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and mental suffering, can only be raised and purified by knowledge and humanitarian sympathy. This is a social task for everyone. Above all, we must recognize that the young can no longer be abandoned to the total darkness that is haunted with terrors to the mind and perils to the body."
THE WORKING GIRL.
We owe a debt to youth which can never be liquidated. Youth has died for us. Youth is sacrificing its best for us. Youth stands between the enemy and all that we count worth living and fighting for. It is a plain duty to study the nature and needs of the adolescent. A helpful little volume on "The Girl in Industry' has recently been written by Miss D. J. Collier, and is published by Messrs. G. Bell and Sons, Ltd. (price 9d. net). A suggestive foreword and informing introduction are provided by Miss B. L. Hutchins. The brochure summarizes the chief results and the conclusions of an investigation of a number of working girls. According to the Census returns of 1911, there were no less than a million and a half of girls employed from 10 to 21 years of age. That is about 40 per cent. of the total female population of that age. Of adolescent girls between 14 and 18 the number employed amounted to nearly 794,800, or 58.6 per cent. of the whole. And of these 30'5 per cent. had entered domestic service, including hotel work but not including laundry and washing work. The textile trades employed 16.8 per cent. of occupied girls, and the various dress trades 19:2 per cent. Nearly 71 per cent. of occupied girls under normal conditions are engaged in conditions usually regarded as "womanly." But the coming of war has altered the distribution of adolescent workers. A year ago it was estimated that the total increase in the number of female workers amounted to over 1,420,000, or about 42°5 per cent. It is impossible to give any definite return regarding the exact number of adolescent girls at present engaged in war work and other industries. War conditions have led to the relaxation or temporary suspension of regulations under the Factory Act governing the labour of adolescents. On the other hand, much has been accomplished for the
betterment of workers generally, and particularly for the safeguarding of women and girls. Miss Collier's report, although limited in scope and restricted in regard to matters discussed, is highly suggestive, and indicates lines on which future investigations may be advantageously undertaken. The Report deals with the effects of hours of work, length of spells, number and duration of pauses for rest and meals, influence of protracted standing and opportunities for rest, effects of weight carrying, heavy work, and specialized movements, and sanitary conditions and meals. The induction of certain ailments and physical disabilities is discussed. The Report contains a valuable section on "Recommendations," from which we venture to quote the following: "It is now generally recognized that 'fatigue has a larger share in the promotion and permission of disease than any other causal condition,' and as adolescents need a sufficient reserve of energy to maintain growth as well as health, it is obvious that conditions of work that exert no injurious effect on adults may be unduly fatiguing for juvenile workers with their twofold need. Consequently the best criterion for judging the effect of industry on the health of adolescent girls will be based on observation as to the incidence of fatigue with different industrial occupations. Physio
logical research has conclusively proved that subject sensations are not a measure or even an early sign of fatigue, and that real or objective fatigue is shown, and is measurable only by the diminished capacity for performing the act that caused it. . . . Measurement of the output of work gives the most direct test of fatigue provided allowance is made for all variable factors except the worker's changing capacity. In addition, the observation of certain secondary symptoms supplies a useful index to the degree of fatigue which work induces. Lack of co-ordination, one of the earliest manifestations of nervous fatigue, results in increased accidents. The accident rate in factories tends to be 25 to 55 per cent. higher for boys and girls than for men and women.
During adolescence the plasticity of the human organism makes it more easily affected by external factors. Chief among the external influences which may
disturb normal development are the attitudes, postures, and movements which industrial work involves. If these are cramped and constrained the healthy action of the heart and lungs and their natural development may be retarded, while if excessive muscular strain, such as that resulting from heavy lifting or prolonged standing, is experienced, active injury to vital organs may be brought about, and similarly these factors and the demands which excessive fatigue due to long hours, &c., makes on the growing organism may result in stunted growth and abnormal development." The Report is of particular value as indicating the importance of continued inquiry regarding all matters relating to the welfare of adolescent working girls. "What is needed is exact scientific information available for the guidance of those responsible for the organization of adolescent labour, and, more important still, as a basis for new regulations controlling the extent and conditions of this labour."
Mr. T. Vivian-Rees, the President of the Sunday School Union (London), 56, Old Bailey, E.C., has issued, under the title of "The Sevenfold Grip of Love upon the Life of the Young," the first two sections of a "Presidential Handbook" (price 3d. and 1d. respectively).
The Committee on Provision for the Feeble-minded, 702, Empire Building, Philadelphia, Pa., U.S.A., are publishing a series of practical Bulletins. following are already available: No. 1, "The Binet-Simon Measuring Scale for Intelligence: What it is; What it Does; How it Does it; with a Brief Biography of its Authors, Alfred Binet and Dr. Thomas Simon," by Elizabeth S. Kite. No. 2, "Stimulating Public Interest in the Feeble-minded: How it was Done in New Jersey." No. 3, "Colony Care for the Feeble-minded." No. 4, (6 Special Classes in the Public Schools." The Committee exist "to disseminate knowledge concerning the extent and menace of feeble-mindedness, and to suggest and initiate methods for its control and ultimate eradication from the American people." We commend the Bulletins of this far-seeing Committee to all workers for the welfare of the feeble-minded in this country.
The Third Annual Report of the Forsyth Dental Infirmary for Children, 140, The Fenway, Boston, U.S.A., is an attractively illustrated informing record of the work of an institution which exists : (1) To educate parents, teachers, nurses, and children in the hygienic value of healthy mouths and sound teeth, and to furnish instruction as to the best methods of securing the same. (2) To prevent dental caries by oral prophylaxis and by the care and preservation of the temporary teeth. (3) To investigate the causes and to study the prevention of oral diseases and caries of the teeth. To remedy, as far as possible, existing conditions of dental caries and other oral diseases. (5) To establish and promulgate a higher standard of dental asepsis. (6) To furnish for the dental profession an opportunity for charitable work and for the educative experience of a large clinic.
Lord and Lady Cavan have offered to give an annual prize to the boy and girl of the Wheathampstead School, Hertfordshire, who are considered to be the best children in regard to conduct in church, chapel, school, home, and street. The prize will be awarded at the end of the year dating from June 1, 1918, by the vote of their schoolfellows, supported by the opinion of the clergy, minister, schoolmaster or schoolmistress and parents. Here is an example which should be followed extensively.
Under the title of "The Forgotten Army," the Committee on Criminal Courts, 105, East 22nd Street, New York City, have issued a record of six years' work. It is the story of an endeavour to secure clean, intelligent and kindly administration in the Inferior Criminal Courts of New York City. There is much information on the working of the Children's Court.
The Lord Mayor has opened a Mansion House Fund for the financial assistance of seven of the principal orphanagesnamely, the Royal British Orphan Schools, Slough; the Brixton Orphanage for Fatherless Girls; the Home for Female Orphans, St. John's Wood; the Royal Female Orphan Asylum, Beddington; the Infant Orphan Asylum, Wanstead; the Orphan Working School, Haverstock Hill; and the Reedham Orphanage at Purley.
CHILD WELFARE AND STATE SERVICES.
In this section are inserted records of the progress of Child Welfare Work as carried out by various State Services dealing with Health, Education, Industry, Delinquency, Defectiveness, and other questions relating to the care and control of the young. We shall be glad to receive copies of reports and all other official publications as soon after issue as may be possible.
GERMANY AND INFANT
War has wakened the belligerent nations to a realization of the value of child life. Even the most ignorant and apathetic understand in some measure that the fate of the future lies in the hands of the dependent infant of the present. The real issue of the existing conflict will not be fully seen until the days come when it can be estimated what sort of children have been born and bred in these momentous years of struggle and sacrifice. The importance of conserving infant life is forcibly set forth in "Infancy Welfare in Germany during the War," which has just been issued as a Report prepared in the Intelligence Department of the Local Government Board. This official publication of 37 pages can be procured from H.M. Stationery Office, Imperial House, Kingsway, London, W.C.2 (price 6d. net), and we earnestly commend it to the serious consideration of all medical officers and every worker for child betterment. The Report has been prepared under the experienced direction of Mr. I. G. Gibbon, C.B.E., and special pains have been taken to secure completeness and accuracy, the information being obtained from authoritative or responsible sources in Germany. The space at our disposal only permits of a few references and condensed abstracts. Germany has suffered a very conspicuous reduction in the number of births. The first three years alone of the war saw a diminution by over 2,000,000 babies who it is estimated would have been born under normal peace conditions. Some 40 per cent. fewer infants were born in 1916 than in 1913. Generally, however, the infantile death-rate has been kept comparatively low. Although Germany is ever claiming a position of light and leading in the thought and conduct of the
affairs of the world, its culture has not enabled it to take a foremost place in regard to infant welfare. In the first years of the present century, out of every 1,000 children born alive in Germany 200 died before attaining 1 year of age, a rate nearly 50 per cent. higher than in England and Wales, and more than twice as high as that prevailing in Norway and Sweden. The German birth-rate before the War was comparatively high. In the decade 1841 to 1850 it was 36°1 per 1,000 of estimated inhabitants, and in 1871-1880 it had risen to 391. For the decade 18911900 it was 31°9 per 1,000, but in the ten years 1901-1910 the mean rate fell to a little under 32 per 1,000. The rate for 1912 was 28.3. It has been estimated that during three years of war there has been a diminution equivalent to over 2,500,000 lives. In Germany in 1913 there were 1,839,000 live births; in 1914, 1,820,000; in 1915, 1,416,000; and in 1916, 1,003,000. In 1916 the decrease as compared with 1913 was 40 per cent. The corresponding figures for England and Wales show the number of live births to be as follows: in 1913, 881,890; in 1914, 879,096; in 1915, 814,614; in 1916, 78,552. The decrease in 1916 as compared with 1913 is 10.9 per cent. The statistics presented regarding the relative infant mortality rates before the War in Germany and this country are of special interest. In 1901 the infant death-rate in the German Empire was 207, while in England and Wales it was 151. In 1913 the rate for Germany was 151, and for England and Wales 108. Infant welfare work in Germany received a setback by the outbreak of war, but it has since received a great impetus. New centres are being opened, and schemes for semi-rural and rural districts, where the infant mortality and morbidity rates are usually higher than in urban districts are being developed. The effect of war conditions on the wellbeing
of children just above the age of infancy has induced a large number of centres to extend their care and supervision to children of from 1 to 5 years of age. The distribution of milk, generally in prepared portions, for artificially-fed intants was undertaken by a very large number of centres. It appears to be a growing practice for the cards entitling mothers to buy extra quantities of certain kinds of food for themselves and their young children to be distributed by the welfare centres. The tendency has been for the expense of carrying on infant welfare work to be thrown more and more upon public funds, with the control passing largely into the hands of the local authorities. There is an increasing demand for the establishment of an imperial law to make it the duty of all local authorities to undertake infant welfare work. It is interesting to find that in some German towns the sickness insurance societies have themselves started various schemes of infant welfare work on somewhat different lines from those followed by infant welfare associations. Illegitimate children are receiving increasing care and attention. Endeavours are being made to provide suitable institutions for all classes of young children wherever they are needed. The increasing industrial employment of women under war conditions, with night shifts, long hours of labour, and unusual stress and strain are exercising profound influence on maternity and child welfare. The Report is very definite that the food conditions existing in Germany have not been associated with excessive infant mortality, at all events up to the end of 1916. In the towns, when the shortage of food has gradually become more pronounced, and the difficulties of distribution have increased, the death-rate has tended to diminish. In the country the scarcity of food has been less keenly felt than in the towns, yet all the evidence goes to show that the infant death-rate has remained higher in the rural districts taken as a whole than in the urban districts. The Report furnishes much valuable information regarding the schemes for and conduct of infant welfare work before the War, and the development of activities to meet needs under war conditions.
A special section is devoted to a
consideration of the work of welfare centres and the Imperial maternity grants. Much suggestive information is provided regarding the care of illegitimate children. The Report is a document of much value, and should have a far-reaching stimulating effect on all forms of maternity and infant welfare work in this country and in Britain's Over-seas Dominions. We cannot afford to despise or to neglect the plans and purposes which Germany is eagerly seeking for the safeguarding of its future. With scientific precision and statesman-like prescience Germany is endeavouring to safeguard her coming citizens in order that in future days there shall be slaves for her military machine and servants for the conduct of her schemes for commercial extension and penetration. It is up to Britain and her Allies not only to prove themselves victors in the present stupendous conflict, but to conserve and equip sons and daughters who, as proud, free, healthy and happy citizens, shall be desirous and able of serving their States in equity and righteousness. Of all measures making for the successful conduct of war, the establishment and perpetuation of peace, the evolution of human powers, and the harnessing of the forces of nature for the betterment of mankind, there are none of greater importance or more present urgency than those pertaining to maternal and child welfare. We congratulate Mr. Gibbon and his colleagues and the Local Government Board on their statesman-like action in issuing so helpful and stimulating a document, and we trust that from time to time it may be possible to issue somewhat similar reports dealing in convenient form with the records of the progress of child welfare work in this country and in other parts of the British Empire.
THE WORK OF THE CHILDREN'S YEAR IN AMERICA.
The Children's Year Movement is being carried forward throughout the United States of America with enthusiasm, intelligence, and skill. The work is being organized by experts. The U.S. Department of Labour through its Children's Bureau, the chief of which is Miss Julia C. Lathrop, is rendering invaluable aid.
The Bureau, in collaboration with the Department of Child Welfare of the Woman's Committee, Council of National Defence, is issuing a series of "Children Year Leaflets." No. I has the title, "Save 100,000 Babies: Get a Square Deal for Children," and presents an outline of the working programme. The work is grouped under certain topics, four of them are concerned primarily with the needs of normal children living in their own normal homes, and a fifth deals with the special problems of children whose homes have broken down, or who for any reason require special care. Here are the heads: "I.-Public Protection for Mothers, Infants, and Young Children"; 'II.-Home Care and Income"; "III.Child Labour and Education"; "IV. Recreation"; "V.-Children in Need of Special Care." Leaflet 2 deals with the work for April and May, "Weighing and Measuring Test," and is in two parts: "Part I.-Suggestions to Local Committees," and "Part II.-Suggestions to Examiners." The Bureau has also issued a particularly valuable guide, "How to Conduct a Children's Health Conference," by Frances Sage Bradley, M.D., and Florence Brown Sherbon, M.D., which is full of practical advice and helpful suggestions. Another recent publication of the Children's Bureau is No. 4 in the "Care of Children Series" (or Bureau Publication No. 35). It is entitled "Milk : The Indispensable Food for Children," and it has been written by Dorothy Reed Mendenhall, M.D. It deals with the effect of war on the production and consumption of milk, the nature of milk as a food, the kinds of milk which can be used for infants, older children, and for cooking. There is a useful section on Dry Milk. The pamphlet is a strong plea and an irresistible argument for the maintenance of the proper nutrition of coming citizens: "Ultimate victory can come only to the nation that carefully conserves the stamina of its children, upon whom depends the future of the race."
We have also received through the courtesy of Dr. Jessica B. Peixotto, Executive Chairman of the Department of Child Welfare of the Council of National Defence, Washington, copies of the particularly valuable "Child Welfare Circulars," which deal with the
many and varied aspects of child welfare work in the United States. The carrying out of the weighing and measuring test of American children under 5 years of age is the first feature of Children's Year, which began on April 6. Many of the physical defects causing the rejection of something like one-third of the men coming up for examination in the first draft are believed to date from some slight trouble neglected in early childhood. A higher standard of physical fitness in the rising generation can be assured only by greater attention to the physical condition of children. Height and weight and their relation to each other are a rough index of a young child's health and development. For instance, when a child is strikingly below the average weight for his height, or is strikingly small for his age, it indicates that expert advice about diet and daily care is needed. In so far as the test makes it plain to parents that the physical condition of their children needs special attention, and in so far as it leads to community provision for public health nurses and consultation centres for babies and young children, to a safeguarding of the milk. supply, and to other measures for the protection of children, it will aid in conserving their health and in reaching the goal of 100,000 lives saved during Children's Year. The record card which the Children's Bureau has prepared for the test gives a table of average heights and weights for boys and girls at birth, at every month of age from the 6th to the 48th, and at every year from the 5th to the 16th. One-half of the card will be retained by the parents. It includes the table of heights and weights, and has blanks for subsequent records so that parents can watch the child's growth; for while a single examination is valuable, a series of examinations is far more valuable. The other half of the card provides also for recording the height and weight of the child at the time of the national test. It will be used by the local committee in analysing the facts about its own community, and then it will be forwarded to the Children's Bureau at Washington. Parents who wish to enter their children in the national test are asked to communicate with the local chairman of the Child Welfare Committee