Emaciation and extreme stunting in length, weight and mental development, usually to a degree of two years below standard for age prevails throughout childhood.

Among the communicable diseases, aside from diarrhea in summer, and dysentery of the older children, tuberculosis is the only one showing an increase. Scarlet fever, diphtheria, whooping cough and mumps all show very low incidence. The closing of many of the tuberculosis sanatoria, the unemployment, the lack of separate rooms and beds for the advanced cases at home has led to a massive exposure of little children and a great increase in active disease in the first 5-10 years of life. It is in the age groups, 10-20, and 2030 that the greatest increase in deaths from tuberculosis has occurred in the past year, and it is with ages under ten that the greatest increase in tuberculous infections has appeared. Syphilis has not increased notably among children.

The third notable change in the general picture of children's diseases is to be found chiefly in the out-patient departments or dispensaries where eczema, contagious skin infections such as impetigo, scabies and pediculosis or louse infection are amazingly frequent and particularly noticeable in a people rather remarkable formerly for their cleanliness of person and living places. Lack of soap, of warm water, of clean underclothes, closing of public baths, and cold, crowded living and sleeping rooms appear to be responsible for the prevalence of skin infections.

FOOD, CLOTHING, HOUSING AND UNEMPLOYMENT

The best single index and probably the most reliable material measure of the adequacy of children's nutrition in a modern municipality is the daily per capita consumption of milk. Owing to depreciation in the value of the mark, the farmers have bought little or none of the oil cake and other imported food and forage supplies for milk cattle. The cows, fewer in number than before the war, produce much less milk and of a lower butterfat content and presumably lower

also in vitamin elements. When, therefore, we find reductions to one-sixth and one-eighth commonly, and in some instances to one-twentieth of the milk formerly taken daily in the cities now brought in, and of this sometimes one-sixth not sold because of the rise in price, we can picture the results upon children's growth and health. Few if any children over four have had milk in the cities since 1914, unless they were sick in hospitals. The milk rarely runs over 3%, and more commonly 2.7% butterfat. The price formerly five cents or less a quart is now up to seven and a half to twelve cents a quart.

Reduction in the per capita consumption of meats and other foods, though serious, has not been so great a factor in deterioration of children's health and has not been of such extent.

Examinations which I made of upward of 300 children of pre-school and school ages, fully confirms the reports which had been received by the health officers of districts and cities throughout Germany in November, 1923, to the effect that ragged, soiled, thin, unsuitable or wornout underclothes and shoes were to be found to an extent never known to teachers, nurses or doctors before. Outerclothing in the main is well mended, and in good order, although many girls are wearing calico and other thin dresses even in winter weather. Overcoats are often lacking and this with poor shoes keeps many children at home in cold and stormy weather.

Poor sleeping, bad air, exposure to infection, demoralization, result from the prevalent or common use of the one or two bedrooms and the closely placed beds by many persons of both sexes and all age groups. Three children in a bed and five or six persons in a bedroom are common in city and country. I found a grandmother, mother and child of three all sleeping in the same bed and all with tuberculosis. Premises formerly forbidden as unfit for human habitation are now crowded, in cellars below street level, in attics with no artificial light, with the occasional heat from the cook stove, warmed up once a day-and still whole families have to resort

to the municipal lodging house for lack of other shelter. Every city visited has thousands of homeless people for whom housing in any reasonable sense of the word is impossible. The children suffer most from these conditions and while public and private institutions are closing for lack of means to meet the upkeep, the appeals to them to give shelter to the children increase.

Unemployment exists to the extent of twenty to forty per cent of the population of the various cities visited and the most that can be given to sustain life for a man, wife and two children under fourteen years of age is 10.5 gold marks a week, or about $2.50, an amount, even when considering the further concessions as to rent, bread, public kitchens, etc., which barely permits survival, but forbids cleanliness of body, replacement of wornout clothing, or actual growth, or healthy maintenance of weight of children under five years of age. The family budgets which follow are from among those whose homes I visited in Berlin and Breslau.

Man 40, wife 37, formerly furworker, unemployed, four children, 12, 10, 9 and 2. One room and kitchen, rear tenement.

Man 40, wife 38.

(Deficit made up by German Red Cross)

Children 14, 12, 10, 6 and 21⁄2 years (another

Public relief and volunteer agencies are well organized and do high grade work with the least possible personnel and expense. Much help is given by teachers, doctors, and neighbors, but the middle class is so reduced in means and even doctors, artists, officials, are so often themselves necessary recipients of public dole that little can be given in cash. Neighborhood relief such as luncheons and extra meals is increasing. The public as a whole and those who still have material resources to spare are being educated to the necessity of giving to others. But the lifelong experience of the people of modern Germany, that poverty, old age, sickness and unemployment were problems to be met through government and not by private aid makes it difficult to shift the burden now to the very small groups of relatively well-to-do.

Contrasts are abundant and luxury is to be found in clothing, amusements, eating and traveling among a very small group in the large cities. Those who appear to have wealth are: 1. People who borrowed largely and paid their debts and mortgages in worthless paper marks; 2. The so-called industrialists; 3. The persons who through native shrewdness or warned by friends in government and banking circles avoided investments in German securities and placed all their financial assets outside of their country where income in stable currency could be counted and taxation largely avoided; 4. The bankers; 5. Some of the larger farmers.

A government such as Germany has, today receiving 80% of its income from wage-earners, which has not succeeded in reaching for purposes of revenue the wealth of the groups above mentioned, cannot support from public revenue the constantly increasing proportion of the entire population now, without savings or earnings, at least under such conditions of environment and nutrition as will maintain the life and growth of children and spare them the dangers of increasing physical deterioration and an unprecedented amount of infection with tuberculosis.

It would appear reasonably clear from the fluctuations in

birthrates, deathrates, and disease incidence that a very considerable amount of recovery from the most serious results of the war, so far as vital statistics reveal the facts, had occurred by 1920 and 1921. During the latter part of 1922, and to a constantly increasing degree throughout 1923 a change has occurred, with a rapidity quite explicable in view of the conditions which had prevailed from 1914-1919, which threatens to become a widespread catastrophe, at least for the children of Germany.

The results of thrift, insurance, sickness benefits, etc., have now been swept away by the progressive depreciation of the mark. The people of Germany, and in particular the children of the country are at present the helpless victims of the complete wrecking of the monetary value of human labor and the cessation of employment.

January 14, 1924