 per cent were males and 22.2 per cent were females. Eleven of these institutions, however, handle either dependent children or adult offenders. If we subtract their enrollment of 9550 from the total given above, we find 41,837 delinquent children in the industrial schools and reformatories, but unfortunately a nmn- ber of parental schools and other institutions are omitted. The total number of delinquents in institutions of all kinds in the United States is therefore somewhat larger than the figures given above. The number of probation cases in the United States is at least equal to the number sent to institutions. Besides these some are fined, others are merely reprimanded, while many are discharged directly. The proportion of all boys reaching the age of ten who have juvenile court records varies from about 7 to 10 per cent. The percentage among newsboys and other boys of the street is, however, much larger. In the country districts there are few delinquents, partly because of the absence of courts, but largely because of the favorable environment. On the whole, the total number of delinquent children varies from two to three times the number in our reformatory insti- tutions. ' The Training School, Vol. IX, No. 3, May, 1912. CHAPTER II THE JUVENILE COURT I. The Juvenile Court Movement. The first oflScial juvenile court in the United States was estab- lished in Chicago in 1899. The rapid spread of the juvenile court idea is a marked instance of the imitativeness of the American mind. Although the new child psychology had deeply permeated the minds of leaders in philanthropic work, the court movement made but little headway. The public was not ready, neither were the politicians. Social workers had begun to em- phasize the value of the child, but their efforts were not appre- ciated. Children were still the victims of retributive justice ; for example, in Chicago boys were being thrown into the police station ; in Denver, within the six years before the inauguration of the juvenile court, about 2000 boys had been temporarily placed in jail ; in IndianapoHs, Buffalo, and elsewhere the large number of children subjected to intolerable conditions caused a revolt which needed only the example of a new way of han- dling juvenile cases. The states which practiced the most ad- vanced methods of child saving did not lead in the estabUshment of the juvenile court, for their need was less. It was the reaction against antiquated methods of handling children that finally brought the court. In 1869 Massachusetts had granted children separate trials, at which it also required the state agent for children to be present. Delinquent children were also placed with private societies instead of being held in jails and prisons. Ontario passed a law in 1893 which made provision for the care of delinquent children. This was very similar to our juvenile court laws. Several years of agitation preceded the successful attempt to secure a law for Illinois. When the beginning was once made the states 363 364 PROBLEMS OF CHILD WELFARE where little had been done began to realize their shortcomings, and adopted the juvenile court plan with great enthusiasm. The law was scattered broadcast and became a basis for laws elsewhere. In Denver a court was established prior to the meeting of the Colorado legislature which enacted a suitable juvenile court law; Philadelphia introduced its court in 1901. The Pennsylvania law, however, was declared unconstitutional, but a new law was passed in 1903, and the court was then per- manently established. New York City followed in 1902, and the cities of Brooklyn and St. Louis in the succeeding year. The efficient Indianapolis court was organized in 1902, and in most of our cities of 50,000 or more juvenile courts have now been established, or methods have been devised of granting children separate trials. Everywhere, the establishment of an authorized juvenile court has depended upon action by the state legislature. This is true whether it is part of the criminal court or is organized on a separate footing. The states have usually applied the juvenile court system first to the large cities, then to the smaller communities, and finally some of them have extended it to the entire state. 2. Extension and Organization. The general extension of the court to the counties and the method of operation has become a problem of considerable concern. A goodly proportion of the inmates of the state industrial schools are committed from the circuit courts of the state. These children have been handled in practically the same way as adults; they have been confined in the county jails and have been given a regular trial, waiting for their turn according to court docket. The chief difficulty of extending the juvenile court into the counties has been the discontinuous sessions of the county courts. Many circuit court districts comprise a number of counties, in each of which the judge spends some time in trying criminal cases. Should a child be arrested in a county in which court is not being held, he may have to be confined or detained for several months before he can get a hearing, and as there is usually no detention home, the jail is used. THE JUVENILE COURT 365 Another difficulty consists in making provision for the child's probation, so children have either been sentenced to the indus- trial school, or given their freedom. The juvenile court idea implies probation for some children, but the number of such cases in the country districts is small, and they live at consider- able distance from each other. Can the county afford to pro- vide a paid probation officer? Can it arrange for the care of the child with some local social agency? These are some of the problems which confront the county courts, and which make it difficult to institute a new system. The fact that some states send slightly delinquent children and also dependent children to reformatories makes a state- wide juvenile court system necessary. The Indiana and Mis- souri laws are types of laws providing for the extension of the system. The Indiana law of 1913 provides for the estab- lishment of a juvenile court in any county desiring one, but makes it a division of the circuit court. The law, however, allows separate hearings for delinquents, and at times when the circuit court is not in session. The procedure is to be that of the regular juvenile court and the jurisdiction extends to ju- venile delinquents, truants, neglected and dependent children, including cases brought in on petition of the board of children's guardians. The Missouri law of 1913, which extended the juvenile court to the entire state, provides that delinquency cases may be handled in the probate courts in the counties — that is, in the civil courts. Theoretically, the delinquent is no more criminal than the dependent child. The position taken is similar to that of the Oklahoma court, which decided that a child under 16 could not commit a crime, or to that of the New York law, according to which a child under 16 may be guilty of a delin- quency, but not of a crime. The Missouri law, if placed in operation, would insure prompt dealing with each case of delinquency. Several minor courts have, however, declared the law unconstitutional. In the majority of cases, the juvenile court merely consists of separate sessions of the circuit court, and is not organized on 366 PROBLEMS OF CHILD WELFARE an independent footing. It is a branch of some other court and is served by one or more judges from that court. In Denver and Boston, the courts are separately organized, with judges confining their judicial work to the business of the juvenile court, but this differentiation has only recently taken place. New Jersey has enacted a law providing for separate juvenile courts for all cities of the first class within the state. The es- tablishment of children's courts entirely separated from the other forms of the administration of justice is a movement in the right direction. The juvenile court must be thoroughly divested of its criminal taint and be given the atmosphere of the civil courts, where dependency and other family relations as well as deUnquency are handled. 3. Selection and Qualifications of Judges. The rotation of judges in the juvenile court is one of the glar- ing weaknesses of the system. The act of presiding over cases that merely involved children used to be regarded as be- neath the dignity of a judge, and a burden that ought to be avoided. Children's cases do not lead to a great career as a jurist, so the time spent was time lost ! Consequently short terms became the rule, especially when the judges themselves designated one of their number to serve, although there have been several notable exceptions to this rule. The Chicago judges selected one of their number for a year, but continued the same man for several years ; consequently Chicago has given several well-known juvenile court judges to the world. Recently Chicago paved the way for another excellent reform. A woman was appointed as assistant to the judge, and she handles all the female dehnquency cases. Girls need to be tried before a woman. The term of office among judges has varied from two months to four years : the short term has been the outcome of a vicious system of rotation ; the latter the result of election, as in Denver, or of appointment by the governor, as in Boston. Short terms lessen the interest of the judge in the problems of juvenile delinquency. However, if he is frequently brought back his interest may revive somewhat, but good results cannot be THE JUVENILE COURT 367 expected if the juvenile court is not taken seriously. Satis- factory work can only follow experience, and this requires an extended term of office or continuous assignment to the position. Judges are usually selected from the criminal bench, but in Cleveland they are taken from the civil courts. Although some of our judges began as martyrs, the work of the juvenile court has recently received a greater appreciation, and the aversion to the work has dechned. Furthermore, some socially minded men have found the court an opportunity for genuine pubUc service, as well as for gaining a reputation. The growing con- sciousness that the best constructive work consists in deaUng with children partly accounts for this changing attitude. In many respects the children's judge must possess qualities which may be absent in his compatriots in the criminal court. He should possess the legal knowledge and training with which every judge should be equipped, as training should only enhance his efficiency. Other quahties are, however, more essential for successful work : first, the judge must have a definite knowledge of child psychology. He must be able to know and interpret the child, to see the limitation of the child's horizon, and to understand the natural subjective effects of external influences. To know the mind of the child is the first step toward his refor- mation. Behind the offense stands the offender, and behind the offender stands the home. However, it is with the child that the judge must deal and must deal wisely. Children can- not be handled in job lots. Successful work by the judge also depends upon his knowledge of social problems and conditions. The problem of juvenile delinquency is a social question, and its legal phases are only the vehicles used to transport the child to the right destination. The purpose and aim of the work must be distinctly understood. The social as well as the indi- vidual causes of delinquency, the handicaps of bad parentage, and the compulsion of environment are factors which every judge must consider in his disposition of cases. Another quality with which the judge must be specially en- dowed is a sympathetic temperament. The so-called judicial tem- perament is out of place in the children's court, and if introduced 368 PROBLEMS OF CHILD WELFARE ■will only multiply the mass of sin and suffering which already exists. Although the functions of the judge and the probation officer must be separated (and in few cases is it possible or advis- able for the former to perform any of the work assigned to the latter), still the judge must plan actively for the full reclamation of the child — a task which cannot be effectively performed without human sympathy duly tempered with prudence. The proper attitude of the judge is summed up in the following extract from an address by JuUan W. Mack, formerly judge of the juvenile court of Chicago: "Unless the judge be really interested in philanthropy, you might as well give up the juve- nile court; unless he realizes that the problem before him is totally different from the problem either in the civil or the crim- inal court, that the question which he has to determine is not — has the child done a certain thing and should a certain thing be done to the child because of the act — but it is purely and simply, what can we do to save and redeem this child ; he might as well abandon his position. But even though the judge have the proper conception of the function of the juvenile court, he must gain a thorough experience in order to be able to deal with the problem. It takes study and thought and patience and above all, experience . . . ." The need of judges fitted to direct the lives of the vast numbers of erring children coming under their control cannot be too strongly emphasized. 4. Appearance of the Delinquent in Court. In the best type of juvenile courts the child is not brought in until a thorough investigation has been made by the probation officer. A sociological diagnosis of the child is necessary to make a wise disposition of the case. The investigation should include the following information : the charge against the child ; his family history ; the habits and morals of parents ; their hered- ity; their social and financial conditions; the child's school attendance; his habits and associations; the steps that led to the delinquency; and his physical and mental condition. The probation officer's investigation should be supplemented by a complete physical and mental examination from competent physicians. A psychopathic clinic, such as the one established THE JUVENILE COURT 369 in Chicago, should test every child before the court tries the case. The physical condition of the child may make a physi- cian's care the next step, after which further action can be taken if necessary. In some states the child's case is presented to the court by petition instead of complaint and the child comes into court in answer to a "summons," and warrants are not issued except as a last resort. Many courts, however, still cling to the old forms of procedure. The temporary detention of the child pending his trial in- volves some difficulties. In the majority of cases the child is at large and expected to answer the summons. He is practi- cally under the care of a probation officer, and imless absolutely necessary he is not detained, but is allowed his liberty. Other- wise the detention home, or rooms used for detention, or even the jail are used to hold the child until trial. Many states have laws prohibiting the placing of children under certain ages — usually 14 — in jail ; other methods of accommodation must then be found. 5. Court Hearings. The pubUcity of children's cases has been a problem of long standing, and was not solved by the founding of the juvenile court. Newspapers in some instances have agreed not to pub- lish accounts of juvenile delinquency because they might em- barrass the youthfvd offender and accordingly promote crime. Previously they had often exploited some spectacular case and caused much harm. Separate hearings for children, some of them private, also preceded the court proper and so the type of hearings now conducted in the juvenile courts were gradually evolved. Officially the hearings are of two kinds, public and private. Most of the cities retain the public hearing, but their methods have been so developed that the public can gain but little through attendance at the trials. Few people seem to know when the children are on trial, and, on account of the informal method adopted, those who do attend gain no advantage from their attendance. The judge is usually seated at his bench, and the defendants, complainants, witnesses, officers, and others directly 370 PROBLEMS OF CHILD WELFARE interested crowd about him. The oath may or may not be ad- ministered, and then the trial proceeds. The parties almost invariably speak in low tones ; after a short trial the case is concluded and its disposition ordered. Persons in the audience learn little or nothing of the merits of the case, and the interest which is excited is so meager that few spectators consider it worth while to attend. What is nominally a public hearing consequently becomes one which is in practice largely private. The chief advantage of the public hearing is in the opportunity it gives to philanthropic persons to ascertain whether the cMId secures proper and humane treatment. Abuse of the powers of the juvenile court is also impossible under such an arrangement. The representatives of children's societies, of orphans' homes, and persons directly interested in children attend the hearings in many cities, and satisfy themselves concerning the justice of the disposition of cases. Private hearings are in vogue in a number of cities, of which Boston is an example. According to this system spectators are not allowed, and no one is present except the parties directly participating in the trial and the necessary officials. The children are entirely saved from the confusion resulting from the presence of an audience. A child is usually embarrassed on meet- ing a person who attended his trial at the juvenile court, and the avoidance of this possibility makes his reclamation more prob- able. Part of the gain resulting from private hearings is coun- teracted if children and witnesses are detained together in some waiting room. On the other hand, the secrecy of private hear- ings invites suspicion, and the public may become dissatisfied. Star chamber methods are hinted at, for no one knows of the methods employed in dealing with the children. Although no harm has followed, the public hearing enjoys an advantage because it allays suspicion. It allows a probing of method, but secures virtual privacy by means of the court practices that have developed. The juvenile court is or should be one of original and un- limited jurisdiction. This enables the judge to deal adequately with the child. In exercising the parental functions of the THE JUVENILE COURT 371 state the delegated authority must have a free hand to govern the situation, otherwise the exercise of the rights will be useless. The juvenile delinquent is a diflScult case; hence efficient methods must be authorized. Jury trial, although allowed almost without exception, is seldom employed by the court and the case is handled by the judge who, guided by the facts gathered, disposes of the case directly. The judgment of trained officials is far superior to that of the jury which would be secured, and in theory the judge is regarded as the friend and protector of the child. Accordingly the interests of the child will not suffer. By retaining his control over the dispo- sition of the delinquent, the judge can facilitate effective refor- mation. 6. Disposition of Offenders. Juvenile offenders are subject to several forms of disposition, including acquittal, dismissal, fines, supervision, probation, commitment to institutions or to individuals, and the require- ment of restitution for property destroyed. Children also are sometimes placed out in family homes. In disposing of an offender, sentence is imposed not as a punishment but as a part of a program of upbuilding character. At first the offense was all-important and the case was judged accordingly. Em- phasis was later shifted to the child and less attention was paid to the particular offense committed. As has been said, in some cities the charge is merely "delinquency," and the officials who supervise the case do not know the nature of the act commit- ted. The most advanced view regards the child as a social symptom — the outgrowth of family and environmental condi- tions. The treatment is social as well as individual. It is a mistake to suppress the facts as to the offense committed, for the offense throws light on the character of the child and on the influences that are producing that character. Many cases are everywhere settled out of court. In some cities the character of the law allows complaints on flimsy and unwarranted charges, but on investigation many of these grievances are settled amicably without judicial intervention. A considerable percentage of the defendants are discharged 01 372 PROBLEMS OF CHILD WELFARE dismissed after hearing in court, but in some cases even the guilty are discharged, especially in case of a first offense. A reprimand and warning from the judge usually accompanies such a disposition of the case. A large proportion of the chil- dren in New York City were formerly handled in this way, since the city had no official probation system, although one of the private societies supervised many cases. Naturally commit- ments to institutions were heavy. In making dispositions, the influence of local conditions, the presence of parental schools or reformatories, the adequacy of the probation system, and the attitude of the judges toward the problem have been sharply felt. Some judges favor commitment to institutions, others, probation ; and the pro- portions between these two forms of disposition are constantly changing. Some cities, such as Denver and Indianapolis, place most of their delinquent children on probation, but send a small number to institutions. Here as elsewhere the older and more hardened offender is usually sent to the reform school. Almost without exception the juvenile courts have gradually increased the proportion of cases given a probationary treat- ment and have reduced the percentage sent to institutions for first offenses. The more degraded the home and the environ- ment of the child, the greater the tendency to place him in an institution. Girls are also subject to a different disposition from boys. Owing to the fact that a great proportion of the delinquent girls are immoral, it is necessary that many be removed from the home and be given treatment elsewhere. The Chicago records show that the percentage of girls sent to institutions is two and one-half times that of the boys. Other differences depend upon the policy of the particular court as to the handling of only serious, or both serious and minor, cases. In some states when the child has been placed in the custody of the court, he cannot be discharged from an institution or from the care of an individual except with the court's consent. In other states this decision rests with agencies handling the children. THE JUVENILE COURT 373 7. Evolution of the Juvenile Court. When first organized the juvenile court was merely regarded as an institution dealing with juvenile offenders. Separate detention of children, separate trials, and probationary over- sight — these were the principal functions of the court. The system, however, could not long exist on the theory that no child is a criminal, without developing preventive methods. The court therefore tends to become a constructive force in the community, and cooperates with other agencies to imptove the moral and social environment of the child. Its great function is the moral rehabilitation of the family. This, how- ever, depends in part on the social and economic remaking of the home. The increasing cooperation with attendance ofS.cers, factory inspectors, school physicians, children's societies, settle- ments, churches, and charitable societies is an evidence that this view is being rapidly recognized. There is no theoretical reason why the juvenile court should be a branch of the criminal court, therefore it can expand its functions so as to include the disposition of every variety of case involving children, — delinquent, neglected, dependent, and cruelty cases. Dependent children are at present usually handled in the probate courts, but these cases could very properly be transferred to a children's court. This is precisely the direction which the evolution of the juvenile court is taking. As soon as the court is in actual practice, as well as in theory, divested of its criminal taint, so soon children's cases of every variety can be handled. Many courts have long since ex- panded their functions so as to cover cases of neglect. The St. Louis juvenile court deals with delinquent and neglected children ; the Chicago court with delinquent and dependent, but classes neglected children under the term dependent ; the Denver court recognizes each of these three classes ; many courts recognize the contributory delinquency of parents; some handle non-support cases. A real children's court dealing with every variety of child problem that requires the attention of some court would greatly increase its own importance and add to its dignity. Judges would also become more ambitious 374 PROBLEMS OF CHILD WELFARE to serve in this capacity and would study the social problems of child life more intensively. The expanding functions of the juvenile court do not insure its permanency. Advanced methods of treatment will, of course, remain, but what agency will administer the law is uncertain. The history of the Indianapolis court is interesting in this connection. It was organized in 1903, and dealt with juvenile delinquents, truants, and neglected children on petition of the board of guardians ; in 1905 it assumed jurisdiction over contributory delinquency cases ; in 1907 it was empowered to consider cases against parents for abandonment, non-support, and neglect ; to take children away from vicious parents, and if parents were separated, to decide which one should have cus- tody of the child; finally it was given charge of homeless, abandoned, and destitute children. In 191 1 the court changed its name to the Marion County JuvenUe and Domestic Rela- tions Court because it had been dealing with every variety of case handled in a domestic relations court except divorce, ali- mony, and closely allied cases. The court has also been spend- ing about one-half of its time with adults, but usually only so far as they affected children. We are recognizing more clearly than in earher years that delinquency problems are essentially family questions, and we are now insisting that constructive work shall be done for the child long before he arrives at the court. We are learning that the problems afifecting children in the home are closely interwoven; therefore we shall work for the upbuilding and integrity of the home. In other words, we have begun to think that the subject of domestic relations covers every phase of the delinquent, dependent, and neglected child problems. Accordingly, the juvenile court must either expand or contract its sphere of operations. Several large cities have each recently established a court of domestic relations, but the immense amount of work that needs to be done in these cities has prevented any interference by this court with the juvenile court. In smaller cities this would not be the case ; so it seems that here, if not in the larger cities as well, these courts must THE JUVENILE COURT 375 eventuyiy merge and handle the problems now covered by both, and deal with them from a thoroughly social point of view. 8. The Juvenile Court in Other Countries. The juvenile court has had its greatest development in the United States. Canada, however, which really began the system, has established juvenile courts which deal very effec- tively with her children. There, as here, the courts are estab- lished separately in each state or province. South Australia estabhshed a children's court in 1895, and New South Wales in 1905, and in the latter state a system of probation was also established. The German government has projected a rather elaborate plan of procedure for the handling of juvenile delinquents. Among the provisions of its code are the following : The term "juvenile" is applied to persons under 18 years of age. In each judicial district a juvenile court is to be established with one judge and two laymen in charge. The public attorney decides whether a case shall be prosecuted or given educational treatment. The accused child may be defended by a lawyer. While awaiting trial the child may be detained in a reform- atory. Trials are separate from those of adults. The child may be placed in an institution or on probation. A system of paid probation officers has been established, but it is maintained largely by private societies, although some cities pay the officials from the public fund. The greatest advance in juvenile court legislation in Europe has been made by England, where the institutional care of juve- nile delinquents has long been considered a superior form of treatment. The Children Act of 1908, which is an elaborate code covering many phases of child protection, devotes one of its six parts to the juvenile offender. The principal points in the procedure of the law are as follows : ' I Children Act, 1908, 8 Edw. 7, Ch. 67, pp. 55-66. 376 PROBLEMS OF CHILD WELFARE Children apparently under i6 are included under the law. The ofl&cials may release the accused on a recognizance for such an amount as will secure his attendance at court. Detention homes must be provided. Parents or guardians of children must attend court. In case of guilt the following punishments are provided : Fines may be imposed on children or on the parents of the offenders. The child may be placed under the supervision of a proba- tion officer or committed to some other fit person. He may be sent to an institution or a detention home. He may be whipped. He may be discharged provisionally. The parent may be required to give security for the behavior of his child. JuvenUe court hearings must be held in a different building or room than that in which the court ordinarily meets. Children while detained for trial are not allowed to associate with adults. Private hearings are provided except that representatives of the press may be present. The imprisonment of children is abolished. The provisions of the English law took effect in 1909 except the part relating to imprisonment, which was put in operation in 1910. The law itself embodies most of the features common to the American laws. The probation system, however, is still in its infancy, for the tradition of institutional treatment is hard to overcome. France and the Latin countries are practically without juve- nile courts, but in Paris children may be placed under the pro- bationary care of private societies. Some advance has also been made in Italy, and children are being treated with more humane- ness in the ordinary courts. CHAPTER III THE PROBATION SYSTEM I. Development of the Probation System. The probation system has been called the "keystone" of the juvenile court, and with reason, because it alone makes the success of the court possible. The court itself is little more than the disposing agency directing what shall be done with the child, but the probation officer is the arm of the law which deals with the child directly. These children are the wards of the state and it is the probation officer who makes the state's guardianship effective. The probation system antedated the juvenile court by many years, Massachusetts having introduced it in 1869; and several other states used it before they established the juvenile court. With the rise of the court, however, the probation system sprang into greater prominence. While the juvenile court itself dates only from 1899, at least 38 states have enacted probation laws and are using the new method of dealing with the youthful delinquent. All the states containing large cities are included among this number. In 1898 Rhode Island passed a law pro- viding for the temporary supervision of delinquents; the Illi- nois law was passed in 1899; and a number of states made provision for probation in 1903. Since then the system has been rapidly extended. The probation system is being grad- ually brought under state supervision ; already 1 2 states have adopted a partial or complete system of such supervision. Rhode Island was again the pioneer, and in 1899 placed the general direction of the work under the authority of the state board of charities, which also appoints the officers and fixes their salaries. The small size of the state renders this function an easier one than would otherwise be the case. Other agen- 377 378 PROBLEMS OF CHILD WELFARE cies to which some states have given the control of the probation system are: State Board of Prison Commissioners, Prison Association, Board of Control, and State Probation Commis- sion. Several states, including Massachusetts and New York, have adopted the last method of control. State control in Colorado permits the rejection of local appointments to the posi- tion of probation officer. The state of Utah allows its commis- sion to appoint and fix the salaries of both juvenile court judges and probation officers. Other states limit the functions of the state bodies to inquiries into the methods and results of pro- bation work, to suggestions for its improvement, to the gathering of statistics, and to attempts to secure a unification of policy throughout the state. 2. Probation Officers and their Duties. The primary duties of the probation officer are well expressed in the Illinois statute : " It shall be the duty of the probation officer to make such investigation as may be required by the court ; to be present in court in order to represent the interest of the chUd when the case is heard ; to furnish the court such information and assistance as the judge may require; and to take such charge of the child before and after trial as may be directed by the court." In some cities a chief probation officer is appointed who has charge of the other officers. In the larger cities the work of the officers is usually specialized and some are detailed to confine themselves to the investigation of cases to be brought into the court. Probationary work may be carried on directly by the following classes of individuals : 1. Paid officers confining their efforts to probationary care of the child. 2. Unpaid volunteer workers whose duties are limited to super- visory work. 3. The judge acting in the capacity of probation officer. 4. The police serving as probation officials. a. Investigating Officials. The delinquent child may be summoned into court after complaint by some citizen or official or he may be brought on warrant. Before the case of the child is settled by the court, THE PROBATION SYSTEM 379 a preliminary investigation is made by the probation officer, or in the large cities by the oflacers detailed for the work of investigating the cases of children against whom charges have been preferred. Such official attempts to present sufficiently complete information to enable the judge to dispose of the case without further evidence. This information is secured in part from the child and his parents directly, but is supplemented and corroborated by neighbors and acquaintances, whUe school records and employment records are used when necessary. The chief probation officer bases his judgment on the facts presented and the judge in most cases follows the suggestions made. Un- less he is skiUful in his task, the investigating officer will fail to collect many of the most important facts about the child. A trained worker is most necessary for this work, and consider- able skill is necessary to extort the truth from the unwilling subjects of investigation. By giving his entire time to investi- gation the worker acquires a high degree of skill and increases the efficiency of the probation force. It is also desirable to place the child under the probationary care of some other officer than the one who made the investigation of the case. Better results are usually accomplished. b. Officials engaged in Probationary Work. The work of the judge is less important than that of the probation officers, who carry out the instructions of the court. The judge can only determine what shall be done with the delinquent; the probation officer must endeavor to restore him to a normal moral status. In the first place the probation officer sometimes brings the child to the detention home, al- though in most cases the police do so if the child is arrested for the first time. If relieved of the task of making preHminary investigations, the probation officer must still be familiar with the facts that have been obtained, in order to supervise the child efficiently, for his duties then have just begun. When a child remains in his old environment — and in a majority of cases the environment, including the home, has been responsible for the deHnquency — the probation officer must become familiar with the influences that surround the delinquent. Although 380 PROBLEMS OF CHILD WELFARE not a spy nor detective, he must acquaint himself with the daily routine of the child's life, and if he is an efficient friend of delin- quent children, he will take such steps as will lessen the tempta- tion to repeat offenses, and will strengthen children in their purpose to remain law-abiding. To supervise the activities of the child in order to prevent degeneration, to turn his atten- tion to wholesome sports and amusements, to interest him in better companionship, to surround him with elevating influences, to discourage any proclivity toward truancy, to persuade and enable parents to give their children proper care and guardian- ship, to make the child's home his opportunity instead of his stumbHng block ; in short, to build up his character — these are some of the duties which the probation system imposes upon its officials. The probation officer should do considerable field work as well as require the child to report in person at stated intervals, although reports need not always be made at the court, especially in the case of girls. These conferences should cover the work and conduct of the child since the time of the last report and contain suggestions for the future. Written reports are also filed. These consist of reports made out by the delinquent himself, reports from the school which he attends, reports from parents or guardians, and perhaps employers, and occa- sionally from others. The probation officer also files his own report of the conduct of the child, and his official record should be a reliable history of the moral advance of the child. Success can be best obtained by securing the cooperation of those agencies that are able to work permanently for the reclamation of wayward children and to surround them with good influences after they have been released from the jurisdiction of the proba- tion officer. The officers must deal with two kinds of delinquents : those who are released and simply placed under the care of some official, and the children who are conditionally released from some institution and who are said to be "on parole." Two distinct classes of offenders are represented in these types and the methods of supervision must be made to correspond. THE PROBATION SYSTEM 381 At the beginning of the juvenile court movement, probation officers in many cities were designated by the court to serve without pay and were not considered professional workers. The Pennsylvania law of 1903, for example, provided for the appoint- ment by the court of one or more discreet persons of good char- acter to serve as probation officers during the pleasure of the court, said probation officers to receive no compensation from the pubUc treasury ; and it further required that the probation officers make such investigations as the court might demand, that they be present in court when the case was heard, that they furnish the court such information and assistance as might be required, and that they take such charge of the child before or after trial as the court might direct. Volunteers had to be discovered to do this work. Social workers recognized almost immediately the necessity of granting compensation to the probation officers in order to secure enough competent officials for the work. The burden of providing salaries was sometimes borne by women's clubs, some- times by churches, and sometimes by settlements and other organizations interested in social betterment. It is needless to say that the compensation given under this system was far from adequate. This fact, together with the justice and pro- priety of salaries paid from the public treasiuy, hastened the advent of a system of public compensation. Exceptions still occur. For example Brooklyn has regularly had three officers — a Catholic, a Protestant, and a Jew — each supported by those of his own faith. Practically every state with probation laws has provided public compensation for its probation officers, although in many cases very meager salaries are being paid. c. Volunteer Workers. The relation of the volunteer worker to the court system is somewhat different from that of the appointed unpaid worker. The volunteer deliberately undertakes without compensation part of the work falling within the jurisdiction of the probation officials, and is expected to do faithfully the work assigned to him. In Germany under the Elberfeld system such honor 382 PROBLEMS OF CHILD WELFARE attaches to unpaid work as to make the office a stepping stone to a public career. Only an incentive of this kind can insure successful results from unpaid work, but in the United States, as yet, no such incentive has been developed. The volunteer is not drafted into the service, but is appointed only after signi- fying his desire to assist in the work of the probation office. Therefore it might be supposed that only persons sincerely interested in the work would apply for appointment. In actual practice, volunteer work, which is most commonly carried on by women, is handicapped by the following dis- advantages : 1. Frequently the volunteer has only a short-lived interest in probation work — an interest excited by a sudden contact with the fascinating features of the problem. After a few reverses in attempting to reform delinquent children, her ardor cools, and as she does not feel the responsibility borne by a paid official, her efficiency rapidly declines. 2. Volunteer work is often in danger of becoming fashionable. When this is true it is less the spirit, than the popiilarity, of service which dominates the volunteer. 3. It can never be regarded as more than a mere avocation, and this can often be conveniently slighted, when other interests absorb the mind. The needs of the child are not made para- mount, and therefore do not receive sufficient attention. On the other hand, capable volunteers for probation work are frequently secured from the general body of social workers in any community. The principle of volunteer service must be maintained, but whether such service shall be given in con- nection with the juvenUe court or with some other form of philanthropic endeavor depends upon the results. Some tem- porary harm may be tolerated if the undoubted result would be an increased voluntary interest in social conditions. Social progress depends upon a widened area of intelKgent interest in the welfare of humanity. The most extensive experiment with volunteer probation officers in the United States was tried in Indianapolis where, since only two regular probation officers were at first available, THE PROBATION SYSTEM 383 it was necessary to rely in part upon volunteer help.^ During the first year of the existence of the juvenile court in that city, nearly 190 men and women ofEered their services. A large percentage of the volunteers were men of affairs full of practical suggestions. The philanthropic organizations and societies also contributed some efficient workers. About 80 of the vol- imteers were employed, and 240 children, or an average of three each, were assigned to them. At first the system in Indianapolis met with considerable success, but its efficiency gradually de- clined. The city of Buffalo depends largely upon a corps of volunteers for its probation work. The court is assisted by many such persons, the majority of whom are connected with educational, religious, or philanthropic work. In many of the larger cities volunteers have been accepted and a number of cases assigned to each officer, but the practice is being discouraged in favor of a working corps of paid officials. d. The Jttdge as Probation Officer. In a few cases the judges partially assume the function of probation officer, and compel delinquent children to report to them as well as to other officials. The principal cities in which this system has found favor are Denver and Washington. Its success depends largely upon the concurrence of two factors: a judge with a strong personal influence, and a city of small or medium size, such as the cities named above. Judge Lindsey of the Denver juvenile court originated the system ; boys report to him at regular intervals, and come into direct touch with his personality ; common-sense talks are given, and loyalty to the court and to law is inspired in the boys. When this system began, a class of voluntary dehnquents developed — that is, a class of boys who voluntarily confessed to the court that they had been violating the law. Many of these boys wished to mend their ways, but found it difficult to do so without being placed under the jurisdiction of the court. Although several cities have adopted in part the method of ' Children's Courts in the United States, 58th Congress, 2d Session. House of Representatives, Document No. 701, p. 143. 384 PROBLEMS OF CHILD WELFARE the Denver court, the majority have delegated the work of pro- bation to their probation ofBcers. Unless the judge understands children thoroughly and has the proper temperament, he cannot inspire the delinquent boy with uplifting motives, but loses his dignity and falls into contempt. Under ordinary conditions this plan should not be attempted. e. The Police as Probation Officials. Little needs to be said about the police. It would be better if regular probation officials could be secured in sufficient num- bers to do all of the work required. Often this is not the case, and policemen are detailed to assist the probation officers in their work. 3. Qualities of Probation Officers. Since probation officers are the most important adjunct of the juvenile court, their qualities will determine the success of the system. They must have a comprehensive understanding of child psychology and know how to deal with children ; they must have personal touch and know the secret byways to the child's heart; they must be able to influence their wards and rouse in them moral and noble ambitions, and they must pro- mote the development of the child's moral quahties. This they cannot do without an unlimited fund of patience.' They must be sympathetic, but not sentimental, and they require a quahty of firmness which will give the child resolution. This is urgently needed, for the absence of firmness in the home is responsible for much serious delinquency. The probation offi- cer must have a good knowledge of family standards, be able to deal with parents, and know how to develop proper respon- sibiUty in them. Finally, he must be never ceasing in his vigils, for the time allowed him to mold the child's character is all too short. 4. Selection of Probation Officers. Probation officers have usually been appointed by the judges, although there is no good reason why this method should be made permanent. Where this method of appointment is not used there is usually some form of state control. The appoint- ing power should be required to make the selection from a certi- THE PROBATION SYSTEM 385 fied list of names chosen by civil service examination. Politi- cal considerations should not be allowed to enter, and applicants ought to have had some social service training. The examina- tion should include a written test covering the field of social service as related to children, an oral test, and an estimate of the applicant's personality. The written test should have a value of at least 50 per cent out of the total number of points. Such a test will exclude the bookworm as well as the person who relies on his personality alone. The increased emphasis on personality as demanded by some is fraught with serious dangers, as it opens the way for the manipulation of results. By giving due weight to the written work as well as to personality, the evils of the original civil service selections are obviated. The merit system is gradually being introduced, Missouri cities, Chicago, and Buffalo having led the way. 5. Probation Districts. Two different methods of assigning cases to the probation officers are in operation. According to one, the city is divided into districts, to each of which a different officer is assigned, who cares for all the cases in this district. The advantage of this plan lies in the fact that the territory to be covered by the offi- cial is so compact that he is able to become acquainted with the conditions and can therefore plan more successfully the program for each child. On the other hand, the acceptance of every variety of case prevents such specialization as would conduce to the most intelligent methods of treatment. The district plan may be somewhat modi&ed by increasing the size of each district and placing two officers therein. One of these should be a woman having charge of delinquent girls and the smaller boys. Philadelphia and Chicago furnish examples of the dis- trict method. According to the second method, each probation officer has charge of special types of cases throughout the city. Colored children are cared for by a colored official; white girls by a white woman ; and cases of very serious delinquency by a man trained in the art of handling this type of boys. This plan, while it may enable the official to acquaint himself with the 2C 386 PROBLEMS OF CHILD WELFARE details of a case, does not allow Mm to understand thoroughly the community in which the delinquent lives. It likewise compels him to cover a large territory, and occasions a consid- erable loss of time, as well as lessens the opportunity of the pro- bation oflScer to identify himself with a community in a positive and constructive manner. Its chief virtue lies in the advantage which specialization in types of delinquency affords. St. Louis and Brooklyn are the principal examples of this method of as- signing probation cases. 6. Length of Probation. Courts occasionally grant a suspension of sentence without submitting the offender to probation, but ordinarily juvenile delinquents are placed on probation for a limited time. The average length of probation in several leading cities is shown in the following table, taken from the report of the Juvenile Court of St. Louis for 1908. Cities Length of Probation St. Louis Brooklyn Boston 6 to 18 months (average 10 months) Average 4 months 6 to 18 months (average 9 months) Average i year Average 3 months From 6 months to 3 or 4 years 6 months to 2 years Indianapolis Cleveland Chicago Denver These figures show great variety in the average length of pro- bation, as well as uncertainty on the part of some of the courts as to the approximate average which their statistics would yield. The tendency is clearly away from short probation periods, and the New York State Probation Commission has recommended a minimum period of six months for practically all delinquent cases. It should be evident that if permanent cures are to be effected, a reasonable length of time must be allowed to enable the probation officer to perfect a program of reform for each child under his control, and an average of nine or ten months is none too long for this purpose. Pro- THE PROBATION SYSTEM 387 bation oflBicers are usually so overburdened with work that delinquents are released before they should be. 7. Number of Cases per Official. Volunteer officers do not usually care for more than two or three cases each, but regularly paid officials each handle a large number. The different cities vary widely in this respect, the number of probationers per official rising as high as 130. The number which can be conveniently handled depends principally on the character of the offenders, for this determines the time necessary for each delinquent. Serious cases cannot be given too much attention. The care of 75 delinquents is sufficient work for the average probation officer and if this number is exceeded, unsatisfactory results are likely to follow. In some cities neglected children are also placed under the supervision of probation officers. Extreme instances are known of more than 200 such children in charge of a single official, but without doubt this is too many for one person to supervise properly. 8. County Probation. With the extension of the juvenile court to the counties and rural districts, a county probation system is gradually develop- ing. Experience in the states where a state- wide juvenUe court law has been enacted indicates that it is unwise to appoint pro- bation officers whose duties are limited to service in a single town. Usually the number of cases handled in any town is so small that the official devotes only a small part of his time to the work, so he naturally becomes neglectful of his duties. Again the compensation paid under these conditions is small and expert service is not secured. The better plan consists of the appointment by the county authorities of a probation officer who carries on his work throughout the county and who handles all juvenile delinquents placed on probation. A full time worker must then be secured, more attention will be paid to the quali- fications necessary for success, and a reasonable salary can be paid. The official will be compelled to do much traveling, but this must be done to insure proper supervision of the children. He can also take charge of the children who have been paroled 388 PROBLEMS OF CHILD WELFARE by the reformatory institutions and returned to their homes. In this way much of the expense incident to the after care of parokd delinquents can be avoided. In some counties and states the work with children may be combined with adult probation and thereby insure full time em- ployment for the oJSEicer. County probation work will lessen the proportion of delinquents now sent to institutions and will also insure court supervision for a group of children who are otherwise unmolested because they are not regarded as institu- tion cases. Unfortunately, the plan of volunteer officials in towns and counties has been tried in imitation of the original system in many cities, but gradually the sentiment in favor of paid county probation officers is gaining ground. 9. Results of Probation. The precise results of the new system of handling children cannot be determined, as the method has not been in operation long enough as yet. It wiU first be necessary to ascertain to what extent penitentiary convicts as well as vagrants, mendi- cants, and inefficient workingmen are recruited from the ranks of former juvenile delinquents. English reformers have been somewhat skeptical about the probation system and have op- posed it on the theory that we cannot expect favorable results by leaving the child in the environment which produced the delinquency. Yet the system measured by such tests as can be applied has accomplished much. Unfortunately we do not know much about the number reformed according to char- acter of offense committed. The proportion of children who are brought into court on a second or third charge are an indication of the effects of proba- tion. The Chicago records for eight years show that 67.9 per cent of the boys and 79.7 per cent of the girls were brought into court but once; 18.3 per cent of the boys and 17 per cent of the girls appeared twice, and smaller proportions appeared oftener. According to these figures about two-thirds of the boys and four-fifths of the girls appeared but once in court.^ Pro- fessor Thurston, however, also writing for Chicago, states that ' Breckinridge and Abbott, The Delinquent Child and the Home, pp. 41-42. THE PROBATION SYSTEM 389 up to July, 1909, only 55 per cent of the delinquent girls appeared but once.i In St. Louis out of 1397 delinquent children before the court during one year, 37.5 per cent had appeared before, the percent- age of reappearances among the boys being higher than that among the girls. On the whole, we find that a considerable proportion of deUnquents — from 20 to 30 per cent, must be dealt with a second time or oftener. We have no information on the relation of recidivism to character of offense, although German statistics indicate that offenses against property are repeated more often than assault and forms of violence against the, person. It is likely that probation succeeds better when certain offenses have been committed than in the case of some others. The New York State Probation Commission has attempted to weigh the effects of probation in that state and presents the following table to indicate the results : ^ Resuxts of Probation Results Boys Girls Number Per Cent Number Per Cent Discharged with improvement Discharged without improve- 2263 75-2 SI2 79-0 ment 66 2.0 10 i-S Committed Removed with permission, to other localities 476 30 iS-7 •9 90 s 13-9 .8 Absconded or lost from over- sight Unstated results 15 177 •4 S.8 3 28 •S 4-3 Total 3027 loo.o 648 lOO.O According to this table about three-fourths of the boys and a slightly larger percentage of the girls were discharged with improvement. Most of the remainder were either sent to insti- tutions or failed to improve, and were discharged, but probably ' The Survey, February 5, igio, p. 658. ' Fifth Annual Report of the State Fiobation Conmussion, p. 66. 39° PROBLEMS OF CHILD WELFARE a large proportion of the group for which results were not given also failed to improve. Information as to the proportion of juvenile delinquents who later enter penal institutions is very meager, statistics from Chicago showing that in 1908, 4.5 per cent of the probation cases were in prison. This is a very small number, but again is based on the cases of minor delinquency.^ The claims for probation when it was first instituted were most sanguine. It was insisted that in Denver 95 per cent of the cases resulted favorably, and more recently Winnipeg has made a similar claim. Conservative figures of to-day show that such results are not being achieved, although the possibilities of pro- bation, however, have not been reached. In no American city has the system been perfected, and in some cities the juvenile court hardly accepts the theories of modern psychology but flagrantly disregards the fact that the delinquent child is not a criminal. Neither the juvenile court nor the probation system has accomplished what was claimed for them, but they have proved superior to the methods they supplanted. The problem must be faced in an entirely unbiased manner, and if these institutions can be perfected, we should strive to do so, but if better substitutes can be found, we should not hesitate to use them. 10. Probation and CoSperating Agencies. The effects of probation are profoundly modified by the exist- ence of adequate supplementary agencies, aiming to fill the life of the child with forms of activity which tend to develop his better nature. The success of probation in the parts of Chicago supplied with small parks is an example, while the Chicago Juvenile Protective Association, which constantly watches amusement places, dance halls, and picture shows is another valuable cooperating agency. Attendance officers can do much to make the probation system successful. Settlements and other philanthropic agencies should also be powerful agencies. Although the juvenile court carries on preventive work, its ' The Survey, February s, 1910, p. 658. THE PROBATION SYSTEM 391 function in this direction is comparatively limited, and it remains for other agencies to develop the constructive work in a com- munity so that delinquency may be prevented. The test of probation is to perform with a maximum of efficiency the task of reforming delinquent children. CHAPTER IV OTHER REFORMATORY AGENCIES 1. Detention Homes. The detention home is a temporary shelter for the child about to be brought into the juvenile court. When the child is ar- rested he is taken to this home or, in certain cases, allowed his liberty if reasonable assurances are given that he will appear in court at the proper time. The detention homes seldom provide for a large number of children. They take the place of police stations, but must not be connected with them or with jails. Children are usually held here for a short time only, but separate accommodations should be provided for the two sexes, also playrooms, lounging rooms, classrooms for teaching pur- poses, a library, etc. Detention homes should not be made so attractive, however, that they fail to develop a proper respect for law and order. In the smaller cities, where court convenes but once through- out the week, a child may be detained for a period of six days, and toward the approach of court day the home is often filled with prospective delinquents. In the larger cities, where the court holds its sessions three or more times per week, the day of trial arrives sooner and the problem of the detention home is less acute. After the conclusion of the trial the child is re- moved from the home and the court's decision is carried out. In a limited number of instances, children are sentenced for a short time to the home, and frequently they are detained, pending their transferal to some institution. 2. Disciplinary Schools. According to the new theory it is the duty of the school to educate the bad boy as well as the good one, but they should not be educated together. The semi-delinquent children form 392 OTHER REFORMATORY AGENCIES 393 a special group who need particular attention and who must be trained in special classes ; otherwise they will hamper the prog- ress of normal children. Furthermore by receiving special care they may be saved from the juvenile court, and therefore the special day school for incorrigible children has arisen. This school varies its curriculum somewhat from the normal and emphasizes manual training and handicraft work in order to hold the interest of the child and keep him busy. New York City has projected five such disciplinary schools, to which children are sent for truancy, theft, insubordination, and immorality. The oldest of these schools claims 55 per cent of cures in seven years. Chicago has four divisions in its regular schools for truants and violators of rules who are not sufficiently grave offenders to be sent to the parental school. When the school authorities find it impossible to retain a child in the regular classes, parents are notified and directed to send the cluld to the truant school. The first special school of this class in the United States was established in Philadelphia in 1898, and nine such schools are now conducted in that city. The experience here has also demonstrated that a close relation exists between truant and backward children. Most large cities have opened disciplinary schools, usually with good effects ; truancy and insubordination have been greatly reduced and a better spirit has developed among the large body of pupils. Transferal to these schools depends on the order of the principal or school superintendent, although in Cincinnati certain juvenile court children also attend. 3. Institutional Care. Institutional care represents the original form of care provided for delinquent children. Most states are equipped with at least one reformatory for youthful offenders, and usually with two, since the sexes cannot well be cared for in the same institution or in the same town. A majority of these institutions are public, but there are a number of private industrial schools, one of which, located in New York, has from 2500 to 3000 inmates, but most private homes are comparatively small. The states differ 394 PROBLEMS OF CHILD WELFARE widely in the proportion of delinquent children cared for in institutions. New York, for example, places an excessive pro- portion of her delinquent children in institutions and now has three times as many cared for in this way as has any other state. In the Southern states, on the other hand, the number of children in reformatories is low, due largely to the absence of well-developed systems of child care. a. Evolution of Institutional Care. Adequate care of delinquent children cannot be given with- out the aid of reformatory institutions of various kinds. At each stage of their adolescence children must be subjected to forms of treatment appropriate to their psychological and physiological needs. Probation may be best for one child; institutional care for another. The former, however, has limi- tations which cannot at present be overcome, hence the reform- atory is a necessary supplement. The age of the child often determines the t)rpe of institution best fitted to benefit him. The social attitude toward the proper function of an institu- tion for delinquent children has undergone a very interesting change, and is reflected in the names given to such institutions. Originally they were named "Houses of Refuge" — a name which still clings to a number of reform schools throughout the country. The name is a relic of the day when the chief object of institutional care was to provide a means of escape from temp- tation, but such an object is wholly foreign to the enlightened methods of to-day. The first House of Refuge in the United States was established in New York City in 1825 and the Ljonan School in Massachusetts, opened in 1848, was the first reforma- tory institution placed under the exclusive control of the state.' As long as venerable notions of human depravity and the full responsibility of children for their delinquencies prevailed, the modern view was quite impossible. The idea of reformation, however, took root, and soon "Reform School" became an appropriate name for these institutions. The method of reform was crude and unscientific because the essential elements of child nature were not understood. Reform meant the complete ' National Conference of Charities and Correction, igoi, p. 245 ff. OTHER REFORMATORY AGENCIES 395 subjugation of the boy, which often resulted in the development of a malevolent spirit, owing to cruel treatment and too frequent corporal punishment. Repression instead of development was the keynote of the earlier attempts to care for children, and the reform school is the legacy of this period of effort. The growing belief that children were largely untrained in- stead of criminal led to the idea of the training school. Accord- ingly, training was seized upon as the remedy for youthful criminality. The need of filling the mind of the boy with good wholesome thoughts and of preparing him for a useful career was recognized in the program of the institution. In assum- ing this position the men in charge of reformatories applied the correct principle. Experience has shown that the most suc- cessful reformation has been accomplished by means of trade training, and therefore some of the institutions have assumed the name of "Industrial Schools," thus recognizing not only the need of training but the character of training necessary to meet the demands of the present industrial world. That truancy and dissatisfaction with the kind of instruction re- ceived in schools are important causes of delinquency is a note- worthy fact. That industrial training is far more agreeable than hterary education to this class of persons is equally true. Accordingly, the introduction of industrial training becomes the logical outcome of the attempt to use effective reformatory measures. The last step in the evolution of institutional treatment con- sists of the attempt to realize within the walls of an institution the advantages which a good home affords. No institution can rival our best homes in their possibilities of making good citi- zens; and the average home is better than most institutions. Accordingly, the tried methods of millions of homes must be imitated as far as possible in the treatment of delinquents placed in industrial schools. In order to preserve or reproduce this home hfe the "Cottage System" was introduced. Although this system was begun in 1833 in Hamburg, Germany, it is not yet fully developed and does not properly supplement the indus- trial training which the institution child now receives. The 396 PROBLEMS OF CHILD WELFARE term "Home" is now applied to some training schools in recog- nition of their purpose. They should be homelike as well as preparatory for industrial life. b. Present Functions of Institutions. Institutions are needed for several reasons: first, the incor- rigible and dangerous child must be definitely segregated from his erstwhile associates in order to prevent their ruin. Proba- tion, even though it should prove ultimately successful with the incorrigible, would be too costly in view of the numbers who would be led astray meanwhile. Social quarantine is necessary to prevent the outbreak of an epidemic of delinquency. Sec- ond, many children cannot be reformed outside of institutions, and training schools furnish the only safeguard to society. The rigid discipline which the institution enforces cannot be supplied elsewhere, and the habits which must be formed can only be acquired under close surveillance. Some judges hold that the first offender gains a very wholesome lesson if he is permitted to serve several months in the training school. The majority of judges, however, do not commit the first offender except in the more flagrant cases. It is wrong to place a child in an industrial or training school until milder methods of reform have failed, since first offenses are not usually so serious as to endanger society to any great extent. Third, commitment, or its prospect, has a deterring influence, and the effectiveness of the probation system would be reduced but for the fear of the reformatory. Fourth, children suffering from evil homes can be given a much better environment and more homelike surroundings in model institutions such as are arising at the present time. Probation is doomed to failure from the outset if bad boys are allowed to remain in some of the homes from which they came. A change of residence or the "placing-out" of the boys is often impracticable or unwise, so the only remaining course is commitment to an institution. 4. Types of Institutions. Roughly speaking, institutions may be subdivided into the following types : OTHER REFORMATORY AGENCIES 397 The parental school — for minor offenders and children of school age. The industrial school — established by cities or coxinties for various classes of offenders. Reform schools — for the more serious delinquents. Republics — partly self-governing groups of delinquent children. a. Parental or Truant Schools. It has usually been necessary for local boards of education to receive special authority from the state to enable them to estab- lish parental schools, the original limitation being based on the theory that school funds must be used for educational purposes only. It was not clear that the building and operation of a parental school came within the meaning of the. original right, but nevertheless the schools sprang up in many cities. They stand intermediate between the disciplinary school and the industrial or reform school. The parental school receives children on commitment by the juvenile court. Its function is theoretically to reclaim the wayward, incorrigible, and truant children who defy the school authorities ; but in practice it usually receives children sent by the court for minor offenses, whether connected with school or not. The parental school is, however, essentially a part of the educational process. Children should not be sent unless they are ten years old or over, but rigorous discipline is often neces- sary for the boy in the upper grades, and this can best be provided through a short term in the school. The Chicago school, comprising eight cottages with a capacity of 40 children each, is situated on a farm of 70 acres. The average stay of the children is a little less than seven months, and over 400 boys are committed annually. The per capita cost of maintenance in 1910 was $273. 40. About 20 per cent of the children return for the second time. In the New York Parental School the average stay is almost five months, while in its Truant School it is only two months. It is apparent from these facts that short terms are common ; in fact complaint is often made that time for reformation is not really given. The parental school should restore the child to 398 PROBLEMS OF CHILD WELFARE normal life so as to make his reappearance in court unneces- sary. He is mider watchful care, receives instruction along both literary and industrial lines, and special emphasis is laid on decorum and behavior. Food, clothing, bedding, medical care, and other services are usually supplied by the school, although part of the burden should in many cases be borne by the parents. In 1910, 24 cities operated parental schools ; ten of these were in the North Atlantic States,' but the proportion of large cities having such institutions was largest in the West. b. Training and Industrial Schools. Many cities or counties containing large cities have estab- lished an institution for the more serious or chronic oSenders. Most of these schools have been independently established, but they may be merely a branch of the local penal institution, as in the case of the John Worthy School in Chicago. The term of commitment to such schools is usually a short one, although in some places children remain until their majority. They should not be released until they give evidence that their recom- mitment will not be necessary, and when released they should usually be placed on parole for a limited time under the super- vision of a parole officer. In addition to public institutions of this class a considerable number of public and semi-public training schools exist. These receive children from the courts, care for them and educate them, and frequently place many of them in good family homes. They generally confine themselves to the less serious offenders, however, unless religious considerations enter very strongly. The New York Juvenile Asylum is an example of this type of school. The courts are able to dispose of many children in this way who wovild otherwise become serious problems. In many states the public does not pay these institutions for the han- dling of delinquent children. All training schools should be connected with the local educa- tional system, since in theory they are merely training schools dealing with a class of very difficult cases. The logical sequence of the theory demands that the school become an integral part ' United States Bureau o£ Education, Bulletin, 1911, No. 14, p. 33. OTHER REFORMATORY AGENCIES 399 of the educational work of the community, and managers of such schools are beginning to recognize the fact. Boards of education, however, have been slow to appreciate their respon- sibility for the education of the delinquent child. The work of an industrial school is essentially educational, although men with social training are needed to manage the institutions. c. State Reform Schools. The state reform schools differ somewhat from the group of institutions just discussed. Most states maintaiu two schools each — one for boys, the other for girls. Cities maintaining industrial schools usually send to the state institution those children who have committed what would be a penitentiary ofiense if perpetrated by an adult, and these reformatories, therefore, receive the worst class of juvenile offender. But the sparsely settled districts have no educational institutions; consequently, if a child is committed, he must be sent to the reform school. The less serious offenders from the rural districts and the more depraved classes from the cities are brought to- gether — an evil that cannot be easily corrected. Many state reform schools admit children up to the age of eighteen years and then classify the inmates so as to make the associations as wholesome as possible, since the less serious offenders and the hardened cases cannot be allowed to mingle with each other. Offenders are sent to these institutions to remain there a considerable period of time; consequently one of two forms of commitment is usually employed, either an indeterminate sentence or commitment during minority. In practice these differ but little, for the indeterminate sentence applied to children ends with their coming of age. Several states, such as Illinois, Ohio, New York, and Pennsylvania, usually follow the indeterminate sentence plan, but most western states commit during minority only. In the latter case the sentence can usually be suspended when in the judgment of the proper authorities the case justifies such action. In the two Massachusetts schools, the actual length of stay before the child is placed on probation for the first time is about 18 months. 400 PROBLEMS OF CHILD WELFARE d. Republics. A novel experiment in the treatment of delinquent children has been attempted by the so-called "Republics." The George Junior Republic at Freeville, New York, was begun in 1895, and is practically a farm colony of children who exercise very extensive powers of self-government. The enforcement of rules is accomplished largely through the efforts of "citizens," and the arrangements in regard to work and leisure are made in a similar way. The children receive regular instruction from public school teachers, but gain most from actual practice in industrial operations. Although founded on the principle of self-government, the institution cautiously limits the powers of the children. The inmates may be delinquents ordered to the institution by the courts, or volunteers who consider the Republic an opportunity for self-development, or children in need of training who are sent by parents or guardians. Both boys and girls are admitted. Seven junior Republics have been established in six states, and others are being contemplated. A National Association of Junior Republics has been formed, in order to promote the idea on which the institutions are based. S. Principles of Institutional Care. a. Separation of the Sexes. The number of boys committed to public institutions for delinquent children is about four times that of girls. One essential of successful control is the separation of the sexes, either through the establishment of separate institutions or of separate departments in the same institution, so conducted that no communication wUl be possible. Separate institutions entail a considerable duplication of equipment, but insure the neces- sary separation of the sexes. As the schools for girls are usually small there is danger that they will have incompetent heads, but this difficulty is partly overcome when the two sexes are placed in separate departments of the same institution. The de- linquent girl is a most serious problem and cannot have too much attention. Regardless of the specific offense for which they have been committed, a large majority of these girls are immoral and OTHER REFORMATORY AGENCIES 401 their moral rehabilitation will tax the energies of the most capa- ble superintendents. Separate and well-equipped schools yield the best results. b. The Cottage System. The cottage system is most necessary to meet the need of delinquent children, most of whom lack the uplifting and steady- ing influence of good family life. Certain virtues almost de- pend upon the home for their perpetuation ; for the develop- ment of these virtues, home life must be restored as far as possible. In the parental schools to which the yoxmger chil- dren are sent, the need of the cottage system is less apparent. Such children are sent for stated periods of time, usually not more than six months, and the chief purpose to be accomplished is submission to authority and the enforcement of discipline. The essential features of the cottage plan are these : separate buildings for each family of children ; families not exceeding 25 in number (the best results, however, cannot be achieved unless the size of the group is reduced to about 15) ; a house father and mother for each cottage ; separate dining rooms ; and a home life distinct from that of the other cottages. The per- sonnel of each cottage should consist of varied but congenial individuals, so as to reproduce typical home conditions. The children of a family are not of like ages, neither should those of a cottage be, unless the different age groups are liable to con- taminate each other. The progress of the cottage system has been considerably retarded by its great cost. The institution type of building is so much cheaper that the cottage plan has been unpopular on account of the added expense. And where the system has been nominally adopted, the number of persons per cottage has usually ranged from about 40 to 60. The hoped-for individual contacts have therefore failed of realization. Institutions within the borders of a large city seldom hold a sufficient amount of land to attempt the plan at all. The greater the approximation to the family ideal, the surer will be the hope of reformation. The modified cottage plan, on the other hand, is better than the old institution type of building, for with this system come 402 PROBLEMS OF CHILD WELFARE pictures, decorations, and other forms of beautification, all of which serve to inspire and uplift the delinquent. The number of children in reform schools is not so large but that our public agencies can properly develop a fairly successful system based upon the cottage plan. c. Physical Training. A very large percentage of delinquents are subnormal physi- cally and mentally. This is shown from the measurements made in such institutions as the John Worthy School of Chicago, the Philadelphia House of Refuge, and the Elmira Reformatory. An undoubted efiect upon morals is caused by these subnormal- ities, and something must be done to overcome them. Com- plete reformation is not usually accomplished without two important requisites ; sufficient good wholesome food and abun- dant physical exercise. Much of the success of Elmira Reform- atory is due to the emphasis which is placed on physical train- ing, and the experience of other reformatories also verifies this principle. After the body has been restored to normal condi- tions, the child becomes more susceptible to the moral influences with which he is surrounded. Strength, desirable mental attri- butes, and discipline are promoted by exercise, gymnastics, and military drill. Every well-equipped school is provided with a gymnasium, the use of which for purposes of physical relaxation and moral stimulation cannot be too highly recommended, and stress should be laid upon this feature in the schools for each sex. So large a proportion of delinquents suffer from misfeediag that a carefully supervised dietary is also necessary. This will result in better physical conditions and increased mental alert- ness. The training school is a moral hospital, and good physique conduces to good morals. d. Industrial and Literary Training. Training schools should without exception be located in rural districts where an abundance of pure air can be secured and where ample room is not too costly. Furthermore, the schools should be provided with extensive farming facilities ; sufficient buildings can then be erected, farming can be successfully carried on, and ample instruction given in trade and industry. The OTHER REFORMATORY AGENCIES 403 precise value of the practice in farming depends upon the personnel of the inmates of the institution. If the children have been largely gathered from the rural districts, it is reason- ably certain that a considerable proportion will return to the farm or small town, and a better knowledge of farming methods will be a distinct gain. If the great majority of the boys are from the large cities, with no knowledge of farming, nor incli- nation to study it, practice along this line must be regarded as discipline rather than as an attempt to prepare the child for his life work. The probability that a boy will migrate to the farm and become successful there is quite remote. The importance of the farm for purposes of industrial training has been over- emphasized, but its value for the promotion of good physique and right living cannot be overestimated. In addition to farming and gardening, the schools aim to give instruction in such trades as the following : carpentering, paint- ing, shoemaking, tailoring, sewing, baking, bricklaying, plas- tering, and printing. Very properly many institutions are almost entirely supplied by their own inmates with the neces- sary clothing, bedding, and agricultural produce ; buildings are repaired by their own labor; and the laundry, kitchen, and print shop are operated by the delinquents. The training which the average inmate receives equips him for successful competition with other members of his trade when he is released from school. Industrial training, by making a livelihood possible for every inmate, lessens the incentive to continue a career of lawlessness. Furthermore, the great majority of these children are intensely interested in the manual arts to the exclusion of literary education. In the old disciplinary school in New York City a majority of the boys are unable to carry the regular course, a condition ascribed, not to dullness, but to lack of interest in the literary side of education. The boys do enjoy the shop work, and frequently they forget their mischievous tendencies. Inadequate facilities for practice along these lines handicap many of our institutions. The literary training provided is similar to such training else- where. Many of the children are woefully lacking in this re- 404 PROBLEMS OF CHILD WELFARE spect, but every progressive school grants ample means for the child's education, and in fact insists upon his literary develop- ment. Industrial training is usually given precedence, but the combination of the two is necessary in the outside world if the child is to hold his own. Music plays an important part in the life of an institution ; especially is this true of schools for boys. The band is not only an educative force, but a disciplinary power, and conduces to the moral elevation of the members of the school. Many of the children show considerable talent and inclination in the direction of musical education. It is more difficult to train girls than boys because of two very grave considerations : ignorance and immorality, both of which are more prevalent among the girls than among the boys. Ex- periments in preparing them for such high-grade occupations as stenography and typewriting have been comparatively unsuc- cessful, and professional work is in most instances an absolute impossibility. Trade training is attempted at present in such departments as sewing, millinery, ironing, and occasional forms of factory work, but the girl in industrial establishments is almost wholly without supervision, and therefore is in a danger- ous position morally. Special stress is now being placed on preparation for household work and such other occupations as will probably give the girl immediate supervision. In these occupations personal relations can be established between em- ployer and employee. Accordingly an interest in the girl's welfare may be developed, but the high rate of immorality among domestics necessitates the most cautious work in plac- ing the girls. The practice of holding them until appropriate situations can be found for them is a wise one ; for imless the utmost care is taken reform will have failed. The dif&culties are evident from the statistics of the Massachusetts Industrial School for Girls — an excellent institution and which during the years 1891-1911 had a total number of 7739 inmates. Of the entire number discharged, 57.9 per cent were found to be living respectably ; the remainder were classed as doubtful, bad, or conditions unknown, while some defectives were unclassified. The figures indicate a large number of failures. OTHER REFORMATORY AGENCIES 405 e. Discipline. Present methods of discipline differ widely from those in opera- tion some years ago. The recognition of the fact that the chil- dren are hot fully responsible for their misdeeds, and that their minds and morals are still growing, serves to throw emphasis upon the positive upbuilding of character. To lead them to do right and to interest them in things worth while rather than to defy them to do wrong, represents the principle on which proper discipline is based. A premium is placed on the act of doing right and a system of rewards for good conduct insti- tuted, but, if necessary for the reformation of the child, punish- ment is not withheld. Corporal punishment is seldom used. Segregation in a disciplinary cottage or the curtailment of privi- leges constitutes the form of punishment enforced in many cases. Inmates come to value the slightest privileges and their removal is not only a hardship but a weighty deterring influence. The increased use of the indeterminate sentence practically grants the inmate the power of releasing himself whenever his conduct justifies his freedom. An institution should be as free as possible from prison features, even though an occasional boy should escape. Modern discipline rightly accommodates itself to this condition, and the gain to the in- mates in self-respect is immeasurable. 6. Placing in Family Homes. This form of treatment must be confined to mUd cases, and to those delinquents whose probationary care has resulted so successfully that they can now be thrown on their own respon- sibility with comparatively little oversight. Even the best institutions cannot prevent children from contaminating each other, and if many institution cases could be isolated in a good home, the chances of improvement would be greatly enhanced. Consequently when a child must be rescued from his own home because of its viciousness, a good home elsewhere is often much better than an institution. An increasing number of children are receiving this form of care, and states are making provision for such treatment. Virginia recently authorized its state board of charities to place certain delinquent groups in family homes. 4o6 PROBLEMS OF CHILD WELFARE Pennsylvania has begun the system, while Massachusetts has been doing such work for many years. Other states are copying the plan, and even private institutions recognize the principle. The New York Juvenile Asylum, for example, has kept delin- quent children for a while, then placed many of them in homes, some of them being sent to the West. Here they have been supervised by western aid and home-finding societies. CHAPTER V MEASURES OF CHILD PROTECTION 1. Introduction. The essential unity of the problems of delinquency and neglect makes a program of preventive work applicable to both. In dealing with these subjects it is recognized, of course, that the existence of poverty is a prime factor in the problem, and that its removal would mean education, better surroundings, and more wholesome life, but it would not altogether abolish delin- quency. Meanwhile practicable methods of child protection must be instituted. One of the needed steps in a program of child protection is to ascertain additional information in regard to both the immediate and fundamental causes of neglect. A knowledge of the comparative importance of various precipitating causes would be most important in developing methods of preventive work. It would determine what particular program of ac- tion should be emphasized, for the effects of immediate causes can be largely nullified by protective measures. Again we may learn the extent to which broken homes are a factor, yet broken homes are themselves a result of causes that must be removed. Our knowledge of causes must likewise be supplemented by the careful study of the results of the present methods of handling delinquent children, so that we may be properly guided in our work. 2. Contributory Delinquency and Non-support Laws. One method of lessening juvenile delinquency is by the enact- ment and enforcement of adult or contributory delinquency laws. The purpose of such laws is to force the responsibility of caring for the child upon the rightful authority — the parents. While the interests of the child must be safeguarded, if possible, this 407 4o8 PROBLEMS OF CHILD WELFARE should be done by the parents rather than by the state. Accord- ingly, if a child becomes a delinquent, and the parents have aided or encouraged such delinquency, both child and parents should come within reach of the law. The parent should be punished in order to encourage him to care properly for his children. Contributory delinquency laws consist of three principal provisions ; first, a parent, guardian, or other person having the custody of a child, who encourages, aids, and contributes to the delinquency of such child, is guilty of a misdemeanor. Second, the guilty person is subject to fine or imprisonment or both. Fines usually range from purely nominal sums to $1000, and imprisonment may be allowed in the county jaU for a term not exceeding one year. Third, the judge may suspend the sen- tence, provided the guUty party complies with the conditions imposed upon him by the court. In a few states the jurisdiction has been placed with the juvenile courts, but in most cases the regular criminal procedure is followed. Some courts have given these laws real vitality by compelling the misdemeanant to pay a small part of the fine imposed upon him or to spend several days in jaU as a reminder of his duties and then suspend- ing the remainder of the sentence. Thereafter the guilty par- ents have seldom neglected to discourage delinquency among their children. Most states, however, have done but little to enforce such laws, the success of which has been hampered by the difficulty of fastening responsibility upon the parent or guardian. It is not purposeful neglect, but ignorance and even helplessness, that frequently accounts for the appearance of complicity. Colorado was the first state to enact a contributory delin- quency law, but similar laws have since been enacted in about one-half of the states. The provisions of the different laws are much alike, but in some states they apply to the larger cities only. The English law of 1908, although inspired by American legislation, is far more drastic in that it provides that parents may be compelled to pay fines, damages, and costs charged against delinquent children and to give security for the be- havior of their children. MEASURES OF CHILD PROTECTION 409 An additional method of enforcing parental responsibility consists of compelling the persons legally responsible for the child to pay part or all of the cost of maintaining the latter in an industrial or training school. Such a provision of the law should not be mandatory, but its application be left to the dis- cretion of the court. If parents have been deliberately neglect- ful, charges for maintenance may be justifiably required of them, but if they have exhausted their resources in training their children, such additional costs will tend to make them harsh and brutal in the treatment of the children. On the other hand, free care of children in parental schools sometimes enables parents to shirk the responsibility of training difficult boys, the parents themselves being foremost in their efforts to have the children committed. Cases have been reported of parents who were unwilling to pay for the temporary placing of their children in foster homes, who finally succeeded in having them sent to industrial schools. Judges have occasionally foxmd it ex- pedient to place parents under an order to contribute a weekly sum to the support of their children in truant schools. In our treatment of the juvenile offender, we have almost neglected the parents, and this is one reason why we have not been more successful. If delinquency becomes costly, parents will develop greater responsibility and delinquency will be reduced. Laws pimishing parents for neglecting and failing to support their children are equally important, as child neglect easily ripens into dependency and delinquency. Instead of waiting until children must be brought into court, we should require parents to exercise a proper guardianship over their children. Frequently when the father refuses to support his family, the mother is compelled to work away from home, while the chil- dren are left alone. In many instances this proves most disas- trous to the children, especially to the girls, who become restive and sink into immorality. Again, our laws are so inadequate or are so poorly enforced that a brutal husband is seldom reached ; < therefore the wife and mother frequently finds it necessary to desert her husband. If this is done, she has no redress, since she is the actual deserter, although the blame should rest upon the 4IO PROBLEMS OF CHILD WELFARE man. Furthermore, our desertion and non-support laws do not adequately protect the children, a large number of whom are on the verge of poverty and neglect. 3. Age of Consent Laws. By the age of consent is meant that age at which a girl can legally consent to sex relations. Any male who has such rela- tions with a girl under this age with or without her consent is guilty of a crime. The purpose of such a law is to protect innocent girls against the wiles and deceptions of vicious men. Formerly the age of consent was ridiculously low, the laws of some states having fixed it at seven years ! The gradual recog- nition of the helplessness of the girl and of the direful conse- quences of illicit sex relations has resulted in a series of laws raising the age of consent, but the legislation of the different states still varies widely, the age limit fixed by statute ranging from 10 to 18 years, although the majority of states now fix the age at 14 or 16 years. In some states the law provides a qualified age of consent, as in Missouri, where the limit fixed is 15 years and where girls from 15 to 18 can also be protected provided they are able to prove that they were previously of chaste character. As this is an exceedingly difficult thing to do, the portion of the law relating to the older girls is practically inoperative. In every state the age of consent should be made to correspond with the age limit of juvenile delinquency, which is usually 16 or 17 years. If this were done, it is probable that adequate protection to girls would be afforded. In some states the law presents a curious anomaly, in allow- ing common law marriages by girls of 12, while the age of con- sent is from two to four years higher. This makes temporary marriages with young girls possible and, while such instances are comparatively rare, it tends to defeat the purpose of an age of consent law. 4. Neighborhood Activities. Among the most valuable forms of work for children are the various activities of settlements, neighborhood centers, institu- tional churches, and clubhouses. These agencies provide boys and girls with opportunities for the wholesome use of leisure MEASURES OF CHILD PROTECTION 411 through their clubs, entertainments, classes, and other activities. The organization of boys requires time, thought, and energy, but it is one of the most useful methods of preventing them from doing mischief. The club operates to attract the boy from the street ; to give an honorable outlet to his surplus vitality ; and to socialize him as well as to prevent his moral decay. Boys will associate with each other and enjoy themselves whether under good auspices or not. They will gather in the most inconceivable places, and frequently in the very shadow of vice and crime. The street gang tends to organize itself imcon- sciously into a club, and if without proper leaders, establishes itself in a degrading environment. It usually consists of boys of similar ages who differ but little in race and religion ; there- fore it can easily furnish the raw material for successful organiza- tion. A gang usually develops a leader whose authority becomes well-nigh despotic and who is able to develop an orderly club or to complete its demoralization. It is very important there- fore to capture this type of boy, as he can be of great service in a neighborhood center. The homes of many prospective delinquents are so disrep- utable, and their parents so degraded and incompetent that vari- ous activities must be introduced to give the boy an opportunity for wholesome leisure, for games, for sport, for reading, for liter- ary training, for high-minded social intercourse, and for proper physical development. Settlements and clubs must provide advantages which homes, as existing in thousands of instances, can in nowise afford. Some happy antidote is necessary for the squalor and wretchedness of these homes in order to prevent boys from passing to the sinister environment of the street or to other questionable associations. Neighborhood work is not only a hopeful preventive of juvenile delinquency, but promises to uplift home conditions themselves. Eventually the home may become so attractive that boys wiU not be anxious to seek amusements elsewhere. There are two principal types of clubs into which boys may be organized : the large club which they join without the expec- tation of meeting weekly in an organized capacity; and the 412 PROBLEMS OF CHILD WELFARE small club, limited to perhaps not more than 25 members, which generally acts as a body. The former has in a number of instances achieved a marked success. Its chief purpose is rec- reation, and the boys may come and go when they please, their chief delights being games and gymnastic advantages. Excel- lent examples of this kind of club are the three downtown Chicago Boys' Clubs, which out of an enrollment of approxi- mately 1500 members contributed only three boys to the juvenile court in 1912.^ The library, gymnasium, playroom, employment bureau, and other facilities — all lessen the tend- ency to roam the streets and to commit misdemeanors. Although some settlements encourage the formation of this tjrpe of clubs, in the majority of instances they develop the smaller one conducted by a resident or volunteer worker. These clubs are normally organized on an age basis ; otherwise much discord prevails. The smaller boys usually indulge in games and sports, intellectual pursuits being quite completely ex- cluded; but boys of 14 or more can more profitably combine debating, dramatics, current topics, and varied literary pro- grams with amusement and social intercourse. To be successful the leader must grant the club the greatest possible amount of self-government, in order that patience, self-control, orderliness, and other desirable qualities may be developed. Responsibility is increased by a policy of requiring initiation fees and regular dues, neither, of course, being prohibitive in amount. These clubs, although they do not reach so many individuals, are thoroughly effective in restraining juvenile excesses. Neighborhood work has also given rise to the Big Brother and Big Sister Movement, which, although it has accomplished but little as yet, has the inherent capacity of doing much good. The idea behind this movement is simply that of the value of friendship. Men and women are asked to become the depend- able friends of the boys and girls in need of counsel and advice. The big brother or sister selects one or more children, becomes interested in them, learns of their home conditions, confers 1 Witter, J. H., The Chili, July, 1913. MEASURES OF CHILD PROTECTION 413 with them regularly, aids them in finding positions, develops their capacity for work, advises them in their choice of pleas- ures and amusements, counsels them in regard to personal habits, and proves helpful in every possible way. Constructive friendship carried on in this way shoxild develop the boy or girl into a good, capable, self-respecting individual. The chief obstacle to the development of such a movement is the self -centered life of the man or woman capable of befriend- ing the poor. The number of volunteers is too few, and many who begin to serve in this capacity soon tire and withdraw their assistance. Yet unless personal interest is aroused and people come in direct contact with the poor, the seriousness of their problems will not be appreciated and complete sympathy for the work of reform will not be given. 5. Parks and Playgrounds. Playgrounds are a factor in reducing juvenile delinquency. Play facilities which will draw the boy between the ages of 12 and 16 — the years of greatest delinquency — necessarily lessen the opportunity of such boys to give vent to their surplus energies in unlawful ways. Wholesome sport soon becomes attractive and employs the energies of the boys. The recency of the playground movement makes it impossible to judge of its exact moral effects ; and the relative value of playgrounds for small children and of those for larger boys has not been determined. To be successful the playground must attract the boy of juvenile court age. The small child may be influ- enced, but the effects cannot be easily measured. For the older children, however, the rate of juvenile delinquency furnishes a good test of the moral values of the playground. The influences exerted on a community by a playground have been definitely studied in Chicago. Here the establishment of recreation centers was shown to have a decisive effect in reduc- ing juvenile delinquency in the neighborhoods contributing to these centers. Furthermore, in those districts where the population was comparatively stationary, the greatest reduction in dehnquency occurred, and the percentage of successful pro- bation cases was much increased. In a similar way these civic 414 PROBLEMS OF CHILD WELFARE centers have reduced the number of saloons and dance halls in their territory. They have furnished opportunities for pleas- ure under good conditions, so have reduced the profits of doubt- ful commercial amusements. Although little is definitely proven on the subject, it is cur- rently believed that in the large cities a smaller proportion of delinquents come from the neighborhood of parks and play- grounds than from the districts without such facilities. The experience of teachers and probation officers shows that bad boys frequently yield to reformatory treatment when oppor- tunities for play and exercise, or club work are provided. Without doubt, play facilities are a considerable factor in the development of moral fiber and in the reduction of juvenile delinquency. 6. Prevention of Idleness. That idleness is a cause of mischief has been well expressed in adage and epigram. While idleness produces crime and delinquency, it is also a cause of many lesser evils, which are not usually charged against it. It makes people irregular in habits, undermines their .character, develops a spirit of indolence, and saps the vigor and ambitions of its victims. Child idle- ness is a curse which in our cities blights the homes of both the wealthy and the poor. One of the great character-developing agencies in the rural districts is farm life with its steadying effect upon mind and morals. The country child attends school and uses part of the day in play, but almost without exception he is charged with some small responsibilities about the house or farmyard, and is expected to perform some regular piece of work. In the evening he may be required to gather the eggs, feed the pigs, or assist in milking the cows — work that does not unduly tax his energies, but which is useful labor and lightens the burdens of father and mother. Better yet, it develops habits of industry which are responsible for the many successes which country boys have attained. These considerations do not justify child labor in its tech- nical sense. On the contrary, they condemn it, for the labor of children in factory and store does not develop the good habits MEASURES OF CHILD PROTECTION 415 mentioned. The child idleness that prevails in the cities with all its attendant evils must be prevented. The boy suffers from this handicap much more than does the girl, who can assist her mother in the home and perform many useful duties which will develop habits of industry and regularity. On the other hand, the boy often finds little to do and parents refuse to permit him to do the tasks which he might perform. This is especially, true among the well-to-do, who employ servants and laborers for the performing of all necessary work about the house and yard, yet young boys could receive no better training than to be given the responsibility for a Umited amount of daily work. During the spring and fall months when the gardens can be used, such opportunities should always be available. Many of the worthless, idle rich of to-day owe their uselessness to the folly of their parents, who have pampered them and spoiled them for the regular, industrious life necessary for useftd service. The poor boy in the city faces actual difiSculties. Probably he can neither have a workshop nor any other special facilities for the practice of handiwork, and a garden is usually beyond his reach. Perhaps a number of household duties may remain for him to perform, and if so, it will be to his advantage. If not, then the community, through its social agencies, should seek to provide him with a regular routine of action. Some of his time may well be spent in organized play ; some must be given to practice in developing the quahties that are needed to make successful men. How this shall be done is an open question, but is one that must be considered and solved. The school garden and vacation school in summer, the opportunities afforded by churches and social agencies in winter offer some advantages, but are only a step in the right direction. Prob- ably the schools will find it necessary to control a larger portion of the daily hfe of the older children, the additional hours to be used in a manner consistent with the development of character and habits of industry. 7. The Training of Parents. The failure of parents to become big brothers and big sisters to their children is one cause of the low ideals of many children. 41 6 PROBLEMS OF CHILD WELFARE It is parents, not volunteer workers, who should counsel and guide and befriend their children. The better education of parents for the duties that accompany parenthood is a profound necessity, and if such instruction cannot be given to the boy and girl in school, then settlements and other social agencies must perform the service. It is clear from the evidence of our juvenile courts that many parents are utterly unable to give their children proper training. They do not seem to under- stand the elements of good citizenship, nor the requisites of ordinary law, nor the moral dangers of the city. Likewise they know but little of child nature and of correct methods of disci- pline. Accordingly their children become unmanageable, dis- obedient, unsteady in habits, and are gradually demoralized. It is difficult, however, to reach parents, although the various neighborhood centers through their mothers' meetings, men's clubs, and individual instruction can accomplish something. Probation and truant officers when once they regard their bad boys and girls as family symptoms, will be capable of effectual work. In all this work emphasis must be placed on the impor- tant social functions of the home, and parents must be made to realize that the state requires the adequate training of the youth. Undoubtedly the best time to begin training for parent- hood is during the period of adolescence and when young people begin to take life seriously. This is the time at which training can be made most effective, but whether it shall be given through the schools or the churches or other agencies is still unsettled. One conclusion, however, is clear — the training must be given. 8. Reduction of Personal Vice. Because so large a proportion of the lesser criminals or minor offenders are young men under 25 years of age, the causes of their criminality must be sought in conditions growing out of the home, the schools, or their employment. The conviction is strongly warranted that the intemperance of parents, espe- cially of fathers, is demoralizing to a large number of boys and girls. If it does not lead to delinquency in children, it does cause shiftlessness and irregular habits and intemperance which crop out in early manhood, giving us a considerable share of MEASURES OF CHILD PROTECTION 417 our workhouse population. It has been shown by the Com- mittee of Fifty that intemperance is a factor in practically one- half of the major crimes committed ; that it contributed to the pauperism of 41.55 per cent of the almshouse population inves- tigated ; that it was a cause of about 27.8 per cent of the poverty relieved by charitable societies ; and that 45.8 per cent of the destitute children studied owed their condition to the intemper- ance of parents or guardians.^ Such measures as will reduce intemperance are therefore an important factor in a program of child protection, and cer- tain laws directly affecting children should also be enacted. Two of these are of special importance : children under a cer- tain age should be prohibited from entering saloons ; and any person selling intoxicants to a minor should be punished there- for. Any form of social activity which will promote temper- ance in the home will also greatly benefit children because their social environment will be much improved. Another wholesome reform consists of the efforts to prohibit the use of tobacco by young boys. When boys are not under careful supervision, they frequently become addicted to the tobacco habit, and in many cases the parents actually encourage it. An important need is the enactment and enforcement of laws prohibiting the selling of cigarettes to boys under 17 or 18 years of age. The tobacco habit, if acquired by young boys, frequently leads to other vices of a more serious nature, but if the habit has not been formed, the training of children is usually less difi&cult. 9. Additional Measures of Protection. In addition to the subjects discussed we find that a large pro- portion of the methods of improving the conditions of children are also measures which result in the reduction of juvenile delin- quency. As these measures are discussed in other parts of the book they can only receive mention here, but such mention is necessary to indicate that they form a part of a comprehen- sive plan of child protection. Among these measures are the following : ' Economic Aspects of the Liquor Problem, pp. 121, 130, 155. 2E 4l8 PROBLEMS OF CHILD WELFARE (i) Regulation of the Street Trades. (2) The Prevention of Truancy. (3) Vocational Training. (4) The Wider Use of Schools. (s) Censorship of Commercial Amusements. (6) The Institutional Care of Feeble-minded Girls. (7) Sex and Moral Education. (8) Protection of Illegitimate Children. PART VI PROBLEMS OF DEPENDENT CHILDREN CHAPTER I THE DEPENDENT AND NEGLECTED CHILD 1. Definitions. The dependent child is one thrown on the public for support. The neglected child is one who is destitute, homeless, abandoned, dependent on the public for support ; one who habitually begs or receives alms ; one who is found in any house of ill fame, or with any vicious or disreputable person ; or one who is suffering from the depravity or cruelty of its parents or other persons in whose care he may be. Although these are typical definitions of these two classes of children, it will appear at once that the dependent chUd may be included under the other group. The definition for the neglected child is also very similar to that frequently given for the juvenile delinquent. Dependent and neglected children are not separated by hard and fast hnes; nor are the neglected from the delinquents. They are all mem- bers of a series with the dependent and delinquent groups at the extremes. Our present methods of social work are such, however, that similar treatment of these classes is not always desirable. 2. Types of Dependents. There are many dependent and neglected children represent- ing numerous types and forms of dependency. One group of children consists of those who are crippled or deformed from birth. Although their number is not large, accommodations for their care are usually lacking, and thus they become a grievous burden to their parents and fail to receive the atten- tion which they merit. A portion are curable, or may at least be made partially self-supporting, if they are provided with the proper medical and educational facilities. A second class includes illegitimate children, foundlings, and 421 422 PROBLEMS OF CHILD WELFARE abandoned infants. Society has very unjustly charged such children with the blame of their ignoble birth, and their entire lives are often spent under the handicap of such a terrible injustice. These infants deserve every consideration given to the legitimate child, and equal provision for their care should be made. In the United States the number of illegitimate children is relatively small and the nimiber of foundlings quite insignificant except in the large cities, where shame can be concealed and where poverty often pinches. A large number of children, especially in our industrial centers and in the congested portions of our cities, cannot be comfort- ably provided for by their parents. Frequently the mother is forced to spend the day in the factory, and her children are either neglected or placed in the care of a small daughter — a "child mother." Again, among the poor, medical attention is often omitted because financial means are wanting, and ac- cordingly children do not recover fully from disease; scars, traces, and minor defects remain, and sometimes more serious defects permanently handicap the child. This group of chil- dren constitute a semi-neglected class, and the neglect fre- quently leads to such conditions of subnormality as will render the individual barely self-supporting on his reaching maturity. The largest group of children considered in this class are those who for various reasons are partially or completely depend- ent upon society. Many are without natural family support, owing to the desertion of the father or mother, to separation and divorce, or to the death of one of the parents; and some are orphans — too young to support themselves. In some cases parents are temporarily or permanently disabled and the chil- dren must be given temporary relief, but in other instances parents are simply not able to provide for their children. A closely related type is the neglected chUd for whom his parents fail to care so that he suffers from actual want or is demoralized. The following case occurring in New York illus- trates the type. Investigation by the New York Society for the Prevention of Cruelty to Children disclosed " two children, aged six and four years respectively, badly neglected by a THE DEPENDENT AND NEGLECTED CHILD 423 drunken mother. The surroundings were filthy, the mother abnost hopelessly intoxicated, the children quite nude, and a sister of the mother lay dying from consumption on a bed of rags near by." Neglect does not necessarily depend on the economic condition of the parents, but is largely the result of an attitude of mind. It is this which frequently differentiates such a case from that of dependency and makes another form of disposition necessary. The solution of the problem of the neglected child often means the disruption rather than the preservation of the home. 3. Causes of Dependency. The prevention of dependency furnishes one of the most diffi- cult of all child problems. A very large percentage of depend- ency is due to fundamental conditions that cannot easily be remedied, and a radical reconstruction of social relations would be necessary to prevent its regular recurrence. Hereditary influences, unexpected death of parent or natiiral supporter, industrial maladjustment, poverty, sickness, and many other causes of dependency are hard to control. Nevertheless the situation is not hopeless; much dependency among children can be mitigated ; and some of it can be entirely prevented, especially since the causes differ materially from the causes of dependency among adults. The German statistics compiled by Bohmert in 1893, based on the cases of 13,000 children, are still valuable for comparative purposes. According to these figures the chief causes of dependency were distributed as follows: orphanage, 38.75 per cent; lack of work, 14.90; sick- ness, etc., 11.88; abandonment, 11.66; imprisonment of guardian, 4.70; abuse and neglect, 4.5 ; sickness of guardian, 4.34; laziness of guardian, 3.49; drunkenness of guardian, 1.54 ; mental or physical defect in guardian, 1.74. The remain- ing causes are of minor importance. According to Bohmert, one-fourth of the children are dependent, owing to causes con- trolled by their parents or guardians, but this estimate includes only the more obvious forms of parental neglect and omits lack of work, sickness, and, of course, orphanage. To a large degree lack of work depends on the inefficiency of the parent, and is 424 PROBLEMS OF CHILD WELFARE a remediable evil ; furthermore, much sickness could be avoided by the exercise of a little more intelligence, and by improving conditions in factories and workshops. The amount of unnec- essary dependency is therefore much larger than the estimate given above. The lessening of the death rate through the decrease of the number of accidents, better sanitation, the elimination of certain diseases especially prevalent among the poor, and the reduction of our occupational mortality will de- crease the aggregate amount of orphanage. Contrasted with these figures are some American statistics of interest, especially those collected by the New York Board of Charities.' These figures are a compilation from reports sent by local agencies to the state board, and they are somewhat lacking in accuracy, because of the many interpreters of the causes of dependency, but the larger number of cases reduces the percentage of probable error. According to these figures based on 29,137 cases observed in the two years, 1910-1911, the causes of dependency were distributed as follows : Causes of Dependency Percentage 1 Desertion of parent 2 Neglect, intemperance, immorality, or imprison- 11.8 % 6.5% 7.1% 16.1 % 6.4% 17.3 % 13-8 % iS-o % .8% 4 Sickness, physical or mental incapacity .... 5 Unemployment or insufficient earnings .... 6 Child an orphan, foundling, or illegitimate . . . 7 Child dehnquent or vagrant 8 Destitution 9 Child ill or defective 10 Parent employed and unable to give home care . . 11 Parents separated 4-8% .4% These proximate causes of dependency need further examina- tion in many instances, in order to learn the ultimate causes to which they are related. It is clear, however, that a large proportion of the given causes must lie within the control of ' See report of State Board of Charities of New York, 1912, p. 180. THE DEPENDENT AND NEGLECTED CHILD 425 society. More than one-fourth of the children are suffering because of the vice and neglect of parents, and nearly one-seventh are delmquent, — a condition largely due to the fault of parents. Sickness and incapacity account for one-sixth of the cases and direct poverty, including insufficient earnings, is responsible for more than one-fourth of the dependency. How much indi- viduals are to blame for this condition is not brought out, nor can this be done with any degree of accuracy. Nearly all of the shortcomings of the individual are, to some extent, affected by social conditions. An adequate program of social reform should remove most of the conditions which handicap the indi- vidual, who in turn neglects or handicaps his children. The parental condition of dependent children is an important factor in our problems. In the following table this is shown for children in New York state ; for the inmates of the Michigan State School from the beginning of the school up to 191 2 ; for those of the Minnesota School, also up to 191 2 ; and for the institutions for dependent children in St. Louis for the years 1909-1910. Parental Condition New York Michigan Minnesota St. Louis Parents living (per cent) Half-orphans " " Orphans, foundlings " " Unknown " " Total children handled . . . 35-8 47.2 17.0 * 33,761 52-4 3S.6 6.0 6.0 7413 S4-8 40.0 S-2 4577 42 40 18 3430 * Unknown included under Orphans, etc. These figures indicate that the problem of dependency is not a mere problem of orphanage. A small proportion of the chil- dren are full orphans, but in no case more than one-fifth of the total number. About 40 per cent, however, are half-orphans, the remaining parent usually being unable or unwilling to care for the child and to earn the means of support as well. The New ' York state and St. Louis figures indicate that about three-fifths of the children came from homes broken by death, but in Michi- 426 PROBLEMS OF CHILD WELFARE gan and Minnesota the parents of the majority are still Uving. In many cases it is true that they are not living together, but that fact makes the problem of rehabilitating these homes one which needs our urgent study. Few cases of dependency have much justification when both parents are alive, and in most instances our charitable societies should be able to compel sup- port from the parents or relatives rather than remove the child from the home. This, however, does not apply in cases of cruelty or neglect. The illegitimate child is usually a victim of the ignorance and poverty of a mother. A study of 1292 unmarried mothers in St. Louis showed that 348 were under 18, and the large majority were under 21. It has been claimed that three-fourths of the girls under 17 with illegitimate children are ignorant of the laws of sex, although data on this point are lacking. According to a study of 194 unmarried mothers in Baltimore 23 per cent lost their mothers in childhood and had to shift for themselves ; one-third went to work before they were twelve ; one-sixth grew up in immoral homes, and nearly one-fourth were earning less than a subsistence wage at the time of seduction. Most found- lings are illegitimate ; likewise a large proportion of the aban- ' doned children. While the number of illegitimate children in the United States is unknown, European statistics are rather carefully kept. During the years 1901-1904 the nmnber of illegitimate births per 10,000 of the population in Ireland was 5, in Austria 57, showing a great variation between these countries. Leffingwell, who made a painstaking study of this subject, claims that such wide differences are not due to poverty, nor religion, nor lack of edu- cation, but to laws regulating marriage, and to heredity. The argument concerning heredity is, however, in need of more substantial proof than has been offered. Mayo-Smith says that illegitimate children are comparatively few among girls living with their parents, a fact which plainly indicates that social conditions are an influence. The French experiment of relieving parents of responsibility for their illegitimate chil- dren proved extremely disastrous, as it not only increased THE DEPENDENT AND NEGLECTED CHILD 427 illegitimacy enormously, but the number of abandoned infants as well. Laxity on the part of the public has clearly been proven a cause of illegitimacy, and low morals are also responsible. All the blame cannot be placed outside of the individual ; some must rest on the guilty parties themselves. The large families among the poor are an additional cause of dependency. Rowntree showed that in York, England, the proportion of actual poverty due to the existence of large fam- ihes was 22.16 per cent, the death of one of the parents in such cases almost necessarily making the children at least partially dependent. Frequently temporary aid in the home is sufficient to meet such needs, but often the family must be separated. Excessive reproduction, coupled with precarious economic con- ditions, makes considerable relief necessary. The niunber of dependent children is closely related to the prevaihng relief policy. Certain systems foster the increase of dependents, while others as faithfully diminish their number, unwise philanthropy undoubtedly accentuating the problem. The orphanage and institution have not reduced dependency to a minimvmi, but have rather tended to prevent the greatest possible reduction. The proportion of dependent children in the state of New York, which relies chiefly on the institution is much larger than in other states where placing-out methods are used. However, there are other reasons why New York should have an unusually large number of dependent children. The causes of neglect are similar to those of dependency, but more differences may be noted. Although alcohol is a cause of dependency, it is to a far greater extent a cause of neglect. One large western home-finding society reports that a majority of its cases are at least partially the result of alcoholism. The New York Society for the Prevention of Cruelty to Children has published in one of its annual reports the following statement : "Reference to the records of the society during the entire years of its existence would establish beyond all controversy the fact that to the excessive use of intoxicants by parents is largely due the great neglect, the suffering, and grosser forms of cruelty imposed upon childhood. It has been the province of the 428 PROBLEMS OF CHILD WELFARE society to respond to constant appeals made for the protection of children against drunken and brutal parents." ^ A similar society in California reports that 90 per cent of the neglected cases are in part due to alcoholism, and about 30 per cent are directly due to this cause. The Massachusetts society says in its report for 1912 : "Every year we are increasingly impressed with the terrible toll that inebriety demands of our communities." A study of 1000 neglected children appearing before the juvenile court of St. Louis revealed the following facts : 42 per cent were brought because of broken homes ; 23 because parents were intemperate; 15 on the charge of immo- rality of the mother, and 20 per cent because of general incom- petency.^ An examination of the habits and conditions of the parents showed that while nearly one-fourth of the children were the direct victims of their parents' intemperance, the great majority of the fathers, and about one-half of the mothers, were intemperate. Undoubtedly intemperance contributed largely to incompetency and to broken homes ; and indirectly it affected most of the cases. Drunkenness easily degenerates into bru- tality and breaks up the home, or it makes its victims unsteady and useless and promotes incompetency. Abnormal family conditions play an important part in caus- ing neglect. From the study to which we have just referred, it appears that the actual percentage of broken homes among these children was 70.5 ; separation and divorce were responsible for 33.4, the death of one parent for 27.7, orphanage for 4.3, and illegitimacy for 4.8. Less than 30 per cent of the parents lived together. Is it any wonder then that the children were neglected? These extraordinary conditions are, however, secondary causes, pro- duced either by peculiar social maladjustments or individual peculiarities, or a combination of the two. While desertion is a large factor, it is itself due to the bad habits of husband or 1 Annual Report of New York Society for Prevention of Cruelty to Children, 1908. 2 Unpublished Report of School of Social Economy of Wsishington University, on " Neglected Children in St. Louis. " THE DEPENDENT AND NEGLECTED CHILD 429 wife, to general incompatibility, and to lack of employment . The evasion of moral responsibility is the principal immediate cause. Irresponsibility takes other forms. Fathers refuse to turn over to mothers a sufficient portion of the income to make proper care of the children possible. Again parents allow children to indulge in pernicious associations, to beg, to frequent saloons and gambhng houses, to sleep away from home, and to sell papers or appear on the stage at an early age; they refuse to give the children proper medical attention, thus frequently jeopardizing their health or lives. Cruelty takes such gross forms as beating, kicking, and similar abuses; and children who are frightened by excessive corporal punishment often become refractory, and perhaps incorrigible. Boys are driven away from home, they drift from bad to worse until their piti- able condition draws attention, and the public or philanthropy intervenes. It is unfortunate that neither the wife-beater nor the chUd-beater has become extinct. The desire of children in the great majority of cases to go with the mother on her separation from the father indicates the worthlessness and cruelty of the father. The twin evils of ignorance and poverty are factors of con- siderable importance, and as with the delinquent child, so with the neglected, a large majority come from inferior homes situated in the disreputable portions of the city. That the economic status of the family yielding neglect cases is precarious is indicated by careful observation of the facts. Here, however, poverty is distinctly an effect as well as a cause. 4. Number of Dependent Children. It would be impossible even to estimate the total number of children in the United States who are receiving rehef in some form. The majority of families aided by the charitable societies or public relief agencies contain children, so, in these cases, the children are considered minor parts of the family and do not receive special attention. It is the dependent and neglected children living apart from their parents either in institutions or foster homes, that receive particular notice, and special chil- dren's agencies have arisen to care for them. The nxunber of 430 PROBLEMS OF CHILD WELFARE such children can be estimated, although complete statistics are not available. The following table shows the number of children in institutions in 1904 and in 1910 according to the tabulations made by the Bureau of the Census. Separate figures are given also for a number of the leading states.^ In this table the nimiber of children in orphanages and chil- dren's homes does not include that considerable proportion of children who are placed in some institution with one of their parents. Accordingly the table understates the number who are actually receiving institutional relief, since in 1904 5625 children were enumerated in so-called "Permanent Homes.'' The figures for the years 1904 and 1910 for orphanages and children's homes, however, are quite comparable and indicate a slight increase during these six years in the proportion of chil- dren in institutions. The highest rates are in New York, which state has in its children's homes more than one-fourth of all the children found in such institutions in the United States. Ac- cording to figures by its State Board of Charities, New York- had 34,530 children in institutions in 1910, or 4000 more than the number stated by the Bureau of the Census, which did not include foundUngs and some classes counted by the New York Board. The District of Columbia and California follow New York in their high percentage of children in institutions, and as will be shown later, the system of relief used is largely responsible for this condition. Eleven states each had more than 2000 inmates in their insti- tutions at the close of 1910. In the United States as a whole and in the majority of states the number of children remaining in the homes at the end of the year is greater than the admissions during the year — a fact which implies that the length of stay in the institutions averages more than one year. In some states, such as Massachusetts and New Jersey, the opposite is true, children being returned to their homes or placed out with a considerable degree of rapidity. The total number of institutions apparently rose from 1075 ' United States Bureau of the Census. Benevolent Institutions, p. 26 fi. The Survey, February 15, 1913, pp. 712-713. THE DEPENDENT AND NEGLECTED CHILD 431 o a < o a in 0\0 -^00 M i-.t^oo 10 2 00 t^iO^Ovt~»tH *-t \o t^t^c^fO-^OjM^r* 1^ pi : w 3 » P cj S ^ « ^Ft-coO'O'O viCJ H ^ 1 WcIrR ^ to M H H H ^ 1 i! OiWO HOO M t^V>CI ^i! wo !-• 00 Ov v> ^ u « t^wiO^OO lOi-J^O pj o» lOlO^cTinH COMH g pa s CO 1 s *J c 1^ -^lOThw cow t^Tj-O OvM W J>.101-l t^OO ^ >^ S -1 OqOvOHCJvOCO'NH si 3* M M •^r>.iotocoM « MfOMI-iMOHHtO ■*-> I'S •* vq covq M Tfoo'O q '^ ^8 Ov C0t^f0lOC>6 -^O^H ?! M MlOt^0>0\W W « s HIOHH WHHfO Oi HtJ-OO t^coooo coco u t~*0»MOOOO lOCOCOH -y ii w w <« J3 M a gtS g K*© Ot^oO lOOoO coi>> ►k 01 00 H t^'!j-00 OviO^O c^Oj-^'O^c^vq^ioqjo^ i d 1 0\ w w M I>-0 «O00O fO»OfO H H C 33 ') ignorance and, 77 ; in cities, 53 ; in Europe, 56 ; in slums, 48 ; in the registration area, 52 ; in the United States, 55 ; poverty and, 38 ; prevent- able, 73 ; rate of, 55 ; reduction of, through education, 55, through im- proved milk supply, 87, 88, through prenatal work, gg ; relation of, to age, 50, to illegitimacy, 50, to sex, 51, to social conditions, 48; rural m. urban, 44 ; statistics of, 52, 57. Infanticide, 20. Inspection, dairy, 80, 83 ; factory, for child labor, 340; medical, of schools, 136. Institutions for dependents, advantages of, 467 ; cottage system in, 468 ; dis- advantages of, 468 ; importance of, 467 ; public vs. private, 467 ; rela- tion of, to child saving, 441 ; tempo- rary care in, 436. Intemperance and neglect, 427. Investigation, spirit of, 488. Iowa, home for dependents in, 474. Jenner, 34. Jews, stature of, 123. John Worthy School, 343, 398. Judges, as probation officers in juvenile court, 383 ; qualifications of juvenile court, 367 ; selection of, 366. Jury trial in juvenile court, 371. Juvenile court, and probation, 377 ; beginnings of, 377 ; disposition of offenders by, 371 ; establishment of, 363 ; evolution of, 373 ; functions of, 364; hearings in, 369; in England, 373; in Germany, 373; jury trial 5i8 INDEX in, 371 ; organization of, 365 ; quali- fication of judges in, 367 ; relation of, to criminal court, 364; rotation of judges in, 366 ; state- wide extension of, 365- Juvenile delinquency, 34s ; caused by, associations and environment, 35s, child labor, 358, criminal tendencies, 357, cruelty, 354, defectiveness, 357, dishonesty of parents, 356, home conditions, 349, neglect, 354, poverty, 359, retardation, 357, saloons, 356, street trades, 359; definition of, 346; investigation of causes of, 359; pre- vention of, by adult delinquency laws, 407, age of consent laws, 410, boys' clubs, 411, neighborhood work, 411, parks and playgrounds, 413, reduc- tion of idleness, 413, of intemperance, 417, of personal vice, 417, training of parents, 415, wider use of schools, 418. Juvenile delinquents, appearance in court of, 368; disposition of, 371; investi- gation of, 379 ; number of, in reforma- tories, 362 ; occupations of working, 305 ; offenses of, 361 ; physical defects among, 358, 402 ; probation of, 377. Juvenile offenses, classification of, 361 ; nature of, 361. Labor, child, see Child labor. Laboring classes, infant mortality among, 49- Laundries, heat in, 315. Legislation, agencies supporting child labor, 321; see also Child labor legislation. Libraries, in public schools, 195. Life, preservation of, 10; right to, 11. Literacy, of working children, 291. Little mothers, 106. London, crippled children in, 129; de- cline of death rates in, 33 ; open air schools in, 157. Lunches, in Chicago schools, 164; in New York schools, 163. Lutherans, placing out by, 453. Machinery, influence of, on apprentice- ship, 249, on child labor, 280. Mack, Judge, 368. Malnutrition, extent of, 9, 146. Manual training, extent of, 248. Manufacturers, child labor legislation opposed by, 278. Manufactures, importance of child labot in, 2S5 ; night shifts in, 295. Marriage, number of births per, 24. Massachusetts, society for prevention of cruelty to children in, 463 ; state care of children in, 479. Maternal feeding, advantages of, 75. Measles, 62. Medical inspection of schools, beginning of, 137; by board of education, 140; by board of health, 139; defects discovered through, 138; legal pro- vision for, r49 ; methods of, 141 ; nature of, 138; organization of, 139; progress of, 149; purpose of, 138; results of, 144; scope of, 138; state laws governing, 150; theory of, 136- Medical inspector, duties of, 142 ; physi- cal examinations made by, 143. Meningitis, 68. Mercantile establishments, overtime in, 295- Messenger service, the, delinquency of boys in, 306. Michigan state school, 474; description of, 475 ; length of stay in, 476 ; placing out by, 476; results of, 477. Midwifery, in; dangers from, 112; regulation of, 112. Milk, bacteria in, 80 ; certified, 92 ; chemical constituency of, 74; clean, 79 : cow's, 74 ; dairy, 92 ; diseases carried by, 79; experiments with, in Chicago, 83, in Rochester, 85; modified, 93; pasteurization of, 84; temperature of, 80. Milk depots, in France, 93, in Rochester, 86, in United States, 94; public, 94; purpose of, 94. Milk problem, 79. Milk stations, see Milk depots. Milk supply, methods of purifying the, 82 ; municipal control of, 84 ; state control of, 91. Milwaukee, educational health center in, 114. Minimum wage legislation, 338. Minnesota state school, 476. Modem industrial conditions, child labor caused by, 280. Montessori method, the, 225. Moron, the, 206. MortaHty, see Infant mortality. Motherhood, cost of, 23. INDEX 519 Motion picttires, 185 ; censorship of, 185 ; value of, 185. National Child Labor Committee, 321. Native women, fecmidity of, 25. Neglect, deUnquency caused by, 354. Neglected children, and intemperance, 428; care of, 461; pubHc provision for, 48. Negro children, deaths among, 46; illiteracy of, 231; retardation among, 237- Netherlands, duration of hfe in, 38. New Jersey, boarding out in, 478. Newman, George, on infant mortality, 71- Newsboys, delinquency among, 306.' Newsholme, Arthur, on infant mortality, 71- New York, canneries in, 290 ; child labor law in, 329, 330 ; classification of juvenile offenses in, 361 ; dependent children in, 424; probation in, 380; subsidy system in, 481. New York Children's Aid Society, 451 ; work of, 452. New York City, dairy milk in, 88; diphtheria in, 60 ; infant mortality in, 66 ; physical requirements of working children in, 327 ; playgrounds in, 171 ; truancy in, how caused, 242. New York Society for the Prevention of Cruelty to Children, 463 ; on in- temperance, 427; work of, 46s- New York State Probation Commission, 389. Night work, effect of, 309; prohibition of, 331- Nonsupport laws, 442. Norway, law relating to illegitimacy in, 445- Nurse, school, 145 ; visiting, 102. Nursery, day, 104, 470. Occupations, lack of training for, 300; unhealthful, 313. Ohio, county home system in, 480. Open air schools, 156 ; character of, 157 ; establishment of, in Germany, 157, in London, 157, in the United States, 158; management of, 159; success attained by, 160. Ophthalmia, 125. Orphanage, dependency caused by, 423. Overcrowding, 107 ; prevention of, 107 ; relation of, to infant mortality, 108. Overtime, in seasonal trades, 295. Parental greed, child labor caused by, 271. Parental school, 397 ; function of, 397. Parents, education of, 266 ; ignorance of, 99; punishment of delinquent, 408; responsibility of, for juvenile delin- quency, 407. Parker school, physical training in, 197. Parks, city, 176; as playgrounds, 173; small, 173. Pasteur, 37. Pasteurization, defined, 84 ; effects of, 83. Pennsylvania, child labor in, 286. Pensions for mothers, 482 ; difiSculties attending public system of, 483 ; laws providing, 484; need of, 483. Pennsylvania Children's Aid Society, 450. Perishable goods, 278. Philadelphia, child saving in, 439. Physical defects, 132; examination for, 143 ; nature of, 143 ; number of, 133 ; proportion of children having, 133; removal of, 144. Physical degeneracy, 40. Physical examination, need of, 132, 143 ; results from, 134. Physical training, 197. Physician, school, 142. Physique, standards of, 119. Placing out, city systems for, 479; denominations engaged in, 452 ; diffi- culties in, 453 ; essentials of, 453-455 ; importance of, 435 ; machinery of, in Michigan state school, 475 ; state systems of, 478; steps in, 453. Play, and tuberculosis, 167; coopera- tion fostered by, 168; discipline of, 169; gang spirit in, 168; moral effects of, 169; physical influence of, 167; social value of, 167; theories of, 166; toleration of, 170. Playground Association, National, 177. Playgroimd movement, 177; origin of, 177; progress of, 178. Playgroimds, administration of, 181 ; equipment of, 1 74 ; for older children, 175; in Chicago, 175; in New York, 171, 177; public, 173; school, 189; supervision of, 179; types of, 173; vacant lots as, 172, 520 INDEX Police, as probation officers, 384. Poverty, child labor and, 274; infant mortality increased by, 73 ; large families a cause of, 427. Prematurity, 67. Prenatal work, effects of, 100; methods of, 99 ; reasons for, 98. Preventable mortality, extent of, 55. Pre-vocational schools, 248. Principles of child saving, 433. Probation, 377; essentials of successful, 379; extent of, 377; system of, 378; length of, 386; origin of, 377 ; results of, 388; state supervision of, 377. Probation districts, 385. Probation officers, 378; compensation for, 381 ; cooperation by, 390; county, 387; duties of, 378; investigations by, 379 ; number of cases supervised by, 387 ; qualifications of, 384 ; selection of, 384; types of, 378; volunteer, 381. Public, responsibiUty of, for child labor, 281. Pubhc care of dependent children, 474; methods of, 474 ; boarding out, 478 ; county home system, 480 ; placing out, 478; public subsidy to private in- stitutions, 481 ; state school, 474. Public schools, dancing in, 199 ; facilities for recreation in, 190; motion pictures in, 192 ; wider use of, 189. Public subsidies to private charities, 481 ; evils of, 481. Quetelet, 120. Records, need of, 30, 439. Recreation, commercial, 184 ; evening, 190; facilities for, 171; forms of, 166; value of, 167. Recreation centers, in Chicago, 74; public, 173; supervision of, 179; types of, 173. Recreation piers, 177. Reformatory institutions, 392 ; cottage system in, 401 ; discipline in, 405 ; essentials of, 400; evolution of treat- ment in, 394 ; farming taught in, 403 ; functions of, 396; home life in, 401; household economy taught in, 404; indeterminate sentence in, 399; in- dustrial training in, 402 ; necessity for, 396 ; number of juvenile delin- quents in, 362 ; parental schools as, 397 ; physical training in, 402 ; present functions of, 396; separation of sexei in, 400 ; types of, 396. Registration area, deaths of children in, 55 ; diarrhoeal diseases in, 65. Repeaters, number of, 238. Republics, 400. Retardation of school children, causes of, 238; extent of , 239 ; among foreign born, 237 ; among natives, 237. Rights of childhood, to health, 11; to leisure, 13 ; to life, 10 ; to training, 14. Rochester, milk problem in, 85; reduc- tion of infant mortality in, 87 ; social centers in, 193. Rockefeller Institute, milk tests in, 75. Roof playgrounds, 171. Rowntree, 427. Rural districts, births in, 24; sterility in, 26. St. Louis, illegitimacy in, 426; neglected children in, 428. Saloons, 356. Scarlet fever, defects caused by, 63 ; methods of communicating, 63. School attendance, by age groups, 228 ; causes of irregular, 239; compulsory, 240; in cities, 229; in country dis- tricts, 230; of negroes, 229; of whites, 229. School baths, igS' School children, defects among, 133 ; malnutrition among, 146; number of, 228 ; physical examination of, 143. School gardens, 201. School nurse, 14s; duties of, 14s; success attained by, 148. School playgrounds, 189. School term, average length of, 230. Schools, baths in, 195 ; commercial, 253; continuation, 251; for the blind, 152 ; for the deaf, 153 ; industrial training in, 247, 251 ; library stations in, 19s; medical inspection of, 137; physical training in, 197 ; sex educa- tion in, 262 ; social center work in, 192; vacation, 200; wider use of, 189. Seasonal trades, 335. Sex education, arguments against, 264; difficulties of, 262; parents and, 266; reasons for, 259; schools and, 262. Sex hygiene, American Federation for, 260; plan of, for sex education, 263. Silk mills, child labor in, 285. INDEX 521 Siphilis, effects of, 230. Smallpox, deaths caused by, 34 ; decline of, 34- Social centers, in Gary, 194; in Roches- ter, 193. Social diseases, blindness due to, 125. Social heredity, 7. Social hygiene, societies of, 260 ; methods used by, 261. Social training, required by juvenile court judge, 368. Society for the prevention of cruelty to children, function of, 46; in Massa- chusetts, 465 ; in New York, 466 ; influence of intemperance reported by, 427 ; organization of, 462 ; origin of, 462 ; purpose of, in Massachusetts, 465 >■ types of, 465 ; work of, 465. South, child labor in, 286; illiteracy in, 232. Special schools, for the blind, 152, crippled, 155, deaf, 153, feebleminded, 217, tubercular, 156. Starbuck, 348. State, the, aid by, to maintain trade schools, 256; dairy inspection by, 91 ; supervision of private agencies by, 437- State care of dependent children, 474; systems of, 474. State school system, description of, 475 ; examples of, 474 ; Michigan, 475 ; placing out under, 476. Statistics, inaccurate, 9 ; need of, g. Sterility, among foreign bom women, 27 ; among native women, 27 ; causes of, 27. Sterilization, 83. Still births, 27. Stores, exempted from child labor laws, 336- Straus milk depots, 94. Strayer, G. D., on elimination of school children, 235. Street associations, juvenile delinquency caused by, 355. Streets, as playgrounds, 172. Street trades, the, child labor in, 287; delinquency caused by, 306 ; effects of, 307 ; legislation covering, 336. Subsidies, see Public subsidies. Supervision, of child, in foster home, 4s S ; state, of private child saving agencies, 437. Sweated trades, child labor in, 288. Teacher, relation of, to medical inspec- tion, 144. Temporary home, for dependent children, 4S8. Textile mills, physical effects of working in, 314. Thomdyke, E., elimination of school children according to, 234. Thurston, H. W., 388. Tobacco, use of, 417. Tobacco factories, poisonous fumes in, 314- Trade and transportation, children em- ployed in, 287. Trade life, shortening of, 3ir. Trade schools, commercial, 252 ; courses in, 253 ; evening, 253 ; private, 252 ; public, 253 ; purpose of, 245 ; types of, 252; union labor and, 255; training in, 253. Trades, dangerous, S3S ; children pro- hibited from working in, 333 ; types of, 333- Truancy, causes of, 242. Truant schools, 397. Tubercular children, care of, 156; open air schools for, 157. Tuberculosis, causes of, in children, r3i; prevalence of, among children, 130; recreation and, 167. Underfed children, i6r ; free feeding of, 162 ; meals for, 163 ; number of, 162 ; problems of, 161 ; provisions for, in schools, 163. Uniformity of child labor laws, 322. United States, deaths of children in, 55 ; education of backward children in, 221; feebleminded in, 206; juvenile offenses in, classified, 361. Untrained children, 245. Unwise philanthropy, dependency caused by, 427. Vacation schools, 200. Vaccination, discovery of, 34; results from, 34. Venereal disease, 27, 259. Vice, causes of, 257; delinquency and, 3S8. Visiting nm'se, the, duties of, 102. Vocational guidance, in Boston, 246; purpose of, 246. Vocational schools, Cooley on, 254; development of, 255 ; types of, 254. 522 INDEX Volunteer worker, the, 382 ; advantages of, 382 ; in Buffalo, 383 ; in Indian- apolis, 382 ; objections to, 382. Wages, legislation for minimum, 338; relation of, to age, 293, to grade of children, 293. Walker-Gordon laboratories, 93. Washington, law on desertion in, 443 ; milk inspection in, 90. Waste of child life, 32. Wasting diseases, 68. White House Conference, 434. Whooping cough, 64. Widows' pensions, see Pensions for mothers. Wife desertion, 442. Williamson Free School, 253. Wisconsin, social centers in, 194. Wolf, 49. Women, employment of married, log; fecundity of foreign, 25, of native, 25 ; infant mortality increased by employ- ment of married, 109. Working children, see Children in in- dustry. Working papers, 331 ; methods of grant- ing, 332- Printed in the United States of America. *HE following pages contain advertisements of books by the same author or on kindred subjects SOCIAL SCIENCE TEXT-BOOKS Edited by Richaed T. Ely Business Organization and Combination An Analysis of the Evolution and Makers of Business Organization in the United States and a Tentative Solution of the Corporation and Trust Problems. By lewis H. HANEY, Ph.D. Professor of Economics in the University of Texas Cloth, 8vo, 483 pp., $2,00 EXTRACTS FROM THE PREFACE This book deals with the organization of business enterprises, chiefly in the United States. While the author has designed the book for use in American colleges and universities, he has kept in mind the interests of the business man and of the general reader. It is hoped that the book ■will be of service to that large class of thoughtful business men who desire a comprehensive knowledge of the economic and legal espects of the organizations with which they are associated. . . . The general scheme of the work is as follows : First comes a series of chapters describing and analyzing the various forms of business organization in such a way as to bring out the centuries-long evolu- tion which has molded them. Then, the corporate form, being clearly dominant, the life history of a corporation is set forth in a series of chapters which describe in some detail the main events; promotion, underwriting, reorganization, and the like. 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Ely Outlines of Economics By RICHARD T. ELY, Ph.D., LL.D. Professor of Political Economy in the University of Wisconsin. Revised and enlarged by the Author and Thomas S. Adams, Ph.D., Professor of Political Economy in the University of Wisconsin ; Max O. Lorenz, Ph.D., Assistant Professor of Political Economy in the University of Wisconsin ; and Allyn A. Young, Ph.D., Professor of Economics in Leland Stanford Jr. University. Third revised edition. Cloth, 8vo, $2.2S The new edition of Professor Richard T. Ely's "OutUnes of Eco- nomics," which has just been published, marks the great advance that has been made in the study of economics in the last decade. The new edition is practically a new work, completely revised and rewritten and about twice the size of the old book. In this revision Professor Ely has had the assistance of Professors T. S. Adams and Max O. Lorenz of the University of Wisconsin, and Professor A. A. Young of Stanford University. All of these men are experts in vari- ous departments of economics. Professor Young is an expert on statistics and a mathematician, and has given especial attention to banking and insurance. Professor Adams has been employed as an expert in United States census work and also as an expert in taxa- tion by the Wisconsin Taxation Commission. Professor Lorenz is Deputy Labor Commissioner of the State of Wisconsin, and a spe- cialist in labor problems. In its pfesen'L form, Ely's "Outlines of Economics" is, perhaps, the most comprehensive discussion of the whole subject of economics yet produced in America. It has often been remarked of the earher book that it is one of the most interesting of all economic treatises. The new edition, with its fuller discussion of many subjects, is even more readable. The special treatment of practical problems in eco- nomics is fuller than in any other text-book in English, and such subjects as the railway problem, forestry, labor problems, and social- ism are dealt with fully. The book is also unique in the extent to which principle is illustrated with concrete appKcations. In this particular the book may not inaptly be compared to Adam Smith's "Wealth of Nations." In view of Professor Ely's great authority as an economist, the expert assistance which he has been able to command and the imique plan of his book, it is safe to say that this will be accepted as one of the most important American contributions to the science of eco- nomics. As such, it will receive attention not only as a text-book, but as a work for the general reader who wishes to familiarize him- self with the whole field of economic thought. Social Science Text-books Edited by RICHARD T. ELY, Ph.D., LL.D. 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Cloth, i2mo, $1.2$ That every child who comes into existence must be given the full est possible opportunities for right development if a nation is to bt properly conserved, is now generally admitted. But under existing social conditions, to just what extent this can be done, and how, means the solving of many serious and difficult problems. The efiorts toward their solution have been in most cases blindly experimental, with little realization of how far-reaching the problems were ; or what others had done along similar lines, and the resiilts of their actions. The great need, therefore, has been just such a book as this one of Mr. Mangold's, stating clearly the many problems relating to the child, showing the serious effect the previous condition of living and health of the parents have upon the child's future ; what has been done to better conditions, and what is yet to be done. 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