sufficient attention has been given is the effect of undernourishment before a child's entrance upon school. The relative starvation in protein, lime, iron, calcium, and magnesium during the first five years of life helps to produce the child suffering from malnutrition. upon entrance to the public school. The report of the medical inspector, however, will probably class such a child as belonging to the group with such physical defects as enlarged tonsils, anemia, or enlarged glands.

The purpose of school lunches is not to relieve acute hunger, but to relieve chronic underfeeding. Dr. McMillan, of Chicago, found 15.9 per cent kindergarten children physically below par, and estimated that underfeeding was the cause of 11 per cent in kindergartens and 7.8 per cent in other grades. Dr. McKenzie regards one-third of all the school children in Edinburgh as poorly nourished. Dr. Francis Warner and Hack Tuke found 28.5 per cent of London school children suffering from deficient feeding. The New York committee on the physical welfare of school children in 1907 declared 13 per cent of 990 children examined to be suffering from malnutrition, and Dr. Sill in 1909 estimated that 40 per cent of the children in the elementary schools of New York City were poorly nourished. The New York school lunch committee in 1910, in an examination of 2,150 children, adjudged 13 per cent to be marked cases of malnutrition. In Chicago, in 1908, of over 10,000 children examined, 12 per cent were reported as suffering from malnutrition. In Boston, in 1909, underfeeding was found in 16 per cent of over 5,000 children. In Philadelphia 24 per cent of 500 children examined were found to be suffering from underfeeding. In St. Paul, in 1910, 20 per cent of 3,200 children in schools in the poorer districts were reported as manifesting the evidences of marked underfeeding.

Regardless of the primary factor in malnutrition, whether it be due to a deteriorative reaction against an oppressive physical environment, to unhygienic home conditions, or to lack of adequate or sufficient food, no inspection card should be regarded as complete. without some notation regarding the state of nutrition. This position is strengthened by the comment of the chief medical inspector of London (1910):

It is certain that malnutrition and physical defects are closely associated and react upon each other, but it is difficult to determine their exact relation to each child or to say in what degree malnutrition causes the other physical evils. Merely to increase the supply of food would in many cases not solve the complex problem of the individual child, although in many cases lack of food lies at the root of the mischief.

The relation between nutrition and medical inspection is patent. Medical inspection should be so thorough as to indicate not merely

the names of various symptoms and conditions, but should suggest whether or not malnutrition could possibly be an underlying factor. Under such conditions school lunches could serve in a remedial way by raising the standard of nutrition. Frequently medical inspections reveal some children not possessing marked defects, but who are very close to the health-poverty line, and for them school lunches could be instituted for prophylactic purposes. Most civilized countries have already installed the school lunch as a natural and normal part of an educational movement, without laying unnecessary stress upon its value as a health measure. As medical inspections are regarded as advantageous to the school system through the lessening of disease and the improvement of the mental caliber of the children, careful attention to nutrition may supply a valuable means of increasing mental activity and building up the physical health of our school children.

C. TEACHING NUTRITION VALUES THROUGH PENNY LUNCHES.

MABEL H. KITTREDGE,

New York School Lunch Committee.

In a list of causes of malnutrition I notice that in England poverty is put first, but it seems to me in this country ignorance comes first, and this ignorance can not be conquered by ladling out a penny's worth of soup and tempting children to buy graham crackers and rice pudding and fruit from a penny table. The general raising of standards will, of necessity, be slow, but are we doing all we can to change the habits of the families of the children who buy luncheons from us? Take, for example, the habit of setting the table at home and having no regular time for meals. This habit among many of our immigrants comes from the confusion of living. The school hour at noon does not fit into the husband's hour off, little children demand food more frequently than their elders, the rooms are small and overcrowded, and after a time it seems too much trouble to set the table.

Every child in our schools should be taught that health is only possible with regular meals; not taught it once, but repeatedly. Every mother, through mothers' meetings or by circulars printed in her own language, should be made to understand that the school lunch is simply one way to make more possible regular hot meals for her children; that we are not feeding her children because of poverty, but because we realize the confusion of conditions that she is obliged to meet; and, incidentally, that if she does not give her child at least 3 cents a day for his lunch she has not done her part.

But even before we get our universally ideal educational system, I believe we who are serving luncheons can do a great deal more than

we are doing. For example, in New York next year we are to serve a noon meal in 17 elementary schools. We estimate that we shall feed 5,000 children a day. If these 5,000 know each day the name of the soup they have eaten and go home and tell their mothers about it, something will have been done. Can not we have on the classroom blackboard the ingredients used in the soup, and, possibly, a short explanation of their food value, showing, for example, the food value of a bean soup over a candied apple, both being the same price, and the latter very popular? It would make the lunch much more interesting, and children do care whether they are strong and big or not. The boy would like to get his money's worth from the penny table. When he saw on the blackboard that the penny he spent to-day for rice pudding gave him four times as much good, growing, running, fighting stuff as the penny he spent yesterday for a sweet cake, it would arouse something in him that would be one step toward better health for that boy.

VIII. SEX HYGIENE.

A. PUBLIC OPINION AND SEX HYGIENE.

CHARLES W. ELIOT, Harvard University.

During my somewhat recent active life I have never seen such a change of public opinion among thoughtful people as has taken place among them within the last 10 years on the subject of sex hygiene, using that term in its broadest sense. The policy of silence on all the functions and relations of sex, whether normal or morbid, was almost universally accepted for centuries by physicians and clergymen, and in family life. In the Protestant denominations of the Christian church the normal processes of procreation and birth were associated with the supposed fall of man and his total depravity. In the Catholic Church the offices of a priest were necessary for the mother and new-born infant by way of purification; and the perversions of the sexual passion were to be dealt with only by the priest in the confessional. The miserable victims of the venereal diseases were excluded from all hospitals and dispensaries, or were treated by compassionate physicians only by stealth. Venereal diseases were regarded exclusively as diseases of sin and shame until their frequent communication to wholly innocent persons had been demonstrated within recent years.

Certain rather recent medical discoveries have contributed to the extraordinary change in public opinion. When blindness was traced to gonorrhea in the mother, a potent cause of the crowding of blind

asylums was thus brought to light. Insanity and general paresis were in many cases traced back to syphilis, and an explanation was thus given of the increase of insanity in civilized communities. It became known to the medical profession, and later to many unprofessional persons, that the consequences of gonorrhea were almost as bad as those of syphilis in regard to the infection of innocent persons and the destruction of family happiness. Quite recently a treatment for syphilis has been discovered which has proved satisfactory in many thousands of cases, although the permanence of the cure can not yet be confidently affirmed, and it has been proved that by persistent treatment gonorrhea can apparently be permanently cured in a large proportion of cases.

In obscure disorders the Wassermann test for syphilis gives the physician, who is trying to make the diagnosis, on the one hand a strong indication of the presence of a serious complication, or on the other of its absence. As a guide to treatment either determination is invaluable. The same test- can supply evidence that a cure has been effected. It will also probably furnish in time trustworthy statistics concerning the prevalence of syphilis in the community at large, statistics greatly needed, because the previous guesses and estimates on that subject and the results of some recent applications of the test to considerable numbers of public hospital patients are disquieting.

These medical discoveries raise important ethical questions. Will the fact that syphilis can apparently be cured in many instances increase sexual immorality? Will the fact that a few dissolute men and women escape venereal diseases, and the further fact that there are antiseptic precautions which diminish somewhat the dangers of licentiousness make young men readier to encounter the dangers of sin? These are questions which only experience can fully answer.

Public opinion has been moved strongly toward the subject of sex hygiene, because of the many signs of physical deterioration among the civilized nations, which suffer from the eager rush out of the country into the city, from the factory system, and from alcoholism and the sexual vices. Many thoughtful persons are anxious about the diminishing size of young men at the age of admission to the national armies, the rapid reduction within 50 years of the size of the average family, the common inability of women to nurse their babies, the terrible infant mortality in cities, the alleged increasing number of physically or mentally defective children, and the increasing proportion in civilized communities of persons-young, mature, or old-who are practically unable to earn their livelihood. The humanitarian policies in regard to the treatment of the defective, the incompetent, and the criminal classes seem to tend to increase the burdens carried by the normal and industrious portion of the population, and these burdens react on the vigor and happiness of the

normal people. The increase of liberty for all classes of the community seems to promote the rapid breeding of the defective, irresponsible, and vicious.

The new interest in sex hygiene is not due, however, only to speculations on the durability of modern civilization or on that of the white race. Political philosophers and biologists naturally take a strong interest in these large problems, but the individual young man or woman has a narrower sentiment on this subject, though one quite as intense. The young people have lately heard for the first time what the risks of marriage are; what the physical enemies of happy family life are; how the different standard of chastity for men and women has worked during the slow development of the society now called civilized. With these young people the problem becomes an intensely personal one. "How can I best regulate my own conduct in order to win the normal satisfactions of family life? How can I be protected from the ignorance or sinfulness of associates? In short, how can I steer a safe course through the swirls and tumults of the sexual passion, which seems to be a principal source not only of the normal satisfactions and delights of human life, but also of its worst anxieties and afflictions?" Intelligent fathers and mothers feel a new sort of duty toward their children, the duty of protecting them from vicious allurements and giving them in due time knowledge of good and evil in sex relations. Teachers in public schools see before them a deplorable proportion. of children who have bad inheritances, both physical and mental, and who live in bad environments; and, sharing the new freedom in the discussion of social problems, they are eager to be told how they can contribute to the arrest and prevention of these miserable tendencies. Churches are taking a new interest in the questions which arise out of unhappy marriage and easy divorce. Many persons who get a smattering on eugenics are eager for legislation to make marriage conditional on bodily and mental health and to keep in confinement the feeble-minded, the alcoholic, and the insane, not only till they are of age, but till they are incapable of breeding their like. Some knowledge of social hygiene and eugenics has led many persons to advocate hastily prepared legislation as a panacea for evils which terribly afflict modern communities, and yet are very ancient. Such is the genesis and such the immediate outcome of the new and widespread interest in sex hygiene.

The most important question before us is the question, "What forces can now be put in play against the formidable evils which gravely threaten family life, human happiness, civilization in general, and the very life of the race?" Something must be done. Christianity, democracy, and humanitarianism have all failed thus far to cope with these evils which are sapping the vitality of civilized