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REPORT UPON HEALTH, SICKNESS AND HUNGER

AMONG GERMAN CHILDREN

TO THE AMERICAN FRIENDS SERVICE COMMITTEE

BY

HAVEN EMERSON, M.D.
Professor of Public Health Administration

Columbia University

As requested by Mr. Wilbur K. Thomas, Executive Secretary of the American Friends Service Committee in his letter of December 12th, I have made a brief but rather intensive survey of the state of health of the children of Germany.

The information upon which I offer the opinions contained below was obtained personally in Germany in the first place by visits in the homes of about one hundred families of various social and economic groups, by inspection of children up to the age of fourteen in fifteen general and special children's hospitals, by examining children in day nurseries, nursing homes, shelters, orphanages and asylums, in the cities of Berlin, Breslau, Dresden, Munich, Frankfurt am Main, Cologne, Coblenz and in the town and district of Opladen; and secondly, by the study of data recorded and issued through public and private agencies concerned with the administration of services for the protection of health, the care of the sick and relief of dependency for Germany as a whole and particularly for those cities and districts where I had made personal investigation of the conditions as they exist at present.

Recognizing the entirely natural skepticism and distrust with which the American public still view any appeal for help from Germany, or any statement of distress designed to enlist sympathy which could lead to political, sentimental, financial or other action helpful to Germany, it was necessary to take unusual precautions in verifying statements coming from official and volunteer relief agencies. It seems to me that the facts I offer from personal observation and the statistical material presented to supplement these, are free from exaggeration or fallacy and are quite as reliable as similar reports would be if obtained in equivalent communities and from comparable sources in the United States. The official reports studied were only those prepared to make the existing state of affairs clear to the government and people of Germany, and were not intended in any way for foreign propaganda.

It was unfortunate for my purposes that all the schools were closed during my stay in Germany, an extra ten days of vacation having been decided upon because of the shortage of coal to heat the schools. The inability to see children in their classrooms and to examine them in large numbers under ordinary conditions of school attendance was to a considerable degree offset by the thoroughness of the recent (October and November, 1923) examinations and questionnaires completed by school physicians and nurses for large school groups throughout Germany, with a view to planning for the increase of relief and feeding which must be provided during the coming school term.

An element likely to lead an observer into error in judging of the clothing and feeding of children between December 23rd and January 3rd (the dates of my visit) was the character of observance of the Christmas and New Year's festivals, when every one made an effort to appear at his best, especially on the street. If it had not been for the opportunities I had to visit in the homes, I should have been grossly deceived in estimating the extent of deprivation.

Cold weather (12-20° F.) with much snow and wind and little sun, prevailed throughout the period of my visit. By

traveling entirely at night, and arranging beforehand for access to the institutions and records desired, no time was lost in the cities visited in obtaining introductions to officials. Public officers were warned in all instances that estimates were not desired, and only conservative and well authen. ticated facts were acceptable.

Owing to local variations in the extent of non-employment, the facilities for housing, the milk supply, the adequacy of official and volunteer health agencies, medical relief resources, etc., there were appreciable differences in the situation of the children in the cities visited, but this report would be made unduly long if such minor details were included. The picture was so nearly the same everywhere that no analysis of conditions by districts will be made here. The impression was quite definite, however, that in Berlin, Breslau, Dresden and Coblenz, there were relatively greater distress and need of quick assistance than in Munich or Frankfurt.

CHILDHOOD IN THE FAMILY

A reduction of the birthrate from about 30 per 1,000 to 15 per 1,000 has not been accompanied by an improvement in the condition of the expectant mother, for there is less prenatal care, an increase in the mortality from childbed fever, an increase in stillbirths, and a great diminution in the proportion of mothers who can nurse their babies. Not over 50% of mothers and in some districts only 33%, are able to nurse their babies, and these for but a few weeks instead of six months and more as formerly. Breast milk is found to be reduced to about one half the usual daily amount. Wet nurses in institutions and hospitals can rarely give more than 100-200 cubic centimeters of milk to a foster child and still nourish their own child, while formerly it was common to obtain 700-900 cubic centimeters a day of surplus breast milk from a wet nurse. One in ten of the babies born alive in Berlin is given over to an institution to raise because of poverty of the family.

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Many healthy, vigorous babies were seen where the mother nursed, but after the early weaning, now so common, the shortage of cow's milk and its expense causes a marked arrest in development and defect in quality as well as in quantity of tissue growth. Beginning with six months and even younger, babies are found in the hospitals in considerable numbers with marked pulmonary tuberculosis. It is not uncommon to find 15% and even 25% of the children under two years of age in hospitals, suffering from lung tuberculosis. This has been a development of the past twelve to eighteen months and is a new experience in the hospitals visited.

The runabout child (2-5 years) is less commonly sturdy than the infant under one, partly because no child over four, unless in the hospital, and in most places no child over two years of age gets any fresh cow's milk, except as a rare treat, and partly because of lack of suitable shoes and outerclothing they are kept indoors and suffer from lack of light and air.

Due to the reduction from 20% to 50% in the number of cribs and beds kept in commission in day nurseries, children's shelters, etc., children under school age less often receive the food, cleanliness and medical supervision which did much to relieve poor home conditions formerly. From infancy to school age marked rickets is so common, anemia, listlessness, poor muscular tone, sunken eyes and emaciation are so generally seen that one loses a sense of proportion and is inclined to underestimate the extent of depreciation of vitality which is almost everywhere obvious among the children of the wage earners, the lesser public officials and the 20% to 40% of the adult population who are unemployed. Children's specialists of German cities who go out of Germany to Switzerland, Holland, Norway or England, return amazed at the appearance of healthy childhood they find abroad..

Among children of school age there is a prevalence of tuberculosis not known to school physicians heretofore. Lack of breakfast and often of lunch, lack of shoes, or worn out or felt shoes, lack of stockings, underclothes and winter

coats are all so common that the undersized, pallid, listless, thin children seem but the natural result. The weakness of children from hunger is a common cause of fainting, dizziness, headache and inability to study. Up to 20% of children applying at six years for admission to school have to be sent home as unfit to attend. School hours are from eight to one o'clock, with no afternoon session. Classes are commonly of 45-60 children instead of 35-40 as formerly. The temperature of class rooms can rarely be kept up to 60° F. Meat once a week, no milk, chiefly potatoes, bread with margarine or vegetable fat, beets and turnips, meal soup, constitute the most liberal diet of an average school child. From 1-2.5% of school children in some districts are found to have open pulmonary tuberculosis. Arrested but crippling rickets, bone and joint and gland tuberculosis are common and there is much skin infection, lousiness and itch among school children.

CHILDREN'S SICKNESS

In the hospitals one might expect to find, if anywhere, evidence of an altered picture of disease in childhood. The outstanding facts are that, as specific results of what we must call undernourishment and unsuitable conditions of home environment:

Rickets of advanced and serious form is almost universal, but quickly remedied by cod liver oil, by artificial light and improved conditions of life;

Scurvy is less common but increasing, particularly in the past three months and in the northern and eastern districts, and is also easily remedied by oranges and fresh vegetables when obtainable;

Keratomalacia has appeared, a form of ulceration of the eye, easily leading to blindness unless quickly recognized, and quickly curable with fresh milk and suitable diet;

Edema, due to lack of fats in the diet is still rare, but beginning to reappear after an absence of several years since 1918-19;

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