Popular Science Monthly/Volume 41/October 1892/American Childhood from a Medical Stand-Point
|AMERICAN CHILDHOOD FROM A MEDICAL STANDPOINT.|
A GOOD deal has been said and written about our national temperament and physique, and it is doubtless true that the various stocks of the Old World, transplanted to our soil and subjected to new conditions of life, have felt the molding influences of changed surroundings. The human organism is preeminent in its marvelous adaptability to the most varied conditions of life. It has complex mechanisms which convey, store up, modify, and discharge the showers of impressions constantly received through nerve-endings in the skin, membranes, and tissues, as well as through the organs of special sense. We recognize that different individuals and races react somewhat differently to stimuli; they have inherited or acquired special characteristics of mind and body, largely due to habits evoked by special surroundings and ingrained by frequent repetition, whether in themselves or in their ancestors. If inherited bias counts for very much in molding the organism, this is equally true of impressions frequently repeated, or the steady push of constantly acting, though it may be scarcely noticed, forces.
Conspicuous factors in modern life are the extreme specialization of pursuits and occupations tending to narrow and restrict experience, and the herding together of dense masses of population in large cities, toward which the more venturesome and ambitious individuals tend to gravitate, and where larger opportunities are provided, only at the cost of more strenuous competition, and in many respects less favorable hygienic conditions. Success is paid for, both directly and remotely, in pounds of flesh. It has been claimed that the strongest blood can not endure continuous city life for more than three generations, but must be kept alive by the infusion of country blood or by the return in some degree to country life. Thus our large cities are a kind of biological furnace, which in the end consumes the lives supplied to it, in order to obtain the product in trade, science, and art which we so much admire. If, in the course of this fiery ordeal, the individual receives a keener temper or a finer polish, he may not become stronger physically or better balanced mentally, and thousands, unable to endure the strain, are cast off or incapacitated, while hundreds of thousands are not able to transmit to their children the physical endowment which they themselves originally possessed. It is the purpose of this paper to study the physiological tendency of the forces to which many American children are subjected, especially in our largest cities, where the logical effects of characteristic habits or traits are most strikingly evident. Physicians know that city children get too little light and air, do not take enough of the right kind of exercise, are often overfed or underfed, are pushed or pampered too much in their studies, and especially in their emotions, and frequently shorten their childhood to become little men and women before emerging from pinafores and knickerbockers. Such criticisms have been frequently passed, and that they are not unfounded we can all testify.
We instinctively recognize more truth than jest in Henry James's description of the little girl who rushed into the hotel parlor on roller skates, shouting: "Get out of the way!" and we have at once a clear mental picture of her pale, eager face, slim figure, shallow chest, attenuated limbs, and weak ankles; so inevitably does the simple exclamation suggest a correlated and too familiar physique. Healthy immigrants, or country people coming to the city to live, usually lose their fresh, ruddy color in a few months, and their firm flesh becomes flabby, though city people are, as a rule, better walkers and can stand more of certain kinds of exertion. We may take the physique of the little girl on roller skates as a type of frequent occurrence. In children of the corresponding class the feelings may be intense or sluggish, but in either case betray the lack of proper balance and correct discipline. There is a precocity in knowledge of people and social relations, darkest ignorance with regard to most natural objects and processes. The mind and body may be restlessly active or listless and indolent; in either case the fundamental qualities of docility and poise are lacking; there may be much development on the aesthetic side, or much in comparison with the neglect of the practical. The city child is handicapped from the start. He is usually produced with difficulty from overtaxed and under-nourished, not necessarily underfed, stock rather than from the superabundant vitality of robust natures. The cultured mother rarely has sufficient vigor to nurse her infant, and it is brought up on some substitute, which at the best is but a makeshift. Whatever modern life and culture may have done for our women, they hardly seem, in their extreme forms, to have prepared them for the intelligent care of their offspring, whose arrival is often regarded with pathetic helplessness. There is, however, enough of New England's "inflamed moral sense" in our midst to furnish our women with a fair share of conscience, so that their errors are as apt to be due to over-solicitude as the reverse. Take the matter of clothing, for example: this is frequently piled on till the hapless youngster presents the appearance of a bale of millinery, impeding movements, keeping the child overheated, and forming a conspicuous part of the hot-house life which the child is henceforth to lead. Literally "hot-house," for there is something in our houses, their heating apparatus, or the habits of the people, which keeps our residences at a tropical heat during the cold season. I am inclined to think it is partly a result of our high-pressure life. A tired brain and exhausted nerves crave warmth; and indolent or sedentary habits do not predispose one to bear a bracing temperature. Be that as it may, the little ones grow up in an atmosphere of steady, relaxing warmth, and the continual endeavor is to protect them from anything approaching cold. Their baths are usually hot, and there is a noticeable absence of that skin culture which comes naturally to country children, living out of doors, sleeping in a cold room, skating or snow-balling in winter, and swimming in the neighboring pond in summer. It seems that the whole tendency of city life is toward "making it easy," physically, for the individual by the elimination of all except the simplest demands on the organism, forgetting that our powers are developed by their cultivation, and inevitably deteriorate with disuse. Our life is so artificial that we require gymnasiums, field-sports, and outings to keep a decent physical equilibrium, and we ought in addition to give particular attention to vascular gymnastics and to the culture and development of the unstriped muscular fibers, which play so fundamental a part in vital economy, by placing more dependence on their adjustive and resisting powers, through a systematic and judicious exposure of the skin to cold water, cold air, and the vicissitudes of weather. As to the diet of children after the nursing age, it is likely that our city children fare better than many of their country cousins. There is probably no country in the world where there is such an attractive variety of cheap and wholesome food of all classes, meats, cereals, vegetables and fruit, as in our own. The general habit of fruit-eating, which seems to be growing, is, I believe, salutary, and to be encouraged. Good fruit is practically within the reach of all at all seasons, and we are probably the only nation out of the tropics where fresh fruit is a staple article of diet every day in the year. The temptation and tendency in the diet of children is toward an over-indulgence in animal and saccharine food, and in elaborate made dishes; and the practice of allowing children to eat at the same hours with their elders, and substantially the same things, is liable to result in a trying regimen for the child.
In regard to fresh air, the youthful citizen of the metropolis is not likely to get too much of it indoors, and the few hours a day spent on the sidewalk or in a perambulator are a sorry substitute for rolling over the grass or tumbling about the door-yard. When the child is a few years older the difficulty is increased. Young children are in constant motion, and this is Nature's method of educating the muscles and nerve-centers in the selection and development of those complicated associated movements and correlated reactions which finally form the automatic groundwork of our life. We are brought by these means into contact with all kinds of natural objects, in order that we may become aware of their attributes and react promptly and advantageously to their stimulation. The city child, however, instead of soil with its diversified coverings, has hard and mostly level floors or pavements; instead of grateful greenish, bluish, or brownish tints, the patchwork surface of our houses and streets; and instead of restful silence or simple and harmonious sounds, the irritating jar of complicated, intense, and discordant noises. We may compare the conditions to which the city child is subjected to the life of a trainman, who is hampered in his movements and at the same time subjected to storms of auditory, visual, and other impressions in unending succession.
I recently had occasion to compare the development of a typical city boy of eighteen months with that of a little girl of fifteen months brought up in a small inland town. The boy was the only child of cultivated city parents; the little girl was the youngest of several children, and her parents were plain trades-people. Though the girl had congenital club-foot and had never walked, she had remarkably good control over the movements of the arms, legs, head, and trunk. She placed her finger on or grasped an object with exactness, threw a ball with force and precision, and hitched herself about the floor with great dexterity and rapidity. All her movements were well planned and well executed, and many of them complicated, such as putting a tin cup upon the end of a stick and shaking it without letting it fall off. She could speak only a few words, but had a great deal to say in her baby language. The expression on her face was placid and contented, though often animated, and she would sit for hours on the floor and amuse herself. She rarely cried, took her daily naps as a matter of course, and slept quietly all night. Teething did not annoy her, and, in spite of irregular feeding, her digestion was good.
The little boy refused to creep or sit on the floor at all, but ran about incessantly. His movements, except locomotion, were far less complicated and precise than those of his playmate. He could not put the cup on the stick, though he tried repeatedly, nor throw a ball nearly so well. He was incessantly and intensely interested in the things he saw, but only fixed his attention on an object for an instant. He had no initiative, and, as he was unable to amuse himself, he was never left alone. He talked a great deal, but not plainly, and understood nearly everything that was said to him; and it pleased him to mimic the little girl's ways and prattle. He was very fond of having the piano played to him, and could always distinguish the tunes he had heard a few times. He was bright and intelligent, and, when feeling well, very good and happy, but was a bad sleeper, and at times cross and fretful; in spite of scrupulous attention to diet, he was a martyr to indigestion, and teething caused him much suffering.
It is noticeable that many city children are thrown more among adults and less with children than is desirable, partly from the custom of relegating a large part of the parental responsibility to a nurse, partly from the small average number of children in a family, and partly from the limiting conditions of city life, which are somewhat unfavorable to real sociability. The chances are that unless a child runs the streets he will see more of two or three or half a dozen adults than of all the rest of the world put together. This is abnormal and unwholesome, as it deprives the child of the kind of mental stimulus and discipline suited to his age, and substitutes something wholly inappropriate and harmful in its tendency. When the school years come, the children have companionship, at least in school hours, but also in many instances an imperfect school hygiene, with its bad air, poor light, cramped positions, and other drawbacks. Dr. C. F. Folsom says of city school children: "Pale faces, languid work, poor appetite, disturbed sleep, headache, and what is vaguely called nervousness, are more common among them than they should be among children of their ages," and speaks of "constitutions weakened during the school years, instead of strengthened, as they should be."
On account of lack of familiarity with country life, many city children of the lower school grades, as shown by President G. Stanley Hall, have the most extraordinarily distorted ideas about the commonest natural objects and phenomena, and much of this mass of misinformation remains in adult life. On the other hand, they may be keen judges of character and conduct and "be well able to hold their own in a bargain or an argument. Of a class of about thirty girls from eight to thirteen years of age living east of the Bowery, only three had been in Central Park and only four had ever visited the country. When taken to Central Park by a friend, they first asked if they might step on the grass, and then, with the natural instinct of young animals, lay down and rolled on it.
As already remarked, it is natural for the young child to move about and change its attitude almost incessantly; in the words of Sir William Jenner, "it joys to exercise every muscle"; and it is equally true that its eyes, attention, and mind should never be directed continuously at one object for very long. A child loves to glance at this object, pick up that, reach out for a third, not restlessly but wonderingly, caressingly, and joyously, just as a short time before the infant played contentedly with its rattle or its ring, waving it about or putting it into its mouth with endless repetition, but always without studious observation or strain of attention. I am afraid we often injure these small eyes and tender brains by requiring continuous repose of body and fixation of eye and attention on some one object, as is often done in the kindergarten and primary work, at the cost of ocular and nervous strain; and this combined with bad light and general driving may account for much of modern myopia, headache, and nervous troubles. We should advance in the education of muscle, eye, and brain from the general to the particular, and impose no task requiring precision or intense application upon young children. Nature is a good schoolmistress, and her lessons are fundamental ones, no matter how much we may supplement them at school or university. The infant is learning fundamental lessons, in the correlation of muscle, brain, and sense, through the almost incessant activity of his arms and legs—at first without purpose, afterward in reaching, grasping, or trying to move about, and also when it smiles back at its mother or is quieted by her voice; so is the child repeating nursery rhymes or busy with its quiet play or romping games; or the youth with his carpenter's tools, or riding, swimming, or hunting, and learning just as truly, and perhaps more truly, than the student burning midnight oil over Greek and calculus. Nature is never systematic in the school sense; and, however much we may systematize, we must at the same time cultivate our powers and round out our individuality by keeping in touch with so much of Nature and man as lies within our horizon in a restful, informal way. If a man is to develop into something more than a machine or formula, he should be encouraged from childhood to bring all his powers into relation with his environment and to seek a wide range of adjustments between himself and the outer world, beyond the tread-mill round of special or formal pursuits which necessarily occupy much of his attention. Many fail to appreciate the importance of this indispensable natural culture, and endeavor to supplant the spontaneous by the formal. I know of a little girl whose interest in flowers was destroyed by an attempt to teach her technical botany at too early an age, forgetting that it means more to love flowers than to know botany. In another case the attempt was made to substitute history for a boy's ordinary reading, with the result of spoiling the boy. On reaching manhood his favorite author was E. P. Roe.
Correct mental reactions must be based upon correct physical reactions, which are naturally evoked by a free open-air life. As Lowell puts it: "The driving-wheels of all-powerful Nature are in the back of the head. . . . But it is ill with a nation when the cerebrum sucks the cerebellum dry, for it can not live by intellect alone. The broad foreheads always carry the day at last, but only when they are based on or buttressed with massive hindheads. . . . Moreover, brain is always to be bought, but passion never comes to market."
The city boy's supplemental training at school is far from perfect, but his fundamental, unstudied training by contact with Nature in the free use of his proper activities is wofully deficient. If restricted to the city, he can hardly become familiar with any natural objects but a few animals, building materials, and foodstuffs; his notion of such fundamental objects as the sky or horizon must be extremely hazy. His relations with people, or at least with certain individuals, are likely to be too close; he can not escape from them, and is over-stimulated or overpowered. This leads me to speak of family life as we observe it, perhaps the most important factor of all in the child's development, physical as well as mental and moral.
It is sometimes claimed that women are not as good housekeepers and home-makers as formerly, and if this be true it is not altogether their fault. It is not to be denied that the number of families in New York, for instance, is far in excess of the number of homes. The tendency with us is for the mistress of the house to participate less and less in the details of household management, and much of the work is left to hirelings inside and outside of the premises. The desire to diminish some of the difficulties of city housekeeping has caused the wholesale introduction of flats, which are, as a rule, cramped and poorly lighted, and, to say the least, ill adapted for the rearing of children. Rooms in suites have made it possible to dispense with the kitchen and its autocrat, and the disintegration of the home is complete in boardinghouses and hotels. The promiscuity of the tenement is equally unfavorable to a home atmosphere and home employments. The modest requirement of a small, plain house with light and air on all sides, is beyond the reach of the millionaire. Unless we stop to think, we are apt to forget how high a price we pay for the privilege of much laborious striving and cramped living.
So much has been said about the frivolity, incompetence, or f ussiness of American mothers that it will not be amiss to inquire into the characteristics of our fathers of families. With the best intentions in the world the time that a city man can spend with his family is usually very limited, and he is not always in the mood to exert a helpful influence, when he returns at night worn out with business cares, and often prefers the club, lodge, or neighboring corner to his family circle; his wife may see little of him and his children less. It is not a matter of indifference, however, even in regard to health, whether the children enjoy a due proportion of their father's companionship, for that is or should be a vital factor in the children's growth and education, and, whenever they are deprived of it, certain elements of character and mind are almost always absent. Look around among your friends where the children have grown up without a father, and see if your observation does not show that there is some quality of mind or heart, some check or balance wanting, that no one else could supply. I observe that American fathers, whether from the exactions of business or other reasons, do not ordinarily come to my office with their ailing children. The whole matter is often left in the hands of the wife or some relative. Germans are more apt to come than Americans, and Hebrews most of all; and indeed I can not refrain from expressing my admiration of the domestic life of the better class of Jews in New York, which, so far as I have observed it, is in many respects more nearly what it should be than that of any class in our community.
Body and mind grow together; what affects the one must affect the other, so that if the influence of either parent is withdrawn the due proportion or balance is lost and certain physical as well as mental peculiarities in the children are dwarfed or accentuated. The home atmosphere often determines the mental and moral, and consequently the physical tone of the children. I claim distinctly that an atmosphere of frivolity, indolence, self -consciousness, fussiness, discontent, sentimentality, or meanness can not be without serious effects not only on the character but on the physique. Selfishness in any form is not only unattractive, but it is unwholesome; it is a depressant to the system. Per contra, high and well-rounded living not only makes sound thinking, but it abbreviates doctors' bills. It is a truism to say that no one has so much' to do with the child's acquisition of a healthy moral and physical tone as his parents, but few realize how tremendous a factor in the evolution of the individual we touch at this point. We need the mother's influence and the father's influence in the family, and also the influence of the children on each other. First children, last children, only children, children of small and large families, all have their special attributes and defects. The child is receiving and adjusting every instant, impressions that will positively determine not only his future career but his bodily structure. Parents and care-takers must see that these impressions are useful and true. The means in the control of the physician are as nothing compared to home influences and conditions in shaping a healthy mind and body. The reactions most frequently evoked will be the dominating ones. As Bacon puts it: "Therefore since Custome is the principle Magistrate of a Man's life; let Men by all Means endeavour to obtain good Customes. Certainly Custome is most perfect when it beginneth in Young Years. This we call Education; which is in effect but an early Custome"; or as another says: "In the conduct of life, habits count for more than maxims, because habit is a living maxim, become flesh and instinct. To reform one's maxims is nothing; it is but to change the title of the book. To learn new habits is everything, for it is to reach the substance of life. Life is but a tissue of habits" (Amiel's Journal, page 7). All of which applies as cogently to the physical as to the mental. "Nothing has ever been invented to take the place of a 'bringing up.'" The home has been compared to the ship-yard where the vessel's construction is slowly and painstakingly elaborated step by step, so that the structure may be able to outride the strains and disintegrating tendencies that are sure to attack it later, just as the growing human organism is built up, under fostering influences, by the gradual incorporation of helpful habits and useful physical reactions. Self-control and transparent honesty in the parent are as essential as obedience and self-reliance in the child. "He that will have a cake of the wheat must tarry in the grinding." The child does not exist who can grow up natural or healthy without a fair share of wholesome neglect and judicious exposure. Few realize the tremendous risk of over-caution and over-attention. A youngster is invariably happier with few and simple playthings than with a multitude of complicated toys. There is no such good fun or good training as making one's self useful, and it is cruelty to deprive the child of this pleasure and stimulus. Let the brain and body be trained through hand, foot, and eye. Dump a load of sand into the back yard and let the children roll in it. Give the boys a carpenter's bench; encourage the girls to do housework. Where possible, let both boy and girl have a little garden-patch, if only a few feet square, and the care of a few plants. A woman in her home, a man in his garden: this seems to be a fundamental type from which we can not entirely depart without risk to body and mind. The training of the muscular reflexes should go hand in hand with the cultivation of simple, natural, beneficent reactions in the higher planes. Cheerfulness, sincerity, industry, perseverance and unselfishness may be acquired by practice and constant repetition, as much as the art of correct speaking or of playing the piano, and are far more necessary to health. We must have a basis of correct fundamental physical and psychical reactions as a help toward a proper balance between feeling and will, or our subsequent building will rest on a foundation of sand. How often is a physician hampered in his efforts to help some sufferer, because the latter has never acquired the art of obedience, or because he can not tolerate a tongue-depressor, or swallow a pill or any unpalatable mixture, or take milk or some mainstay of diet; or because he can not be left alone, or sleep in the daytime, or wear flannels, or sit still, or bear pain, or use his muscles, or take in certain classes of facts or ideas! These and similar peculiarities, which are a formidable hindrance to the physician, and may be a matter of life or death to the sufferer, can usually be prevented by a little care, or overcome by proper training. They are often the result of carelessness or over-indulgence, or that kind of cowardice which instinctively avoids the disagreeable, instead of facing a difficulty fairly and conquering it.
Another way in which children are injured is by being used as playthings for the amusement of relatives and friends. There is the temptation, well-nigh irresistible, to show them off, if they are bright, or later to push them along in school or society, sacrificing wholesome symmetry to immediate showy effect. This tendency has largely molded our private schools, for girls especially, whose basis is too often sentimentality of some sort; and sentimentality is a form of narrowness, an incapacity for seeing things in their true proportions.
There is one characteristic of our metropolitan life so salient that it can hardly fail to make itself felt even in childhood. I mean the mad chase after the dollar, the cause of much of the killing tension of city life. It is curious to note that the nation that is conspicuous by the absence of this spirit—I mean the Japanese—has probably the best-behaved children in the world, and is the land of happy childhood. A crying baby is to them a curiosity. This straining of powers till they crack, this incessant fiddling at the nerves, is apt to make our city life restless, asymmetrical, and unsatisfactory; the children feel it and show it in their faces, in the sensitive structure of their bodies, and in the affections and diseases to which they are subject. And this nervous tension, as much as our tropical summer climate, has necessitated that periodical return to Nature or summer outing, which is a national habit, and is the one efficient means, if properly used, of combating the disintegrating tendencies of city life.
The children of the poor, in spite of many drawbacks, fare better in some respects than those of the well-to-do. They often respond better to treatment when they are sick; they are at least not deprived of that contact with their fellows and struggle for existence which is absolutely essential to health; whereas the children of the so-called higher classes are too often educated in sensitiveness, and false and hurtful views of life, not always by precept or example, but by force of circumstances. A colleague, who is intimately acquainted with the physical condition of some eight thousand children, taken from the worst classes in New York, who have in the course of several years passed through a public institution under his care, says that they improve so much, after having enjoyed for a few months the ample diet and simple and regular life provided, that their physical condition compares favorably with that of any class of children in New York.
Much of what has been said applies to certain classes in certain restricted localities, and it may be thought that the picture is an exaggerated one, but I maintain that the physique of the children that are now growing up under our eyes is not on the whole satisfactory, and that it is a difficult matter to bring up wholesome, hearty children in New York, for example: if this is true, it is well to recognize the fact. The average conditions both within and without the family seem restricted and unnatural; fortunately, there is a large amount of sturdy stock throughout the land, brought up to individual independence in contact with Nature, and in wholesome home surroundings, upon which we can draw indefinitely.
It is true that the advantages are not all on the side of country life; that the struggle with Nature may be strenuous, and the living narrow and poor, and that on the other hand the conditions of city life may bring a better diet and a better knowledge of personal hygiene. Indeed, it is claimed that during our civil war certain city regiments stood campaigning better than the men from the country, possibly because they better understood how to take care of themselves. All this does not militate against my position that the conditions of country life are, or may be made, more favorable for children.
Just because life in our large centers puts such pressure on men and women do we get such remarkable effects in certain directions. Much of the world's best work is the direct result, but it is usually the effect of such stimulation on broad and healthy natures developed partly or wholly in the country; and ultimately, unless there are considerable interruptions, the individual or the family is stamped out, as is every individual or family which pursues a too restricted, too artificial, or too one-sided career.