HB 
 
GIFT OF 
 

GIFT 
 APR 10 
 
 \J IN 1 V I - l\ 
 
 HANDBOOK 
 
 OF 
 
 CHILD HYGIENE 
 
 As civilization 
 oes dovn the 
 baby death rate 
 
 LYDIA ALLEN DEVILBISS, M. D., DIRECTOR 
 DIVISION OF CHILD HYGIENE 
 
 KANSAS STATE BOARD OF HEALTH 
 TOPEKA 
 
 7-4194 
 
y\ 
 
 BULLETIN OF 
 
 The Kansas State Board of Health 
 
 S. J. CRUMBINE, M. D., SECRETAEY. 
 Published monthly at the office of the .'^cretary of the Board, Topeka, Kan. 
 
 VOL. XIV, Nos. 8 and 9. TOPEKA, KAN. Aug. arid Sept., 1918. 
 
 Entered as second-class matter, March 5, 1906, at the post office, Topeka, Kan., under the 
 act of Congress of July 16, 1894. 
 
 CONTENTS. 
 
 The President's Letter. 
 
 Results of the Draft Examination. 
 
 The Significance of the Declining Birth Rate. 
 
 Infant Mortality. 
 
 Studies in Infant Mortality. 
 
 Reduction of the Infant Mortality Rate. 
 
 School Hygiene. 
 
 The Child Wards* of the State. 
 
 Child Welfare 
 
.; T ; ^j^ ,5. 
 
 (COPY.) 
 
 THE WHITE HOUSE, WASHINGTON. 
 My Dear Mr. Secretary: 
 
 Next to the duty, of doing everything possible for the 
 soldiers at the front, there could be, it seems to me, no 
 more patriotic duty than that of protecting the chil- 
 dren, who constitute one-third of our population. 
 
 The success of the efforts made in England in behalf 
 of the children is evidenced by the fact that the infant 
 death rate in England for the second year of the war 
 was the lowest in her history. Attention is now being 
 given to education and labor conditions for children by 
 the legislatures of both France and England, showing 
 that the conviction among th$ Allies is that the protec- 
 tion of childhood is essential to winning the war. 
 
 I am very glad that the same processes are being set 
 afoot in this country, and I heartily approve the plan 
 of the Children's Bureau and the Woman's Committee 
 of the Council of National Defense for making the sec- 
 ond year of the war one of united activity on behalf of 
 children, and in that sense a children's year. 
 
 I trust that the year will not only see the goal reached 
 of saving one hundred thousand lives of infants and 
 young children, but that the work may so successfully 
 develop as to set up certain irreducible minimum 
 standards for the health, education and work of the 
 American child. 
 
 Cordially and sincerely yours, 
 
 (Signed) WOODROW WILSON. 
 
 398582 
 
116 Kansas State Board of Health. 
 
 Results of the Draft Examination. 
 
 "It is not an army we must shape and train for war, it is a nation." President Wilson. 
 
 Report of the Provost Marshal General: 
 
 Total men called by draft 3,802,946 
 
 Total examined by loeal boards 2,510,706 
 
 Total rejected by local boards for physical reasons 730,756 
 
 Percentage of those examined rejected 29.11 
 
 Add 5.8 percent rejected at cantonments (esti- 
 mated) 33.11 
 
 There is no disputing these figures. There is no sentiment 
 attached to them ; they are the cold facts obtained by military 
 machinery. If one-third of American manhood between the 
 ages of 21 and 31 is so physically defective as to be rejected for 
 military service, what is to be expected of those under 21 and 
 past the age of 31?* 
 
 The most superficial analysis of the causes for which men 
 are rejected for service shows that more than 60 percent of 
 these defects are preventable ; that 30 percent are due to poor 
 general physical condition, which can be remedied by proper 
 feeding, by proper attention to personal hygiene and physical 
 training ; that another 30 percent are due to defective eyes and 
 teeth, including bad mouth conditions; and that only 10 per- 
 cent are due to neglected surgery. 
 
 An analysis of the purely preventable defects for which 
 these men have been rejected shows that they are not acute or 
 of recent occurrence, but that they are chronic conditions 
 that is, they have existed for years, many of them from early 
 childhood. A little more attention to the physical needs of 
 children, correction of their minor defects while they are still 
 easily remedied, and proper health protection of the growing 
 boys and girls would result in a very different health and 
 efficiency analysis of the adult population. 
 
 With these figures, is there any further argument needed as 
 to the value of child hygiene and of the necessity of pushing 
 health protection to include all citizens ? 
 
 * Dr. Eugene L. Fiske, Journal of the American Medical Association. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 117 
 
 The Significance of the Declining Birth Rate.* 
 
 The study of American demography reveals a problem of the greatest 
 possible moment. Changes have been progressing in the internal struc- 
 ture of our population which have, for the most part, escaped attention 
 and which, if allowed to continue, will result in very serious national 
 embarrassment. Conditions of war bring into relief the necessity for a 
 vigorous and efficient population. It is not too much to say that the 
 present tendencies in our national and family life are such as seriously 
 threaten the development of groups in the population on which we must 
 rely for vigor and efficiency in thought and action. 
 
 Superficially the growth of American population at present appears 
 to be very satisfactory. Each census shows a marked increase in total 
 population. Our birth rate is probably about 25 per 1,000, and the death 
 rate for the entire country not far from 15 per 1,000. The difference 
 between the birth and the death rate, the rate of natural increase, is 
 about 10 per 1,000, or one percent annually. On the surface this is a 
 very good showing. It is when we observe the varying tendencies in the 
 several groups and in the several sections of the country that the real 
 situation becomes apparent. 
 
 The marked increase in our total population is in large measure the 
 result of two factors: (1) immigration, and (2) a high rate of increase 
 among the foreign-born rather than among our native stock. This is 
 shown by the constantly decreasing proportion which the native whites 
 of native parentage form of the total white population. This decreased 
 from 67.8 percent of the whole in 1870 to 60.5 percent in 1910. In the 
 New England states the proportion of native white stock decreased from 
 52.3 percent of total in 1890 to 40.3 percent in 1910. In the Middle 
 Atlantic states the native white stock decreased from 51.8 percent in 
 1890 to 44.5 percent (or less than half) in 1910. 
 
 Native stock is playing an even smaller part in the composition of the 
 total population and a very definite tendency toward depopulation has 
 already fastened itself upon a large part of the native stock of the 
 country. 
 
 There has been a marked and continuous reduction in the general 
 birth rate in the United States for a period of years. In the absence of 
 comprehensive birth statistics, such as are available for European coun- 
 tries, we may arrive at this through computing the number of children 
 under five years of age per thousand women in the child-bearing ages, 
 namely, 15 to 44 years, inclusive. 
 
 Professor Willcox in a recent paper has shown that this proportion 
 has decreased about 50 percent in the course of the last hundred years. 
 At the beginning of the century there were 976 children under five for 
 every thousand women between the ages of 15 to 44 years, whereas in 
 1910 the number was only 508 per thousand women at these ages. Dur- 
 
 * From an address delivered by Louis I. Dublin before the American Association for 
 Advancement of Science, December, 1917. 
 
118 Kansas State Board of Health. 
 
 ing the 60 years between 1850 and 1910 the number of children under 
 5 per thousand women at the child-bearing ages decreased in the United 
 States by 191, or at an average of 32 in each decade. The rate of decline 
 in the recent decades has been so rapid that Professor Willcox suggests, 
 amusedly, that if it were continued over a period of a century and a half, 
 which is comparatively short time in the life of a nation, there would be 
 no children at all at the end of that time. 
 
 This reduction in birth rate has been severely selective and has af- 
 fected mostly our native stock, and among these especially the groups 
 who are socially and economically best fitted to bear and rear large fam- 
 ilies to maturity. 
 
 A tabulation of the 1910 census returns shows that women of native 
 parentage who had been married from ten to twenty years showed an 
 average of 2.7 children, while the corresponding group of foreign-born 
 women averaged 4.4 children per married woman. Thirteen percent of 
 the group of married women of native stock had borne no children, 
 while only 5.7 percent of the foreign-born group were childless. 
 
 Additional evidence of the selective character of the declining birth 
 rate is presented in special studies on the size of families of college 
 graduates and men of science. The birth rate among graduates of 
 Harvard and Yale during the decade between 1850 and 1860 was 3.25; 
 for the decade 1880-'90 it was a little over 2. The number of children 
 per married-woman graduate of Smith College was 1.3; of Vassar 1.6; 
 of Bryn Mawr 1.7; of Holyoke 1.8. The ratio of children per graduate 
 for all of those colleges is less than one, due to the fact that less than 50 
 percent of graduates of women's colleges marry. According to Professor 
 CattelFs study of the families of 643 American men of science, they had 
 come from families averaging 4.7 children, while their own families 
 averaged only 2.3 children. 
 
 Allowing for sterile marriages, child mortality, and failure to marry, 
 it is estimated that productive unions must average at least four children 
 in order to maintain the population at a stationary figure. It will be- 
 come readily apparent that the best blood of America is being constantly 
 thinned out and replaced by a stock of a different order. 
 
 Remedy: 1. Inculcate the ideal into our educational life that our 
 intellectual, economic and social advancement must be carried forward 
 not only as tradition, but especially in terms of new, vigorous and worthy 
 personalities. 
 
 2. Reconstruct our higher education for women and make it provide 
 primarily an adequate conception of and preparation for the vocation 
 of motherhood. 
 
 3. State reward, both by esteem, and by subsidy when necessary, of 
 all healthy and eugenically sound families which reach or exceed the 
 normal size. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 119 
 
 Infant Mortality. 
 
 The term infant mortality, used technically, applies to death of babies 
 under one year of age. 
 
 The infant mortality rate is the statement of the number of the deaths 
 of such infants in a given year per live 1,000 births in the same year.* 
 
 The infant mortality rate is considered the most sensitive index we 
 possess to social welfare. It reflects at once conditions which improve or 
 interfere with the normal health or life of the community. As condi- 
 tions which make for a nortnal family and community life are improved, 
 the infant death rate decreases. When these conditions are disturbed, 
 the rate correspondingly increases. The infant mortality rate, therefore, 
 may be taken as the barometer of the social welfare of the co/mmunity. 
 
 The state of Kansas enjoys a relatively low infant mortality rate com- 
 pared with other states. According to the birth statistics, Bureau of 
 Census, for the birth registration area for 1915 (the latest figures avail- 
 able), the highest state infant mortality rate was 129 and the lowest 69. 
 
 The division of Vital Statistics of the State Board of Health was es- 
 tablished in July, 1911. The Division of Child Hygiene was established 
 in July, 1915. 
 
 The Kansas infant mortality rates for the period for which records are 
 available are as follows: 1912, 74; 1913, 88; 1914, 77; 1915, 70; 1916, 68.8; 
 1917, 77. 
 
 In 1916 there were 41,163 births reported and 2,832 deaths of babies 
 under one year of age an infant mortality rate of 68.8, the lowest for 
 the six-year period. 
 
 In 1917 there were 38,611 births reported and 3,005 deaths-^-an infant 
 mortality rate of 77. 
 
 The total number of births for 1917 was 2,552 less than for 1916. The 
 total number of baby deaths for 1917 was 173 greater than for 1916.f 
 
 The infant mortality rate proper does not as yet include stillbirths. 
 The number of stillbirths reported for 1916 was 1,328, and for 1917 was 
 1,203. Stillbirths have not shown any appreciable decrease during the 
 six-year period, but are rather on the increase. This increase may be 
 relative rather than actual and may be due to improvement in birth and 
 death reporting. 
 
 Of the 2,832 infants under one year of age who died in 1916, 1,462, or 
 slightly more than half, died of congenital malformation, premature birth 
 or congenital debility. Of the 3,005 deaths of infants under one year 
 who died in 1917, 1,394 deaths are charged to these causes. 
 
 If we add to these figures 1,328 reported stillbirths in 1916, and 1,203 
 in 1917, we have as a total for the two-year period 5,397 babies who never 
 had a chance to live. 
 
 * An exact method of determining the infant mortality rate would require a study of 
 babies born in a given year who died before reaching their first birthday, but for prac- 
 tical purposes the infant mortality rate is determined as above. 
 
 t Whooping cough, measles and broncho-pneumonia were principally responsible 
 for this increase of 173 deaths. Broncho-pneumonia, which is a secondary infection 
 following measles, whooping cough, scarlet fever and other children's diseases, alone 
 was responsible for 107 of the 173 increase. 
 
120 Kansas State Board of Health. 
 
 These figures do not take into consideration the indefinite number of 
 infant lives lost through intrauterine mortality. There is no doubt but 
 that the number of miscarriages and abortions, if they were reported, 
 would equal if not exceed both the stillbirths and congenital mortality. 
 
 This represents an enormous waste. In dollars and cents alone it 
 commands attention. Allowing an average minimum of $50 expense for 
 each of the 5,387 nonproductive confinements, it represents a cash loss 
 of at least $269,350. The loss in cash is the smallest item. It is not 
 possible to estimate the cost in suffering to the mother and her resulting 
 ill health. Frequently she must even lose her own life. This economic 
 and social waste demonstrates the importance of conserving the child 
 life of the commonwealth. 
 
 Studies in Infant Mortality.* 
 
 Studies in infant mortality have been undertaken by the National 
 Children's Bureau in various communities of the United States. These 
 communities have varied greatly city and rural, industrial centers, and 
 suburban residence districts. 
 
 While there is a great difference in the infant mortality figures ob- 
 tained between a city and a rural district, or between an industrial cen- 
 ter and a wealthy surburban residential district, yet in all communities 
 certain factors in every instance are found to influence the infant mor- 
 tality rate. 
 
 Complete statistical data on the relation of these factors to infant 
 mortality is not available for Kansas. The figures and percentages ob- 
 tained by such an investigation (if it were possible to undertake it) would 
 no doubt vary widely from figures obtained in other parts of the United 
 States, just as they would vary widely in the various communities of 
 Kansas. However, the relation of these factors to infant mortality would 
 not be altered. 
 
 For practical purposes the results of these investigations conducted 
 elsewhere may be taken as an indication of the lines along which public- 
 health work must be directed if the infant mortality rate of Kansas is to 
 be reduced to the minimum. 
 
 FATHERS' EARNINGS AND INFANT MORTALITY. 
 
 The infant mortality rate shows a marked and almost regular decline 
 as the father's earnings become larger. For the group of babies in which 
 the father's earnings are less than $450 per annum, the infant mortality 
 rate is 242.9 per 1,000 live births, while in the next group, in which the 
 father earns from $450 to $549, the rate is 173.6. It rises very slightly 
 in the next class, $550 to $649, to 174.5, and thereafter drops steadily 
 with each advance in economic status. The rate, however, does not fall 
 below 100 until the father's earnings reach $1,050 or more. Babies 
 whose fathers earn $1,250 and over per annum have a death rate of 
 only 58.3. 
 
 * Statistical tables and data from "Studies in Infant Mortality," National Children's 
 Bureau. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 121 
 
 HOUSING AND INFANT MORTALITY. 
 
 Low wages and small income for the family necessarily result in cheap 
 rents and poor housing conditions. Bad housing and insanitary environ- 
 ment are accompanied by high infant mortality rates. 
 
 The homes of 1,510 babies visited had street frontage; 129 had alley 
 frontage. Conditions in and around alley and rear houses were found 
 to be almost uniformly bad, and the infant mortality rate for babies in 
 such houses was high. Live-born babies in these houses numbered 123, or 
 7.9 percent of the whole number. These babies died at a rate of 227.6 
 per 1,000 live-births, while the death .rate among babies in homes with 
 
 a street frontage and a good sanitary environment was only 159.4. 
 
 
 
 ROOM CONGESTION AND INFANT MORTALITY. 
 
 Room congestion has a direct influence on the infant mortality rate. 
 Of the live-born babies included in this investigation 42.5 percent came 
 from homes in which the number of persons, exclusive of the baby, av- 
 eraged less than 1 per room; 46 percent in which the average was 1 but 
 less than 2 ; 6.8 percent from homes in which the average was 2 but less 
 than 3; and 1 percent came from homes in which the average number 
 of persons per room was from 3 to 5. 
 
 The infant mortality rate showed a steady increase according to the 
 number of persons per room. Where the average number of persons to 
 the room was less than 1, the infant mortality was 123.3; where the 
 average was more than 1 but less than 2, the infant mortality rate was 
 177.8; where the average number of persons to a room was 2 or more but 
 less than 3, the infant mortality rate was 261.7. 
 
 EMPLOYMENT OF MOTHER DURING PREGNANCY AND INFANT MORTALITY. 
 
 Work during the year before baby's birth exerts a marked influence 
 on the infant mortality rate. Nearly half of the entire number of babies 
 included in the investigation had mothers who had engaged in gainful 
 employment at some time during the year previous to the baby'g birth. 
 The occupations included 504 cases where the work was away from home, 
 427 of which consisted of employment in the textile mills and 47 in other 
 factories. 
 
 Babies of mothers gainfully employed during the year preceding the 
 baby's birth had a mortality ' rate of 199.2, whereas the rate for babies 
 of mothers who were not so employed was 133.9. The rate for babies of 
 mothers whose gainful work was in the home was 149.8; for babies 
 whose mothers worked away from home, 227.5. 
 
 THE EMPLOYMENT OF MOTHERS DURING PREGNANCY AND STILLBIRTHS. 
 
 The results upon stillbirths of a mother's work during pregnancy show 
 that mothers gainfully employed have a higher percentage of stillbirths 
 than all mothers, or than those mothers not gainfully employed. The 
 highest percentage occurs among mothers gainfully employed away from 
 home, and the lowest among those gainfully employed at home. 
 
122 Kansas State Board of Health. 
 
 EMPLOYMENT OF MOTHER DURING FIRST YEAR AFTER BABY'S BIRTH 
 AND INFANT MORTALITY. 
 
 The employment of a mother during the first year after the baby's 
 birth exerts an influence on infant mortality, especially if complicated by 
 low wages and insufficient food and rest. A mother's intelligence and 
 care are also reflected in the infant mortality, although the mother's 
 ignorance often is a consequence of her low wages and of being compelled 
 to work at an early age. 
 
 The employment of a mother during the first year of her baby's birth 
 directly interferes with breast feeding, and the lack of breast feeding in 
 turn raises the baby death rate. It is impracticable for a mother to be 
 'gainfully employed away from home and to breast feed a young infant. 
 A baby may be bottle fed at six months with comparative safety. He may 
 be bottle fed at three months if extreme care is exercised. To put 
 a baby under three months of age on a bottle is an exceedingly hazardous 
 undertaking. 
 
 BREAST FEEDING AND INFANT MORTALITY. 
 
 The chance of survival for babies deprived of breast milk at an early 
 age is decidedly less than that for babies nursed for a longer period. 
 A comparison of the breast fed and artificially fed babies from any month 
 up to its ninth month reveals the fact that the percentage which fails 
 to survive infancy is from two to five times higher among the artificially 
 fed babies than among the exclusively breast fed. 
 
 LARGE FAMILIES AND INFANT MORTALITY. 
 
 There is a higher mortality in the larger families. Combina- 
 tions of four or less pregnancies are, for convenience, considered as 
 Group 1, while the combinations of over four are designated Group 2. 
 The differences in rates in the two groups are notable. The infant mor- 
 tality is much lower for the first than for the second group. 
 
 REPORTABLB PREGNANCIES Infant 
 
 FOR MARRIED MOTHERS. mortality 
 
 Group 1 : rate - 
 
 2 or less 108 . 5 
 
 3 or less 124 . 7 
 
 4 or less..... 119.2 
 
 Group 2 : 
 
 Over 4 171.5 
 
 Over 5 178.8 
 
 Over 6 183.9 
 
 ILLEGITIMACY AND INFANT MORTALITY. 
 
 Of the 1,551 babies included in this investigation, 34, or 2.2 percent, 
 were born out of wedlock. Nine of the 32 illegitimate babies born alive 
 died during their first year. 
 
 MATERNAL MORTALITY.* 
 
 The sickness or death of the mother inevitably lessens the chances of 
 the baby for life and health. A large proportion of the deaths of babies 
 occur in the first days and weeks of life. These early deaths can be 
 
 * From "Studies in Maternal Mortality," by the National Children's Bureau. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 123 
 
 prevented only through proper care of the mother before and at the 
 birth of her baby. 
 
 In 1913 in this country at least 15,000 women, it is estimated, died 
 from conditions caused by childbirth; about 7,000 of these died from 
 child-bed fever, a disease proved to be almost entirely preventable, and 
 the remaining 8,000 from diseases now known to be to a great extent 
 preventable or curable. Physicians and statisticians agree that these 
 figures are a great underestimate. 
 
 In 1913 childbirth caused more deaths among women 15 to 44 years 
 old than any disease except tuberculosis. The death rates from child- 
 birth and from child-bed fever for the registration area of this country 
 are not falling; during the 13 years from 1900 to 1913 they have shown 
 no demonstrable decrease. During that time the typhoid death rate 
 has been cut in half, th death rate of tuberculosis markedly reduced, 
 and the death rate for diphtheria reduced to less than one-half. 
 
 The low standards at present existing in this country result chiefly 
 from two causes: (1) General ignorance of the dangers connected with 
 childbirth, and of the need for proper hygiene and skilled care in order 
 to prevent them; (2) difficulty in the provision of adequate care due to 
 special problems characteristic of this country. Such problems vary 
 greatly in city and in country. In the country the inaccessibility of 
 skilled care, due to pioneer conditions, is a chief factor. 
 
 Improvement will come only through a general realization of the 
 necessity for better care at childbirth. If women demand better care 
 physicians will provide it, medical colleges will furnish better training in 
 obstetrics, and communities will realize the vital importance of com- 
 munity measures to insure good care for all classes of women. 
 
 While the figures given in this report are a startling indication of 
 the great number of deaths in childbirth occurring in various parts of 
 the country, no estimate can be made of the number of mothers who sur- 
 vive, only to suffer ill health which limits or defeats the well-being and 
 happiness of their households. Nor do they include the deaths of women 
 from kidney, heart and liver diseases, which are aggravated by child 
 bearing to such an extent that the conscientious physician warns against 
 pregnancy in such diseases. 
 
 Reduction of the Infant Mortality Rate. 
 
 Studies in infant mortality leave no doubt that certain factors in- 
 variably increase infant mortality. Among them are poverty (low 
 wages), the employment of pregnant and nursing mothers in gainful 
 occupations, too large families, illegitimacy, low mentality of the parents 
 inseparably associated with pauperism and illegitimacy, poor housing 
 and insanitary surroundings, impure milk and bad food, and a lack of 
 adequate public health protection. 
 
 Ignorance, disease and poverty sum up the principal causes of infant 
 mortality. A program for the reduction of infant mortality to its lowest 
 irreducible minimum must take cognizance of these principal factors. 
 
124 Kansas State Board of Health. 
 
 To control them properly will require fundamental changes in our edu- 
 cational, social, economic and political life. 
 
 But before such changes may be effected and for the immediate pres- 
 ent certain methods are being furthered which have proved their worth 
 in the reduction of the infant mortality rate and in improving the health 
 of all children. These efforts are recognized by the boards of health as 
 an important part of their necessary program for public health pro- 
 tection. 
 
 PUBLIC HEALTH DOCTORS AND NURSES. 
 
 "An epidemic prevented is better than two epidemics cured" is the 
 modern paraphrasing of an old motto. This also is the spirit of the new 
 awakening in public-health matters, which is crystallizing itself into a 
 demand on the part of all citizens that they and their families be pro- 
 tected from communicable diseases and that they be accorded the very 
 best of opportunities for life, health and happiness. 
 
 The organized effort to protect public health has grown to such pro- 
 portions as to demand the entire time of men and women who are es- 
 pecially qualified to serve in this capacity. Thus a new branch of pre- 
 ventive medical activity has been evolved, requiring public-health nurses, 
 public-health physicians, and full-time health officers. 
 
 The acquisition of a public-health nurse is the first step in efficient 
 public-health work. Especially is this true in regard to work for chil- 
 dren. A nurse is necessary to the proper conduct of a child-hygiene sta- 
 tion, and her instruction is indispensable to the proper education of 
 mothers. Nurses giving prenatal instructions to mothers have made 
 wonderful records in saving mothers' and babies' lives and great im- 
 provement in the health of both. Public-health nurses are invaluable in 
 obtaining thorough physical inspection of school children, assisting at 
 school clinics, preventing outbreaks of disease among school children, and 
 for follow-up work in the home. 
 
 The trained public-health physician is no less important than the pub- 
 lic-health nurse. The custom has been to employ as city and county 
 health officers busy doctors who, in addition to their regular practice and 
 for a small yearly stipend, have been attending to the quarantining of 
 communicable diseases. This quarantining of communicable diseases is 
 many times more expensive and less efficient than searching out the 
 causes of epidemic diseases and preventing them altogether. To do the 
 latter work effectively requires the services of a trained public-health 
 physician devoting his whole time exclusively to that purpose. 
 
 Proper public-health protection pays. 
 
 PURE MILK. 
 
 Milk has no substitute in the diet of a child. Milk is the one in- 
 dispensable food for children. 
 
 The results of underfeeding and of the indiscriminate use of food sub- 
 stitutes in feeding children, as a result of the war, are being startlingly 
 shown abroad and are beginning to be evident in American cities. The 
 nourishment of its children is plainly one of the first duties of a nation. 
 And since milk and milk products are a vital necessity for children, for 
 
Bulletins Nos. 8 and 9, August-September, 1918. 125 
 
 nursing mothers and for the sick and wounded, the safeguarding of the 
 milk supply is a matter of first concern. 
 
 The character of the milk supply for cities in Kansas is controlled by 
 city ordinance. A properly drawn ordinance should require: Healthy 
 cows; clean dairies and premises; clean operators, free from com- 
 municable disease; facilities for hot water and for sterilizing all milk 
 utensils; clean and well-drained and screened milk houses; and proper 
 provision for immediately cooling milk and keeping it cool until de- 
 livered. To determine whether milk is produced under such conditions 
 requires frequent examination of milk and plant, and laboratory tests. 
 
 In cities where the milk supply is not so safeguarded the parents of 
 small children may well visit the dairy from which they receive their 
 supply in order to assure themselves that the milk is cared for under clean 
 and sanitary conditions and cooled immediately. Sanitary standards for 
 the production of safe milk and models for city ordinances may be ob- 
 tained free on request to the State Board of Health, Topeka. 
 
 But a proper safeguarding of the milk from a sanitary standpoint 
 does not obviate the difficulties arising from the increased cost of feed and 
 labor necessary to produce milk, and the failure of the average income to 
 keep pace with the ever-increasing high cost of living. Milk is one of the 
 food products which probably can be handled best and cheapest by a 
 central receiving station and pasteurizing plant, and by a single system 
 of distribution. The production of a clean, safe and abundant supply of 
 milk at a price within the reach of every family is a serious immediate 
 problem facing many Kansas cities. 
 
 PRENATAL CARE. 
 
 The first month of life is the period of the highest infant mortality 
 rate. In the United States registration area for 1915, 46 percent of the 
 deaths under one year of age occurred during the first month, 32 percent 
 during the first week, and 16 percent during the first day. 
 
 Obviously this high infant mortality rate cannot be prevented by 
 measures instituted after the baby is born. Instead, this condition pre- 
 sents an urgent necessity for preventive health measures before and 
 after the baby is conceived. Proper selection of stock and right care 
 before birth has long been recognized as a cardinal principle by animal 
 breeders, but it is only within the past few years that the same principles 
 have been generally recognized as applying to human beings. 
 
 Prenatal care offers an opportunity to the city and state to direct its 
 health protection measures to the "production plant" of its citizens 
 rather than to the "repair shops." It will cost much less in time and 
 money to prevent illness and deaths of babies than it will to pay for them 
 and, besides, we would have the babies left. A summary of reports of 
 various experiments has abundantly proved the worth of prenatal care. 
 
 Prenatal care: 
 
 Reduces the baby deaths during the first year by at least one- 
 half. 
 
 Reduces the number of stillbirths one-half. 
 Reduces the number of miscarriages and premature births. 
 
126 Kansas State Board of Health. 
 
 Reduces greatly the sickness and death of the mothers puer- 
 peral eclampsia and septicemia (convulsions and childbed 
 
 fever) being reduced in one experiment 80 percent.* 
 Produces healthier babies of increased weight. 
 Produces a greater number of normal deliveries. 
 Increases the possibilities of the mother nursing her baby, thus 
 
 giving the baby a better chance for its life. 
 Affords comfort to the baby, and peace to the mind of the more 
 
 or less sick and harrassed mother. 
 
 Make possible a trained attendant at every childbirth. 
 Method and cost. The method of administering prenatal care is simple 
 and may be undertaken by any thoroughly trained nurse. The best results 
 are attained when she is able to watch her patient throughout the entire 
 period of pregnancy. The nurse visits her patients every week or ten days, 
 or oftener if necessary, keeping under close supervision the patients' diet, 
 exercise, hours of work and rest, hygiene and health, including periodic 
 urinalysis. The nurse immediately refers to the patient's doctor any 
 unusual or untoward symptoms which her trained eyes may detect. 
 
 Where the distances between patients are not too great, a nurse by 
 carefully systematizing her work may make from 80 to 100 visits a 
 week. Averaging the difficult cases, which may require daily visits, 
 with those in which the expectant mother is in exceptionally good health, 
 requiring visits only every second or third week, the nurse can care for 
 an average of more than 100 patients. 
 
 The public health nurse's salary is about $1,000 per annum, with an 
 allowance of several hundred dollars for traveling expense and supplies. 
 Experiments in prenatal care have demonstrated that where the nurse 
 can be kept comfortably busy the expense averages about $3 per* patient. 
 Fewer patients would raise the average cost, but in no community, except 
 perhaps the sparsely settled rural districts or where the roads are im- 
 passable, would the service exceed $5, a sum which most expectant 
 mothers would pay cheerfully as a wise investment. 
 
 County commissioners and boards of health, public-health nursing 
 associations, women's clubs and health societies may profitably employ 
 or underwrite the salary and expense of a nurse, so that every sizable 
 community in the state may have at least one prenatal nurse to prevent 
 sickness and loss of life among the babies and mothers. 
 
 INFANT WELFARE STATIONS. 
 
 The surest test of a child's proper growth and development is the 
 steady increase in weight, evidenced by regular weighing. A baby 
 should be weighed every week until he is one year old, and then every 
 few weeks or month until he is two and one-half or three years old. 
 After that age he should be weighed at least twice yearly and also given 
 a thorough inspection so that any minor irregularities of teeth, posture, 
 nutrition or other organ, or function, may be remedied promptly. 
 
 The ordinary spring baby scales are scarcely accurate enough for 
 this purpose, especially as the baby becomes older and heavier. Scales 
 
 * Women's Municipal League, Boston. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 127 
 
 with a platform and beam, similar to the grocer's counter scales, and 
 fitted with a pan or basket, are much more satisfactory. But these 
 scales are comparatively expensive, and not all homes are equipped with 
 them. 
 
 To overcome this difficulty a group of mothers may request the 
 county health authorities to provide proper scales and to place them 
 conveniently at the county seat. If the city or county employs a public- 
 health nurse, she may meet with the mothers one afternoon a week, 
 assist them with the weighing, inspect the babies, and refer those 
 who need medical attention to their doctors. The nurse may also advise 
 the mothers about the care and feeding of the children and about the 
 health of themselves and their families. 
 
 Location. By experience it has been found that stations in rest rooms 
 of dry-goods stores are very well attended. The mother, incidental to 
 her shopping, can have her baby weighed and inspected by the nurse, 
 thus saving her a special trip for the purpose. A public rest room also 
 offers a good headquarters for a welfare station. Many country women 
 visit these rooms. Incidentally they may become interested in having 
 their children examined when otherwise they would not go to a station' 
 in another location. 
 
 The public schoolhouse, especially in those districts in which the 
 infant mortality rate is high, is another good location for a child-hygiene 
 or infant-welfare station. In most school buildings a room may be found 
 which can be used for this purpose one-half or one day each week and 
 in which the records and necessary equipment may be kept. This plan 
 has the approval of the state department of education. A room in the 
 city building or other public building may serve. But the farther the 
 mother is compelled to go in order to reach the station the more difficult 
 it is for her and the less likely she is to attend. 
 
 Equipment. .The furnishings of a station should be of the simplest 
 and the plainest kind. Each should be equipped with a good pair of 
 scales and suitable pan or basket for weighing the babies, a measuring 
 rod and tape line, a table, sufficient chairs and suitable records, and 
 always with paper towels and sufficient linen for sanitary standards. If 
 funds and space permit, a table and utensils for modification of milk, 
 blackboard, exhibit of layette, and a model nursery may be provided. 
 
 BETTER BABY EXAMINATIONS OR CHILDREN'S HEALTH CONFERENCE. 
 
 The infant-welfare station makes possible the periodic examination of 
 large numbers of babies. Where there are no such stations established 
 these examinations may be conducted singly and privately, one baby at a 
 time, in the doctor's office, or they may be conducted in groups publicly as 
 Baby Day or Better Babies Week. 
 
 Examination cards, instructions and literature necessary to the con- 
 duct of a baby examination are furnished free by the Kansas State Board 
 of Health, Division of Child Hygiene. 
 
 BIRTH REGISTRATION TEST. 
 
 Births are reportable by law, and there is a heavy penalty for failing 
 or refusing to report them. However, birth reports are sometimes over- 
 looked or forgotten. It is obvious that if all the deaths of a community 
 
128 Kansas State Board of Health. 
 
 are reported and that only part of the births are reported, that commun- 
 ity is being charged with a higher infant mortality rate than it merits. 
 
 Correct birth reports and birth certificates are becoming increasingly 
 important. A certificate of birth may be required to prove descent, to 
 prove inheritance of property, to obtain a pension, to enter school, to ob- 
 tain employment, for civil service, to establish ability to make contracts, 
 to enter the professions, to join the army or navy, for court purposes, 
 to marry, and for other purposes. 
 
 A careful checking of all the births in a community is not only a val- 
 uable service to the community itself, but it may be of inestimable service 
 to the citizens born within its limits. 
 
 EDUCATIONAL LITERATURE KANSAS MOTHERS' BOOK. 
 
 While a careful birth registration test will reduce the infant mortality 
 rate, it will not reduce the actual number of baby deaths. This can be 
 done by improving the health conditions of a community, and especially 
 by reaching the mothers with educational literature and personal instruc- 
 tion. 
 
 The Kansas Mothers' Book, issued by the Kansas State Board of 
 Health, Division of Child Hygiene, contains practical information re- 
 garding child-bearing and child-rearing in simple and concise language. 
 It discusses also the public-health phases of child hygiene and welfare, 
 so that the mother may understand and cooperate with the various 
 agencies of the state to which she may appeal for service. 
 
 MOTHERS CONFIDENTIAL REGISTRY FOR PRENATAL LETTERS. 
 
 Important factors influencing a child's health and life begin before he 
 is born. To be born well is a considerable part of the battle. When 
 conception occurs the "gates of gifts" to the child are closed. The par- 
 ents gave their child what they were, not what they would like to be. 
 From this time on they can only conserve the life and provide the best 
 possible environment for their child's development, both before and after 
 birth. 
 
 Expectant mothers are urged to enroll in the Mothers' Confidential 
 Registry, Division of Child Hygiene, Topeka, giving name and address 
 and the date of the expected confinement. They will receive, without 
 charge, a series of nine prenatal letters and the phamplet "Prenatal 
 Care," issued by the National Children's Bureau. 
 
 When the birth of a baby is reported a blank certificate and a Kansas 
 Mothers' Book will be sent, provided the mother has not already received 
 one. Expectant mothers and mothers of children may also write the 
 Division of Child Hygiene regarding the many perplexing questions as- 
 sociated with child-bearing and child-rearing. 
 
 CARE AND TREATMENT OF DEFECTIVE, CRIPPLED OR DEPENDENT CHILDREN. 
 
 It is not alone the children of parents in poor circumstances who need 
 physical or medical attention. A considerable percentage of all children 
 need dental, medical, hygienic or corrective treatment. If not remedied 
 these apparently simple physical ailments of childhood sometimes seriously 
 interfere with a child's growth and development, and his health and 
 
Bulletins Nos. 8 and 9, August-September, 1918. 129 
 
 efficiency in later years. The results of the draft examination in the 
 United States abundantly attest this fact. 
 
 It is hoped that the significance of the neglect of physical ailments of 
 children may be brought to the attention of every parent or guardian of 
 a child. By reporting such children to the State Board of Health, 
 Division of Child Hygiene, an effort will be made to advise parents or 
 guardians as to the appropriate kind and suitable source of treatment. 
 
 COMMUNICABLE DISEASE CONTROL, 
 
 The common diseases of childhood measles, whooping cough, and so 
 forth which are erroneously thought to be comparatively harmless, are 
 responsible for the deaths of thousands of children annually. The 
 younger the child contracts* one of these diseases, the greater the chances 
 that he will die, for the younger the child, always the higher the mor- 
 tality rate. 
 
 While these diseases do not always kill, they are likely to cripple and 
 maim. They are responsible for much of the deafness, poor eyesight and 
 illhealth of adults. Thus the conservation of child life and the health 
 of the adult depend to a considerable degree upon the control of these 
 diseases. 
 
 Every epidemic has its starting point in some unrecognized commu- 
 nicable disease, or from the delayed report and the consequent delay of 
 quarantine or other public-health protection measure. The efficiency of at 
 health department depends upon its means and ability to isolate promptly 
 and to prevent the spread of contagion. 
 
 Physicians are required to report all communicable diseases to the 
 health officer. But many cases occur where no physician is in attendance. 
 In such cases the householder is charged with the responsibility of report- 
 ing. If he fails to do so his neighbors ought to report the cases in jus- 
 tice to the health of their own families. 
 
 Public health and welfare demand that every person, to a certain ex- 
 tent, shall be a deputy health officer and sanitary inspector. The matter 
 of proper public-health protection is a matter of good citizenship and an 
 exemplification of the Golden Rule. 
 
 CHILD CONSERVATION HOUSE-TO-HOUSE CANVASS. 
 
 There is no other method of putting literature into the hands of every 
 mother and expectant mother and of checking all births and epidemic 
 diseases except by the house-to-house canvass. Clubs, Sunday-school or- 
 ganizations, senior high-school students, colleges and other groups in- 
 terested in public health and child hygiene are invited to undertake this 
 survey in their home precincts. This canvass is made by voting precincts, 
 and wherever possible, under the direction of a county chairman, woman's 
 committee, Council of Defense. Blanks for this canvass, press material 
 and all necessary literature are furnished by the State Board of Health, 
 Division of Child Hygiene. 
 
 2 Health 4194 
 
SCHOOL HYGIENE.* 
 
 The Cost of Neglect. 
 
 A PROBLEM IN SCHOOL ARITHMETIC. 
 
 Enrollment in grade schools, total for year 1916 1 398,288 
 
 Expenditures for grade schools, total for year 1916 1 $13,358,750.86 
 
 Average cost of school year per pupil enrolled $33 . 54 
 
 Pupils failing to make a grade each year, average, city and country 2 . ... 14.3% 
 
 Annual number of pupils failing to make a grade 56,955 
 
 Annual loss caused by pupils repeating grades $1,910,270 . 70 
 
 A saving of this amount of money will not be represented by less 
 money being spent on the schools, but by obtaining value received for 
 money now being wasted. This first cost of retardation, the loss of school 
 money alone if it might be so utilized, would provide: 
 
 One school nurse (salaries and expenses) for each thousand grade 
 pupils and a similar amount for school physicians and school clinics. 
 
 One teacher of. physical education for each thousand grade pupils, and 
 similar sum for playground and gymnasium equipment. 
 
 One special teacher for ungraded classes for each thousand grade 
 pupils, and for the necessary trained mental examiners. 
 
 Those special teachers would enable normal children to keep up with 
 their grades and assist the supernormal children to go ahead as fast as 
 their ability would permit. They would also relieve the classroom of the 
 drag of the subnormal and feebleminded children and give them the rudi- 
 ments of training which, supplemented by special institutional train- 
 ing, 3 would make them more or less self-supporting and self-respecting 
 citizens. 
 
 * The subject of School Hygiene will be taken up in a later issue of the bulletin of 
 the Kansas State Board of Health. 
 
 1. From the twentieth biennial report of the state superintendent of public instruction 
 of Kansas for the year ending June 30, 1916. 
 
 2. Total retardation pupils one year or more behind the proper grade for their age 
 jn cities, 30.6 percent; in country, 39 percent. Investigation conducted by School of Edu- 
 cation, University of Kansas, school year ending June, 1916. 
 
 3. This estimated cost of preventing retardation does not include the cost of caring 
 4 or the 2 percent of school children who are recognized as feeble-minded. Such care can- 
 not properly be charged to the public school funds. Funds for the care of feeble-minded 
 in this state are appropriated to the departments of charities and corrections administered 
 U>y the Board of Administration. 
 
 (130) 
 
Bulletins Nos. 8 and 9, August-September, 1918. 131 
 
 Physical Examination of School Children. 
 
 The schools are spending millions in educating or trying to educate 
 children who are kept back by ill health, when the expenditure of thou- 
 sands in a judicious health program would produce an extraordinary 
 saving of ill health and an increase in economy and efficiency. A dollar 
 spent in wise, constructive effort to conserve a child's health and general 
 welfare will be more fruitful for the child and for the general good than 
 a hundred times that sum delayed for twenty years. The principle of 
 thrift in education finds its first and most vital application in the con- 
 servation and improvement of the health of the children. 
 
 Every school child should have a health examination once a year. 
 More frequent examinations should be provided for individual pupils who 
 need special attention. All health examinations and attention in rural 
 and in city schools should be under the supervision of regularly appointed 
 school physicians thoroughly trained for their work. There should be 
 for every child a health as well as a scholarship record which accom- 
 panies him through his public school career. This should be a part of the 
 records of the school which the child is attending. 
 
 The simpler tests of vision and hearing can be made by the teacher 
 as well as the routine morning health inspection. Capable teachers can 
 easily learn simple methods of routine physical examination. The more 
 detailed examination is the work of the physician. But where even 
 the simplest of physical examinations may not be undertaken, every 
 teacher may take the height and weight of each child. This height and 
 weight and their relation to each other and to the child's age are a rough 
 index to his physical condition. 
 
 Standard height and weight cards, also blanks for complete physical 
 examination of school children, will be sent free on application to the 
 State Board of Health, Division of Child Hygiene. 
 
 Height and Weight Tests of School Children.* 
 
 An adult may be underfed for a long period without serious results, 
 but a child if undernourished will never become as strong and capable an 
 adult as he might have been. The detection of malnutrition requires no 
 expert medical knowledge. The weight of the child and his rate of gain 
 tells the story. 
 
 Malnutrition exists among school children to an almost incredible de- 
 gree. A recent survey in New York shows that of a million school 
 children in that city, approximately 150,000 are stunted in their growth, 
 retarded from one to three years in height and weight. In other parts of 
 the country malnutrition prevails probably to even a greater degree, as 
 New York has shown more than ordinary interest in the welfare of her 
 school children and has made relatively large appropriations for the pro- 
 tection of the health of her children. This degree of malnutrition (proba- 
 
 * Adapted from publications of Child Health Organization, 289 Fourth avenue, New 
 York City. Free literature sent on request. 
 
132 Kansas State Board of Health. 
 
 bly one-third of all school children) extended into adult life would cause 
 every one of these individuals to be rejected from the army as physically 
 unfit. 
 
 Malnutrition to this degree exists because there has been no effective 
 physical inspection of school children, which would have located it and 
 steps therefore would have been taken to correct it. Undernourished chil- 
 dren may look well when dressed, thus they are considered to be well. 
 But a careful inquiry into their condition would reveal that they are pale 
 or even anemic, that they are listless and inattentive to their studies, and 
 that they are easily fatigued both physically and mentally. When such 
 children fall behind in their studies they are considered lazy, and pres- 
 sure at home and school is increased. Thus a vicious circle is established 
 which further increases the difficulty. These children in later life often 
 become physical and nervous wrecks. 
 
 The first step in combating malnutrition among school children is to 
 locate individual cases. This requires no expert medical knowledge. A 
 pair of scales, a tape measure and a chart of heights and weights are all 
 that is necessary. If the school does not possess a pair of scales or can- 
 not buy them, the children will readily go to the grocers or butchers to be 
 weighed regularly for the fun of it, especially if a game is made of the 
 proceeding and a little rivalry or competition is arranged for them. The 
 children will also enter heartily into the idea of bringing themselves up to 
 normal weight and condition as a part of their patriotic duty as good 
 citizens. 
 
 Having located the undernourishment, the next thing to do is to 
 discover the causes. A sympathetic physician will be of inestimable serv- 
 ice at this point. In almost every school district one or more doctors 
 may be found Who will donate their services for the necessary physical 
 examination. This examination will show from three to nine defects in 
 every undernourished child, and often as many in those of normal weight. 
 The defects of most serious concern to the child's condition are those that 
 interfere with respiration, enlarged or diseased tonsils or adenoids and 
 faulty posture. Other common defects which affect the child's health and 
 school efficiency are bad teeth, faulty vision, bad hearing or discharging 
 ears, skin diseases, and results of children's diseases. It is most im- 
 portant that the child and the parents understand these defects and the 
 urgent necessity for their treatment. 
 
 The third step is to check up the food habits of the children and pro- 
 vide them with a proper diet for their age and condition. Besides taking 
 too little food, many of these children have bad food habits eating too 
 fast, going without breakfast, drinking tea or coffee, eating candy be- 
 tween meals, or refusing cereals and milk. The child's habits of sleep, 
 study, play and exercise should also receive attention, as all are con- 
 cerned in his health and growth. 
 
 Such physical inspection and care would eliminate malnutrition among 
 school children in a short time. It would also effect a tremendous saving 
 of school money which is now wasted in trying to educate children who 
 are, to all intents and purposes, sick children. 
 
CHILD WARDS OF THE STATE. 
 
 Dependent Children. 
 
 The child may be taken out of home life and become dependent upon 
 the state for a variety of reasons. In every instance the state becomes 
 responsible for the providing or the failing to provide the personal care 
 and educational facilities which will make that child an independent citi- 
 zen, a happy human being and a worthy social unit. In cases where it 
 is not possible to make a safe member of society out of the child he is 
 entitled to be given into humane and scientific custodial care. This is 
 essential both for the sake of the child and for the best interest of society. 
 
 In spite of a general social quickening to the rights of the dependent 
 child, many states, including Kansas, still remain curiously apathetic 
 and inert with reference to his rights. While no one could be found 
 who would wish for this child to receive anything but fair treatment, there 
 are few willing to actively espouse his cause and see that he gets a square 
 deal. As it is, the state seems to be satisfied with the cold charity of a 
 private institution, or by grudging appropriations to state institutions 
 keep only soul and body together, and provide the modicum of education 
 stipulated in the constitution. 
 
 There are at present time some 1,000 dependent children living in 23 
 institutions designed for their care.* The State Orphanage cares for less 
 than 200 of these; the rest are to be found scattered about in orphans' 
 homes of the widest range of purpose, equipment and efficiency. These 
 homes are incorporated under the laws of the state, and thirteen of 
 them receive some state aid. In addition to these incorporated institu- 
 tions there are an unknown number of nonincorporated, private board- 
 ing houses and maternity homes which exploit their victims instead of 
 soliciting funds. Thus they evade the letter of the law which regulates 
 the conduct of only those institutions soliciting funds for charitable pur- 
 poses. Worst of all, several counties in the state of Kansas still consign 
 children to the poorhouse. 
 
 What is a Good Children's Home? 
 
 The state of Kansas, which permits dependent .children, orphaned or 
 half -orphaned, to be cared for by a variety of children's institutions, 
 homes and home-finding societies, each of which is a separate corpora- 
 tion, se 1 f -perpetuating, virtually self-directing and practically without 
 supervision, is beginning to question, "What is a good children's home?" 
 
 The average citizen .probably could answer the question, "What is a 
 good children's home?" only in the most general terms that the children 
 be well fed; that they be clothed and kept clean; that they be kindly 
 
 * Sixth Biennial Report of Board of Control of State Charitable Institutions. 
 
 (133) 
 
134 Kansas State Board of Health. 
 
 treated, and that a doctor be called when they are sick. And an insti- 
 tution apparently answering such requirements no doubt would be re- 
 ported upon as a first-class institution by a visiting lay committee. 
 Where such institutions have been visited and so reported by lay com- 
 mittees, a trained investigator following has uncovered some unexpected 
 details. 
 
 That the children be well fed: The expert found extremes of under- 
 weight and overweight, indicating that these children were not well fed; 
 that the same food was being served to the entire group of children 
 ranging in age from 2 to 16 years; that there were no prepared menus 
 or other provision for such variety of diet as would give the children 
 nutritious and at the same time the most palatable food. 
 
 That the children be clothed and kept clean: The trained investigator 
 found that the children were kept clean because they were not per- 
 mitted to play for fear of soiling their clothes. 
 
 That the children be kindly treated: The trained investigator found 
 that the children were not whipped but they were deprived of necessary 
 articles of food for petty offenses, made to kneel on cold stone floors or 
 shut in dark closets for misconduct growing out of nervous disorders, 
 when they needed instead expert medical attention. 
 
 That a doctor be called when they are sick: The expert found that 
 more than half of these children in such institutions required medical or 
 dental care, and that such care as was being given sick children was 
 indifferent, careless and incompetent. 
 
 The absence of sickness does not indicate proper nor sufficient medical 
 attention for a children's institution. Some children's homes pride them- 
 selves on the statement that "No doctor has been inside our home for a 
 year or more." This is not a matter for congratulation. Instead, it is 
 a serious comment upon the lack of understanding of the service a doctor 
 should perform for children. Prevention is the goal of modern medical 
 science, and "no sickness" does not necessarily indicate health. 
 
 It is not safe for any nonmedical superintendent of a children's 
 institution to assume that the children are well so long as he does not 
 see that they are ill. Accurate knowledge of a child's physical condi- 
 tion is essential to determine what is necessary to his perfect health and 
 welfare. This knowledge can be obtained only by thorough and periodic 
 physical examination by a competent physician, and the services of ex- 
 perts in consultation or treatment when necessary. 
 
 Obviously then these general terms that the children be well fed, 
 clothed, kept clean, kindly treated, and a doctor called when they are 
 sick do not adequately characterize what properly might be called a 
 good children's home. These must be followed by specifications as to 
 what is the right sort of feeding, what is proper cleanliness, what is 
 meant by being kindly treated, and what is sufficient health protection. 
 
 In addition to these purely physical aspects of a good children's home, 
 what about its management and more especially its ideals? What atti- 
 tude does the institution take concerning the children? Are the children 
 themselves the real ends developed and conserved, or are they the mere 
 pawns of some other purpose of the institution? 
 
 What provision is made for the higher educational and vocational 
 
Bulletins Nos. 8 and*9, August-September, 1918. 135 
 
 equipment for life of these children? What are the aims of the insti- 
 tution as to the attainment of its wards? Does it regard each child as 
 an individual, especially as to the kind of work required of him? 
 
 And what is most important of all, is the institution getting anywhere 
 in its service to the children? Or does it fill in a few years of their 
 young lives in a sort of indifferent way, beginning with no fixed pro- 
 gram and ending with no definite results? 
 
 In an effort to answer the perplexing question as to what is a good 
 children's home, various boards of health, charities and welfare have 
 investigated hundreds of these homes. They have enumerated all the 
 factors entering into a children's home, its plant, administration and 
 ideals, and have endeavored to fix a minimum standard of excellence for 
 each factor. It was found comparatively easy to enumerate factors and 
 standards of excellence so far as the physical plant of the institution is 
 concerned. It is vastly more difficult and very much more important to 
 enumerate them so far as the management and ideals are concerned. 
 
 Obviously any arbitrary standard of excellence for children's homes 
 has had to undergo numerous modifications in the light of practice and 
 experience. No doubt, as methods in the care and management of chil- 
 dren progress, these standards will undergo still further changes. How- 
 ever, in the light of our present knowledge and experience, a home for 
 children should be able to pass a creditable inspection according to such 
 standards already outlined.* 
 
 How Institutions are Rated. For convenience in rating, institutions 
 ordinarily fall roughly into one of four classes A, B, C, and D. 
 
 Class A institutions are those which measure up to the general re- 
 quirements. These institutions are adequately equipped, well managed, 
 effectively planned and efficiently conducted. They are giving scientific 
 care to their children as well as a happy home life, and are meeting the 
 needs of their community to the extent of their capacity. 
 
 Class B institutions are those which are lacking in some respects, but 
 which are making a strong effort to attain to the general requirements. 
 These institutions are not always properly equipped. In their manage- 
 ment they are prone to substitute good intentions for scientific knowledge. 
 And while their ideals are high enough, they have rather hazy and in- 
 definite or altogether mistaken ideas as to how to put them into prac- 
 tice or bring them about. 
 
 Behind such an institution one generally finds a genuinely self-sacri- 
 ficing board, working not for glory or for profits but solely for the wel- 
 fare of the children. This sort of institution offers something tangible to 
 work upon. With scientific direction as to hygienic arrangements, bal- 
 anced diets, medical treatment of children, child placing and other prob- 
 lems, and with proper official recognition and support, such homes may 
 readily be brought into class A. 
 
 Class C institutions are those which have serious defects as to plant, 
 administration and ideals. The equipment of these institutions is poor, 
 the management lax or grossly incompetent, the ideals low, and the pur- 
 poses for which a children's home should be maintained lost sight of in 
 the pursuit of money, religious proselyting or fanaticism, or merely the 
 
 * Child Caring Institutions, Department of Public Charities, New York City. 
 
136 Kansas State Board of Health. 
 
 endeavor to appear philanthropic. While in a few instances these in- 
 stitutions may be cited as doing good, yet on the whole they are doing 
 actual harm in that they fall so far short of any satisfactory program of 
 child care or of equipping their children in any measure for a normal 
 home life. These institutions have been allowed to exist for years on 
 the same dead level of inefficiency, because of a general lack of under- 
 standing as to what a children's institution should be, also because of 
 lack of interest or courage on the part of the community and the state to 
 demand their improvement. 
 
 Class D institutions are those showing an absence of all progressive 
 child-caring standards in plant, administration and ideals. Among these 
 are the wholly useless, the disreputable and the illicit. 
 
 According to this method of rating, there is not a single home for 
 children in Kansas entitled to a rating of class A, although there are 
 several that with a little assistance and direction may attain this rating. 
 There are many class B institutions, and as many or more perhaps in 
 class C than in class B ; there are several in class D. 
 
 Class B institutions need official recognition and constructive super- 
 vision. 
 
 Class C institutions need the same perhaps in greater detail. If they 
 fail to take cognizance of official direction, they should be compelled to 
 improve or be closed. 
 
 Class D institutions should be discontinued without parley or tempo- 
 rizing and the helpless children removed to more favorable environment. 
 
 Inspection of Children's Institutions. 
 
 The wide diversity of conditions obtaining among the children's insti- 
 tutions in Kansas may be judged from the following extracts from con- 
 fidential reports on file with the State Board of Health and the State 
 Board of Administration. These reports were made by various compe- 
 tent persons members of the Boards of Health and Administration and 
 their staffs, by agents of the Federal Children's Bureau, by college in- 
 structors, and by others equipped for special phases of this sort of in- 
 spection. 
 
 CHILDREN'S HOMES. 
 
 Rescue Mission and Orphan Asylum. This institution harbored 55 in- 
 mates, about half of them babies under three years of age. The adults 
 represented various stages of social maladjustments. A tabulation of 
 the infant deaths in this institution showed that out of a total of 26 
 deaths for the given period, 6 were from inanition and 10 from entero- 
 colitis, which are terms for improper feeding. 
 
 Twenty or more toddlers were found in a so-called day nursery, which 
 was reached by passing through a filthy kitchen and unlocking a door. 
 All of them were whining or fretting some were coughing. Around 
 three sides of this room was a shelf about a foot wide and covered with 
 oil cloth. The small chairs were pushed in front of it, and from the shelf 
 th} children were eating. There was absolutely nothing in the room be- 
 side this shelf, the chairs and the children. The little ones were dirty and 
 unkept. There was no older person with them. Both doors were locked 
 
Bulletins Nos. 8 and 9, August-September, 1918. 137 
 
 and windows tightly closed and covered with dust and cobwebs. On 
 asking to see the play yard, a back door was opened and a chicken pen 
 divided from barn by high board fence and gate was revealed. The barn 
 with a manure pile thrown out of its window was within thirty feet of 
 this place, while investigation showed the front yard was large and set 
 with shrubbery and flower beds. 
 
 Five or six babies were found in the nursery upstairs, several of them 
 exhibiting extreme degrees of malnutrition. The odor in this nursery 
 was so vile that it was almost impossible to stay in the room. A number 
 of young children in the cribs were in wretched condition. One was suck- 
 ing a mixture of peach tree leaves, supposedly for teething troubles. 
 
 The one small bathroom in the house was equipped with one tub, one 
 seat, an old tin wash basin and a common towel. The matron told us 
 these were for the use of the entire establishment. A few wash bowls 
 and pitchers were seen on the third floor, which apparently constituted a 
 rude hospital for the care of women in confinement. 
 
 This home is not properly equipped to take care of children; it is in- 
 s?nitary and dirty; the children are not kept clean nor properly fed; the 
 death rate is higher than it ought to be; it is not a fit place for young 
 children so long as adults of all ages and stages of moral and social de- 
 generacy are being brought there constantly; and the managemeiit is 
 bringing children from other states contrary to law, such children being 
 likely to become public charges in Kansas. 
 
 Children's Home No. 1. The children in this institution were found 
 playing happily. They were entirely free from restraint and called the 
 matron "mother." They were clean and in very good condition con- 
 sidering the lack of equipment. The building is old, without running 
 water, toilet or bathroom facilities, and entirely unsuited for the purpose. 
 There were more than 20 children, with sleeping quarters for only half 
 that number. The children were sleeping four or five in one bed. 
 
 Children's Home No. 2. The equipment of this home is pitifully in- 
 sufficient. The house is old and in such a bad state of repair that it needs 
 to be replaced by a new one. Considering its age and condition and the 
 difficulty of keeping such a home clean, the house was in exceedingly good 
 order. The chi!4ren were happy, free from restraint, and gave every evi- 
 dence of being kindly treated and well cared for to the best ability of the 
 management. 
 
 The home needs to provide individual towels and toothbrushes for the 
 children's bathroom. The teeth of all the children should be examined 
 and necessary dental work undertaken. Many of the teeth were in bad 
 condition. The health of these children would be greatly improved by a 
 thorough physical examination and corrective treatment. A mental 
 test should also be given each child when admitted. It was apparent 
 that several of these children were feeble-minded or suffering such other 
 mental defects as would make them unsuitable for adoption or indenture 
 purposes. Such mental and physical examination should be extended 
 also to the employees, several of whom did not come up to proper 
 health and ability standards. One woman in particular was waiting on 
 the children while suffering with a bad cough, obviously of a tubercular 
 nature. 
 
138 Kansas State Board of Health. 
 
 Children's Home No. 3. This institution was housed in an old two- 
 story frame building which was as clean as good housekeeping can make 
 it. The sanitary arrangements were bad and the building was totally 
 inadequate for the purpose for which it was being used. The steam- 
 heating plant was out of order. A few of the rooms were being heated 
 by gas stoves. 
 
 The children, about a dozen of them, including three of the superinten- 
 dent's own, were found in a dark semibasement, which was used also as 
 a kitchen and dining room. To reach this room the children must 
 descend a very steep, dark and unsafe stairway and pass through a room 
 which is used as a laundry. It was neither a safe nor proper place for 
 them, and instructions were given to the superintendent to utilize a 
 large room on the first floor, which needs only heat and some equipment 
 to make a first-class play room. 
 
 This home has been warned repeatedly by the former Board of 
 Control to put its heating plant in order and to take the children out of 
 the dark semibasement. Apparently it needs more than warning. 
 
 Children's Home No. 4. This institution contains about a dozen 
 children, with adequate quarters for twice that number. The place was 
 immaculately clean perhaps too clean for comfort. The best room in 
 the house a large south room which would be ideal for a children's play 
 room has been reserved for the exclusive use of the board meetings. 
 
 The day the inspection was made the children were in the yard, locked 
 out of the house while the kitchen floor was being cleaned. There was 
 no play room in this house, no library, and very few games or toys. The 
 dining room was cheerless, and no tablecloths or napkins were used. The 
 food was good, but the service was so unattractive and the dining room 
 so cheerless as not to be conducive to good manners or good digestion. 
 
 There was no tooth powder nor toothbrushes for the children. Prac- 
 tically every child in this institution needs some medical or dental treat- 
 ment. At the time of the inspection there were two feeble-minded girls 
 of child-bearing age in the home. Both of them should be sent to Win- 
 field for permanent custodial care. 
 
 Children's Home No. 5. This children's home was housed in a beauti- 
 fully appointed building and in most respects was in excellent order. The 
 children were absolutely free from restraint and the institution would 
 pass as high class. The present dormitories were crowded, making it 
 difficult to obtain a sufficient supply of fresh air. The windows in the 
 boys' play room were closed and the fastenings 'were locked. This room 
 was crowded also and had a decidedly bad odor. 
 
 The medical attention, while of a high order and better than the aver- 
 age children's home, still is not adequate. One physician in general local 
 practice devoting his part-time services to more than seventy children 
 cannot give them medical attention in accordance with modern standards. 
 It is suggested that instead of one practicing physician, a staff of chil- 
 dren's specialists which are available for this institution be organized, 
 so that these children may have the best treatment obtainable. With a 
 few minor changes this institution could come into class A. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 139 
 
 MATERNITY HOMES. 
 
 Maternity Home No. 1. This institution was found to be in beautiful 
 condition. The home was clean and attractive and the girls gave every 
 evidence of being well cared for. At the time the inspection was made 
 there was found an imbecile who had just given birth to a baby her 
 third. She had given birth to twins preyiously. Yet this girl cannot 
 be sent to a proper institution without the consent of her parent or guar- 
 dian. Unfortunately parents and guardians rarely, if ever, recognize 
 the need for proper care for this sort of a girl.* 
 
 Maternity Home No. 2. This home -was housed in an old two-story 
 frame dwelling in a bad state of repair. The inmates consisted of sev- 
 eral aged indigents, six children from eleven to sixteen years of age, 
 and one maternity case. The maternity case was a colored imbecile, 
 thirty years of age, of a very low order of intelligence, almost an idiot, 
 who had given birth to a baby a month previous. A mother of such 1 a 
 low grade of intelligence cannot in any sense be held responsible for her 
 conduct, nor is such a baby fit for adoption. 
 
 Application papers were sent to her county to have the mother and 
 baby sent to Winfield for permanent custodial care, but owing to the 
 peculiarities of the feeble-minded law in Kansas such a girl cannot be sent 
 without the consent of her guardian or parent. The girl presumably has 
 been returned to her home. The usual history of such cases is that they 
 return in a few years with another baby. 
 
 Maternity Home No. 3. This maternity home is also being used as 
 a temporary detention home for children and adults. The home is wretch- 
 edly poor and in exceedingly bad hygienic condition. There is no medical 
 attention, as the matron herself is a midwife and attends the girls in 
 confinment. 
 
 At the time of the inspection there was in the home a feeble-minded 
 pregnant woman (possibly insane), twenty years old, with her two de- 
 fective children. The oldest child, two years old, could not stand alone. 
 The baby was seven or eight months old, and the woman was expecting 
 the third child in a few months more. The husband at the time was 
 before the court on nonsupport and cruelty charges. This man may be 
 punished by being fined or sent to jail. There is -no law which provides 
 permanent custodial care for such a man and woman and their children. 
 Yet it is very obvious that if these two are allowed to continue in their 
 present way they will in time produce a large family of feeble-minded 
 and defective children. 
 
 Maternity Home No. 4- This institution was housed in a three-story 
 ramshackle old fire trap. The sanitary arrangements were very bad 
 and the home was exceedingly dirty. There was no heat provided in any 
 of the girls' rooms. The confinment room was heated by an open stove. 
 The ward room where the patients convalesce was heated by a soft-coal 
 laundry stove. This home is so far below the minimum standards of 
 hygiene and decency that it ought either to be compelled to improve and 
 clean up at once, or it should be closed without any further temporizing, 
 and the girls removed to better surroundings. 
 
 * Since sent to Winfield. 
 
140 Kansas State Board of Health. 
 
 PRIVATE INSTITUTIONS FOR CHILDREN, NONINCORPORATED AND 
 NONCHARITABLE. 
 
 If present methods of inspection and regulation are lax concerning 
 incorporated institutions, they are hopeless in so far as the nonincor- 
 porated institutions are concerned. 
 
 Not one board in the state ^of Kansas, nor the combined authority of 
 all, can reach the very worst offenders the private boarding home or 
 institution which is nonincorporated and which does not solicit funds. 
 
 Under the present laws of Kansas any sort of person at any time or 
 place may open any sort of home or hospital for children or expectant 
 mothers, and conduct it in any sort of way, without even the knowledge 
 of any authority of the state, much less any kind of supervision or con- 
 trol. 
 
 The following extract from a Kansas City paper is a glaring example 
 of what has already happened in Kansas. The Charter Board has no 
 record of this home, and neither the Board of Administration nor the 
 Board of Health knew that such a home was in operation until the story 
 was uncovered by newspaper reporters. 
 
 Maternity Home. "Amid the most miserable surroundings, in a house 
 in which there was no light, no heat except a small oil stove in one room, 
 and no water, a nameless baby boy came into the world at last Fri- 
 day night. The only attendant to the unfortunate eighteen-year-old 
 mother was another girl whose baby had been born five days before and 
 taken from her. She had never seen it. The telephone in the house had 
 not been connected, and help could not be summoned by that means. 
 There was no food in the house. Alone with the young mother, in abso- 
 lute darkness save for the red glare on the floor from the oil stove, she 
 had been carried into the house but a few hours before. The other girl 
 dressed herself as best she could and in the chilling wind made her way 
 to the house of a neighbor. ' There she told the story of the unfortunate 
 young mother in the big, cold, dark house across the street. 
 
 "These girls had come to the so-called maternity home which had been 
 advertised in Kansas City papers. They were charged $10 a week and 
 $25 when the baby was born. In spite of the fact that they had paid for 
 care and medical attention, the unfortunate girls were given no medical 
 attention, not even a nurse, were given only cold food ham, crackers 
 and oranges and were not provided with hot water. The doctor who 
 had been conducting this maternity home has a long and unenviable court 
 record."* 
 
 A Private Boarding Home for Children. This home boards children, 
 charging from two to five dollars a week. Living in a six-room cottage 
 were the matron and three adult members of her family, one boarding 
 mother, and ten children. The five adults and ten children were pro- 
 vided with three double beds and one tick on the floor. Two of these 
 children were girls about eleven and thirteen, and one boy was about 
 thirteen. The sanitary and hygienic conditions of this home were in- 
 describable. 
 
 * This doctor was brought into the county court, but as the girls did not appear against 
 him he was acquitted. His court re9ord was submitted to the Kansas State Board of 
 Medical Examiners, who have auhority to revoke the license, but so far no action has been 
 taken. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 141 
 
 The only recourse under the present law is to obtain a court order for 
 removal of these children. There is nothing to prevent others from being 
 put there as fast as the court takes them out. 
 
 Day Nursery and Boarding Home. The home was fairly well ar- 
 ranged, but was very untidy. As too many children were taken, it was 
 too crowded. The matron and one feeble-minded woman were trying to 
 feed and care for twenty-five or thirty children. The nursery beds were 
 not supplied with sheets and clean bedding. The beds and mattresses 
 were in bad condition. 
 
 SUMMARY. 
 
 Instances of exploitation and tragic lack of proper care of the de- 
 pendent children of Kansas could be repeated in endless sequence, but 
 enough has been said to indicate that there is something radically wrong 
 with the present method of dealing with dependent children. More than 
 a million dollars is invested in the state of Kansas in orphanages for the 
 care of these children. These places spend in the aggregate between two 
 and three hundred thousand dollars every year, and still these unfor- 
 tunates receive nothing but bare subsistence. The method is wasteful 
 and inefficient, and what is worse, robs defenseless children of their 
 natural birthright. 
 
 A state orphan asylum in this day and age is an anachronism. It 
 does n't belong. It exists only as a monument to indifference, ignorance 
 and neglect. The present State Orphans' Home could with advantage be 
 transformed into a clearing-house and child-study laboratory the only 
 legitimate use for a congregate home. This should be used as a receiv- 
 ing station for every unfortunate child in the state. Here the child should 
 have complete physical and mental examination and treatment and should 
 be brought up to physical par with the greatest possible rapidity. His 
 heredity and temperament should be studied, and when it becomes clear as 
 to what is the proper place for him he should be fitted into that place. If 
 he is a fit subject for adoption or care in a normal home, he should be 
 given into the care of a specially trained agent to be fitted into a home, 
 and carefully watched until he reaches maturity and relieves the state of 
 further responsibility. 
 
 If he is found to be unfit for life in a home by reason of physical or 
 hereditary limitations, he should be placed in the custody of some institu- 
 tion especially equipped to care for his particular condition. This method 
 would automatically empty and dispense with the small, inefficient local 
 orphanages. 
 
 The state of Kansas should make it impossible for any individual or 
 group of individuals to receive children or pregnant women without a 
 proper license, regular inspection, and the same amenability to the law as 
 incorporated hospitals, hotels, eating houses and other public accommoda- 
 tions. 
 
 It should forbid the detention of children in pcorhouses, jails or other 
 places where feeble-minded, insane or criminals are kept, or other persons 
 of a character undesirable as associates of innocent childhood. 
 
 It should arrange for the creation of a responsible body of specialists, 
 or the powers of the Division of Child Hygiene should be increased, to 
 
142 Kansas State Board of Health. 
 
 whom should be entrusted the working out and administration of a plan 
 for the care of all child wards of the state, including foundlings. 
 
 Child Placing. 
 
 The normal child belongs in a home, not in an institution. Every insti- 
 tution in Kansas receiving children has the right to indenture or adopt 
 children into homes, but not a single institution has adequate and compe- 
 tent machinery for placing children or for supervising them after adop- 
 tion. 
 
 The biennial report of the State Orphans' Home for 1914-'16 states 
 that the Home at that time had out under active indenture more than 500 
 children. It has one agent to place and supervise these children. The 
 maximum number which one agent can place and keep under supervision 
 with anything like adequate attention is fifty. With a small district, good 
 facilities for transportation and the cumulative advantage of acquaint- 
 ance with the territory, this number may under favorable conditions be 
 increased to 100. The advice of expert investigators, however, is that the 
 number be limited to 50 children per agent. The statement made in this 
 report that the one state agent of the State Orphanage cannot possibly 
 supervise 500 children should receive attention and active consideration.* 
 
 There are no reports available as to the number of children who have 
 been indentured previously by other organizations caring for children, 
 with the exception of the State Orphan's Home and the Kansas Children's 
 Home-finding Society. If the State Orphans' Home, caring for less than 
 one-fifth of the dependent children of the state, has 500 out at one time 
 under indenture, it is probable that there are from 3,000 to 4,000 children 
 scattered about in homes of the state. 
 
 It is inhumane to take a defenseless child out into the state and lose 
 him, for that is what it amounts to when the agency which places the 
 child fails to keep in touch with him. Families have even moved out of 
 the state taking indentured children with them, and left no trace. It 
 would be difficult, if not impossible, to even locate all the children of pres- 
 ent minor age who have been thrown upon the tender mercies of families 
 and forgotten. 
 
 One children's home-finding society has about 1,000 children under 
 supervision in homes. These are under the active supervision of six dis- 
 trict agents. These children remained in the receiving home for an av- 
 erage of only twenty days each. Children in need of surgery or medical 
 attention were attended to before they were sent into the homes. This 
 organization finds no difficulty in finding homes for children. The super- 
 intendent states that there are always from one to two hundred appli- 
 
 * "Our experience in placing of children has completely confirmed in our mind that 
 90 percent of those who take our children into their homes do so for commercial reasons 
 and not because of any real love for the child or desire to benefit his condition. It is for 
 what they can get out of him in dollars and cents rather than for what they can see in 
 him as a future citizen of the commonwealth. . . . Those in need of cheap help take 
 the children out in the spring and keep them during the busy season, and return them 
 when the work is over and they must be at the expense and trouble of sending them to 
 school and otherwise provide for their training." From Report of Superintendent of 
 State Orphans' Home for biennial period 1914-'16. This statement is sufficient evidence 
 of the charge that the State Orphans' Home is not competent to investigate the homes 
 into which it sends the cMld wards of the state, nor equipped to supervise them. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 143 
 
 cations for children on file. No papers are made out until a child has 
 been on probation in the home under the supervision of an agent for 
 ninety days. If at the end of this time both family and child seem happy 
 and suited to each other, papers of indenture or adoption are signed. 
 Children are often moved before the expiration of the probation period, 
 but seldom afterward. 
 
 This organization at one time offered to accept from the state and place 
 in suitable homes and supervise all the children suitable for placement 
 which should be given to them for this purpose, and to do it at a total cost 
 to the state of $50 per child. It cost during the biennial period of 1914-'16 
 an average of $239.34 yearly per capita for the support of the children 
 in the State Orphans' Home. Certain of these children properly belong 
 in the School for the Feeble-minded. The majority of them, however, 
 are suitable or can be made suitable for placement and adoption. There 
 is no question but that it is far cheaper in the long run to place and 
 supervise than to support them. 
 
 Granting that there are 1,000 children in residence in orphanages and 
 4,000 more scattered over the state, or an estimated total of 5,000 chil- 
 dren whom we will assume to be suitable for normal home life, it would 
 require a force of fifty paid agents to place' and systematically visit all 
 these children, and the total expense to the state would approximate 
 $150,000. Allowing a maximum salary of $1,800 and maximum travel- 
 ing expenses of $1,200 a total of $3,000 per year for each agent with 
 an average of 100 children assigned to each for placement and super- 
 vision, the average per capita expense per child would approximate $30. 
 
 The reports from the private orphanages are too imperfect to fur- 
 nish data as to per capita cost and attendance.* Taking the per capita 
 cost at the State Orphans' Home as a basis (in all probability some 
 homes spend less and some more), it costs the public of the state approxi- 
 mately $240,000 per year to support this thousand children in residence in 
 institutions, or a sum sufficient to place and adequately supervise all the 
 5,000 dependent children of the state and keep a record of them until 
 maturity, and have a balance of some $90,000 per year to devote to the 
 maintenance of an adequate* clearing house, detention home and child 
 laboratory. 
 
 It is not good business, it is not humane, to continue the present ar- 
 chaic, ineffective, outgrown method. The war is raising thetvalue of the 
 individual citizen and making Ufe very hard for the unprotected. Both 
 sentiment and common sense demand speedy action. 
 
 * Tabulations were made of the reports for the fiscal year ending June 30, 1916, of 
 twenty-two institutions legally authorized by the state to receive and dispose at will of de- 
 pendent children, and required by law to render yearly reports covering specified points. 
 Two children's homes and five maternity homes made no report whatever as to the number 
 of children handled or their disposition. Nine homes reported receiving a total of 208 
 more children than they accounted for, while five other institutions reported the disposal 
 of a total of 47 more children than they had received! 
 
 The institutions (including the State Orphans' Home) reporting on this point reported 
 themselves as having cared for a total of 1,803 children during the year. They reported 
 908 as remaining in residence at the end of the year covered by the report. A minimum 
 estimate of the children cared for by the remaining seven institutions makes it appear 
 certain that at least a thousand children were at that time in residence in these twenty- 
 two homes. It is safe to assume that this figure remains fairly stationary. 
 
 The average daily number of inmates does not appear on these reports, with the excep- 
 tion of the State Orphans' Home. The financial reports are not accurately made, only six 
 showing debit and credit statements which balance. It is therefore impossible to figure 
 the per capita cost of the support of the inmates of private orphanages. 
 
144 Kansas State Board of Health. 
 
 Children in Kansas Poorhouses. 
 
 , The county poorhouse, as it is usually administered, is a close relative 
 of the medieval almshouse of deservedly odious repute. Yet within the 
 past year in the state of Kansas twenty-four children in six counties have 
 been incarcerated with the veritable "scum" of feeble-minded, hopelessly 
 insane and social derelicts who people these institutions. 
 
 In response to inquiry as to why these children were harbored in the 
 poorhouses, several reasons were given: 
 
 Most often, the young child remains in the custody of a feeble-minded 
 or derelict mother, who goes and comes. Sometimes she goes and comes 
 until she has two or three children for the obliging county officials to 
 take care of. 
 
 A temporarily dependent mother and children are cared for in the 
 poorhouse and the children sent to school. This is not in accordance with 
 the intent of the mother's pension law. 
 
 The probate judge commits juvenile offenders or truants to the alms- 
 house awaiting their trial. In one county a colored girl of eleven and a 
 white girl of about the same age were kept in the county house all sum- 
 mer awaiting the action of court. 
 
 Dependent children are carelessly committed to the county house be- 
 cause there is no orphanage near and it seems easier to keep them at the 
 expense of the county in the county home than to send them to the state 
 orphanage. One boy of thirteen was sent to the poor farm when both 
 his parents were sent to the penitentiary and has remained there for 
 three years, and is now drawing wages as a helper. 
 
 Every one of these classes of children belongs elsewhere. No county 
 house or other place stigmatized by the term "pauper" is a proper place 
 for any child. No child is or can become a pauper, because the state 
 which permitted him to be born within its jurisdiction owes him support 
 and education commensurate with good standards of citizenship, regard- 
 less of adverse accidents of circumstance. 
 
 Defective Children. 
 
 There are five special classes of defective children who should be 
 separated from normal dependent children and also from normal homes. 
 These are the feeble-minded, the blind, the deaf and dumb, the epileptic, 
 and the crippled. This separation is necessary, both for the sake of 
 obtaining for the atypical child the specialized care his condition indicates, 
 and also for the sake of relieving the home and school in certain instances 
 of his undesirable influence. 
 
 Kansas has established the following institutions for the care of these 
 children : 
 
 Population. 
 
 State School for the Feeble-minded, Winfield 663 
 
 State School for the Blind, Kansas City 104 
 
 State School for the Deaf, Olathe 240 
 
 Colony for Epileptics, Parsons (both adults and children), chil- 
 dren, approximately 125 
 
 1,132 
 
Bulletins Nos. 8 and 9, August-September, 1918. 145 
 
 Besides these four classes, the state provides medical and surgical care 
 for indigent children at the State University Medical School at Rosedale. 
 
 While the exceptional child must have specialized care such as can sel- 
 dom be given him in any home, every precaution should be taken to 
 make him feel as normal as possible. A special study should be made 
 in each of these groups of the psychology of "set-apartness" and its 
 reaction upon the effective physical and mental life of the child. 
 
 Along with orphanage, the special institution needs to emerge from 
 the custodial to the research conception of its function and duty. No 
 institution for defective children should be permitted to lapse into mere 
 custody of the person of the limited child. 
 
 FEEBLE-MINDED. 
 
 There are at present 663 feeble-minded persons in residence in the 
 state institution at Winfield. These are chiefly idiots and low-grade 
 feeble-minded, whose mentality is of such a caliber that they do not re- 
 spond to educational effort. 
 
 The vital problem to the state is not the detection and care of the low- 
 grade idiot who can harm no one, but rather the individual who becomes 
 arrested at the mental age of 7, 8 or 10 years, but whose animal appetites 
 and passions go on to full maturity. These are the individuals who 
 furnish a very important percentage of the inmates of penitentiaries, 
 houses of prostitution, jails, poorhouses, houses of correction and re- 
 formatories. These individuals propagate their kind freely and un- 
 reservedly. The consequence is that society replenishes itself much more 
 lavishly from the bottom than from the top. 
 
 The crux of -the whole matter lies in getting the mentally retarded 
 child young enough to give him appropriate vocational training and 
 chance for self-development. // it be found that he can never arrive 
 at a mental age of sufficient maturity for social safety, he should be seg- 
 regated in time to keep him from becoming a social menace. 
 
 A complex machinery is necessary in order to accomplish this effect- 
 ively: . 
 
 1. The location of mentally retarded children in the schools. This 
 can be done within wide limits by the untrained teacher. It can be done 
 effectively only by the trained psychiatrist. 
 
 2. The establishment of a suitable number of ungraded classes under 
 specially trained teachers, in order that these children may be taught the 
 things that they have the capacity to learn, and especially that they may 
 have vocational training to fit them to become self-supporting. When it 
 becomes apparent that they cannot be made competent to lead a safe and 
 independent existence, they should be taken out of the public school and 
 sent to the state school. 
 
 3. A state training school and psychopathic hospital for the study of 
 the problems of feeble-mindedness, for research, and for the education of 
 children who do not have access to special teaching in the public school 
 or who present special problems in mental abnormality. 
 
 This training school and psychopathic hospital might be built in con- 
 nection with the present custodial institution at Winfield. This would mass 
 3 Health 4194 
 
146 Kansas State Board of Health. 
 
 the problem of mental variation which would be an advantage as far as 
 research activities are concerned and it would economize administrative 
 machinery. Other phases of the problem of feeble-mindedness are dis- 
 cussed in the legal section of this bulletin. 
 
 THE BLIND AND DEAF. 
 
 The vocational competency in after life of both the blind and the deaf 
 depends so directly upon the quality of specialized teaching they receive, 
 that it is necessary that they be well taught in order to save them from 
 lifelong dependency. Many soldiers will be coming back blind and deaf 
 and in urgent need of specialized vocational training. It is a mistake 
 not to keep these schools at their highest efficiency on the eve of a greater 
 need than ever for highly specialized teaching machinery. 
 
 The state of Kansas, in common with many others, has deemed it the 
 part of economy to get the work of its institutions done as cheaply as 
 possible. This is a false economy for any institution, but more especially 
 in the case of the blind, because they are less able to assist with the work 
 of the school plant and require more personal assistance. 
 
 A certain percentage of blindness and of deafness is inheritable. It is 
 known that there is a group of men and women in southeastern Kansas 
 affected with inheritable forms of these defects (some of them former 
 students of the state schools) who, if not properly controlled, will by 
 their numerous progeny keep the schools for the blind and deaf people 
 indefinitely. Another considerable percentage of blindness and deafness 
 might have been prevented by proper attention in time to babies' eyes 
 and ears. 
 
 The prevention of both the inherited and the acquired forms of blind- 
 ness and deafness will cost infinitely less than to support and educate the 
 unfortunate victims. 
 
 THE COLONY FOR EPILEPTICS. 
 
 The state of Kansas has established a colony for epileptics with a total 
 population of 530, approximately a fourth of whom are children. 9 There 
 still remain many epileptics who should reside in this colony. Were the 
 advantages both to the epileptic himself and to his community better and 
 more widely understood, there would be fewer at large. 
 
 Epilepsy has thus far baffled medical science, but it is bound to be 
 conquered some time, just as so many other diseases have been and are 
 being conquered. Until that time there should be insistent and untiring 
 research in every institution harboring these unfortunates. Instead, the 
 state of Kansas provides only custodial care. 
 
 CRIPPLED AND SICK CHILDREN. 
 
 The epidemics of infantile paralysis have left a trail of pathetic little 
 victims. This is another instance where highly specialized care is neces- 
 sary if the child is to be saved from lifelong helplessness. Bone tuber- 
 culosis numbers many victims who need orthopedic, medical and hygienic 
 treatment. Various nervous and constitutional maladies require hospital 
 care and spdal medical attention. A great variety of defects aside from 
 those mentioned should have surgical relief. 
 
 In recognition of the fact that many children in many communities 
 
Bulletins Nos. 8 and 9, August-September, 1918. 147 
 
 were totally unable to have proper attention, the state legislature in 
 1911 provided a method by which parents who are unable to pay for 
 hospital treatment for their children might have them cared for by the 
 hospital of the University School of Medicine at Rosedale. But the appro- 
 priation and equipment for the care of crippled children at Rosedale is 
 entirely inadequate to meet the demands. 
 
 The state should provide the Division of Child Hygiene with sufficient 
 funds for locating these children and the University Hospital with ade- 
 quate facilities for giving them proper care. 
 
 THE INCORRIGIBLE CHILD. 
 
 Population. 
 
 Industrial School for Boys, Topeka 239 
 
 Industrial School for Girls, Beloit 165 
 
 Students of childhood say that there are no bad children; there are 
 only misunderstood children and children who have never had a chance 
 to be good. There are also children who have inherited tendencies and 
 mental limitations which prevent them from discriminating between right 
 and wrong. There are others who offend because of the incessant irrita- 
 tion and drag of defective and undernourished bodies. These children 
 should be no longer punished and branded with disgrace. They should 
 be studied. The fault usually is found to reside not in the child, but in 
 his inheritance and environment. When the fault is in the child there is 
 all the more reason to study him, for he has a sick mind or a sick body 
 often both. 
 
 There is no greater need for a clearing-house ; and child-study labora- 
 tory than in the case of the child who rebels against his environment 
 and wreaks his vengeance upon it in some way which makes it desirable 
 to remove him from it. It is an infamous thing to stigmatize such a 
 child by sending him to a reformatory or prison. This whole matter 
 could be handled through a clearing-house system with far greater justice, 
 economy and safety to the child than obtains under the present method 
 of commitment. Every child should automatically be put in good physical 
 condition. This alone will dispose of a certain number of cases. The 
 child who is merely unfortunate and misunderstood, and who shows char- 
 acter in resisting a bad environment in the only way he knows, need 
 never be sent to an institution at all. He should be placed in the care 
 of a discriminating agent and fitted into the place he needs a home. 
 The child who has a perverted or retarded or abnormal mind should be 
 placed in the( psychopathic department of the proper institution. He 
 should be studied, and helped if possible. But he will be safe, and so 
 will society. This last class should not be kept with the children who can 
 be helped and who are relatively normal. It is an injustice to both classes 
 of children and to the management, since the same treatment is not 
 applicable to both. 
 
 The weeding out of the misunderstood, the physically defective, the 
 psychopathic, the subnormal and the degenerate will leave a small residue 
 of "difficult" children who need careful training and study, but who may 
 become fairly good citizens under proper care. This is the only legiti- 
 mate use for a congregate school of this sort. 
 
CHILD- WELFARE LEGISLATION. 
 
 For the legal research necessary to the following analysis of child-hygiene legislation 
 in Kansas we are indebted to Edna Pierson Hopkins, LL. B., Topeka. 
 
 As the infant mortality rate is said to be the most sensitive index we 
 possess to social welfare, so the laws relating to children may be said 
 to reflect accurately the social tendencies of the times. Nothing is more 
 significant of the social awakening than the many movements for the 
 study and the improvement of legislation guarding the rights of the 
 child. 
 
 Statutes have mainly to do with the protection of the property and the 
 social rights of citizens, and the punishment of offenders. Statutes take 
 cognizance of the status of the child. The law specifically exempts a 
 child of seven years or under from punishment for crime. In the eyes of 
 the law the child under seven can commit no crime. The law also recog- 
 nizes the principle of accountability as expressed in the age at which ma- 
 jority is attained. Generally at eighteen or twenty-one the citizen is held 
 to be an adult and fully accountable before the law. 
 
 What the law has not yet recognized (in line with the latest develop- 
 ments in science) is that the chronological birthday, eighteen or twenty- 
 one, does not indicate necessarily that the citizen has reached that age of 
 accountability. A twenty-first birthday does not differentiate adequately 
 between the minor and the adult, because a considerable percentage of 
 offenders before the law never reach the mental age of eighteen or 
 twenty-one nor the status of accountability as an adult. They are and 
 always will be of the mental status of a child, and so cannot properly be 
 held to account according to adult standards of conduct. 
 
 In another respect legislation for children differs from average legis- 
 lation for adults. Child legislation must look to the preventive side of 
 offenses and crime rather than to the curative. Legislation for children 
 must throw such safeguards about the child, his home, his parents or 
 guardians and his environment as to make offenses against the law 
 approximately impossible. To do this, laws for children need to follow 
 less the established procedure or precedence in law and to follow more 
 the latest and -best discoveries in the science of child hygiene and welfare. 
 
 With the thought of stimulating an inquiry into the present status of 
 Kansas laws for children, this short analysis was written. Only a few of 
 the more immediately important laws were investigated, and of these a 
 necessarily incomplete analysis is presented because of the short time 
 and the very limited funds at the disposal of the Division of Child 
 Hygiene. This is presented, however, with the hope that it will stim- 
 ulate a thorough investigation of existing legislation for children in 
 Kansas and that eventually a complete codification of children's laws may 
 be effected. 
 
 (148) 
 
Bulletins N os. 8 and 9, August-September, 1918. 149 
 
 Birth Registration. 
 
 Scarcely a day passes but that some bewildered individual comes to 
 the vital statistics office of the State Board of Health seeking proof that 
 he is an American citizen and a Kansan. 
 
 France has had complete and accurate records of her citizens since 
 1687. Kansas has records dating only to 1911. In order to make avail- 
 able a permanent record of the birth of every Kansan the State Board 
 of Health is establishing files antedating 1911 and sufficiently complete to 
 include every citizen who will avail himself of the privilege of registering. 
 These records will become increasingly important to succeeding gen- 
 erations. 
 
 Following the close of the great war hundreds of claims of various 
 kinds will appear, in the settlement of which a demand is likely to be 
 made for a certificate of birth as proof of citizenship. If this certificate 
 were on file with the Kansas State Board of Health it could be had in a 
 few minutes' time. If it is not on file the claimant will be required to go 
 to considerable effort and expense to furnish the proper proofs. 
 
 A birth certificate is now required to obtain a passport to a foreign 
 country, to obtain a soldier's pension, and to establish American citizen- 
 ship. , 
 
 A birth certificate may be required to establish identity, to enter school, 
 to employment under child labor laws, to inherit property, to establish 
 liability for military service and exemption therefrom, to vote, to hold 
 title, to buy or sell real estate, to marry. 
 
 In order to make the importance of birth registration more generally 
 known and Kansas records more complete, a request was sent to school 
 authorities asking that they require a birth certificate as proof of age 
 when entering school. As a further check on the birth registration, the 
 Department of Labor requested county and city superintendents of 
 schools to require a birth certificate in granting work permits to children. 
 With these two checks through the school authorities, Kansas birth 
 registration should be made practically complete. 
 
 Mothers' Pension Act. 
 
 The problem of poverty exerts a marked influence on child mortality. 
 Whenever the standard of living drops to or below the border line of 
 economic security, immediately the death rate of minor children begins 
 to rise. When the father as a principal breadwinner is absent and the 
 mother compelled to take both a father's and mother's place, the problem 
 is still further complicated by an additional increase in child mortality 
 and an increase of juvenile delinquency as a result of the lack of watch- 
 ful care of a mother. 
 
 In recognition of this condition and to a somewhat less extent in 
 recognition of mother's service to her state in producing children, 
 the mothers' pension acts came into existence. The Kansas mothers' 
 
150 Kansas State Board of Health. 
 
 pension act, as it now reads in Session Laws of 1917, is "An act to amend 
 chapter 261 of the Session Laws of 1915, the same being an act to amend 
 section 6624 of the General Statutes of 1915, relating to the poor, for 
 the relief of widows and dependent children, and repealing said original 
 section. This act provides that the board of county commissioners may, 
 in their discretion, allow and pay to poor persons who may become 
 chargeable as paupers such annual allowances as will not exceed the 
 charge of their maintenance in the ordinary mode. Such allowances are 
 to be paid from the funds in the general revenue fund of the county. 
 
 In order to obtain a knowledge of the practical workings of this law 
 a questionnaire letter was sent to numerous counties asking for the 
 number of mothers helped, the amount of money paid out for pensions 
 by the county, the type of women given assistance, and the attitude of 
 the commissioners toward giving pensions. A digest of the answers 
 follows : 
 
 County A Reports: There are no mothers receiving the pension, but 
 about $400 is paid out each month to the poor of the county. None of 
 this money is paid under the provisions of the mothers' pension act. 
 
 County B reports: Seven mothers were given assistance during the 
 year. The amount of money paid out was $804. Good, hard-working 
 women were given the pensions. The attitude of the commissioners 
 toward the pensions reported as being all that could be desired. 
 
 County C reports: Commissioners are opposed to giving pensions, 
 because the county is an industrial center and there are so many widows 
 that the commissioners say it would bankrupt the county to begin giv- 
 ing pensions. The question is asked from this county, whether or not 
 the law would be more effective if the fund were provided by the state 
 instead of each individual county. They suggest that as the state reaps 
 the benefit from these industrial counties, it should share the responsi- 
 bility. 
 
 County D reports : Six pensions were given during the year. Amount 
 paid out, $564. Commissioners are very slow to give pensions on account 
 of lack of funds in the county. Type of women given aid are unfor- 
 tunates who are left with large families to support. 
 
 County E reports: Work progressing well, but commissioners more 
 or less hampered in the giving of pensions by the lack of funds. 
 
 Further reports and interviews with women appointed to investigate 
 applications for funds under this act concede the same essential details : 
 That the county commissioners as a whole would favor the granting of 
 mothers' pensions if they had a definite fund to draw from ; that trained 
 supervision of investigations, and uniformity of method is desirable. 
 
 The adoption of a mothers' pension act in Kansas was a big step for- 
 ward. But it is not enough merely to place an act on the statute 
 books the law must be a workable one and provisions must be made to 
 have it carried out in proper spirit of the statute. Nor should any act 
 be permitted to lose its force because of lack of funds by which it may 
 be administered and the provisions carried out. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 151 
 
 The Kansas mothers' pension law as it now stands nee'ds further study 
 as to the provision of funds by which the law will become effective, and 
 as to the methods of administering which will carry out the purposes 
 for which the act was intended. 
 
 Children Born Out of Wedlock. 
 
 The Declaration of Independence declares all men to be born free and 
 equal ; the constitution of the United States guarantees to all life, liberty 
 and the pursuit of happiness. Neither specifically excludes the child born 
 out of wedlock. Yet if a child is so indiscreet as to be born without a mar- 
 riage certificate having first been obtained by his parents he is deprived 
 of a natural home, parental care, guardianship and sustenance, and he 
 stands condemned as a quasi-criminal throughout his life. 
 
 Laws affecting children born out of wedlock are a heritage along with 
 the rest of the common law. The Napoleonic code not only gave the child 
 born out of wedlock no rights, but it forbade any inquiry into its paternity. 
 The common law of England, failing to stop illegitimacy by punishment of 
 the women, visited the punishment upon the innocent child by declaring it 
 to be "the child of no one" (filius nullius) , and entirely relieved those who 
 gave life to it from all responsibility. Later laws were enacted regarding 
 illegitimacy, not with a view of doing the innocent child justice but as a 
 part of the poor laws, with a view to protecting* the community on which 
 fell the burden of the child's support. 
 
 The law concerning illegitimate children in many parts of the United 
 States, including Kansas, still stigmatizes a child born out of wedlock as a 
 "bastard." In Kansas an unmarried mother who is delivered of or preg- 
 nant with a "bastard" child may make a complaint in writing before a 
 justice of the peace charging the father of her child, who is thereupon ar- 
 rested and brought before the magistrate. If the case is sufficiently clear 
 the accused man is held for trial before the district court. If the de- 
 fendant denies the charge, the trial must be by jury. 
 
 These cases are tried in open court, usually with a large and interested 
 audience. The girl is subject to severe and often shocking examination 
 and cross-examination. A common form of defense is to attack and try 
 to tear down her previous good character, often going to the length of in- 
 troducing several witnesses for the defense to swear to improper relations 
 with the girl in order to throw in doubt the paternity of the child. If the 
 girl is successful in her suit, the man is adjudged the father of the child 
 and is charged with its maintenance and education. If he fails to do so, 
 he may be sent to jail, but not for more than one year. If in the mean- 
 time he should leave the state, there is no law for bringing him back as in 
 the case of stealing a horse or selling a jug of whiskey, unless he should 
 be charged also with criminal action. 
 
 The law primarily .does not protect the child and the mother, but 
 the possible father. She and her child are guilty. He is guilty only if 
 she can prove it. And the length of publicity and public humiliation to 
 which she must go in order to prove paternity and obtain support for her 
 child is scarely worth the effort. If the mother is ignorant of the law, 
 
152 Kansas State Board of Health. 
 
 or if, as the case often happens, she is poor and without friends or is of 
 low mentality,* she can obtain no redress whatever. 
 
 As a result of this condition, a girl who finds herself in trouble 
 generally flees to a distant city to hide her shame.f Often she does not 
 give her right name. She goes to the hospital alone, and there alone 
 she brings forth her child. When she has again recovered her strength, 
 she goes on her way alone. Or, with a courage beside which ordinary 
 heroic achievements pale into insignificance, she takes up the unequal 
 burden of supporting them both she an "outcast" of society, her child 
 a "bastard" before the law. 
 
 One of the most potent signs of the awakening social consciousness is 
 the agitation for an improvement of the conditions of the unmarried 
 mother and her child. One proposed remedy which has received a great 
 deal of public attention is the so-called Castberg law, now in force in 
 Norway. Under the Castberg law the burden of proof is thrown upon 
 the reputed father, who is guilty until he proves his innocence. If more 
 than one man may be the possible father of the child, each may be held 
 liable to contribute to its support. 
 
 Any proposed statute for the protection of a child born out of wedlock 
 should provide for the legal status of the child, its maintenance and 
 education, and should relieve the mother of the cost and entire responsi- 
 bility for the action. The guiding spirit of such a law should be the 
 welfare of the child. To this end the court should be empowered to decree 
 whether the child takes the name of the father or the mother, how much 
 each shall contribute to his suport, including cost of confinement and cost 
 of suit, which one shall have the custody of the child, and all such other 
 necessary power to give the child all its legal rights as though it were 
 born of lawful wedlock. 
 
 Laws now enacted by progressive states provide that any interested 
 person (by permission of the court) may bring action to determine 
 paternity; that the service may be obtained by publication instead of 
 arrest and the case heard in closed court, that the evidence may be sealed, 
 and that the right of extradition be provided. Should the court find the 
 defendant to be the real father of the child, it enters a decree that the 
 child is to all legal intents and purposes the child of the natural father 
 and entitled to all the rights pertaining thereto. 
 
 Abuse of Children. 
 
 A man who cruelly assaults and beats a defenseless child merits the 
 suspicion that he is either under the influence of alcohol or drugs, or 
 that he is insane or degenerate. Such a man is not a safe person to be 
 at large in the community. 
 
 Under the Kansas law (section 6403, General Statutes of 1915) the 
 offense of assault of a child is still regarded as only a misdemeanor. The 
 
 * "The result of two separate tests leads to the conclusion that not more than 20 percent 
 
 of the unmarried mothers cared for by the obstetrical service of General Hospital 
 
 may safely be pronounced normal." From Mentality of the Unmarried Mother by Jean 
 West, Asst. Director, Psychological Clinic. 
 
 t Girls from neighboring states come to Kansas. Kansas girls go to Missouri, Okla- 
 homa and Colorado. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 153 
 
 maximum penalty is a fine of $250 and imprisonment in the county jail 
 for a term not to exceed one year. 
 
 Inadequate as this statute is, in actual practice the offender may be 
 let off with a very much lighter sentence if he is apprehended by the 
 police and brought to trial in a police court. Although the district court 
 has concurrent jurisdiction, the -county attorney as a rule does not 
 prosecute a man who has already been convicted in police court on a 
 charge of this nature. 
 
 Attention was catted to this unfortunatly common method of pro- 
 cedure and to the inadequacy of the present statute by the case of Ollie 
 Bussy, who was arrested and convicted of cruelly beating an eighteen- 
 months-old baby. Competent testimony established the fact that the child 
 had been most outrageously and atrociously assaulted. The judge im- 
 posed a fine of $100, the maximum penalty under city ordinance 1203, 
 Revised Ordinances, City of Topeka, 1916. Upon investigation it was 
 found that Ollie Bussy had had a long criminal record, and that at the 
 time he was on parole from the penitentiary. He was returned promptly 
 to the Penitentiary on violation of his parole. 
 
 Had Ollie Bussy not been on parole, and his parole not been revoked, 
 the only punishment he would have received for the offense of beating 
 a helpless baby would have been the $100 fine. Had the county attorney 
 also prosecuted him he might have received an additional fine of $250 
 and imprisonment of not more than one year in the county jail, which 
 altogether does not seem an adequate sentence for this crime. 
 
 What has happened in Topeka can happen elsewhere, and probably is 
 happening. To brutally assault a child is such a heinous offense that 
 whenever such cases come before the attention of the citizens or police 
 they ought at once -to lay the evidence before the county attorney 
 in order that the offender may be given immediately the maximum penalty 
 of the law. 
 
 Crimes against children aptly illustrate the inadequacy and incom- 
 petency of the present procedure in law as to the punishment of crime. 
 The whole modern tendency of science is towards prevention rather than 
 cure or punishment. The proper protection of children demands that the 
 law keep abreast of science. 
 
 When Ollie Bussy committed his first offense in all probability he 
 would have been recommended by a psychologist for permanent custodial 
 care. Certainly after a proper examination into his mental condition 
 he would not have been released from custody repeatedly, only to commit 
 other and more serious offenses for which he must be retried and re- 
 sentenced. The cost of such procedure undoubtedly is many times that 
 of the preventive method, and furthermore so clumsy and inefficient that 
 it ought not to be tolerated. 
 
 The remedy in the law may be through the establishment of a state 
 bureau of mental examination, accessible to all courts, with provision 
 in court for the appointment of a qualified mental examiner. When a 
 mentally irresponsible person with criminal instincts is once apprehended 
 he should be retained in permanent custody of the state. Such a pro- 
 cedure would prevent the majority of repetitions of offense and violations 
 of parole which contribute to a long criminal record. 
 
154 Kansas State Board of Health. 
 
 Care of Feeble-minded Children. 
 
 Feeble-mindedness is an inheritable defect. No normal child ever has 
 been born to feeble-minded parents. If one parent is feeble-minded and 
 the other is normal the child has about an even chance of being feeble- 
 minded or apparently normal. This normal child, however, transmits 
 feeble-mindedness to his offspring, and a certain percent of them will be 
 feeble-minded. 
 
 To permit a feeble-minded or otherwise mentally irresponsible person 
 to have offspring is a rank injustice to the child, to the parent and to the 
 state. Common justice and fairness demand that a feeble-minded child or 
 child of mentally irresponsible persons, having once been born, be given 
 every opportunity for the fullest possible development of his feeble talents. 
 This is necessary to make him self-repecting and self-supporting, and to 
 give him a small measure of happiness which is a poor enough return for 
 the injustice already inflicted upon him. 
 
 The legislative committee of the Kansas Commission on Provision for 
 the Feeble-Minded investigated the existing legislation regarding feeble- 
 mindedness in this state. The following is an excerpt from their report. 
 A full report of the Commission will be published later: 
 
 "Session Laws, 1881, chapter 35 (section 9671, G. S. 1915), established 
 an institution for the education of idiots and imbecile children, to be de- 
 nominated the 'Kansas State Asylum for Idiotic and Imbecile Youth.' 
 Session Laws, 1909, chapter 233, changed the name of the institution to 
 the 'State Home for the Feeble-Minded.' The institution was originally 
 intended to be a training school for these unfortunate children. As there 
 has been no sufficient provision for educating such children as might be 
 trained, it has been permitted to become a custodial asylum for low- 
 grade feeble-minded. 
 
 "A larger appropriation is necessary to provide a modern training 
 school at Winfield and to establish colonies in order to segregate properly 
 the various grades of feeble-minded into such groups as would best fa- 
 cilitate their training and care. In connection with this training school a 
 properly equipped medical and psychological clinic should be established 
 to give these children the most favorable classification and treatment. If 
 this were done, parents of mentally backward or feeble-minded children 
 would cheerfully send their children for such special training as they re- 
 quire, just as parents now send their children to the State School for the 
 Blind or Deaf. This would better the condition of the children and re- 
 lieve the communities of hundreds who are now a drag in the school room, 
 who exercise a degenerating influence on the younger children with whom 
 they are associated, and who, as they grow older, constitute a steady and 
 constant stream of petty criminals. 
 
 "Admission to the Winfield institution is now on application of parent 
 or guardian. There being no commitment law in the state, no court has 
 the authority to commit a feeble-minded person, even though he may be a 
 public nuisance or menace.* Frequently it happens that the parent or 
 
 * Section 6098, General Statutes of 1915, provides for inquiry to be made when 
 verified information in writing is given that any resident of a county is insane, a lunatic, 
 an idiot, an imbecile, a feeble-minded person, drug habitue or habitual drunkard, and for 
 any of these reasons is incapable of managing his affairs. 
 
 Section 6100, General Statutes of 1915, provides that if the jury impaneled to try the 
 case finds that the person is insane, a lunatic, an idiot, an imbecile, a distracted person, 
 a feeble-minded person, a drug habitue, an habitual drunkard, or one incapable of manag- 
 ing his affairs and in need of a guardian, the court may, if it finds that such order is 
 necessary, appoint a guardian of the person or estate of such person, or both, as the 
 circumstances of the case may require. 
 
 Section 6107, General Statutes of 1915, provides that every probate court by whom 
 
Bulletins Nos. 8 and 9, August-September, 1918. 155 
 
 guardian (if he be a relative) of the feeble-minded person is of such low- 
 grade intelligence that he himself is a proper person for custodial care. 
 The absurdity of the lack of proper commitment power by the courts im- 
 mediately becomes apparent. 
 
 "The legislative committee therefore recommends : 
 
 "First: That the name of the State Home for Feeble-minded be 
 changed to the State Training School, and that sufficient appropriation 
 be made to restore the original purpose of the institution. 
 
 "Second: That a proper commitment law for feeble-minded be en- 
 acted, enabling the state, when the best interests of society or the in- 
 dividual demand to transfer a feeble-minded child or adult to this institu- 
 tion. 
 
 "Such legislation, and sufficient appropriation to carry it out, both as to 
 the letter and the spirit of the law, would enable Kansas to care for the 
 feeble-minded in a scientific manner, and in the way demanded by 
 modern ideas for the care of these unfortunates." 
 
 Physical Inspection of School Children. 
 
 Before starting on a long journey the careful automobilist makes cer- 
 tain that his machine is in perfect condition for the trip. Even starting 
 with a perfect machine, a long trip is likely to bring out or develop un- 
 suspected defects. Just as logical as the careful inspection and repair of 
 an automobile preparatory to a trip is the examination and treatment of 
 the defects of a child before starting to school each year. A parent or 
 guardian of a school child needs to be certain that the child can see well, 
 that he hears well, that his teeth are good, and that he is free from defects 
 which will interfere with his health and school progress. 
 
 But granted that a child starts to school in perfect condition, a parent 
 has no assurance that his child will not come in contact with children who 
 have not had such ca^re. Neither has he any assurance that his child will 
 not be exposed to contagious diseases or to conditions which may be 
 attended with unpleasant if not dangerous consequences. The majority 
 of all children attending school are without proper protection from the 
 spread of communicable diseases, and their minor physical ailments are 
 undiscovered and neglected. Only a few states and a few large cities have 
 made legal provision for periodic inspection of school children, and still 
 fewer of them are providing adequate methods of treatment. This legal 
 protection should be extended with all possible rapidity until every child 
 in the country is thus safeguarded. No parent can feel secure as to the 
 health protection of his own child until all the children with whom his 
 child comes in contact are also protected from contagion and from all 
 conditions coincident with school life which affect the health of any child 
 unfavorably. 
 
 Sections 9099 and 9100, General Statutes of 1915, provide for the ex- 
 penditure of school funds for dental inspection in cities of 40,000 or over. 
 These sections should be enlarged to permit all school boards to use school 
 funds for the employment of school nurses, doctors and dentists, for the 
 establishment of school clinics, and for such other measures as will insure 
 the complete protection of all school children. 
 
 any such person is committed to guardianship may make an order for the support, care 
 and safe-keeping of such person. In this roundabout way the guardian and the probate 
 court may send the person to Winfield. 
 
156 Kansas State Board of Health. 
 
 Marriage. 
 
 The prevalence of divorce and the numbers of children of ill-considered 
 and unfit marriages, handicapped at the start by mental, physical and 
 economic limitations, compels the conclusion that marriage is not ade- 
 quately safeguarded by law. 
 
 Many of the spur-of-the-moment and ill-advised marriages would be 
 prevented if the statutes required a five days' notice for the issuing of the 
 marriage license. Several of the states already have legislation along 
 this line. 
 
 Wisconsin requires that not less than five days previous to persons 
 being joined in marriage a license shall be obtained from the county 
 clerk of the county in which the female resides, or if not a resident of 
 the state, then from the county where the marriage is to take place in the 
 state. In addition Wisconsin requires a health certificate certifying that 
 the male applying for the license has been examined with fifteen days 
 prior to application for license to marry, and is free from veneral disease. 
 Massachusetts and New Hampshire also require a five days' notice for a 
 marriage license. 
 
 The Missouri children's code commission recommends that common-law 
 marriages be abolished, and that there should be an interval of five days 
 between the application for a marriage license and its issuance. The 
 marriage of feebleminded, epileptic and insane is already prohibited. 
 
 Kansas forbids the contracting of marriage within prohibited degrees 
 of relationship. It also forbids the issuance of a license to epileptics 
 unless the female is over forty-five years of age, and the marriage of the 
 insane, but there is no provision for the necessary supervision aa to make 
 these laws effective. Ultimately Kansas should provide that no marriage 
 license may be issued until both parties present certificates of mental and 
 physical fitness for caring for themselves and their progeny, and in every 
 case there should be at least five days' notice of the intended marriage. 
 
 Compulsory Education and Child Labor. 
 
 According to the federal census of 1910, 6,857 Kansas children be- 
 tween the ages of ten and thirteen are at work. The undesirable char- 
 acter of jobs offered to children who leave school early causes them to 
 change their employment constantly. By so doing they acquire habits of 
 shifting, which habits are not only hard to overcome, but leave an un- 
 desirable mark on their character. 
 
 Every year 23,000 American children between the ages of nine and 
 fifteen are injured, crippled or lose their lives by playing in other dan- 
 gerous places and by accidents in industry. In addition to the di- 
 rect injuries to the young child in industry, he is likely to be so 
 injured in body and so stunted in mind by the long hours and unhealth- 
 ful conditions that in later life he finds it impossible to compete success- 
 fully with the more fortunate workers who were protected in childhood. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 157 
 
 The federal child-labor law, which offered direct protection to more 
 than 150,000 children, was recently declared unconstitutional. These 
 'children are now without any protection except such as their respective 
 states afford them. Perhaps one of the best protections against child 
 labor and its attendant degenerating influences on childhood is a good 
 compulsory education law rigidly enforced. The census of 1910 reports 
 28,968 illiterates over ten years of age in Kansas. 
 
 Section 9415, General Statutes of 1915, provides that every parent, 
 guardian, or other person in the state of Kansas having control or charge 
 of any child or children between the ages of eight and fifteen years, in- 
 clusive, shall be required to send such child or children "to a public 
 school or a private, denominational or parochial school, taught by a 
 competent instructor, each school year for such period as said school 
 is in session." The age limit in this section has been enforced heretofore 
 to the fifteenth birthday. 
 
 The attorney-general gave an opinion May 28, 1916, on section 9415 
 as follows: "In my judgment it includes those (children) between their 
 eighth and sixteenth birthdays. The language without the word 'in- 
 clusive' would include all children between their eighth and fifteenth 
 birthdays, and it was evidently the intention of the legislature, by the 
 use of the word 'inclusive,' to include those in the sixteenth year; other- 
 wise the word 'inclusive' would have no meaning.". 
 
 The attorney-general goes on to state in the same opinion that chapter 
 227, Session Laws of 1917, generally spoken of as the "child-labor act," 
 controls and limits section 9415, since legally no child under the age of 
 sixteen can be regularly employed in any of the occupations mentioned 
 in the act unless he has the work permit, which permit he cannot have 
 unless he has completed the course of study prescribed for elementary 
 schools. 
 
 This opinion properly connects the two laws as they should be, and 
 removes the discrepancy which has caused so much trouble in the enforc- 
 ing of both laws. The state of Kansas is now in a position to put into 
 effect at once a most modern law for the education of children. With 
 the cooperation of parents, employees and school authorities, standards 
 may be promoted which will further advance the welfare of Kansas 
 children. 
 
 Adoption. 
 
 The best interests of children and of society demand that every child 
 have a good home. Where a child is deprived of his natural home by 
 reason of death or disability of his parents, the law provides means by 
 which he may be taken by foster parents and become an actual member 
 of their family, entitled to all the rights and privileges of a natural child. 
 
 In Kansas, section 6361, General Statutes of 1915, provides for the 
 relinquishment of parental rights by the natural parent. In this sec- 
 tion it is contemplated that relinquishment shall be had in the court of 
 the county where the natural parent resides. 
 
 Section 6362 deals with the adopting parents, and provides that any 
 person may go into the probate court of a county in which he resides and 
 
158 Kansas State Board of Health. 
 
 offer to adopt a child. When the adopting parents live in one county and 
 the natural parents live in another, the question arises whether an adop- 
 tion proceeding can be split up, part of it being made in one county and 
 part in another. 
 
 Section 6362 also provides that the "court shall investigate the matter," 
 and if the probate court "on investigation finds the person offering to 
 adopt some minor child is unfit or financially unable," such court shall 
 refuse to permit such adoption to be made. The spirit of this section is 
 clear, but there is no provision made in any section relating to adoption 
 for the making of such investigation, other than for the judge to require 
 such persons to appear before him for such personal inquiry as he is 
 able or inclined to make. 
 
 Section 6369 provides that parents may relinquish their children to 
 corporations authorized to receive children. This relinquishment is in 
 writing, and the corporation acquires the legal custody of the child. 
 
 Sections 6369 and 6361 not being connected, child-placing agencies, 
 wholly in good faith, have acted upon the assumption that section 6369 
 was sufficient by itself. This has led to difficulties in the way of proving 
 inheritance to property, the court holding that adoption by contract 
 between parties is not sufficient to make the child the legal heir of the 
 adopting parties. (See 98 Kansas, 620.) 
 
 In a matter so vitally important as the relinquishment and adoption of 
 children it is very necessary that the laws be so clear and concise that 
 they leave no room for doubt or misinterpretation. An irregular adop- 
 tion may lead to very serious difficulties in the inheritance of property 
 and the establishment of other legal rights. 
 
 The investigation of possible homes for orphaned and destitute chil- 
 dren, and the investigation of such children physically, mentally and 
 socially as to their fitness for adoption into normal homes presents 
 another very difficult problem. Neither the courts, children's institutions, 
 child placing societies nor the state is at present equipped to undertake 
 such necessary investigations as to prevent injustices to the children and 
 the homes into which they are adopted. And under the present system 
 it is not possible for such investigation and records as may have been 
 made by one society, court or state to be made available to all the other 
 societies, organizations or courts that may become interested in a given 
 child or family. 
 
 The whole problem of supporting and educating the child wards of the 
 state is at present in a chaotic condition. Helpless infants and children 
 are being exploited in unlicensed boarding homes, or cared for in meagerly 
 supported, badly managed, unstandardized private institutions, or con- 
 signed to the custody of state institutions which are not up to modern 
 standards institutions which are too prone to put an institutional stamp 
 upon the child, institutions in which the same atmosphere of repression 
 prevails that is found in penal, correctional and insane institutions. 
 
 The whole plan needs revision, so that it will become comprehensive 
 enough to bring all helpless minor children under direct custody of the 
 state, and organic and scientific enough that the state will be able to give 
 every one of these potential citizens a square deal and assure itself of a 
 definite unit of good citizenship. 
 
Bulletins Nos. 8 and 9, August-September, 1918. 159 
 
 Licensing Homes for Children, and Maternity Homes. 
 
 The statutes of Kansas require : 
 
 A license to run a private boarding house for adults; no license for 
 conducting a private boarding house for helpless children. 
 
 A license to run a private hotel for adults; none for operating a paying 
 institution for children. , 
 
 A license to operate a private hospital for sick or insane; none for op- 
 erating a private hospital for expectant mothers and their helpless babies. 
 
 In other words, the Kansas statutes specifically protect adults from 
 insanitary surroundings and from being exploited, but it makes no such 
 provision for helpless babies and children in private institutions. 
 
 Any incorporated institution in the state of Kansas must apply for 
 and be granted a charter from the State Charter Board. The statute 
 provides for the inspection by the State Board of Administration of 
 private, charitable institutions receiving state aid (section 9586, statutes 
 of 1915, and for those soliciting funds outside of their own county 
 (chapter 132, Session Laws of 1911). The State Board of Health 
 regulations provide that all state charitable institutions shall be in- 
 spected annually. But there is no provision for one definite board, com- 
 mission, or other central authority whose specific business it is to look 
 after all institutions and societies harboring or caring for dependent 
 children. As a result, these inspections have been more or less haphazard 
 and without any special directed effort of one agency whose business it 
 is to see that such inspections have been followed up, and that such 
 orders as may have been issued are carried out. 
 
 Reports of inspections of children's institutions on file with the State 
 Board of Health are the best possible argument for the need of a strict 
 license and supervision over all homes or institutions, public or private, 
 harboring children or defenseless expectant women. Such license should 
 provide for strict inquiry into the character of the person or persons 
 applying for the license ; evidence of the need or demand for the proposed 
 type of home or institution; strict classification of inmates as to what 
 ages, kinds and classes of inmates, and how many may be housed in a 
 given home, and for such other requirements as may be necessary to 
 assure helpless women and children decent surroundings and scientific 
 and humane care. Specified provisions are very necessary to prevent 
 persons suffering with tuberculosis, syphilis and other communicable dis- 
 eases being housed with children, also to prevent children of tender age 
 from being housed with confinement cases, or with aged indigents, insane, 
 feeble-minded, police cases and other improper persons. 
 
 The license should provide for at least an annual or semiannual in- 
 spection, and for such further inspections as may be necessary by reg- 
 ularly salaried trained inspectors, such as are now employed by the 
 state to inspect livestock, hotels, dairies and places employing labor. It 
 should include the necessary authority to issue orders and provision for 
 carrying them out. The license to operate an institution should be posted 
 in a public place in such institution. 
 
160 Kansas State Board of Health. 
 
 A health and hygiene license provided by the State Board of 
 Health, together with the present regulation and license for solicitation 
 of funds by the Board of Administration, will give a valuable double 
 check on children's institutions, both public and private. With such regu- 
 lation and supervision it would only be a question of time until all the 
 better institutions could be strengthened and improved, while the improper 
 ones could be made to clean up or get out of business. 
 
 Women and Children in Industry. 
 
 Because of the maternal functions, the protection of women in industry 
 is even more important than the protection of men. The strain of con- 
 tinuous standing, bad hygiene and overwork, to which young women may 
 be subjected in stores and factories, is responsible for such ill health as 
 seriously interferes with childbearing functions. Protection of women in 
 industry is necessary not only to safeguard the labor supply, but to con- 
 serve the nation's human resources. 
 
 The Kansas Industrial Welfare Commission, whose powers are set 
 out in Chapter 108, General Statutes of 1915, establishes the regulation 
 of hours, wages and sanitary conditions of women and children. This 
 Commission has made regulations governing hours and wages for mer- 
 cantile establishments, laundries and telephone companies. Just as soon 
 as the necessary investigations can be made, the Commission will establish 
 regulations covering other industries. 
 
 While the hours and wages for women vary with the degree of skill 
 necessary to the occupation, the intent of the Kansas regulations is that 
 women and minors shall be paid a living wage; that they shall not work 
 too long hours, and that they shall work in sanitary surroundings. 
 
 In the process of the Working out of any progressive measure, mis- 
 understandings, minor injustices and complaints are likely to arise; also 
 strenuous opposition from those who profit from exploited labor will be 
 encountered. The rulings of the Industrial Commission are based on the 
 theory that women and children are entitled to work in decently clean 
 surroundings and for a living wage. If the industry cannot afford the 
 cost of sanitary surroundings and living wages, neither can Kansas afford 
 to allow her women and children to be used up to supply the deficit. 
 
RETURN TO the circulation desk of any 
 University of California Library 
 
 or to the 
 
 NORTHERN REGIONAL LIBRARY FACILITY 
 Bldg. 400, Richmond Field Station 
 University of California 
 Richmond, CA 94804-4698 
 
 ALL BOOKS MAY BE RECALLED AFTER 7 DAYS 
 
 2-month loans may be renewed by calling 
 (510)642-6753 
 
 1-year loans may be recharged by bringing 
 books to NRLF 
 
 Renewals and recharges may be made 
 4 days prior to due date 
 
 DUE AS STAMPED BELOW 
 
 SEMtONILL 
 
 MAR 3 2004 
 
 U. C. BERKELEY 
 
 DD20 15M 4-02 
 
UNIVERSITY OF CALIFORNIA UBRARY