If we wish to ascertain 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 defective 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 accurately 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 defects, the young present a larger proportion of sufferers than we find among the general population, because the mortality of the children thus affected 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 perfectly normal mental powers. It is even maintained that from such children, if they are otherwise healthy, we can, with comparatively trifling 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 permanently 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 retardation 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 inevitably attendant upon its deafness. As soon as examination by the school doctor shows 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 diffusion 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 organise and unify these associations. Such country holidays are an important feature of the campaign against tuberculosis. 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 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 sufficiently 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 confinement 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 remove a child for institutional care, it should only be till such a time as is requisite 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 partially 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 astounding how little the laity 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 infancy. This is due to the fact that there is no proper teaching of these specialties 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.