Hungry Children
I
WHEN children are the victims of catastrophic forces, there is a reflex action characteristic of Americans. We hear the news, and instantly our hands go to our pockets. Within my own short memory, we have fed starving Belgians, famine-stricken Russian waifs, hungry Armenians, and Austrian babies pallid with anæmia and gnarled with rickets after the Allied blockade.
Yet four years ago, when we began to hear that American children were hungry, we were only slightly agitated. At that time one child in every five in the United States was not getting enough to eat. True, those children were rarely actually starving; they only missed breakfast or lunch; they had subsistence rations the rest of the day.
Somehow, there was nothing very terrible about that. We were preoccupied then. Banks were toppling, factory furnaces guttering, the stock market daily reaching new lows. So absorbed were most of us with feeding and sheltering our own families that we gave little thought to other people’s children. Moreover it was true, as so many were pointing out then, that everyone in America did have something to eat. Even in such a typically poverty-stricken mining community as Fayette County, Pennsylvania, everyone was fed. Grocery orders equivalent to $1.97 per week for a family of five went to the workless. On this income there was a regulation diet of corn meal, bread, and coffee for breakfast; potatoes and bread for lunch; for a lavish dinner, rice, fried oatmeal, and coffee.
In the fall of 1933, the Children’s Bureau of the Department of Labor etched the results of such nourishment. It called to Washington a conference of experts composed of representatives of the departments of health of thirtyeight states, the American Medical and the American Dental Associations, and other civic, welfare, and educational groups. From their discussions this picture emerged: —
In New York City, where more than 300,000 school children are examined annually, malnutrition was jumping. In the borough of Manhattan it had increased from 16 per cent in 1929 to 29 per cent in 1932. In the Bronx it had mounted from 13 to 23 per cent in the same period.
The health officer of Detroit reported that a special survey showed 18 per cent of the school children in the lower grades of eighteen selected schools to be undernourished.
The records of the Community Health Center of Philadelphia indicated an increase in malnutrition from 30 per cent in 1929 to 42 per cent in 1932.
The Pennsylvania State Department of Health, which annually examines nearly a million children in every county outside Philadelphia, announced increases of from 10 to 45 per cent in undernourishment.
The American Friends Service Committee found that half the children in five counties of two coal-mining states were underweight. In some schools 90 per cent showed signs of malnutrition.
In Springfield, Ohio, 31 per cent of the children in the elementary grades showed the effects of hunger.
One of the physicians in the Maryland State Department of Health, referring to the work of his departments in certain mill towns, said, ‘Despite all our efforts to put milk and eggs and some meat into the families, especially where there are children, we have not succeeded in preventing a considerable appearance of malnutrition.’
Most of the members of the conference stated that their more informal observations had led them to the same conclusions.
Now we do not know exactly the effect of niggardly and inadequate diet upon children, whether or not they grow up bitter, resentful, warped, or morbid. To what degree the Nazi mind is the result of the war and the blockade cannot be computed. It is not unreasonable to assume, however, that the restricted diet had some effect. Certainly there was concrete evidence of its physical effect, for the German children born during the war were small; the pegs on which they hung their hats and coats in school had to be lowered several inches.
We in this country cannot afford to ignore the menace of malnutrition within our own borders. If the United States is to continue a community of free men, making revisions and changes in institutions with discrimination dictated by insistence on preserving the essence of the democratic philosophy, a healthy, and a healthy-minded, populace is an obvious necessity.
Well — the Children’s Bureau’s conference formulated a ‘Child Recovery Programme.’ Federal Relief Administrator Harry Hopkins promised that the eight million children on relief rolls should have not only enough to fill their stomachs, but enough of all varieties of food to ensure them a healthy growth.
II
What, then, is the situation to-day? Here are some recent reports which give a fair indication of conditions, now that our machines are gaining impetus and the business index is rising steadily.
In 1935 the New York Board of Education announced that malnutrition had rendered 135,000 children in the city’s elementary schools too weak and undernourished to profit by attendance in classes.
The Children’s Bureau made a study of 259 households in Atlanta and Memphis; Racine, Wisconsin; Terre Haute, Indiana; and Washington, D. C. In one fifth of these families the diet consisted chiefly of bread, beans, and potatoes. In 61 per cent of all these homes there was a serious lack of sufficient vegetables containing essential diet elements. A very large proportion of these youngsters — 43 per cent of 504 children in all these cities except Washington — had absolutely no milk at all either at home or at school.
The Children’s Bureau has made another study in coöperation with the National Organization for Public Health Nursing and fifty-seven public health nursing agencies in cities in thirty-three states. They found that only 8 per cent of the 10,000 families they reached had an adequate milk supply, and 48 per cent of their 28,000 children had less than half the milk they needed.
Eighteen of the standard railway unions and three bureaus of the United States Department of Labor made a comprehensive study of the earnings and standards of living of 1000 railway employees. Their findings are far from reassuring. More than half of all the families had cut down from 50 to 75 per cent of their milk supply since the beginning of the depression. Butter, meat, fresh fruits, and vegetables were most often drastically reduced, and occasionally eliminated entirely from budgets.
The investigators found widespread neglect of health in these homes. In nearly a third of these thousand families, one or more members needed medical attention, but could not afford it. Notices from schools that children’s teeth required attention were disregarded. Repeated requests from school authorities for removal of children’s tonsils were ignored by ordinarily solicitous parents. Reports showed that in more than a quarter of these families at least one person needed examination for eye trouble, 72 of them young children.
Now these reductions in the food the mothers purchase for their children have not been the results of idiosyncrasies of the relief administration. Of the 259 families interviewed in five cities, 41 per cent had never had relief at any time; 47 per cent had had help during the depression, and only 10 per cent were so-called ‘ chronic ’ relief cases.
The study of the railroad employees depicts conditions in the homes of men employed in a well-organized and thoroughly regulated industry. Those New York school children were not examined as the victims of relief.
As a matter of fact, as long as grocery orders were given, or as long as housewives utilized their cash relief funds according to the budgets prepared by the Administration’s experts, children of destitution were actually better off than those living on incomes always low and further depressed by the past years of hard times. The serious deficiencies in the food which can be given the children of parents living on low incomes are demonstrated in a significant study being made at present by the United States Bureau of Home Economics and the Bureau of Labor Statistics. These two agencies have gathered about 3000 weekly records of food consumption from urban families in different parts of the country at different seasons of the year, and are analyzing them from a nutritional standpoint. The first of the surveys — on winter diets of 209 white families in eight North Atlantic states — brings into sharp relief the differences in consumer choices as the housewife has more money for food. Those homes which could spend only $1.20 to $1.80 per week per food cost unit were unable to secure a diet with enough of any of the elements generally regarded as essential except vitamin A. When the families had from $2.38 to $3.00, they were able to have — and did buy — enough of all the varied factors of a well-balanced diet; while those who spent from $3.57 to $4.17 had ample to eat of everything. This latter group had between two and three times as much eggs, milk, meat, fruits, and vegetables, other than potatoes and dried legumes, as the poorest families.
In New Orleans, according to this study, 31 per cent of the representative families whose budgets were analyzed did not spend enough for food to obtain an adequate diet at minimum cost, and in Birmingham the figure jumped to 43 per cent.
III
It is too soon to ascertain the results of these conditions in this country. The studies have been sketchy; few of these children have been watched over a period of years to determine their development in relation to nutrition and other factors. We do, however, know the general results of undernourishment.
We can see dietary lacks in deficiency diseases as clearly as we can see a broken leg. There is xerophthalmia, from lack of vitamin A, which causes blindness. Milk fat is the best preventive for this, and a quart of milk a day is sufficient to avert it, though vegetables, citrus fruits, and cod-liver oil added to the child’s rations provide a wider margin of safety.
Rickets and pellagra are widely known. Rickets, with its heart-rending manifestation of misshapen legs and arms, deformed head, chest, or pelvis, is caused by absence of vitamin D, cheaply supplied by cod-liver oil. Pellagra, indicated by extreme weakness, sores, bleeding gums, and gastric disturbances, appears in children who do not have vitamin G, which can be economically provided in yeast, dried skim milk, or canned salmon.
These diseases are, however, relatively rare. There are many more pale, irritable children the country over whose unmet needs are not so conspicuous. These underfed children are not growing properly, in mind or body. They are dull in school. Their eyesight is not as good as it should be. Their teeth decay, and there is a frequent ear discharge. Lack of food causes a continuous subtle pounding on the nervous system, so the underweight child is often overactive although his mind is not alert.
Insufficient food deprives the child of reserve energy and strength. Because he has scarcely enough to get along on from day to day, he is subject to every disease that comes his way. He readily gets measles, whooping cough, influenza, pneumonia, and suffers seriously. His life is a procession of illnesses. Not only is he an easy prey to infectious diseases himself, but he is also a source of danger to other children.
If a child’s mental development is not thus obstructed, he may develop lopsidedly. When he knows that the little boy at the next desk goes home to a fine hot lunch with meat and milk and biscuits and jelly, while he can have nothing but fried oatmeal and coffee, naturally he thinks there is something wrong with the world.
It is hard to measure these subtle results of undernourishment. The British in recent years have, however, seriously concerned themselves with the physical results. In the winter of 1933 the British army had to reduce its minimum requirements to five feet three inches in height and 113 pounds in weight.
Sir John Boyd Orr, one of England’s leading authorities in this field, who argued that half the population of his country are living below his ‘optimum standard,’ — a diet sufficient to maintain fullest health, — made significant tests that showed drastic differences in the children of various income groups.
Measurements for height were taken over a period of years: 1926-1935. A marked difference in the height of boys in the different income classes emerged. At thirteen years of age, boys at Christ’s Hospital School are on an average 2.4 inches taller than those of the free schools. At seventeen, they are 3.8 inches taller than ‘employed males’ who left school, usually at fourteen, and went to work, and who may be taken as the same class as those who attended the free schools. At thirteen and one-half years of age, boys of the lowest class were about 5.8 inches shorter than the average of lads the same age of the public-school class.
Sir John Orr found three signs of malnutrition in children — rickets, bad teeth, and anæmia — fairly widespread in the lower income groups. There is, he states, ‘evidence to show these same deficiencies affect resistance to some infectious diseases such as pulmonary and intestinal disorders in young children. Children with rickets show a higher incidence of complications and a higher death rate from some common diseases, such as whooping cough, measles, and diphtheria, than do those in the same environment without rickets.’
Dr. G. C. M. M’Gonigle, medical officer for Stockton-on-Tees, believes Sir John Orr errs on the side of conservatism. A dramatic survey made by Dr. M’Gonigle and J. Kirby, Poverty and Public Health, presents some facts which are profoundly disturbing.
One group of 777 families showed a shocking death rate. Records of these families were made over a period of four years. The majority of them, 408, were more or less continuously employed, but earning low incomes. The remainder were living on the dole. In the employed families there were 1564 people; in the unemployed, 1572. The mean income of the employed families was about $12.87 per week; that of the unemployed was $7.30. The death rate for the employed group was 21.01, as against the expected rate of 8.53. The death rate for the unemployed was 29.29, compared to the expected 8.75.
‘It would appear,’ say these scientists, ‘from the evidence so far available, that the incidence of physical defects and death rates is associated with nutritional factors, and that the nutritional state is closely associated with purchasing power.’
The importance of nutrition, compared to other factors such as housing, was demonstrated by another set of figures Dr. M’Gonigle describes. He points out that a poor family cannot each week purchase what food it needs and then devote the balance of its funds to other items. Actually, the reverse is true. Each home has certain fixed charges: rent, fuel, light, and so forth. Only when these are met can food be bought, and these items make up the large proportion of the total budgets of impoverished households. If any of these costs increase, the only item in which the housewife can economize is food. This she does, with dire results.
The effect of an increase in rent was shown in a special investigation. In 1927 an ‘unhealthy’ area in Stocktonon-Tees was demolished. The population of 152 families, comprising 710 individuals, were moved into a modern, sanitary housing unit, the Mount Pleasant Estate. These families contained a high percentage of young people. It was expected that the combination of youth and better, though slightly more expensive, housing would result in a low death rate, of about 8.12 per thousand for the five-year period 1928-1932. Actually, it was approximately four times what it should have been: 33.55. The story may be gleaned from the fact that among the employed families in this fine new housing estate 51.2 per cent of the total income was consumed by rent and other necessary expenditures; in the unemployed families it amounted to 60.6 per cent. In both cases the amount available for food was well below the minimum considered necessary by the British Medical Association Nutrition Committee.
IV
With the rise of the cost of living in the United States, and the usual lag between rising wages and increasing living costs, we may perceive a somewhat similar situation. Moreover, we have always had a large sector of the population existing on a relatively very low income. Even in 1929, according to the Brookings Institution’s estimates, 17.33 per cent of American wage earners had an annual income of $1000 or less.
We also have a relief situation which, viewed from this angle, is none too happy. When the Federal Government instituted its WPA programme, it did not, as it promised, take care of all the nation’s unemployed. In great urban centres, especially, it was impossible to set up enough projects to provide employment for all those certified as employable. For instance, in Chicago, 200,000 families were on the relief rolls. The WPA expected to put 80 per cent of them to work. Actually it could use only 50 per cent. Because of finance difficulties, last August the city was giving only a minimum food ration; nothing more.
When Federal aid was withdrawn from Nebraska, family budgets were cut anywhere from a third to one half, the average being $25 per month. Moreover, in the wholesale reduction of the relief rolls made necessary by the state’s constitutional limitations, all who were assigned to WPA were cut off from any aid, whether the WPA could give jobs or not.
In Arkansas, late last spring, the average relief per family in rural districts was $4.00 per month; in urban centres, $5.00. All mothers with children were declared unemployable, and so ineligible for relief, although Arkansas has no mothers’ pension law.
In many states, for instance Missouri, the projection of the WPA programme has been accompanied by diminishing funds for direct relief. In others, when Federal help was withdrawn, state aid was also ended, leaving heavy loads on communities which suffered a concentration of unemployment. Thus St. Louis, with its 8000 ‘unemployables,’ had to cut its allowances last May to an average of $22 per month.
The American Association of Social Workers made a detailed survey of what happened in New Jersey last summer when that rich state laid its relief burden back in the laps of the local communities. In a majority of the forty-one districts surveyed, it found food allowances cut 50 to 75 per cent below the minimum subsistence level fixed by the state relief administration. In twentysix of them no fuel for cooking was provided.
Even the WPA’s ‘security wages’ are not always adequate for the food necessary for healthy growing children. It is illuminating to compare the diet described as essential with the financial possibilities of a large sector of our population. This diet is described by Burnet and Aykroyd in the authoritative survey, Nutrition and Public Health, published by the health organization of the League of Nations: —
The essence of modern practical dietetics can be briefly expressed in terms of foodstuffs. One of the principles is the desirability of a mixed diet. A second is the value of a large intake of the protective foods — milk and green vegetables, to which may be added fruit.
Once the consumption of ‘protective’ foods is assured, elasticity in the remainder of the diet is permissible and choice may be allowed free range. Meat, which some class among the protective foods, in moderation, is a useful and palatable article of diet, supplying first-class protein and vitamin B2. Unmilled cereals are richer than milled cereals in protein, mineral salts, and vitamins. The greater the quantity of cereal in the diet, the more important it becomes that the nutritive parts of the grain be consumed.
In temperate lands it is difficult to provide sufficient vitamin D through ordinary foodstuffs. Infants and children therefore need to be supplied with extra vitamin D in some form, e.g. cod-liver oil. This will ensure freedom from rickets and, assuming the hypothesis of Mrs. Mellanby and her school is correct, from dental caries.
A well-balanced diet is particularly necessary to children. A diet which may keep an adult living an unexacting life in fair health may fail to meet fully the requirements of a growing boy.
Now the United States Department of Agriculture has taken these requirements and translated them into budgets and menus in a useful little pamphlet entitled Diets to Fit the Family Income. It describes four possibilities — a plan for a liberal diet, a moderatecost adequate diet, a minimum-cost adequate diet, and a restricted diet for emergency use.
According to 1935 retail prices, the minimum-cost adequate diet requires an expenditure of $9.15 a week for a family of four, while the restricted diet — which frankly does not provide a sufficient surplus of protective foods to ensure good health over an indefinite period — costs $6.15 a week. However, since these plans were made, food costs have gone up — 5.8 per cent as this is written. And relief wages, to mention this income class only, have not risen correspondingly. Thus if a workman on a $55 WPA wage were to feed his family of four enough to ensure their health, at 1935 prices, he would be spending $39.65 a month, leaving $15.35 for all other costs. Even if his wife were an accomplished home economist, which seems essential to make the very simplest and most practical of these scientific plans work out according to hope, prayer, pencil, and paper, it could not be done.
Even the relief diets expertly planned, and for a long time given out as food rations, did not meet wholly the requirements set by this Department of Agriculture scale. For instance, in Chicago, the average granted by the Illinois Emergency Relief Administration was higher than the restricted diet, but slightly lower than the adequate diet. It amounted to about $27.70 per month.
V
It is apparent that vast numbers of American children are going hungry. We have seen what this may mean in terms of death rate, in terms of public health. We can let our imaginations range unpleasantly over the social consequences.
Without going into such complex and complicated subjects as wage rates or relief-payment scales, there is one easy remedy. That is more milk and food in schools. There is no reason why a quart of milk or a bowl of vegetable soup should be less a part of our educational equipment than gymnasiums or libraries.
Some English experiments bring out the efficacy of this remedy. In 1930 some 20,000 Lanarkshire school children were under review, 10,000 receiving a ration of three quarters of a pint of milk per day, the others receiving no such ration. Both groups were mixed, well-nourished as well as underfed children being included. The results demonstrated that the addition of milk to the diet had a striking effect in improving physique, promoting general health, increasing mental alertness.
Another experiment was carried out by Dr. Corry Mann among schoolboys at an industrial school near London, where the boys were all on a basic diet, considered adequate. Dr. Mann divided the boys into two groups, one remaining on the regular diet and the other receiving additional milk. At the end of a year, the ‘basic5 group had gained an average of 3.85 pounds in weight and 1.84 inches in height; the other, with the supplemented diet, had gained 6.98 pounds and 2.63 inches.
Dr. Mann said in his report, ‘Apart from the marked gain in weight and height, there is also a general improvement in their physical condition. They lose the marked tendency to chilblains. In addition they become far more high-spirited and irrepressible, being often in trouble on that account, and though it is not possible to measure this change in their mentality by statistical methods, yet the change was unmistakable.’
This ounce of prevention is so easy. The price is cheap in return for hearty children and a healthy people.