Medicine, which later offered a prize to be awarded in 1921 for the best study of the subject. The reports of the medical officers who examine children for work certificates in a few cities in this country have already made plain the immediate practical value of such studies by the reports of their own work, showing the need of fuller knowledge of the effect of work and the need of expert examiners. The most recent discussions of this subject were those held at the Children's Bureau conferences on standards of child welfare in 1919. Dr. Emma MacKay Appel, examining physician under the Chicago Board of Education, and Dr. George P. Barth, director, School Hygiene Bureau, Milwaukee, emphasized the practical necessity of "safeguarding the physical condition of the child when he leaves school to go to work." Dr. D. L. Edsall, dean of the Harvard Medical School, at the same meeting pointed out that children, and those in the earlier years immediately following childhood, are peculiarly prone to develop a latent tuberculosis, and they must therefore be protected from dangers that are likely to excite tuberculosis, "which is the great danger beyond all other medical dangers." "Children are also peculiarly prone to the effects of general physical strain and to the effect of postural strains-a fact sometimes overlooked in regulations." At the conclusion of the 1919 conferences a committee on standards of normal development and physical fitness for working children was appointed. The committee has made a preliminary report which includes a statement as to the need of authoritative scientific investigation of the effects of industrial employment upon the development and welfare of children.1 The intelligent protection of the health of working children and the studies upon which that protection should be based are subjects of increased urgency wherever marked underfeeding and hardship have prevailed for a period covering the war and postwar years of the child's life. In the scattered reports available on present conditions in Europe the following is found which bears directly upon the question. The apparent result of the double strain of growth and of hard physical labor has been noted among both town and rural boy workers in an article by Dr. Albert Frome, superintendent of the surgical clinic of the University of Gottengen, who reports numerous cases of a new disease of the bones, occurring mainly in the large cities, but also in rural districts. Its victims seem to be mostly boys 15 to 18 years old who are doing heavy physical work. Its symptoms resemble those of rickets, and it is therefore called by some "late rickets." Recently the number of cases increased to such an extent that the disease can be considered endemic, in the opinion of the author and of a number of his colleagues. The prevalence of the disease among adolescents is ascribed by the author to their growth and to the fact that they should receive more energy than they spend. The fact that the disease is prevalent among boys doing hard physical work is emphasized. The extent of this sign of breakdown, or other signs, such as tuberculosis, which may attack boys and girls beginning hard work 1 See p. 740. after years of undernourishment; the best way to cope with them so as to restore, if possible, the natural vigor of this generation-are questions for concerted and immediate study and action. It is significant that Dr. Ludwig Teleky, of Vienna, who was one of the first to urge the importance of studying the physical effects of industrial life upon children, is now, as reported, devoting himself solely to tuberculosis. Studies of the effect of occupational strains upon these children should prove of special value in determining the effect of such strains upon normal children; those occupations which produced no serious ill effects upon these children with impaired constitutions should be given a clear bill of health, while those which proved too severe for weakened constitutions should be given further study to determine the effect upon children with sound constitutions. Studies should be continued over a term of years; for children reaching the age of 14 within the next 10 years must be considered as within the class subject to the hazards entailed by war hardships, in addition to the usual industrial hazards, whose dangers Dr. Teleky pointed out before the war and whose study he urged then because both human welfare and industrial efficiency were, in his opinion, involved. Such studies are, of course, primarily the concern of scientific observers; but under the present conditions a working arrangement should be reached with adequate relief organizations, so that prompt service, whether public or volunteer, could be insured for the cases of breakdown or threatened danger. Thus far, since the end of the war, little opportunity or occasion to study this question has existed, because of the delays in reestablishing industry. But a slow return to normal conditions is already perceptible, and the time is near when the physical effect of industrial labor upon children and youth will be tested under new conditions. Conferences between authorities on various aspects of scientific study involved in child welfare would doubtless suggest other and perhaps more important considerations. A picture of the results of the war upon the children of central Europe, drawn with scientific faithfulness, would be of world-wide service. Although political and economic understandings between the various States have not yet reached completion, the understanding among men of science is always complete; and a correlated study of the welfare of children would certainly enlist the aid of those who, in every country, are interested in this great matter and who for the last six years have devoted themselves to the service of the young. Whether an international office, a Government, or a private scientific foundation should furnish the necessary initiative is perhaps immaterial. The important consideration is that a way should be found to organize an international study of the effects of the war upon children by the cooperation of the best authorities in every country. JULIA C. LATHROP, Chief. Hon. W. B. WILSON, Secretary of Labor. |