CHILDREN, DISEASES OF. The study of this subject, known also as Pediatrics, is comparatively modern. There was no recognition of the need for special instruction in it as part of the curriculum at the medical schools, until, in 1899, King's College Hospital (London) appointed a physician to treat children only and to teach the students this subject. Gradually the recognition of this need has spread to other medical schools, or been forced upon them by examining bodies.
Methods of Feeding.—Infant feeding has passed through various phases. In the 1 7th century, when the mother was unable to suckle, wet nursing was the recognized alternative. In the 18th century hand-feeding began to replace suckling and brought with it the ills of faulty feeding; in the latter half of the 19th century the importance of infant feeding as one of the largest factors in infant mortality and diseases began to be recognized.
An attempt to replace the haphazard methods of the time was made by the introduction of percentage feeding in America. This necessitated an exact knowledge of the percentage composition of milk, cream, etc. Directions for feeding were given as a prescrip Lion ordering the percentage of proteid, fat, and sugar, and labora tories were established in which such foods could be prepared. This method involved fallacies of theory and practice, but it en couraged more accurate and intelligent understanding of infant feeding.
A new departure is the so-called calorie feeding. The energy producing value of a food, calculated in units of heat which the food would produce on combustion (1 calorie=heat required to heat I kilo of water 1 ° C.) , determines its adequacy for the in fant. At certain ages a certain number of calories per lb. weight is found to be requisite, so that food requirements can be de termined by mathematical calculations. The fallacies of this method are considerable, but it is occasionally useful.
Whilst the physicians and laboratory workers were investigat ing the subject from the scientific standpoint, a great step forward was made by the establishment of Consultations de Nourrissons (1892) in France, and a little later of Infant Consultation Centres or Infant Welfare Centres (1906) in Great Britain and in other parts of the world. Mothers take their healthy infants to these and are instructed as to their feeding and care.
Biochemical research has shown that, besides the gross chemi cal composition of foods, there are subtler constituents, viz., "accessory factors" or "vitamins," which are essential to health, and, indeed, to life. (See BIOCHEMISTRY.) Related to lack of these vitamins are two diseases, infantile scurvy and rickets, the former definitely due to lack of vitamin C, the latter to deficiency of some anti-rachitic factor of which little is known.
In connection with the latter, the value of ultra-violet rays has recently been recognized; whether from sunlight, arc lamp, or mercury vapour lamp, these rays improve the general health and vigour and are beneficial in certain diseases, particularly rickets, in which they effect a rapid cure of the bone affection. To a less degree they are useful in some forms of tuberculosis. Amongst diseases affecting nutrition in infancy, congenital hypertrophy of the pylorus was formerly one of the most fatal; but now has been so successfully treated by surgery that the majority recover.
The rise of bacteriology has revolutionized our views of many diseases of children, but some still await fuller knowledge. Infan tile paralysis is one of these. Flexner and his co-workers in New York, by a series of experiments on monkeys, have shown that, as had already been suspected, this disease which wrecks the lives of so many children is due to some infection, and they have in vestigated the conditions and ways in which it can be communi cated (see SPINAL MENINGITIS). The exact nature of the virus is uncertain, but experiments have shown that infection may enter by the naso-pharynx and may probably be spread by carriers. Isolated cases occur every summer and occasionally epidemics, as in England in 1911 and in America in 1910.
The specific fevers (see INFECTIOUS FEVERS) to which children are most liable, scarlet fever, measles, chicken-pox and mumps, are still a mystery as to their exciting cause. Whooping cough, however, has been traced to a specific bacillus and a vaccine of this organism has been used extensively, but with doubtful bene fit. The discovery of an antitoxin for diphtheria in 1893 led to a large reduction in the mortality from that disease; the deaths from laryngeal diphtheria fell within two years from 62% to 28%, and a few years later to 11.7%.
There has been a striking decrease in the mortality of the specific fevers of childhood during recent years. The annual mortality in England and Wales per million persons living was in 1883: scarlet fever 1,270, measles 962, whooping cough 1,086; in 1923, scarlet fever 83, measles 5o8, whooping cough 399.
The effects of congenital syphilis (see VENEREAL DISEASE), first studied in detail by Diday of Lyons in 1854, have been more fully realized since the introduction of the Wassermann test (1906), in which the examination of the blood indicates the pres ence or absence of this disease. It may be present when no char acteristic symptoms occur, indeed without symptoms of any sort.
Applied indiscriminately to children attending hospitals, this test has shown a positive result in proportions varying from in London to 10.4% in Glasgow, but for the general child population these figures are probably too high. Syphilis causes a large waste of potential lives by miscarriages and still-births, of which there were 4o% in a series of 187 pregnancies in syphilitic families, whilst of 112 live-born children in these families 33% died in infancy or early childhood. Nor does this represent the full extent of its mischief, for mental deficiency, various forms of paralysis, impaired sight, deafness, and various deformities in the child are in some instances direct or indirect results of syphilitic parentage. Of late, a wider knowledge of the effects of syphilis and its prevention and treatment in adults has reduced the frequency and severity of the inherited disease in children. The latest treatment is by subcutaneous or intravenous injections of arsenical or bismuth preparations.
BIBLIOGRAPHY.-L. Emmett Holt, Diseases of Infancy and ChildBibliography.-L. Emmett Holt, Diseases of Infancy and Child- hood (3rd ed., 1918) and The Care and Feeding of Children (3rd ed., 1918) ; Henry Ashby and G. Wright, The Diseases of Children (1922) ; Hugh T. Ashby, Infant Mortality (192 2) ; J. H. Hess, Premature and Congenitally Diseased Infants (1923) ; G. F. Still, Common Disorders and Diseases of Childhood (1924) ; E. M. S. Chesser, Health and Psychology of the Child (1925) ; R. Manning Clark, Children's Diseases: Prevention and Cure (1925) ; Emil Feer, The Diagnosis' of Children's Diseases, trans. C. A. Scherer (1925) ; R. Hutchison, Lec tures on Diseases of Children (1925). (G. F. S.) LAWS. English law has always in theory given to children the same remedies as to adults for ill-usage, whether by their parents or by others, and has never recognized the patria potestas of earlier Roman law. The only points in which infancy created a defect in civil status were that infants were subject to the restraints on complete freedom of action involved in their being in the legal custody of the father, and that it was and is lawful for parents, guardians, employers and teachers to inflict corporal punishment proportional in amount and severity to the nature of the fault committed and to the age and mental capacity of the child punished. But the court of chancery, in delegated exercise of the authority of the SON ereign as parens patriae, always asserted the right to take from parents, and if necessary itself to assume the wardship of children where parental rights were abused or serious cruelty was inflicted, the power being vested in the High Court of Justice. Abuse of the power of correction was regarded as giving a cause of action or prosecution for assault ; and if attended by fatal results rendered the parent liable to indictment for murder or manslaughter.
The conception of what constitutes cruelty to children un doubtedly changed considerably with the relaxation of the ac cepted standard of severity in domestic or scholastic discipline and with the growth of new ideas as to the duties of parents to children.
Starting from the earlier conception, which limited ill-treatment legally punishable to actual threats or blows, the common law came to recognize criminal liability in cases where persons, bound under duty or contract to supply necessaries to a child, unable by reason of its tender years to provide for itself, wilfully neg lected to supply them, and thereby caused the death of the child or injury to its health, although no actual assault had been com mitted. Questions have from time to time arisen as to what could be regarded as necessary within this rule ; and quite apart from legislation, popular opinion has influenced courts of justice in re quiring more from parents and employers than used to be re quired. But parliament has also intervened to punish abandon ment or exposure of infants of under two years, whereby their lives are endangered, or their health has been or is likely to be permanently injured (Offences against the Person Act, 1861, sec. 27), and the neglect or ill-treatment of apprentices or ser vants (same act, sec. 26, and Conspiracy and Protection of Property Act, 1875, sec. 6). By the Poor Law Amendment Act, 1868, parents were rendered summarily punishable who wilfully neglected to provide adequate food, clothing, medical aid or lodg ing for their children under 14 years of age in their custody.
The Acts of 1889, etc.—The chief progress in the direction of adequate protection for children prior to 1889 lay less in positive legal enactment on the subject than in the institution of an effec tive method of discovering and repressing cruelty punishable under the ordinary law. In the absence of any proper system of public prosecution, it is undeniable that numberless cases of neglect and ill-treatment went unpunished. The foundation of the National Society for the Prevention of Cruelty to Children by the late Benjamin Waugh met this need, and through its efforts a statute was passed in 1889 with the special object of preventing cruelty to children. This act was superseded in 1894 by a more stringent act, which was repealed by the Prevention of Cruelty to Children Act, 1904, in its turn superseded for the most part by the Children Act, 1908, which introduced many new provisions in the law relating to children and specifically dealt with the offence of "cruelty" to them. This offence can only be committed by a person over 16 in respect of a child under 16 of whom he has "custody," "charge" or "care." The act presumes that a child is in the custody of its parents, step-parents, or a person cohab iting with its parent, or of its guardians or persons liable by law to maintain it ; that it is in the charge of a person to whom the parent has committed such charge (e.g., schoolmaster), and that it is in the care of a person who has actual possession or control of it. Cruelty is defined as consisting in assault, ill-treatment, neglect, abandonment or exposure of the child in a manner likely to cause unnecessary suffering or injury to health, including in jury to or loss of sight, hearing or limb, or any organ of the body, or any mental derangement ; and the act or omission must be wilful, i.e., deliberate and intentional, and not merely accidental or inadvertent. The offence may be punished either summarily or on indictment, and the offender may be sent to penal servitude if it is shown that he was directly or indirectly interested in any sum of money payable on the death of the child, e.g., by having taken out a policy permitted under the Friendly Societies Acts. A parent or other person legally liable to maintain a child or young person will be deemed to have "neglected" him by failure to provide adequate food, clothing, medical aid or lodging, or if in the event of inability to provide such food, etc., by failure to take steps to procure the same under acts relating to the relief of the poor.
These statutes overlap the common law and the statutes al ready mentioned. Part of their efficacy lies in the provisions which facilitate the taking of evidence of young children, in per mitting poor law authorities to prosecute at the expense of the rates, and in permitting a constable on arresting the offender to take the child away from the accused, and the court of trial on conviction to transfer the custody of the child from the offender to some fit and willing person, including any society or body corporate established for the reception of poor children or for the prevention of cruelty to children. The provisions of the acts as to procedure and custody extend not only to the offence of cruelty but also to all offences involving bodily injury to a child under 16, such as abandonment, assault, kidnapping and illegally engaging a child in a dangerous public performance.
Baby-farming.—The act of 1908 enacted more stringent pro visions against baby-farming (q.v.). The Infant Life Protection Act of 1897 did not apply where only one child was taken, but now by the Act of 1908, where a person undertakes for reward the nursing and maintenance of one or more infants under the age of seven years apart from their parents or having no parents, he must give notice in writing to the local authority within 48 hours from the reception of the child. If an infant is already in the care of a person without reward and he undertakes to continue the nursing for reward, such undertaking is a reception of the child. The notice to the local authority must state the name, sex, date and place of birth of the infant, the name and address of the person receiving the infant and of the person from whom the infant was received. Notice must also be given of any change of address of the person having the care of the infant, or of the death of the infant, or of its removal to the care of some other person, whose name and address must also be given. It is the duty of local authorities to provide for the carrying out in their districts of that portion of the act which refers to nursing and maintenance of infants, to appoint infants' protection visitors, to fix the num ber of infants which any person may retain for nursing, to remove infants improperly kept, etc. Relatives or legal guardians of an infant who undertake its nursing and maintenance, hospitals, convalescent homes or institutions, established for the protection and care of infants, and conducted in good faith for religious and charitable purposes, as well as boarding schools at which efficient elementary education is given, are exempt from the provisions of the act.
The Acts of 1904 and 1908 deal with many other offences in relation to children and young persons. The Act of 1904 intro duced restrictions on the employment of children which lie on the border land between cruelty and the regulation of child labour. It prohibits custodians of children from taking them, or letting them be, in the street or in public-houses to sing, play, perform or sell between 9 P.M. and 6 A.M. These provisions apply to boys under 14 and girls under 16. There are further prohibitions (1) on allowing children under 11 to sing, play, perform or be ex hibited for profit, or offer anything for sale in public-houses or places of public amusement at any hour without a licence from a justice, which is granted only as to children over ten and under stringent conditions; (2) on allowing children under 16 to be trained as acrobats, contortionists or circus performers, or for any dangerous performance ; and the Children's Dangerous Per formances Act, 1879, as amended in 1897, makes it an offence to employ a male young person under 16 and a female under 18 in a dangerous public performance.
The Act of 1908 renders liable to a fine not exceeding £25, or alternatively, or in addition thereto, imprisonment with or without hard labour for any term not exceeding three months, any custo dian, etc., of any child or young person who allows him to be in any street, premises or place for the purpose of begging or receiving alms, or of inducing the giving of alms, whether or not there is a pretence of singing, playing, performing or offering anything for sale. An important departure in the Act of 1908 was the attempt to prevent the exposure of children to the risk of burn ing. Any custodian, etc., of a child under seven who allows that child to be in a room containing an open grate not sufficiently protected to guard against the risk of burning or scalding is liable on summary conviction to a fine not exceeding .f 1 o. Provision is made against allowing children between the ages of four and 16 to be in brothels; it is also made a misdemeanour if any cus todian, etc., of a girl under 16 causes or encourages her seduction or prostitution, and any person having the custody of a young girl may be bound over to exercise proper care if it is shown to the satisfaction of a court of summary jurisdiction, on the complaint of any person, that she is exposed to such risk.
The juvenile offenders committee appointed by the home secre tary has now reported (1927, p. 128) with regard to this section that the age should be raised to 17 years, that the services of probation officers should be made available and that the two following sub-sections should be added : (i.) Children and young persons under 17 who have no parents or guardians, or parents or guardians who are unfit to take care of them, or who do not exer cise proper guardianship, where the court is satisfied that the children or young persons are falling into bad associations, or are exposed to moral danger or are beyond control; (ii.) children or young persons under 17 in respect of whom specified offences (such as cruelty or sexual offences) have been committed, or who are living in homes where such offences have been committed in respect of other children or young persons, and the court is satisfied that they require special protection. If this recommen dation becomes law, as is probable, the two new sub-sections will practically cover all the cases set out in the existing sub-sections.
In the Act of 1908 "child" is defined as a person under the age of 14 years, and "young person" as a person who is 14 years and upwards and under the age of 16 years. The act applies to Scot land and Ireland. Legislation much on the lines of the Acts of 1889-19o8 has been passed in nearly all the British dominions.
See also articles CHILDREN'S COURTS, EDUCATION and LABOUR LAW. (W. F. C.; T. A. I.; W. C. HA.) The tendency of American law has been to enlarge the rights of the child and the measure of protection afforded to him against ill-usage, exploitation and conditions affecting his health, morals and general well-being. While the laws of the various States and the judicial decisions interpreting them differ in details, certain general principles are now quite widely accepted.
The first duty of the parents of children is to provide them with support. This obligation rests principally upon the father but the mother is required to do so upon the death of the father. In recognition of the difficulty in which a widow finds herself in caring for her children and at the same time working to provide support, 39 States have passed so-called mothers' pension laws. Under these laws the mother, upon a proper showing of her own good character and the suitability of her home, may receive regular grants of money from public authority. She is thus enabled to remain in the home and care for her family. The father of step-children is not obligated to provide for them unless he voluntarily undertakes to do so. In the case of an illegitimate child, the mother is liable for its support, and she usually does not have the benefit of mothers' pensions. The father may be required to provide sup port if his paternity has been legally adjudged or if he voluntarily acknowledges it and assumes the duty of support. The precise extent of the duty of support is determined by the law of the particular jurisdiction. Generally it includes food, shelter, cloth ing, medical care and education. Compulsory education laws require the attendance of children at school and impose a penalty upon the parents for non-compliance. At the same time, child labour laws prohibit the employment of the child during the time when he is required to be in school or in dangerous occupations.
Generally speaking, the father has the control and custody of the child and he may determine where it shall live although the modern tendency is to recognize a larger right in the mother as to these matters. Either or both parents may be deprived of custody by conduct harmful to the child. In case of the father's death, the mother assumes full custody and control. An illegiti mate child becomes legitimate upon the subsequent marriage of its parents. In a few States, legitimation can be effected through a judicial proceeding instituted for the purpose or through the process of legal adoption. A legitimated child assumes the same relation to the parent or parents as if born in lawful wedlock. Where a child becomes an orphan or where his parents prove to be wholly unfit to care for him properly, he may be committed in a legal proceeding, usually through the juvenile court, to the guardianship of a suitable person, a public agency or a private philanthropic society. Guardians may be appointed either to con serve the property of the child or to provide care and maintenance, or both.
A guardian does not assume the full status of a parent. This relationship is established only through the process of legal adop tion by which the child becomes the lawful child of his adoptive parents. The tendency of modern legislation is to safeguard adoption proceedings by requiring that the child shall remain in the prospective foster home for a trial period, usually six months, before the proceeding is completed. Georgia, Minnesota, New York, New Mexico, North Dakota, Ohio and Virginia have such laws. In addition, Minnesota, North Dakota, Oregon and Vir ginia require that some investigation of the foster home must be made by public authority and reports presented to the court having jurisdiction of the proceeding as to whether the foster parents are proper persons to adopt the child and their home a suitable one for the purpose.
Because of the abuses arising out of the casual transfer of chil dren from parents to irresponsible people, several States have passed laws prohibiting any transfer of parental control except upon a court order; i.e., through guardianship or adoption pro ceedings or upon order of a juvenile court. This is the law in Minnesota, North Dakota, Michigan, Alabama, Indiana, Nebraska and New Jersey. The law in many jurisdictions prohibits the bringing of children into one State from another for purposes of permanent care until after investigation and approval by the authorities of the State to which the child is brought.
In addition to the duty of support the parent must shield the child from evil surroundings and may not impose injury or cruelty upon him. The parent may use physical force to protect the child from danger and, under proper circumstances, to impose reasonable parental correction. The conduct of any adult which tends to deprave the morals of a child or endanger his health or well being is punishable as a criminal offence.
The White House Conference on the Care of Dependent Chil dren called by President Roosevelt in 1909 incorporated among its conclusions the following: "To engage in the work of caring for needy children is to assume a most serious responsibility, and should, therefore, be permitted only to those who are definitely organized for the purpose, who are of suitable character, and who possess, or have reasonable assurance of securing, the funds needed for their support. The only practicable way of securing this end is to require approval, by a State board of charities, or other body exercising similar powers, of the incorporation of all child caring agencies . . . ; and by forbidding other than duly incorpo rated agencies to engage in the care of needy children." Ten years later the International Conference of Child Welfare Experts called by the Federal Children's Bureau declared in favour of regular inspection and licensing by public authority of pri vately organized and supported child caring agencies.
These pronouncements are in recognition of the duty resting upon the State to provide proper care for dependent children or to insure that only adequately equipped private organizations under take the responsibility. Moreover, it is now clear that mere ap proval by the State of articles of incorporation is not sufficient. There must be regular and continuous public supervision of the work of these societies in the light of changing standards and con ditions. Generally speaking, recent legislation has provided for the annual licensing and regular inspection of three types of or ganizations—those placing children to board or for permanent care in foster homes; institutions for dependent children, and maternity hospitals, particularly those caring for the mothers of children born out of wedlock. It is the latter type of hospital which has frequently carried on a traffic in illegitimate babies often referred to as baby farming, by which is meant the disposal of such babies to any person willing to take them and to pay the amount asked. Alabama, California, Minnesota, Missouri, North Carolina, North Dakota and Virginia have comprehensive legis lation on this subject. Connecticut, Georgia, Kansas, Nebraska, New York. Ohio. South Carolina. Utah and Wisconsin deal with the question in a variety of ways.
Child Welfare Bureaus.—The State is the ultimate guardian of all children who need what they cannot provide for themselves and what natural or legal guardians are not providing for them. To assist in the proper discharge of this obligation, laws have been enacted in several States providing for the establishment of State child welfare bureaus. The work of these bureaus varies widely and is not subject to ready classification. One of the pri mary objectives is to centralize and co-ordinate the child welfare work carried on by public authority. Among other activities the following are typical: securing enforcement of laws for the pro tection of children, child placing, special care for the feeble minded and for children born out of wedlock, supervision of pri vate institutions and child caring institutions, co-operation with juvenile courts and probation departments, assistance to local authorities in the administration of mothers' pensions and, finally, the promotion of good standards of child care by all organizations doing that work. Among some of the States having child welfare bureaus or departments are Alabama, California, Connecticut, Georgia, Illinois, Massachusetts, Minnesota, Missouri, New Jersey, New York, New Mexico, North Carolina, North Dakota, Oregon, Pennsylvania, Virginia, West Virginia, Wisconsin and others.
The growth of legislation for State departments has been paral leled by the creation of local county units of child welfare admin istration. These county boards of public or child welfare deal directly with the delinquent, dependent or neglected child in the city and surrounding rural country and usually work in close harmony with the State office. California, Minnesota, North Caro lina, New Jersey and New York are the leading States which have developed this type of local organization.
Since 191I protective legislation for children has been mark edly accelerated by the work of State commissions for the study and revision of child welfare laws. This movement was no doubt stimulated in part by the British Children Act of 1908, sometimes referred to as the "Children's Magna Charta." While this Act was mainly a codification of existing law on the subject, in the process of compilation and revision distinct advance in protective measures was made. The White House Conference on the Care of Dependent Children recommended periodic review and revision of child welfare legislation. In 1911 the first State commission was appointed for this purpose. By Dec. 1923, 29 States and the District of Columbia had followed the precedent set by Ohio. In the meantime, the conferences on child welfare called by the U.S. Children's Bureau in 1919 again endorsed the principle of careful reconsideration of child welfare legislation at reasonable intervals to secure the proper co-ordination of existing law and new pro visions where experience proved them to be necessary. In 1913 New Hampshire and Oregon appointed commissions ; Missouri in 1915; Minnesota in 1916; Michigan and Montana in 1917; Delaware, Kansas and Wisconsin in 1918 ; Connecticut, Indiana, Nebraska, Oklahoma, South Dakota, South Carolina and Texas in 1919. In 192o New York, Kentucky, Tennessee and the District of Columbia made similar provision ; North Dakota, Utah and Virginia in 1921; Georgia and Maryland in 1922. In 1923 new commissions were created in Florida, Iowa and Pennsylvania. These commissions were created by legislative act or appointed by governors without specific legal authority. In all cases the gov ernors named the members, except where membership was specially provided for. The recommendations of the various commissions have been fairly widely adopted in several States. This is notably true in the State of Minnesota. Iowa, North Da kota and Pennsylvania may also be mentioned as among the States making progress in this field.