The bitter cry of the children

Front matter

I llTTEErQ

|'Bi,r- J OH IS'* SPAROO m> i %

(PfHW

Introduction

I COUNT myself fortunate in having had a hand in bringing this remarkable and invaluable volume into existence. Quite incidentally in my book Poverty I made an estimate of the number of underfed children in New York City. If our experts or our general reading public had been at all famihar with the subject, my estimate would probably have passed without comment, and, in any case, it would not have been considered unreasonable. But the public did not seem to realize that this was merely another way of stating the volume of distress, and, consequently, for several days the newspapers throughout the country discussed the statement and in some instances severely criticised it. One prominent charitable organization, thinking that my estimate referred to starving children, undertook, without delay, to provide meals for the children. In the midst of the excitement Mr. Spargo kindly volunteered to investigate the facts at first hand. His inquiry was so searching and impartial and the data he gathered so interesting and valuable that I urged him to put his material in some permanent form. The following admirable study of this problem is the result of that suggestion.

VUl INTEODUCTION

I am safe in saying that this book is a truly powerful one, destined, I believe, to become a mighty factor in awakening all classes of our people to the necessity of undertaking measures to remedy the condi-, tions which exist. The appeal of adults in poverty is an old appeal, so old indeed that we have become in a measure hardened to its pathos and insensitive to its tragedy. But this book represents the cry of the child in distress, and it will touch every himian heart and even arouse to action the stolid and apathetic. The originality of the book lies in the mass of proof which the author brings before the reader showing that it is not alone, as most of our charitable experts believe, the misery of the neglected or the actively maltreated child that should receive attention. Even more important is the misery of that one whose whole future is darkened and perhaps blasted by reason of the fact that during his early years of helplessness he has not received those elements of nutritious food which are necessary to a wholesome physical Ufe.

Few of us sufficiently realize the powerful effect upon life of adequate nutritious food. Few of us ever think of how much it is responsible for our physical and mental advancement or what a force it has been in forwarding our civilized life. Mr. Spargo does not attempt in this book to make us realize how much the more favored classes owe to the

INTRODUCTION IX

fact that they have been able to obtain proper nutrition. His effort here is to show the fearful devastating effect upon a certain portion of our population of an inadequate and improper food supply. He shows the relation of the lack of food to poverty. The child of poverty is brought before us. His weaknesses, his mental and physical inferiority, his failure, his sickness, his death, are shown in their relation to improper and inadequate food. He first proves to oiu" satisfaction that this child of misery is born into the world with powerful potentialities, and he then shows, with tragic power, how the lack of proper food during infancy makes it inevitable that this child become, if he lives at all, an incompetent, physical weakUng. It is perhaps unnecessary to point out that the problem of poverty is largely summed up in the fate of this child, and when the author deals with this subject he is in reality treating of poverty in the germ.

There have been many books written about the children of the poor, but, in my opinion, none of them give us so impressive a statement as is contained here of the most important and powerful cause of poverty. Among many reasons which may be found for the existence of distress, the author has taken one which seems to be more fundamental than the others. But, while this is true, there is no dogmatic treatment of the problem; for the author reaUzes that the

X INTRODUCTION

causes of poverty in this coxmtry of abundance are numerous. Indeed, wherever one looks, one may see conditions which are fertile in producing it. Students of the poor find some of these causes in the conditions surrounding the poor. Students of finance and of modern industry find causes of poverty in the methods and constitution of this portion of our society. The causes, therefore, of poverty cannot be gone into fully in any partial study of modern society. It is even maintained, and not without reason, that if all men were sober, competent, and industrious, there would be no less poverty in the world. But however that may be, one thing is certain, and that is that as the race as a whole could not have advanced beyond savagery without a fortuitous provision of material necessities, so it is not possible for the children of the poor to overcome their poverty imtil they are assured in their childhood of the physical necessities of life. We should have no civilization to-day, our entire race would still be a wild horde of brutalized savages, but for the meat and milk diet or the grain diet assured to our earhest forefathers. And it should not be forgotten that as this is true of the fife of the race, so is it true of that portion of our community which lives in poverty unable to procure proper food to give its children. This is the great fimdamental fact which lies at the base of the problem of poverty and which

INTRODUCTION XI

is the theme of this book. It is a fact which should be best known to the men and women who work in the field of our philanthropies, and yet it must be said that it is a fact which has heretofore been almost entirely ignored by this class of workers.

For this reason I welcome this volume. I am convinced that it will mark the beginning of an epoch of deeper study and of sounder philanthropy. I look to see in the near future some effort made to estab- Ush a standard of physical well-being for the children. I expect to see the community insisting that some provision shall be made whereby every child born into the world will receive sufficient food to enable him to possess enough vitality to overcome imnecessary and preventable disease and to grow into a manhood physically capable of satisfactorily competing in industrial or intellectual pursuits. I do not beheve that this is a dream impossible of realization. About a htmdred years ago our forefathers decided that there should be a universal standard of literacy. To bring this about the following generations of men established a free school system which was meant to assure to every child a certain minimum of education. If that can be done for the mind, the other thing can be done for the body. And when it is done for the body, we shall make another striking advance in civihzation not imHke that recorded in the history of mankind when the free

XU INTEODUCTION

people of this American continent established a system of free and imiversal education.

If such a momentous thing should follow the publication of this book^ and similar studies which wiU without doubt subsequently be made, its publication would indeed mark an epoch. But, of course, it must be said that before any far-reaching result can come, the general pubhc must be acquainted with the conditions which exist. It is for this reason that I hope Mr. Spargo's book will be read by hundreds of thousands of people, and that it will awaken in them a determination to respond wisely and justly to the bitter cry of the children of the poor.

BOBEET HUNTER.

Preface

The purpose of this volume is to state the problem of poverty as it affects childhood. Years of careful study and investigation have convinced me that the evils inflicted upon children by poverty are responsible for many of the worst features of that hideous phantasmagoria of hunger, disease, vice, crime, and despair which we call the Social Problem. I have tried to visualize some of the principal phases of the problem — the measure in which poverty is responsible for the excessive infantile disease and mortaUty; the tragedy and folly of attempting to educate the hungry, ill-fed school child; the terrible burdens borne by the working child in our modern industrial system.

In the main the book is frankly based upon personal experience and observation. It is essentially a record of what I have myself felt and seen. But I have freely availed myself of the experience and writings of others, as reference to the book itself will show. I have tried to be impartial and unbiassed in my researches, and have not "winnowed the facts till only the pleasing ones remained." At times, indeed, I have found it necessary, while writ-

XIV PEEFACE

ing this book, to abandon ideas which I had held and promulgated for years. That is an experience not uncommon to those who submit opinions formed as a result of general observation to strict scientific scrutiny. I had long believed and had promulgated the opinion that the great mass of the children of the poor were blighted before they were born. The evidence given before the British Interdepartmental Committee, by recognized leaders of the medical profession in England, pointed to a fundamentally different view. According to that evidence, the number of children born healthy and strong is not greater among the well-to-do classes than among the very poorest. The testimony seemed so conclusive, and the corroboration received from many obstetrical experts in this country was so general, that I was forced to abandon as untenable the theory of antenatal degeneration.

In view of the foregoing, I need hardly say that I do not claim any originality for the view that Nature starts all her children, rich and poor, physically equal, and that each generation gets practically a fresh start, unhampered by the diseased and degenerate past.* The tremendous sociological significance of this truth — if truth it be — will, I think, be generally recognized. Readers of Ruskin's Fors Clavigera will remember the story of the dressmaker

* For the necessary qualifications of this broad generalization see the illustrative material in Appendix C, I.

PREFACE XV

with a broken thigh, who was told by the doctors in St. Thomas's Hospital, London, that her bones were in all probability brittle because her mother's grandfather had been employed in the manufacture of sulphur. If this theory of antenatal degeneration is wrong, and we have not to reckon with grandfathers and great-grandfathers, the solution of the problem of arresting and repairing the deterioration of the race is made so much easier. It may be thought by some readers that I have accepted the brighter, more hopeful view too readily, and with too much confidence. I can only say that I have read all the available evidence upon the other side, and found myself at last obUged to accept the brighter view. I cannot but feel that the actual experience of obstetricians deahng with thousands of natural human births every year is far more valuable and conclusive than any number of artificial experiments upon guinea pigs, mice, or other animals. The part of the book devoted to the discussion of remedial measures will probably attract more criticism than any other. I expect, and am prepared for, criticism from those, on the one hand, who will accuse me of being too radical and revolutionary, and, on the other hand, those who will say I have ignored almost all radical measures. I have purposely refrained from considering any of the far-reaching speculations of the "schools," and confined myself

XVI PREFACE

entirely to those measures which have been tried in various places with sufficient success to warrant their general adoption, and which do not involve any revolutionary change in our social system. I have tried, in other words, to formulate a programme of practical measures, all of which have been subjected to the test of experience.

A word of personal explanation may not be out of place here. I have been privileged to know something of the leisure and luxury of wealth, and more of the toil and hardship of poverty. When I write of hunger I write of what I have experienced — not the enviable hunger of health, but the sickening himger of destitution. So, too, when I write of child labor. I know that nothing I have written of the toil of little boys and girls, terrible as it may seem to some readers, approaches the real truth in its horror. I have not tried to write a sensational book, but to present a careful and candid statement of facts which seem to me to be of vital social significance.

As far as possible, I have freely acknowledged my indebtedness to other writers, either in the text or in the list of authorities at the end of the book. It was, however, impossible thus to acknowledge all the help received from so many wilUng friends in this and other countries. Hundreds of school principals and teachers, physicians, nurses, settlement workers, pubhc officials, and others, in this country

PREFACE XVU

and in Europe, have aided me. It is impossible to name them all, and I can only hope that they will find themselves rewarded, in a measure, by the work to which they have contributed so much.

I take this opportunity, however, of expressing my sincere thanks to Mr. Robert Hunter; to Mr. Owen R. Lovejoy, of the National Child Labor Committee; to Dr. George W. Goler, of Rochester, N.Y.; to Dr. S. E. Getty, of St. John's Riverside Hospital, Yonkers, N.Y. ; to Dr. Louis Lichtschem, of New York City; to Dr. George W. Galvin, of Boston, Mass. ; and to Professor G. Stanley Hall, of Clark University, for many valuable suggestions and criticisms. To Mr. Fernando Linderberg, of Copenhagen; to his Excellency, Baron Mayor des Planches, the Italian Ambassador at Washington; and to Professor Emile Vinck, of Brussels, I am indebted for assistance in securing valuable reports which would otherwise have been inaccessible. I am also indebted to my colleague. Miss C. E. A. Carman, of Prospect House ; and especially to Mr. W. J. Ghent for his expert assistance in preparing the book for the press. Finally, I am indebted to my wife, whose practical knowledge of factory conditions, especially as they relate to women and children, has been of immense

service to me.

J. S.

Prospect House, Yonkers, N.Y.

December, 1905.

Contents

PAOB

iNTRODtrCTION vU

Pbbface xiii

II

In England the high infantile mortality has occasioned much alarm and called forth much agitation. There is a world of pathos and rebuke in the grim truth that the knowledge that it is becoming increasingly difficult to get suitable recruits for the army and navy has stirred the nation in a way that the fate of the children themselves and their inability to become good and useful citizens could not do."

* For a contrary view of this question, see Dr. Paton's article on "The Influence of Diet in Pregnancy on the Weight of the OflEspring," Lancet, July 4, 1903; and Dr. Ballantyne's "Antenatal Pathology and Hygiene."

Alarmed by the decline of its industrial and commercial supremacy, and the physical inferiority of its soldiers so manifest in the South African war, a most rigorous investigation of the causes of physical deterioration has been made, with the result that on all sides it is agreed that poverty in childhood is the main cause. Greater attention than ever before has been directed to the excessive mortaUty of infants and young children. Of a total of 587,830 deaths in England and Wales in 1900 no less than 142,912, or more than 24 per cent of the whole, were infants under one year; and 35.76 per cent were imder five years of age. That this death-rate is excessive and that the excess is due to essentially preventable causes is admitted, many of the leading medical authorities contending that under proper social conditions it might be reduced by at least one-half. If that be true, and there is no good reason for doubting it, the present death-rate means that more than 70,000 little baby lives are needlessly sacrificed each year.

No figures can adequately represent the meaning of this phase of the problem which has been so picturesquely named "race suicide." Only by gathering them all into one vast throng would it be possible to conceive vividly the immensity of this annual slaughter of the babies of a'^Christian land. If some awful great child plague came and swept away every child under a year old in the states of Massachusetts, Idaho, and New Mexico, not a babe escaping, the loss would be less than those that are beUeved to be needlessly lost each year in England and Wales. Or, to put it in another form, the total number of these infants believed to have died from causes essentially preventable in the year 1900 was greater than the total number of infants of the same age living in the following six states, — Connecticut, Maine, Delaware, Florida, Colorado, and Idaho. Even if the estimate of the sacrifice be regarded as being excessive, and we reduce it by half, it still remains an awful sum.

Unfortunately, there is no reason to suppose that the infantile death-rate in the United States is nearly so far below that of England as is generally supposed. The general death-rate is given in the census returns as 16.3 per thousand, or about two per thousand less than in England. But owing to a variety of causes, chief of which is the defective system of registration in several states, these figures are not very reliable, and it is generally agreed that the mortaUty for the whole country cannot be less than for the "Registration Area," 17.8 per thousand.. Similarly, the difference in the infantile death-rate of the two coimtries is" much less than the following crude figures contained in the census reports appear at first to indicate : —

THE BITTER CBY OF THE CHILDEEN

Umited SiATna

Enola2(d and Wales

Deaths at all ages, 1,039,094 Deaths under 1 year, 199,325 Deaths under 5 years, 317,532

Deaths at all ages, 587,830 Deaths under 1 year, 142,912 Deaths under 5 years, 209,960

In the English returns the death of every child having had a separate existence is counted, even though it lived only a few seconds, but in this country there is no uniform rule in this respect. In Chicago, for instance, "no account is taken of deaths occurring within twenty-four hours after birth," *^ and in Philadelphia a similar custom prevailed until 1904." Such facts seriously vitiate comparisons of the infantile death-rates of the two countries which are based upon the crude statistics of census returns. But while the difference is much less than the figures given would indicate, it is still safe to assume that the infantile death-rate is lower in this country than in England. Such a condition might reasonably be expected for numerous reasons. We have a larger rural population with a higher economic status; new virile blood is being constantly infused by the immigration of the strongest and most aggressive elements of the population of other lands; our people, especially our women, are more temperate. All these factors would tend naturally to a lower death-rate at all ages, but especially of infants.

H O o

That with all these favorable conditions our infantile mortality should so nearly approximate that of England, that of every thousand deaths 307.8 should be of children imder five years of age — according to the crude figures of the census, more if a correct registration upon the same basis as the English figures could be had — is a matter of grave national concern. If we make an arbitrary allowance of 20 per cent, to accoimt for the slight improvement shown by the death-rates and for other differences, and regard 30 per cent of the infantile death-rate as being due to socially preventable causes, instead of 50 per cent, as in the case of England, we have an appalling total of more than 95,000 imnecessary deaths in a single year.

And of these "socially preventable" causes there can be no doubt that the various phases of poverty represent fully 85 per cent, giving an annual sacrifice to poverty of practically 80,000 baby Hves. If some modern Herod had caused the death of every male child imder twelve months of age in the state of New York in the year 1900, not a single child escaping, the number thus brutally slaughtered would have been practically identical with this sacrifice. Poverty is the Herod of modern civilization, and Justice the warning angel calling upon society to "arise and take the young child" out of the reach of the RjQijster's wrath.

III

If our vital statistics were specially designed to that end, they could not hide the relation of poverty to disease and death more effectually than they do now. It is impossible to tell from any of the elaborate tables compiled by the census authorities what proportion of the total number of infant deaths were due to defective nutrition or other conditions primarily associated with poverty. No one who has studied the question doubts that the proportion is very great, but it is impossible to present the matter statistically, except in the form of a crude estimate. There is much of value in our great collections of statistics, but the most vital facts of all are rarely included in them.

In the great dispensary a little girl of tender years stands holding up a baby not yet able to walk. She is a "little mother," that most pathetic of all poverty's victims, her childhood taken away and the burden of womanly cares thrust upon her. " Please, doctor, do somethin' fer baby!" she pleads. Baby is sick unto death, but she does not realize it. Its breath comes in short, wheezy gasps ; its skin burns, and its little eyes glow with the brightness that doctors and nurses dread. One glance is all the doctor needs; in that brief glance he sees the illshaped head and the bent and twisted legs that tell of rickets. Helpless, with the pathetically perfunctory maimer long grown familiar to him he gives the child some soothing medicine for her tiny charge's bronchial trouble and enters another case of "bronchitis" upon the register. "And if it wasn't bronchitis, 'twould be something else, and death soon, anyhow," he says. Death does come soon, the white symbol of its presence hangs upon the street door of the crowded tenement, and to the long death-roll of the nation another victim of bronchitis is added — one of the eleven thousand so registered under five years of age. The record gives no hint that back of the bronchitis was rickets and back of the rickets poverty and hunger. But the doctor knows — he knows that little Tad's case is typical of thousands who are statistically recorded as dying from bronchitis or some other specific disease when the real cause, the inducing cause of the disease, is malnutrition. Even as the Great White Plague recruits its victims from the haunts of poverty, so bronchitis preys there and gathers most of its victims from the ranks of the children whose lives are spent either in the foul and stuffy atmosphere of overcrowded and ill-ventilated homes, or on the streets, underfed, imperfectly clad, and exposed to all sorts of weather.

For nearly half a century rachitis, or "rickets," has been known as the disease of the children of the poor. It has been so called ever since Sir William Jenner noticed that after the first two births, the children of the poor began to get rickety, and careful investigation showed that the cause was poverty, the mothers being generally too poor to get proper notirishment while niirsing them." It is perhaps the commonest disease from which children of the working-classes suffer. A large proportion of the children in the pubUc schools and on the streets of the poorest quarters of our cities, and a majority of those treated at the dispensaries or admitted into the children's hospitals, are unmistakably victims of this disease. One sees them everjrwhere in the poor neighborhoods. The misshapen heads and the legs bent and twisted awry are unmistakable signs, and the scanty clothing covers pitiful httle "pigeonbreasts." The small chests are narrowed and flattened from side to side, and the breast-bones are forced unnaturally forward and outward. Tens of thousands of children suffer from this disease, which is due almost wholly to poor and inadequate food. Here again statistical records hide and imprison the soul of truth, faiUng to yield the faintest idea of the ravages of this disease. The number of deaths credited to it in 1900 was only 351 for the whole of the United States, whereas 10,000 would not have been too high a figure.

Seldom, if ever, fatal by itself, rickets is indirectly responsible for a tremendous quota of the infantile death-rate.^° In epidemics of such infectious diseases as measles, whooping-cough, and others, the rickety child falls an easy victim. In these diseases, as well as in. bronchitis, pneumonia, convulsions, diarrhoea, and many other disorders, the mortahty is far higher among rickety children than among others. Nor do the evils of rachitis cease with childhood, but in later life they are unquestionably important and severe. There is no escape for the victim even though the storms of childhood be successfully weathered, but like some cruel, relentless Nemesis the consequences pursue the adult. The weakening of the constitution in infancy through poverty and underfeeding cannot be remedied, and epilepsy and tuberculosis find easy prey among those whose childhood had laid upon it the curse of poverty in the form of rickets.

An epidemic of measles spreads over the great city. Silently and mysteriously it enters and, unseen, touches a single child in the street or the school, and the result is as the touch of the blazing torch to dry stubble and straw; only it is not stubble but the nation's heart, its future citizenry, that is attacked. From child to child, home to home, street to street, the epidemic spreads; mansion and tenement are alike stricken, and the city is engaged in a fierce battle against the foe which assails its children. In the tenement districts doctors and nurses hurry through the sun-scorched streets and wearily climb the long flights of stairs hour after hour, day after day ; in the districts where the rich live, doctors drive in their carriages to the mansions, and nurses tread noiselessly in and out of the sick rooms. Rich and poor alike struggle against the foe, but it is only in the homes of the poor that there is no hope in the struggle ; only there that the doctors can say no comforting words of assurance. When the battle is over and the victims are numbered, there is rejoiciag in the mansion and bitter, poignant sorrow in the tenement. For poor children are practically the only ones ever to die from measles. Nature starts all her children equally, rich and poor, but the evil conditions of poverty create and foster vast inequalities of opportunity to hve and flourish.

Dr. Henry Ashby, an eminent authority upon children's diseases, says : " In healthy children among the well-to-do class the mortality (from measles) is practically nil, in the tubercular and wasted children to be found in workhouses, hospitals, and among the lower classes, the mortality is enormous, no disease more certainly being attended with a fatal result. William Squires places it in crowded wards at 20 to 30 per cent of those attacked. Among dispensary patients the mortahty generally amounts to 9 or 10 per cent. In our, own dispensary, during the six years, 1880-1885, 1395 cases were treated with 128 deaths, making a mortality of 9 per cent. Of the fatal cases 73 per cent were imder two years of age and 9 per cent under six months of age." "

These are terrible words coining as they do from a great physician and teacher of physicians. Upon any less authority one would scarcely dare quote them, so terrible are they. They mean that practically the whole 8645 infant deaths recorded from measles in the United States ui the year 1900 were due to poverty — to the measureless inequality of opportunity to Hve and grow which human ignorance and greed have made. Moreover, the full significance of this impressive statement will not be realized if we think only of its relation to one disease. The same might be said of many other diseases of childhood which blight and destroy the lives of babies as mercilessly as the sharp frosts blight and kill the first tender blossoms of spring. The same writer says: "It may be taken for granted that no healthy infants suffer from convulsions; those who do are either rickety or the children of neurotic parents." " And there were no less than 14,288 infant deaths from convulsions in the United States in the census year. It would probably be a considerable underestimate to regard 10,000 of these deaths, or 70 per cent of the whole, as due to poverty.

It is not my intention to attempt the impossible task of sifting the death retiirns so as to measure the sum of infantile mortality due to poverty. These figures and the table which follows are not introduced for that purpose; I have taken only a few of the diseases more conspicuously associated with defective nutrition and other conditions comprehended by the term poverty, and, supported by a strong body of medical testimony, made Certain more or less arbitrary allowances for poverty's influence upon the sum of mortality from each cause. Some of the estimates may perhaps be criticised as being too high, — no man knows, — but I am convinced that upon the whole the table is a conservative one. No competent judge will dispute the statement that some of the estimates are very low, and when it is remembered that only a few of the many causes of infantile mortality are included and that there are many others not enumerated in which poverty plays an important part, I think it can safely be said that in this country, the richest and greatest country in the world's history, poverty is responsible for at least 80,000 infant hves every year — more than two htmdred every day in the year, more than eight lives each hour, day by day, night by night throughout the' year. It is impossible for us to realize fully the immensity of this annual sacrifice of baby lives. Think what it means in five years — in a decade — in a quarter of a century.