Popular Science Monthly/Volume 70/June 1907/The Waste of Children

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THE WASTE OF CHILDREN
By Dr. Geo. B. MANGOLD

UNIVERSITY OF PENNSYLVANIA

LESS than two hundred years ago not more than one fourth of the children born in London ever reached their fifth year of life. The rest were ruthlessly swept aside and died without adding a single iota to the sum of human service. It is a matter of utmost importance to know under what conditions an advance in population is secured. The beginnings of national life in Europe were accompanied by energetic efforts to augment the number of each national group. Necessarily the strength of a nation depended largely upon the size of its population. Despite these efforts, the practical results were lost in the many adverse circumstances which operated to neutralize their effects. A comparatively slow increase of the population of nearly every European country before the last quarter of the eighteenth century was the natural result. Every civilization, however, whether old or new, has purchased progress at considerable cost. Lives, property and happiness have been sacrificed to attain this coveted goal. Civilization spells economy. It means a fuller utilization of our powers, faculties, and our mental and physical equipment, no less than a more capable use of the productive forces of nature. The more primitive a society, the more immediate and absolute is its subjection to environment. From this thraldom civilization is gradually releasing us, and to-day we stand partly above our environment and in a measure mold it by determining its character, and forcing its adaptation to our peculiarities in addition to our own increasing adaptability to its changing conditions.

Probably in no other field of human activity has man's former ignorance 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 is never compensated for by useful and productive lives has been appalling. A recent investigation of the Bontoc Igorrote in the Philippines indicates a mortality of 60 per cent, before the age of puberty is reached. Such people have risen but little above their natural environment and are quite subject to its rigors and destroying processes. Decreasing cost characterizes advancing civilization, yet throughout the eighteenth century the European population, being largely ignorant or indifferent, was blighted by the influence of a destroying environment.

The progress of the industrial world for the last century has been unparalleled and almost incredible. The organization of industry, the rise of combinations, the fuller utilization of the forces of nature, our marvelous inventions, the increasing division of labor and greater insistence upon bodily vigor are devices calculated to lessen the cost of production of goods. In certain industries, for example the oil and packing industries, such a state of perfection has been reached that little if any waste products remain, although twenty years ago a large residue was continually lost. The decrease of unnecessary cost and labor is the goal of industry. Apply this principle to the cost of propagating the human race and what do we find? Is not the tax and strain upon the expectant mother too great to permit even an apathetic society calmly to ignore the just claims of dying infants for the opportunities which make for a life of usefulness and service? The eighteenth century began to answer this question, but even the twentieth has not yet given a satisfactory reply. The darkness and austerity of a civilization finds no mean measure in its infant death rate. In this respect great progress has indeed been made, but it is an advance far outstripped by the progress of industry. Social progress has proved the laggard, but may yet make amends for past neglect.

The wholesome changes of the past one hundred and fifty years are indications of great possibilities. The conditions in London only reflected those existing throughout all England which lived beneath the pall of the blighting destroyer of babes. In recent years three fourths of the children in London have lived to the age of five. As late as 1761, however, 50 per cent, of London's population perished before reaching the age of twenty. To-day half the people of England do not die until after the fifty-fourth year has been reached, and the infant mortality—the death rate for children under one year of age—had fallen in 1903 to the creditable figure of 144 per 1,000 births for the seventy-six great towns of England. Even this rate is somewhat above the average for the entire country. In Prussia during the decade 1751 to 1760 only 312 children out of every 1,000 births survived to the age of ten. At this age the child is still an economic cost; it depends upon others and yields no surplus to society. Yet two thirds of the entire population failed to reach an age of social usefulness, and perished after body, mind and resource had been spent to give it a proper place in human society. The record of a later decade, 1861-70, shines in comparison with the former, but is still fraught with fears for the future. Six hundred and thirty-three individuals were being saved out of every 1,000—a promising decline, but one not measuring up to the hopes of social amelioration. Is it any wonder that former mothers, full of grief and anguish at the sight of lifeless babes, believed more largely in a Providence whose decree was inexorable, who gave and who took away? From this morbid fatalism the medical advance of the past one hundred years and the strenuous efforts of men with human sympathies applying themselves to problems of social betterment have freed the majority of our kind, and the doctrine is properly relegated to the category of abandoned beliefs. The triumph over small-pox has been one of the results contributing to this end. Formerly it was a scourge carrying away large portions of the population. Two thirds of all new-born children are said to have been attacked, of whom one eighth or more regularly died. A frightful mortality thus obtained, and this was minimized only through the introduction of vaccination, which in some countries increased the average duration of life as much as three and one half years. Owing to this direful experience of the past, foreign countries are still more insistent than we are upon employing that method of preventing the disease.

France has paralleled the record of England, and, when once inaugurated, improvements and reforms succeeded with astonishing rapidity. During the first seven years of the last century, the number of male inhabitants reaching an age sufficient to subject them to conscription was but 45 per cent, of the total number born, yet by 1825 the percentage had risen to 61—a most healthful gain in the proportion of those attaining adult life. Backward Russia has been equally a laggard in its attention to the moral and social requirements winch result in a low infantile death rate. At the beginning of the nineteenth century it permitted one third only of the children of its peasants to grow up to maturity and as few as 36 per cent, of its population reached the age of twenty years. Even here science has made advance.

The great changes in the social and economic conditions of the European people have had a marked effect upon the growth of the population. As the power and ability of men to control the conditions of their environment were increasingly realized, beneficent effects were everywhere noticeable. To recuperate the strength lost in war and disaster, men urged the device of a decreased death rate instead of striving as formerly for a larger percentage of births. An observing demographer in the first half of the last century thus expressed himself, 'Population does not so much increase because more are born as because fewer die.' Yet the population of nearly every country has increased wonderfully during the past century, and in view of the new conditions of its expansion what a fine commentary upon the advance of modern civilization and the practical efficiency of government this tremendous fact has been!

From this former dismal reality with its merciless slaughter of helpless babes we in America have made much progress. Accurate data for the earlier years of our history are wanting, and at present very few of our states keep a careful registration of births and deaths, although a large number of our cities are now recording their vital statistics with increasing care. The absence of city life with its baneful consequences somewhat relieves us from the charge of infanticide, but the exposure and the rigors of the Atlantic seaboard worked its many hardships. Data for New York before 1850 show that 27 per cent, of its infants died before reaching the age of one, but the rate for Boston was comparatively low, being recorded as less than 20 per cent.—a figure exceeded by many cities at the present time. Conditions in Massachusetts have been relatively favorable and its vital statistics indicate that the death-dealing influences of the close of the century were more fatal than those operating at the beginning of the Civil War. This observation, discouraging as it is, is somewhat softened by the favorable changes in the death rate of children below the age of five. These records prove that a constantly growing percentage of children live to that age, and once having reached the fifth year the chance of a life of future usefulness is considerably increased. The expectation of life in Boston according to the reports of the Census Bureau was in 1900, 9.74 years greater for the child of five than for the infant at birth. This difference is, moreover, diminishing, as it certainly must if mortality is being checked. A similar difference in the English expectation of life argues for similar rates of mortality for children at these ages. The low death rate of children between the ages of five and fourteen insures the succession of a large majority to an adult age. Civilization demands that this be a constantly increasing proportion and that the fewest possible number of lives be wrecked in the adolescent stage. The energies of society must be expended in many various directions where the need is most urgent, and where reforms are clearly possible. That society should waste vast portions of its accumulating energies is not only deplorable and a hindrance to social advance, but is a mark of criminal neglect. Where waste of lives can be avoided, as the decreasing mortality of children shows, there inaction by society is unpardonable.

In spite of the existence of many plague spots, where innocent infants are barbarously slain, the statistics set forth by the twelfth census furnish ground for a growing optimism. Although a large percentage of inaccuracy obtains, the figures are sufficiently reliable and comparable to indicate quite faithfully the hopeful tendency toward child saving. The tables for the registration area show that the infantile death rate fell from 205 per 1,000 births in 1890 to 165 in 1900. In the former year one out of every five infants died, although allowance should be made for unrecorded births. In the latter year one out of every six—a gain of approximately 20 per cent. For children under five the gain is even more favorable, thus demonstrating an increasing success in bringing children through the most critical stages of life and in lessening the necessary waste. The thousands who die are not the victims of the law of natural selection. It is not largely an elimination of the unfit. More definitely than ever before is it being established that most children enter life with an endowment of native vitality sufficient to weather the ordinary conditions of adversity. The great variations in death rates after the first few months are due largely to postnatal influences, to the social and economic environment in which the child is caught, from which it has no appeal, and which make or mar its future.

The wide range of infant mortality from the lowest rates of the healthful country districts to the fearful massacre of infants in the crowded and unsanitary portions of our larger cities indicates the magnitude of the task still before us. That eminent authority on vital statistics—Dr. Farr—estimated that the annual unnecessary deaths of infants in England during the decade 1851-60 numbered more than 64,000. The conditions in respect to food, water, cleanliness, malnutrition and midwifery, he regarded as the chief causes of this needless loss of life. The proportion of loss suffered from these sources has since undoubtedly diminished, but the aggregate number is greater now than then. The effect of the various factors which influence the rate of our annual loss of children is marked in the difference between our urban and rural rates, and between those of white and colored children. The comparative healthfulness of rural life is attested to by ample evidence. It is indicated not only by the farmer's long expectation of life, but also by the low death rate prevailing among his children. A comparison of the chances of the child in the country and in the city is a proof of the wholesome influence of a favorable environment. It suggests the need of increasing effort to raise the city to the high level of rural vitality. In the registration states the infant mortality for white children varied in 1900 from an average of 116 per 1,000 births in the rural districts to 180 in the cities. The urban rate seems to be more than 50 per cent, higher than that observed among the country population. For every two infants dying in the country, three are sacrificed in the city districts. Yet this is not everywhere the case, nor is it necessarily so. In parts of Germany the rural death rate is enormous. Especially is this true in the agricultural districts of southern Bavaria, where an almost hopeless infant mortality is recorded. The rural region of Prussia shows higher rates than do our American cities, but they still possess a slight advantage over Prussian urban centers. This heavy mortality indicates a social lethargy and backward conditions among the agricultural population, which in spite of many natural sanitary advantages remains handicapped by unfavorable social and industrial surroundings; and these preclude proper attention to the wants of children. In England, again, the rural rate is generally below that of the cities and considerably below the infant mortality of the mining and industrial centers. Compared with Scotland, the entire country has a decided disadvantage. Yet the nature of the problem is somewhat simplified on reflection that the results of an earlier investigation of death rates disclosed the fact that the mortality of the sons of peers before the age of six was less than one third of that obtaining among the rest of the population. On the other hand, many English and American cities record rates lower than the average rate prevailing in the rural district—an eloquent argument for the possibilities of many of our cities. The, statistics of 1881-90 for Massachusetts showed average variations during the decade from 111 to 239 deaths per 1,000 births. The former rate marked the healthfulness of a residential town, the latter portrays the conditions existing in an industrial center. Yet in some of the manufacturing towns where no tenement-house evil existed the infantile death rate was comparatively low. Other American cities show variations equally wide, and even within the same city the most contrasting conditions continue to exist. The lowest rates for cities of considerable size are recorded for Seattle, St. Paul and Minneapolis. The prevailing rates are approximately 100 deaths per 1,000 births, according to their records, which some authorities have, ho.wever, pronounced as giving too favorable a showing. Many of the larger cities double the death rate for infants, while in numerous southern cities it rises to almost criminal proportions. John Spargo has pointed out the differences that may exist within a single city and exemplifies them by quoting a rate of 94.4 per 1,000 in the Back Bay district of Boston against a proportion of 252.1 for one of its poorer districts. Some of our own cities have clearly blazed the path of progress. Buffalo and Rochester, N. Y., have during the decade 1890-1900 made notable reductions in the percentage of loss from infant mortality. Better inspection of the milk supply and increased watchfulness of contagious diseases, especially those of children, have contributed to this end. In Buffalo compulsory vaccination of school children was instituted and circulars distributed which contained instructions concerning the care of children. Among cities which have done noble service during the same decade in reducing the mortality of children under five are Lowell, Lawrence and Haverhill, Mass., Newark and Jersey City. All these had high rates of mortality and present rates still exceed those of many of our cities in which conditions are naturally more favorable. The many remarkable ameliorative changes of the past fifteen years only indicate the possibilities whose limits have not yet been reached, while much pioneer work still remains to be done. In view of the declining rates and the wide variations in them, the existing differences refuse to be explained away, and we can not assign them all to natural causes. Some cities, especially those of the Pacific coast and the mountains, possess natural advantages, yet cities under similar conditions show most striking contrasts. Still worse, the same city may contain the extremes of progress and of neglect. Hence our efforts can not be abated until they have wrested from the destroyer every vestige of his ill-gotten power. It is the province of science and the duty of society to force from nature what she can not rightfully claim, and to leave her the remainder only. Serious changes in our methods and policies may be involved, but these must be molded according to this undying purpose. The miserable conditions still prevailing among the American negroes are evidence of this need. An infant mortality in Charleston where the majority are negroes, of 419 per 1,000, and in other southern cities of more than 300 is little better than barbarism. At first thought the racial factor might be assigned as the cause of this great difference between the vitality of white and colored infants, but this defence of social inaction is unworthy of our race. A closer investigation shows that the death rate in the rural portion of the registration area was 218.9 for colored infants, but that the city rate stood at 387. This difference roughly measures the advantages of a more favorable social environment. Were the care of the children a more capable one and the conditions making for degradation and disordered birth rate ameliorated, this wide difference would not exist, and the rates in the rural districts could be further reduced. Remembering the former pitiless slaughter of white infants, our hopes for the negro need not be abated. Indeed the colored infant mortality of the rural districts in 1900 was but little above that of white infants for the entire registration area in 1890. What hopes then might not knowledge and prosperity offer! Three eighths of the negro infants of the cities dying annually! To their mothers they are nothing but a curse, a cause of pain and sorrow. A cross-section of a darker age resides in our midst. Yet 150 years ago the children of our ancestors died with an equal facility.

Climate and certain phases of nature have so far proved impregnable to the genius of our race. Their disadvantages may have to be borne for years and centuries, but for acclimated peoples an infant death rate of 307 per 1,000, as was recorded for the Philippines for 1903, is only an evidence of an inferior and brutal civilization. To counteract such death rates and provide for a liberal increase of population a birth rate must be excessive if not inhuman.

These facts disclose a cause of the rapid increase of population during the last century. The increased vitality of infants has made it possible. With their rate of mortality cut in two a new era might naturally arise. The English birth rate was higher in 1851 than in 1891, but the percentage of excess of births over deaths was greater in the latter year. The fluctuations between these two dates indicate the highest net increase as occurring during the decade 1871-80, but the significant lesson taught is seen in the possibilities which even a lower birth rate may yield. The continued triumph of knowledge and humaneness draws comfort from the recent history of other European nations. A comparison of birth rates, death rates and excess of births between the period 1861-80 and 1885-96 shows that in nearly every important European country birth rates have declined. Yet no alarming tendency to depopulation has manifested itself, because the decreasing death rates permit a greater net increase of lives. Consequently the rate of increase was augmented during this period in Hungary, Prussia, Austria, Italy, Holland and Belgium, but declined slightly in England, France and Scandinavia. Some of these nations have a mortality which is even now considered excessive and which, if proper measures are inaugurated, can be considerably reduced. Hungary with a birth rate in recent years of 40.4 had a smaller percentage of increase than Sweden whose rate was only 27.1, while the Russian mortality was higher than England's birth rate and but little below that of Germany.

Several observations may be made in respect to the foregoing facts:

First and foremost: The physiological advantage of contributing to a growing population by means of lowering the death rate rather than by increasing the rate of birth. Mental anguish, physical and economic cost, would thus be reduced to a minimum. It is the method of enlightened civilization. The burden of our mothers is not lightly borne, let them enjoy the fruits of their suffering.

Second: The marvelous reduction in the former rate of infant mortality indicates what social reform may accomplish, and what a saving of lives may follow.

Third: The differences between rural and urban death rates suggest the character of the environment needed for the increased healthfulness of cities.

Fourth: The contrasting conditions disclosed in single American cities and the gratifying results of sanitary measures, milk inspection, and advancing intelligence pave the way for a growing hopefulness.

Realizing the importance of the principles which our vital statistics establish, society can insist more strenuously upon preventive reforms. It can reduce the waste of infant lives, and conserve our potential population. Let us ascertain whether our population is sufficiently fecund by giving every new-born babe a fair opportunity for life. Whether 'race suicide' will then have a national aspect, society will be better able to judge. Certain classes are indeed chargeable with a low birth rate, but for the masses the more important problem is a diminishing infant mortality. When the best of society's efforts in this direction have been realized, then a solid basis for subsequent reasoning concerning the probable future of our race will have been established.