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 ill-shaped head and the bent and twisted legs that tell of rickets. Helpless, with the pathetically perfunctory manner 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 nourishment while nursing them.[[14]] It is perhaps the commonest disease from which children of the working-classes suffer. A large proportion of the children in the public 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 everywhere in the poor neighborhoods. The misshapen heads and the legs bent and twisted awry are unmistakable signs, and the scanty clothing covers pitiful little “pigeon-breasts.” 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, failing 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.

BABIES WHOSE MOTHERS WORK—THEY ARE CARED FOR IN A DAY NURSERY

Seldom, if ever, fatal by itself, rickets is indirectly responsible for a tremendous quota of the infantile death-rate.[[15]] 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, diarrhœa, and many other disorders, the mortality 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 rejoicing 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 live 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 mortality 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 under two years of age and 9 per cent under six months of age.”[[16]]

These are terrible words coming 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 in the year 1900 were due to poverty—to the measureless inequality of opportunity to live 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.”[[17]] 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 returns 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 lives every year—more than two hundred 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.

Table showing Infantile Mortality from Eleven Given Causes and the Estimated Influence of Poverty thereon
DiseaseNo. of Deaths under Five YearsEst. Per Cent Due to Bad ConditionsEst. No. of Deaths Due to Bad Conditions—Poverty
Measles8,465857,195
Inanition10,687909,618
Convulsions14,2887010,000
Consumption4,454602,648
Pneumonia37,2064514,340
Bronchitis10,900505,450
Croup10,897454,900
Debility and Atrophy12,130759,397
Cholera Infantum25,5634511,502
Diarrhœa3,962451,782
Cholera Morbus3,180451,431
151,73251.5778,263