f P 01 nc the sio dist 66 GENERAL SESSIONS We have gone beyond them in our needs which can be met only by a general diffusion No building laws will ever make premises safe until the occupancy is intelligent Whom shall we teach and when? First, children, because of their age; they are naturally interested in the acquisition of facts which affect them in their playmates. Next, parents, because of their children; the presence of a child in the family makes the parents more educable than they have been since their childhood. Next, the workers, because if they would continue to work and maintain their health they must compete with the health of others, and each industry has its own hazards against which the workers must be warned. Next, the sick, an army of people always with us and always particularly susceptible to education, partly because they are humbled by their sickness and partly because in their selfishness for recovery they are interested in what is taught. Furthermore, we can teach everyone in a community during a community epidemic whether it be from typhoid, influenza, infantile paralysis, or in the presence of a threat of cholera or plague. Lastly, we should expect to teach public officials and publicists all the time because an error on their part, or ignorance among them, leads to disastrous results. Who will be the teachers? First, the teachers in the public schools. Certainly the facts of causes and means of prevention of communicable diseases, as called for under the laws of Michigan, are more important to a child at school than the branches of the Oronoco or the princes of the Balkan States. The teachers of the laws of hygiene and the prevention of disease must not be the school doctor and the school nurse alone but the same teacher that teaches what are now accepted as the necessary elements of a common-school education. This calls for the training of our teachers in normal schools in the elements of health knowledge. Next, the physicians and nurses, both those in private and public practice who have the best opportunity of reaching people in their homes at times when their services are welcome and when their lessons are heeded. But for this, both doctors and nurses must be taught health in their schools as well as disease, and patients must ask for services while they are well in order to keep well instead of only when they are sick. To build up a family stock will be considered a greater triumph for these professions than the saving of the lives of the disabled. Dentists also have a rare opportunity and those with the modern prophylactic point of view are taking advantage of it to teach health and the laws of oral hygiene. The most recent acquisition to the group of health teachers are the social workers, but among them only those who have come into the profession through medicine or nursing can be considered competent to share in real intelligent constructive health teaching in the community. What shall be taught? This can be determined by the same standards as prevail in other educational efforts; namely, what capacity has the individual for health knowledge; what has been their previous training; and what is the character of their daily acts and lives? It is better to teach nothing than to teach what is not so. There have been three notable successes in community-health knowledge, namely, in the field of tuberculosis, the protection of child life, and the control of venereal disease. We need the same organized effort in the field of heart disease, cancer, mental disease, control of malaria, malnutrition, and hook-worm disease. At present we are searching for a spiritual, an emotional, or an intellectual appeal in the community on which to build the desire for health knowledge. Healthy people do not consciously seek health knowledge. Among the devices we shall certainly use for distributing health knowledge are health centers of whatever genesis and community hospitals, all institutions for social service through which a stream of willing learners are sure to be passing. This so-called health knowledge is most susceptible of confusion from lack of proportion among volunteers in the different health hobbies. There is so much variation in the normal limits of people for work, rest, play, food, endurance, resistance, adaptation to environment, that what is meat to one is poison to another. Mystery must be removed from medicine, and physicians be readier to say "I don't know"; to point out that not drugs but the forces of nature healed and the M.D. was the source of relief of anxiety which permitted, not caused, recovery. The motto "Man Tends, God Mends," is as true now as in the time of Ambroise Paré. What Osler applied to tuberculosis applies as well to many a disease. Not what is in the lungs but what is in the head determines recovery. It is character that cures in many diseases as it is the healing agency in social case work. To summarize: making health knowledge the property of the community depends upon trained teachers, principally school teachers, physicians, and nurses; upon the capacity and desire of the community for the knowledge, and upon teaching the truth personally; upon periodic medical examinations and community hospitals. Information is abundant and at hand but its application has baffled us chiefly because we desire a get-well-quick panacea instead of accepting the evidence that health, as other desirable human assets, is the result of self-control, unselfishness, and personal effort, and cannot be attained through endowment or public funds. The profession of social service has come just in time to take on the burden of recreating the character of beneficiaries of the government. At present the colossal generosity of the government is ruining human character and personal endeavor and initiative among ex-service men and in so doing is causing more social disability and inadaptability than it is curing; is teaching men to say they cannot work; is teaching men to develop and continue symptoms for the dollar; and is reversing the relationship to physicians. The M.D. that convinces the man that he is sicker than he thinks is praised as a benefactor. A hospital has become a boarding-house for financial ends, a school and training-center, a place for postponement of self-support. A claim is a gamble. We are reverting nationally to the charity and political hand-out phase of government subsidy and turning our back on the principles of that justice which is another word for social service. The attitude of the newspapers, of Congress, of the ex-service men through their official spokesmen is in direct opposition to the principles of social justice. Facts as to relief and hospital care are intentionally misstated. Making health knowledge the property of the community will be unattainable while the principles of character formation are undermined. The physical and industrial rehabilitation of our ex-service men and women is only part of the national obligation. For those legally ineligible for compensation, hospitalization, and training, the social forces of the country must mobilize or betray the confidence of the men in a democratic form of government. CONFERENCE DINNER OUR NATION'S OBLIGATION TO HER CHILDREN Julia C. Lathrop, Chief, Federal Children's Bureau, Washington I do not know who gave me this ambitious subject for an address, and yet I am not quite sorry to have it. I understand that someone has spoken about the government at a meeting of this conference in terms of "brass tacks." I, of course, as an employee of our government shall speak with marked gentleness. Times change but is it necessary to have any better definition of the obligation of our nation to her children than that it shall secure to each of them the inalienable right set forth in the Declaration of Independence to life, liberty, and the pursuit of happiness? It is for us in our little day to do what we can toward translating that dictum. We are sure, of course, that we see a few things that our forefathers did not see, and those of us who have any sense of the future know that posterity will smile over the things we do not see. I have been accustomed for the last nine years to think chiefly of the federal government's obligation to children, which is quite a different and much more manageable subject than that assigned me and I shall venture to speak chiefly of the government's obligation. Under the Constitution it is the right of the state to make laws regarding the children and the family. The government has a restricted function-it can investigate and report. This has a hollow sound as applied to the seven million illiterate persons in our land, most of them born and bred here. It is a hollow answer to the parents of more than two hundred thousand children who die yearly, a large proportion of them needlessly. It is a hollow answer to children who begin work before they learn how to use their minds and are doomed to the lowest level of comfort and dignity for all their lives in consequence. It has a hollow sound to the immigrant accustomed to centralized bureaucratic control, who comes to the United States with its magic promise not to any one of the forty-eight states, whose names he does not know, but one of which will govern in the main him and his children. Yet what can be done by investigation and report? Perhaps it is not so discouraging: The great power of the Department of Agriculture lies in fifty years of investigating and reporting. Out of that it has come to have certain regulatory provisions, but its greatest services to the country are those it has made by investigation and report, and these have been fundamental to the laws which have developed from them. The department makes continuously an invaluable contribution toward forwarding the science of agriculture by its laboratory research, and by its investigations at home and in foreign lands. It reports by sending agents into every country to advise as to soils and stock, and the details of farm work. It sends women agents to the door to advise as to household arts. It keeps traveling experts who develop canning clubs for girls; corn clubs, and pig clubs for boys. It shows extraordinary skill, ingenuity, and directness in its reporting the manifold applications of scientific research to the daily work of men and women engaged in agriculture, yet it exerts no authority. It is by this approach that the Children's Bureau is trying to work-investigation and report in the field of child welfare, the social field. Here the methods of research are slow, painstaking, and undeveloped and methods of reporting are still less developed. Yet the spade work of the last nine years encourages a belief in the rich contribution which such a government bureau can in time be made to give. Does not the theory of a democratic non-centralized government depend upon this method? If facts can be discovered and set uncolored in true proportion before us, can we not trust ourselves to understand and work out the remedies? There is only one answer in the long run, and it is affirmative. Ever since I learned of the recent death of Mr. Edward B. Rosa, chief physicist of the Bureau of Standards, I have desired an opportunity before a great audience of social workers to pay tribute to that modest scientific gentleman for the aid which he gave those who work in the field of social science. We are told that after being challenged by the Congressional Appropriations Committee as to the estimates submitted for the expenses of the Bureau of Standards, he determined to assemble precise data as to the general cost of the government, and he prepared a paper which finally took form under the title of "Expenditures and Revenues of the Federal Government," published this May, which showed at an opportune moment the relative cost of the various activities of the government. We shall never know quite how much he has contributed to that change in the popular current thought on the subject of disarmament of which we are now all aware. He made his facts clear by terse statements in simple English, by absolute precision of data, by charts and tables, by "pies” cut in labeled "pieces." In the 1920 "pie" the sector containing social and industrial research is hardly visible to the naked eye, while the share of the Bureau I know best could not be seen. Indeed, the Children's Bureau, spurred on by the indignity of being unable to find itself, turned to calculating percentages whereby it discovered that its cost of $271,000 for the year was less than of 1 per cent of the tiny "piece" spent for educational, developmental, and research functions, and a trifle less than 1% of 1 per cent of the whole budget and exactly Too of 1 per cent of the war "piece." These figures of Rosa's are not new. Usually they have been sedately, innocuously filed. They never entered the popular mind, yet they express stern living facts which he has driven into the understanding of the amiable and careless public. Rosa makes us see that war-past, present and future-cost 93 per cent of all the money the government spent in 1920 and forces us to realize that our only salvation for the improvement of civil government, for social research and betterment must come by reducing the 23 per cent for present military maintenance and preparation, because the great sector of the war debt, 68 per cent, must be paid. Those of us here clearly realize that democratic improvement in attaining standards of living which will make much social work unnecessary must be slackened for many long years because of the war debts, and this meeting of social workers has given evidence of its belief in disarmament for this reason at least. It is the ambition of many a government officer to emulate the ingenuity and skill in research and reporting which made Rosa's modest book his worthy monument. But the government has another method of serving the United States, the method of stimulating the activities of the states and aiding the federal states by appropriations on the fifty-fifty plan with which we are all familiar. For years, by this plan the Department of Agriculture, like a network of university extensions, has helped the farmer and his family. This fifty-fifty plan is improving our roads, and therefore reducing the isolation which is responsible for much illiteracy and child-neglect. It is helping to improve vocational education. It is building up knowledge of social hygiene. Some of us trust that it may be invoked to improve the care of mothers and infants and to reduce the present infant and maternal death rates. The present Federal Child Labor Law, which undertakes to control the labor of children in industry by taxing the net income of industries which employ children illegally, is an experiment not yet passed upon by the Supreme Court. However, whether sustained or not, it can hardly be depended upon as a precedent of federal legislation in the protection of children. Indeed extended governmental control would do violence to local autonomy beyond the measure of any benefit it could confer as some of us believe. On the whole, the great service of the federal government in the child welfare field is that of improving, increasing, and popularizing knowledge-a vast series of government extension schools, if you please, where there is no compulsory attendance, but millions of eager students. The nation, through the machinery of its forty-eight states, is responsible for the welfare of children and in all those matters reserved by the Constitution for state control. The inequalities are great and even shocking. Sometimes they seem beyond toleration, but cheering indications of progress are observable. One may refer to the new interest in child health and the thirty-eight states which have in recent years created child hygiene divisions within their boards of health, to the vast increase in the popular conviction that children can be kept well and not need to be cured. The increase in rural and city public health nursing and in the number of child health centers throughout the country points in the same direction. The solution of the health problem should be more rapid, but it is well begun. The juvenile court movement swept the country with an enthusiasm for taking the helpless child of neglect out of the category of criminals, and all of our states have juvenile court laws, yet we were told in 1918 that of the one hundred and seventy-five thousand children who appeared before the courts, fifty thousand were heard in courts without adequate equipment for their reasonable protection. The effort to control child labor by good schools and compulsory education laws is steadily becoming more effective and is at last reaching toward the rural child. We must not be surprised, however, that foreign visitors are disappointed in us when they see some of our failures instead of looking only at the brilliant successes reported to them abroad and which, as a matter of fact, they have imitated. This inequality is one of the evils of legislation by forty-eight separate states which time and public interest are slowly remedying. The Committee of Juvenile Court Standards which has been formed at this conference gives promise of study and research which will aid in stimulating interest and pride in equipping juvenile courts to serve the ends for which they were intended. |