Euthenics, the science of controllable environment Part 5

If the child is not only in theory but in practice recognized as the main interest in society, the family and society will more and more a.s.sist the mother in his nurture.

_W. I. Thomas, Women and Their Occupations._

Health administration cannot rise far above the hygienic standards of those who provide the means for administering sanitary law. The tax-paying public must believe in the economy, utility, and necessity of efficient health administration.

_Wm. H. Allen, Civics and Health._

The connection between poverty and ill health is so direct, so immediate, and so important that the moment any individual or society turns its attention to the causes of poverty, that moment it finds itself in the thick of the public health movement.

_Homer Folks, Journal Public Hygiene, November, 1909._

CHAPTER IV

FAITH AND HOPE

Progress is a series of zigzags: now the individual goes ahead of the community; now the community outstrips the individual.

The community cannot rise much above the level of the individual home, and the home rises only by the pull of the community regulations, or by the initiative of a few especially farsighted individuals.

The steps need to be carefully measured, for if the family begins to rely on the State for the backbone it should have, it will not stay up, and its fall will be lower than the stage it rose from. "When man reverts, he goes not to Nature, but to death."

The example set by the city in maintaining clean streets and well-kept parks reacts upon the home yards. The insistence by the police on city regulations as to alleys and garbage educates the family as to the general attention to be paid to such things.

The city authorities, on the other hand, are prodded to their work by well-informed individuals who see the great gain to the community from certain measures.

The centers of movement, civic and quasi-religious or philanthropic, are usually the outgrowth of individual effort. The great movements for betterment--water supply, street cleaning, tenement laws, etc.--are carried out by community agreement with a common tax outlay.

The clean city means streets of clean houses. The clean house in the midst of a dirty city may be the match to start a fire of cleansing.

Probably medical inspection in the public school is as good an example as may be given of helpfulness to the community. No quicker means of influencing both home and community life may be found, for in five years it might revolutionize the whole.

School buildings should be so constructed and so managed that they cannot themselves either produce or aggravate physical defects.

Departments of school hygiene should be organized, not only in every city, but for every rural school under county and state superintendents of instruction. The general question of physical welfare of children involves too many considerations to be satisfactorily treated by school physician and school nurse alone, or by busy teachers and princ.i.p.als.

"New York City will spend in 1910 $6,500 for making over twenty rooms in regular buildings, a first step in an entirely new plan of ventilation, which will eventually give outdoor air to all children, sick or well."[8]

[8] Bureau of Munic.i.p.al Research.

Speaking generally, America is one of the last of the civilized nations to deal with the subject of the medical inspection of school children upon a comprehensive and national scheme. But once aroused to the needs, it is safe to say that the nation will speedily educate parents to correct such home conditions as reduce the child's ability to profit from schooling, and to persuade governments to see that safe homes are provided. It will be easy to convince the taxpayer that it is cheaper to provide such care than to neglect the future parent and citizen, for it is easy to prove that medical inspection in our schools returns large dividends on small investments. Dr. Luther Gulick says that it seems probable, though only a guess, that the total annual expenditure for medical inspection of schools in the United States at the present time is perhaps $500,000. The money saved by enabling thousands of children to do one year's work in one year, instead of in two or three years, would greatly exceed the total expense of examining all children in all boroughs.[9]

[9] Quoted in Report on National Vitality, p. 123.

The health of all our school children should be conserved by a system of competent medical inspection which should secure the correction of defects of eyes, ears, teeth, as well as defects due to infection or malnutrition.

The statistics of medical inspection in public schools tell a pitiful tale wherever it has been tried: thirty or forty per cent of the children are found with defective or diseased eyes, ten to twenty per cent with distorted spines, fifteen per cent with throat and nose troubles, all of which directly affect their intellectual proficiency.

When these deficiencies are discovered and reported to the parents, such is the apathy of disbelief that seventy-five per cent of the cases usually go unattended; therefore the school nurse, who follows the case home and explains the needs and sets forth the penalties, has become a necessity.

The parent who permits his child to go to school physically unfitted to profit from school opportunity is not only injuring his own child, but is injuring his neighbor's child, and is taxing that neighbor without the latter's consent.

It would seem as if such parents had forfeited their right to the sole care of the children, and that government would be obliged, for its own protection, to step in and do the work while it is needed. The author has termed this _temporary paternalism_. The providing of penny lunches during the morning recess, the service of the school nurse and the home visitor to teach those parents who are willing to learn all these schemes for the saving of the child, may be carried out in a spirit of helpfulness with a support which may be withdrawn when no longer needed.

Although all America has not become aroused to the undoubted fact of tendencies toward physical deterioration, it is on the verge of an awakening. The public school is the natural medium for the spread of better ideals, and if the teachers of cooking and of hygiene would cooperate and use all the material which sanitary science is heaping on the table before them, we should soon see a betterment of the physical status. Combined with medical inspection and sanitary construction of schoolhouses, this would raise the general health of the community thirty or forty per cent in five years and fifty to seventy per cent in ten years.

There has been in some quarters much objection to public effort towards remedying evils which would not have existed if each family had lived up to its duties. The community is a larger family, with greater resources, and can employ investigators to find the means for greater security. That individual is very foolish who does not recognize this interaction between community and individual, and who objects to taking the benefits of the larger knowledge.

To take one of the latest examples of social problems: In every thousand children in the public schools of any city, probably of the town also, there are perhaps fifty who are ill-nourished (not necessarily underfed), ill-clothed, unwashed, and deprived of good air for sleeping. What is the duty of the public? This is one of the burning questions of the moment. Send missionary teachers to the homes, some say, but that is costly; the selection of the suitable missionary is difficult, and the result may be slight. Others say, give one good luncheon at the school, for which the children pay in part or in whole, and make that an education which, by the aid of the school nurse, will in time affect a change in habit. In short, the problem is this: Shall the children suffer in childhood and become a burden on society in adult years, or shall society protect itself from future expense by community care now? "Because _finding_ diseases and defects does not protect children unless discovery is followed by _treatment_, fifty-eight cities take children to dispensaries or instruct at schoolhouses; fifty-eight send nurses from house to house to instruct parents and to persuade them to have their families cared for; 101 send out cards of instruction to parents either by mail or the children; while 157 cities have arranged special cooperation with dispensaries, hospitals, and relief societies for giving the children the shoes or clothing or medical and dental care which is found necessary."[10]

[10] Bulletin, Bureau of Munic.i.p.al Research.

Nearly all preventive measures adopted by society and ranked as paternalism by timid philanthropists are or may be educative and temporary at the same time. They may be dropped as soon as the end is gained. The attention of parents must be called to neglected duties.

Compulsory attention to such duties as affect the wards of society, the children, may be needed for a time. Just as the wise father, taking the child for a walk, allows him to run free as soon as his strength and courage permit, so the paternalism of society is relaxed as soon as its _protegees_ show themselves both able and willing to do the right thing without its aid or command.

Compulsory school attendance places responsibility for certain care, vaccination, decent clothing, good food, decent shelter. The thousand and one ways in which society is now protecting itself are all educating the newcomers to American ideals. They are all intended to make efficient, self-sustaining citizens who do not feel the pull of the law or the bond of outside care. It is the last conflict between the ideals of individualism and those of the community need, subordinating the individual preference. Much wisdom and forbearance will be needed to secure this community ideal, but in that way evidently lies progress. It behooves the leaders of social effort to make all their work educational, and thus remove the necessity for a repet.i.tion in the future.

Just as the parent in the home establishes habits while the child's mind is plastic, so the community stands _in loco parentis_ to the future citizen, and surrounds him with safeguards while needed.

Knowledge is needed, scientific investigation is fundamental, expert wisdom is indispensable, costly though it is, being the product of long research and rare brain power. This is at the service of the nation for the good of all the people, and it is the surer the wider the range of experience. For this reason chiefly, greater actual knowledge and more complete harmonizing of conflicting interests is necessary. Certain sanitary measures are carried out by the Federal government as an education to communities, just as communities educate individuals. Federal effort may be unwisely put forth in certain cases, investigations of little consequence may be undertaken, but on the whole a democracy must learn to manage its affairs by making mistakes. The principle should not be discarded as a result of the first mistake.

The immediate concern of this chapter is with the leaders of community movements, the educated, sympathetic, farsighted sociologists, sanitarians, and economists, whose concern is for the advancement of mankind. These leaders must have courage and belief in the value of their work, for no half-hearted means will carry the community forward. Still more, they must have knowledge, a sure ground to stand upon. To acquire this means both time and opportunity. To go into betterment work without it is to set back the wheels of progress, not to advance them.

CHAPTER V

_The child to be "raised" as he should be. Restraint for his good. Teaching good habits the chief duty of the family._

Our success or failure with the unending stream of babies (one every eight seconds) is the measure of our civilization: every inst.i.tution stands or falls by its contribution to that result, by the improvement of the children born or by the improvement of the quality of births attained under its influence.

_H. G. Wells, Mankind in the Making._

Children are the most hopeful element of our population, and we should concentrate our efforts on them.

_Dr. W. F. Porter, Harvard Medical School Lectures._

We want the mothers to be the health officers of the home.

_Charles W. Hewitt._