The Health of Proletarian Children.—Owing to the lesser3 resisting power of children, the factors of ill-health operate much more powerfully in the case of youthful than in the case of adult proletarians. But other factors are in operation in addition to this inferior power of resistance. Unfavourable conditions act upon proletarian women during pregnancy4, and affect proletarian children at the time of birth. The circumstance which more than all others is injurious to the health of these children, and which contributes to produce the result that a larger percentage of working-class than of upper-class children are feeble-minded, is quantitative5 and qualitative6 insufficiency of nutriment. Studies of the relationship between the prices of food-stuffs and the average working-class income have shown that the majority of working men have an income too small to provide for themselves and their children the minimum quantity of nutritive materials (of the proper quality) which physiological7 science has proved to be indispensable to the daily renewal8 of the bodily forces. Statistical9 data prove beyond question that the height and the body-weight of proletarian children are less than those of children of the well-to-do. Rickets10 is principally a disease of children of the poorer classes. Among upper-class children the severer forms of this disease is hardly ever seen. Rickets arises[179] chiefly as a sequel of digestive disturbances11; and these, in their turn, are referable to the deficiencies of artificial feeding. Among the poor we find many more blind children and many more deaf mutes than among the rich, the reason being that among the poor, in so many instances, when the defect is first noticed, no attempt is made to seek medical advice. According to trustworthy statistical data, 95 per cent. of the occupants of blind asylums12 belong to the poorer classes.
Causes of the Movement for the Protection of Proletarian Children.—To-day great stress is laid upon attention to the health not only of the general population, but in especial to the health of children. During the nineteenth century the view became general that in the interests of the health of the children, society ought to be prepared to make any sacrifices. In the domain13 of social hygiene—that is, of the science which occupies the borderland between the science of public health and the science of sociology—neither the men of theory nor the men of practice can venture to adopt a one-sided class outlook. During recent years, upon the groundwork of these sound conceptions, a number of new institutions have been founded, by means of which the general condition of public health and the hygiene of childhood (including that of proletarian childhood) have been considerably14 improved. In many directions the advances in medical science tend to counteract15 with success the disorders16 consequent upon the development of capitalism17. The technique of artificial feeding has been greatly improved, and this has led to a reduction in infantile mortality; ophthalmia of the new-born can now be efficiently18 prevented, and this has led to a decrease in the number of blind persons.
To the upper classes of society the health of the lower classes is of importance for two reasons—(a) the former have need of the working powers of the latter, and in bad hygienic conditions these working powers are impaired19; (b) if the health of the lower classes is neglected, it is not these classes alone which suffer, but the rich suffer as well. For example, the well-to-do are endangered when nothing is done to check the spread of infectious diseases among the poor, and when poor persons attacked by these diseases are left without proper[180] treatment. If the health of poor children be neglected, the results are extremely serious, not for these children alone, but for the children of the well-to-do and for adults.
Institutions.—Institutions are of great importance. A larger proportion of the children of the poor than of the children of the well-to-do are dealt with in institutions, for well-to-do parents live in commodious20 houses, in which their children can be properly cared for, they are able to summon the doctor whenever necessary, and so on. The most important institutions in this connection are hospitals for infants and young children. Children’s hospitals are not as yet very numerous; hospitals for infants are still fewer. The majority of these institutions are maintained, not by the State or by the local authority, but by the community at large. It is owing to the fact that children’s and infants’ hospitals are so few in number that medical practitioners21 are so inadequately22 trained in respect of the hygiene of childhood and pediatrics, and in especial in the hygiene and therapy of infant life. The need for such hospitals is not satisfied by the foundation of children’s clinics. A combination of hospitals for infants with lying-in hospitals or foundling hospitals is unquestionably along the proper course of development.
If we wish to ascertain23 the value of institutions for children who are blind, deaf-mute, crippled, or feeble-minded—if we wish to learn whether it is socially worth while to take special pains for the care of such children, or whether they can be adequately cared for in general institutions, and what would be the cost of these respective methods—we must study statistics bearing on these questions. But, unfortunately, these statistics are defective24 and extremely untrustworthy. They are defective, because they fail to give us precise information concerning personal data and concerning the percentage of such children who are or may become fit to earn their own living. They do not classify properly according to age, and they do not state accurately25 how many of the children have inherited and how many have acquired the defect from which they suffer. (The youngest children will usually be found to suffer from an inherited defect, since they will hardly have had time to acquire it. Among those suffering from such[181] defects, the young present a larger proportion of sufferers than we find among the general population, because the mortality of the children thus affected26 is higher than the mortality of healthy children.) The statistics are untrustworthy, because the existence of deaf-mutism is often overlooked until childhood is comparatively advanced, and feeble-mindedness may not be recognised at all. In the twentieth century, in the civilised countries of Europe, we find, per 100,000 of the population, from 50 to 130 blind persons, from 60 to 250 deaf persons, 70 to 450 feeble-minded and insane (minimal and maximal figures), and about 120 cripples. According to certain statistical data, one-fourth of the blind and two-thirds of the deaf-mutes are competent to earn their living, and 90 per cent. of the cripples are endowed with perfectly27 normal mental powers. It is even maintained that from such children, if they are otherwise healthy, we can, with comparatively trifling28 effort, obtain useful members of society.
There is no doubt that when once such children have been born, we must do the best we can for them and with them. They must either be destroyed, or, in default of this, must be developed and educated to the fullest extent of their powers; unless this is done, great evil ensues, for the children become permanently29 dependent upon public assistance; or else (and this applies especially to the feeble-minded) become confirmed criminals. When the defect is a serious one, such children should on no account be brought up in the family circle, or educated in ordinary schools; it is absolutely necessary to provide special schools and institutions for each class of such defectives—blind schools, deaf-mute schools, cripple schools, &c. Feeble-minded children, however, whose mental level is only a very little below the average, or who are merely backward from a temporary retardation30 of development, may be educated in the ordinary schools, or in special classes of these schools. Children with defective hearing should not attend the public elementary school. Even if such a child is exceptionally talented, and if it receives the greatest possible amount of help at home, these circumstances will not make up for the educational defects inevitably31 attendant upon its deafness. As soon as examination by the school doctor shows[182] that serious defect of hearing exists, or if such defect is obvious even before medical examination has been made, the child should be transferred to a special class or to a special school for the deaf. As far as I am aware, such institutions exist as yet only in Berlin.
In the treatment of defective children, the school teachers as well as the doctors have a very important part to play. It is best that those who teach such children should themselves have received specialised medical and educational training. It was not until the beginning of the latter half of the eighteenth century that any serious effort was made to grapple with the problem of the education of the blind and the deaf-mutes; it was more than a hundred years later before the problems of the education of feeble-minded and of crippled children respectively began to receive serious attention.
Country Holiday Funds and Open-air Schools.—The health of town children sometimes needs a thorough restoration, in default of which the child would become seriously ill in the dusty and contaminated air of our large towns. But in children of school age such restoration is possible only during the summer holidays. This is where the country holiday funds can play a very useful part. These began to come into existence in Switzerland about thirty years ago, and have now obtained a wide diffusion32 in all civilised countries, and especially in manufacturing countries. As with every new branch of public care for the needs of the poor, and especially with the institutions considered in this chapter, the first steps in this matter were taken by the community at large—that is to say, by private associations. It will be a task of the near future to organise33 and unify34 these associations. Such country holidays are an important feature of the campaign against tuberculosis35. They have the further advantage, that they provide the child with manifold new experiences. The societies take poor and weakly, but not actually diseased children, and send them to the country for the summer holidays, in some cases boarding them with families, in other cases sending them to special institutions. The advantages of the family system are those of family life in general, and in addition that in such a family the town child will learn much more about the[183] details of country life. Of late some of these societies have gone on to the foundation of permanent holiday homes for the relays of children they send to the country. Inasmuch as the good effect of the summer visit to the country tends soon to pass off, the after-care of the children during the winter is very useful. In the case of children who for one reason or another (for example, because they lack suitable clothing, or because the society does not possess adequate funds) cannot be sent to the country for a sufficiently36 long time, semi-urban colonies and milk-stations are not without their value. The children during the holiday season are taken by the teacher in large groups (forty to sixty) into the open, are well fed, and, if opportunity offers, given baths, and in the evening taken home to their parents. Of late years has originated the idea of the open-air school, which occupies an intermediate place between the school and the sanatorium for children. During the holiday season the children stay in the forest, and receive every day a few hours’ instruction in the open air. Holiday playgrounds provide opportunities for town children to play, under the guidance of suitable persons, in school-yards and in parks. In this connection may also be mentioned arrangements for the exchange of children during the holiday season between town and country families. Certain weakly and sickly children should during the summer be sent to a spa or a sanatorium. There already exist special spas, Kurorts, and sanatoria for children. There are, for example, special seaside resorts for rickety and tubercular children. [e.g. in England, for tubercular children, Margate.]
Proposed Reforms.—It is the duty of the poor-law boards to devote great attention to the health, not merely of those children for whose care they are directly responsible, but also for poor children in general. The law should provide a right of interference on the part of the local authority in the case of children whose health is endangered by prolonged confinement37 to the house—for example, where there is grave danger from exposure to infection—and this in cases in which it is not possible to speak of “neglect” in the narrower sense of the term. But if powers are given, in such cases, to[184] remove a child for institutional care, it should only be till such a time as is requisite38 for the domestic conditions to be transformed, so that the child may return home without danger to its health. In respect of the hospitals under the direct control of the local authorities, it is necessary that the latter should have the right of removal of children needing hospital treatment whose parents do not send them to hospital on their own initiative. This last idea is already partially39 realised, inasmuch as certain modern foundling hospitals receive for treatment sick children who have not entered the hospital as foundlings.
Need for Enlightenment.—It is really astounding40 how little the laity41 know about the elementary principles of the hygiene of child life, and more especially of infant life. In respect of the management of infants, the most absurd practices prevail, some of which are largely responsible for the extent of infant mortality. It is therefore of enormous importance that the population in general, and especially the lower classes, should be properly instructed in these matters. But even medical practitioners lack sufficient instruction in respect of the hygiene and therapy of childhood, and even more in respect of the hygiene and therapy of infancy42. This is due to the fact that there is no proper teaching of these specialties43 at most universities. Quite recently, however, there has been some improvement in these respects.
The Tendency of Evolution.—The importance of such institutions as those we have been discussing will become ever greater. Indeed, the great majority of sick persons will ultimately receive institutional care. The functions we have been considering, at present administered by the community at large and by the local authority, will eventually be taken over by the State.
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1
secondly
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| adv.第二，其次 | |
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hygiene
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| n.健康法，卫生学 （a.hygienic） | |
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lesser
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| adj.次要的，较小的；adv.较小地，较少地 | |
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pregnancy
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| n.怀孕，怀孕期 | |
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quantitative
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| adj.数量的，定量的 | |
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qualitative
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| adj.性质上的，质的，定性的 | |
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physiological
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| adj.生理学的，生理学上的 | |
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renewal
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| adj.(契约)延期，续订，更新，复活，重来 | |
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statistical
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| adj.统计的，统计学的 | |
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rickets
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| n.软骨病，佝偻病，驼背 | |
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disturbances
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| n.骚乱( disturbance的名词复数 )；打扰；困扰；障碍 | |
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asylums
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| n.避难所( asylum的名词复数 )；庇护；政治避难；精神病院 | |
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domain
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| n.(活动等)领域，范围；领地，势力范围 | |
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considerably
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| adv.极大地；相当大地；在很大程度上 | |
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counteract
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| vt.对…起反作用，对抗，抵消 | |
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disorders
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| n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调 | |
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capitalism
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| n.资本主义 | |
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efficiently
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| adv.高效率地，有能力地 | |
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impaired
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| adj.受损的；出毛病的；有（身体或智力）缺陷的v.损害，削弱( impair的过去式和过去分词 ) | |
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commodious
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| adj.宽敞的；使用方便的 | |
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practitioners
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| n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师） | |
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inadequately
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| ad.不够地；不够好地 | |
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ascertain
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| vt.发现，确定，查明，弄清 | |
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defective
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| adj.有毛病的，有问题的，有瑕疵的 | |
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accurately
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| adv.准确地，精确地 | |
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affected
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| adj.不自然的，假装的 | |
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perfectly
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| adv.完美地，无可非议地，彻底地 | |
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trifling
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| adj.微不足道的；没什么价值的 | |
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permanently
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| adv.永恒地，永久地，固定不变地 | |
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retardation
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| n.智力迟钝，精神发育迟缓 | |
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inevitably
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| adv.不可避免地；必然发生地 | |
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diffusion
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| n.流布；普及；散漫 | |
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organise
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| vt.组织，安排，筹办 | |
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unify
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| vt.使联合，统一；使相同，使一致 | |
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tuberculosis
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| n.结核病，肺结核 | |
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sufficiently
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| adv.足够地，充分地 | |
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confinement
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| n.幽禁，拘留，监禁；分娩；限制，局限 | |
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requisite
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| adj.需要的，必不可少的；n.必需品 | |
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partially
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| adv.部分地，从某些方面讲 | |
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astounding
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| adj.使人震惊的vt.使震惊，使大吃一惊astound的现在分词) | |
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laity
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| n.俗人；门外汉 | |
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infancy
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| n.婴儿期；幼年期；初期 | |
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specialties
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| n.专门，特性，特别；专业( specialty的名词复数 )；特性；特制品；盖印的契约 | |
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