RACHITIC TYPES

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 under 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 account 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 unnecessary 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 lives. If some modern Herod had caused the death of every male child under 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 monster’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 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.