Address to Toledo, Ohio, Nurses on the European Food Shortage, January 26, 1920


It is a great pleasure to talk to nurses in these days, both because the profession has received such an impetus from the wonderful work nurses did during the war and also because the general question of public health is of so much more concern than it has ever been in the history of mankind, that the whole question of serving the public by nursing is being viewed from a new aspect. And I am going to ask you this evening to consider with me some of the conditions of public health which I saw in Europe last summer during the fifteen weeks I was there, and the challenge it offers to the fine type of work that nurses all over the world are doing, such nurses as are represented by the visiting nurses of this City.

My friend Dr. Hamilton and I went to Europe last summer to attend a conference in Switzerland. We spent three weeks each in five different countries. The state of public health in each of them was dependent as it always is upon the conditions of food and shelter; they were so similar in these five countries that I think it may be fair to generalize a little as to European conditions.

In France you know the whole question of food and shelter has taken a new aspect. That is, these things with which women have been identified so many years of feeding the children and housing of families, are now put up to the Government in quite a new way.

There is first to be considered the tremendous region which has been devastated, and as you drive over it day by day in an automobile it seemed perfectly endless, --  250 miles one way and 150 the other, in which the housing has been practically all destroyed. The French Government is very much interested in having the new housing of the best sanitary type, for they are terribly disturbed in France over their tuberculosis rate. [page 2] Tuberculosis has always been bad in France in ordinary times. The death rate in Paris has been twice as high as in New York City, and since the war even that tuberculosis rate has increased enormously. So they are quite determined upon two things. First, that they will establish throughout France what they have never had before, centers for the care of tuberculosis where measures for its prevention may be taught, and in this American physicians and nurses have given them a splendid start, actually beginning centers not only in Paris itself but in other areas of France -- and they are determined to rebuild their houses in the devastated region so that they may carry out certain necessary reforms. It is not easy to convince the French peasant that he wants his house built in any other way than the one he is used to and to which his affections cling. The French peasant believes that a commission to distribute the German indemnity will come and they want to show to it the exact number of windows and doors and square feet of wall which have been destroyed and which must be carefully replaced. When Miss Morgan went over from New York with her plans for a model village she encountered a certain amount of opposition from the French peasant himself who was eager to get back to pre-war conditions. In a good many ways the whole housing condition of France has to proceed very slowly and carefully, but many public spirited citizens are determined upon certain housing reforms.

As one visits the devastated villages, it is rather curious to find that a village in which only one person is living, -- that one person who has gotten back first is almost always an old woman. That seems strange. One would think that a young person would go back first, but the young people adapt themselves much more quickly as refugees; it is much easier for them to find work under new conditions, but the older people are determined to go back and live as nearly has they can on the same spot to which they had been accustomed. Sometimes this ↑old↓ woman would be living in the cellar of her old house [page 3] under very peculiar conditions, but the Red Cross, or whatever relief agency would be working that devastated region, would be ministering with great care to this one pioneer that had come back and was trying to start life again in spite of all her poignant experiences of horror and distress.

As nurses you are interested in the food problem affecting, as it does, all questions of health. As you know, the people of devastated Belgium and northern France made a company of nearly 10,000,000 people who were fed under the American Food Administration which for two years and a half carried on one of the most interesting experiments in nutrition which has ever been made. My first view of starved children was in the city of Lille, which you know was occupied in the first weeks of the war, and was held throughout months and years of the war, so that it was typical of food conditions back of the German lines.

We went one morning to see the school children who were being fed under the auspices of the American Red Cross. In the first room we visited the children were being examined for tuberculosis; they were suspects, who were being tested to see whether they ought to be sent to Sanatoria or whether they were well enough to be put in with normal children. We saw a line of little boys between 10 and 12 years of age stripped to the waist, passing along to the doctor. As you looked across the room you had the impression that they were skeletons; you saw nothing but the bony structure. You saw every vertebra and every rib, ↑and↓ their little arms, which hung down perfectly limp, and it took some time to realize that there was skin over these bones and of flesh there was none.

The doctor had lost his voice during the bombardment of Lille. One comes across all kinds of shell-shock in Europe. This particular doctor had been unable to speak above a whisper since Lille had been taken. He was whispering his instructions and the children, thinking it was some sort of a game, whispered back to him, so that one saw not only this ghastly line of skeletonized children [page 4] but also heard not a word. I assure you it was a sad experience, [although] one had this comfort that everything was being done for the school children of Lille. They were being fed at least one meal a day -- not only soup and bread but good hearty stew and dessert and all sorts of things, as much as the children could be induced to eat. The doctors agree that unless these children had what was termed super-feeding, -- unless they were fed as children were fed who have tuberculosis or some wasting disease they would have no chance to recover and grow into the full stature of adults.

We even saw the enormous supply of stores which the American Red Cross had in Lille. We visited a large building full of food and clothing and hospital supplies.

We had our next view of starving children in Switzerland. All during the war Switzerland had been found feeding the children from neighboring countries. They fed Italian children during the years when Italy had so little food; they fed thousands of French children who were repatriated through Evian. After the Armistice was signed and more food was procurable in France and Italy, they have been feeding children from Austria and the Tyrol. The children we saw had come in from Vienna. There were about 600 of them standing on the platform while the Swiss women were taking them away to their houses where the children were received as guests. The Swiss women were giving the children chocolate and little cakes and saying to them "I have a little girl about your size." Or "my little boy is waiting to play with you," to one child and another as they were leading them away. But the Viennese children made little response. They were perfectly listless and quiet. There was none of that bustle and talk which one naturally associates with 600 children. Their shoulders stuck out through their thin clothing they were so [emaciated], they were too weak to make any unnecessary motion, and you had the impression that what they would like to do would be to lie right down on the station [page 5] platform. We felt that each child ought to be in bed and they ought not to be allowed to travel, but these were well children. The sick children were not sent this way. These were the children who had been examined by the physicians in Vienna and pronounced well enough to go into private homes in Switzerland.

You remember that General Smuts had been sent by the Peace Commissioners to Austria and Hungary in order to report upon the conditions there. One story he told I am sure I will never forget. One day one of the young officers of his military escort had gone on the streets of Vienna with some food in his pocket -- seeing some children who looked perfectly starved and wretched he took this food out of his pocket and gave it to them. Before he realized what had happened the children came running from every direction, about 200 of them. They threw him down; they tore his uniform into strips and bits, trying to get more food out of his pocket and they literally almost killed him. When he was finally rescued he had to be sent to a hospital for a week's care. General Smuts said that of course the young man could have protected himself at first, but he did not want to strike those sick children; he did not want to hurt them and while he was parleying, he failed to defend himself and they came in such numbers that they simply overwhelmed him. These were perfectly savage, so determined to have food, so starved that they were free from any restraint and inhibitions that ordinarily controlled children. They were a sample of the dehumanized child which long continued starvation produces. There are other stories about the starving children of Vienna, but perhaps this one will reveal the situation sufficiently. The wretchedness of course is not confined to the children. We heard in Holland, Switzerland and France that the older people of Vienna had entered into a suicide pact, determined that if things did not improve this winter, that they would put [page 6] themselves out of the way in order that the younger people might live. I do not know whether that is going to happen or not, but I should say that it probably never will happen; but that the story should receive credence in one country after another reveals the state of starvation which exists in many cities of Europe.

I went one day in Switzerland to see a woman whom I know. She was the widow of a professor in a University. She lived in a small house in a simple way, but she had entertained from the first months of the war three Belgian women, -- a mother, a daughter and her daughter's friend -- who came as refugees and for more than a year she had added to her household two Austrian boys of 14 and 15. She was afraid if they returned to Austria they would succumb to tuberculosis and there they were, this mixed household, apparently getting along very happily. I expressed my admiration for her kindness and hospitality, which had cared for strangers for so many months, and she said: "If you had gone from my house to the next, or the next, you would have found these houses also full of guests. If you in America had seen these starving people as we have seen them, you could not do otherwise than to feed them and every house would have its guests.

A [traveler] who goes to Switzerland is obliged to have a bread card, a meat card, a milk card, a fat card, etc., and yet the children who were guests were given these various things in abundance and their Swiss hosts were very proud indeed if they were able to bring up the weight record of their little visitors.

When we got back to Paris we found that a mission was planning to go into Germany consisting of four English Quakers and four from the United States. This mission was to report upon the food conditions among the women and children to Mr. Hoover, who was then in Paris. Dr. Hamilton and I were asked to join the American contingent. We were not really Quakers, almost [page 7] I have a Quaker grandmother of whom I am very proud.

While in Holland waiting for our passports we met delegations who had been sent out by various relief agencies coming back from other countries. Of course Armenia was the most desperately in need. I recall some American missionaries who had maintained a food station in northern Syria. Because of their insufficient food supply they would be obliged to say to a mother of three children: "You may send one child to our food station, you must send the same child each day for otherwise we cannot be responsible for keeping him alive, but you cannot send the others." Or, they would be obliged to say; to the mother of six ↑five↓ children: "You may send two children to our food station, but you must always send the same children and never try to send more.”" Of course that was the sort of thing which it was impossible to ask a mother to do, and the missionaries were quite wild with despair. They said: "What is the matter with America? Why cannot we get enough food? Why must we make these impossible conditions and place the mother in such a harrowing situation?"

We met people returning form Poland and from [Romania], and they always told the same tale. Perhaps some of you have heard Canon Savage who has been recently speaking throughout the country about conditions in [Serbia]. He had charge of the distribution of food contributed by England for several years. His accounts are heartrending and yet they are very much like the condition which we saw in other parts of Europe, because Europe throughout years and months had no adequate food supply and all of the countries were reduced to the same expedients in their efforts to keep the children alive. The results upon the health and growth of the children has necessarily been very much the same everywhere. In describing conditions in Germany, therefore, I am giving what is more or less typical of all Europe.

In response to Mr. Hoover's request to visit industrial districts, we went into Saxony. It is largely as you know a mountainous region where [page 8] for many years they have not been able to raise their own food supply but have procured it in exchange for their manufactured goods. Chemnitz, for instance, is an industrial city in which hosiery and knitted underwear are manufactured, largely from cotton. They have had no raw material of course since the war and at the moment we were there, there was no coal. The great factories were closed and we saw the operatives, men and women, standing in idle groups. One had exactly the same impression that one always has in an industrial center during a period of [nonemployment], that almost anything might happen, but added to that these people had been starving for many months. We visited various public kitchens. They were those for the working class and for the very poor to whom tickets had been issued. We heard that in one of the so-called middle class kitchens they were going to have fat in their soup that day. Throughout central Europe during the war there has been no vegetable fats and owing to the great dearth of milk and butter, no animal fats. Thus in addition to the general shortage of food, certain kinds of food have been altogether lacking. In Berlin, for instance, they used to reduce the dishwater from the great hotels in order to get fat for use in the hospitals. In Chemnitz, therefore, we looked into the soup kettles with much interest in order to see this much praised fat. The great cauldrons were filled with a cabbage soup which had been somewhat thickened with war meal. This war meal was everywhere made of a portion of rye flour or wheat flour to which had been added all sorts of other things in order to increase its bulk, dried vegetables ground fine, and sometimes [ground] acorns so that the person eating it might have some sense of repletion. This soup in Chemnitz had been thickened with this war meal and on the top of each of the huge cauldrons had been placed a small piece of vegetable [margarine] about as big as a baby's fist, or an egg. We could see the globules floating on the top, but you felt that the people who rejoiced that day because their soup [page 9] contained fat would be doomed to disappointment.

One day in the city of [Leipzig] we saw some children at a public playground eating their noonday meal. Each child had a pint of war soup which had been made by stirring war meal in hot water and nothing else. The man in charge of the playground made various announcements. He said that there would be prizes for the best gardens and [illegible] he referred to other playground activities. The children did not seem much interested in what was going to happen. They had that same listless air to which we had grown accustomed. They were absolutely unlike normal children in every way. But when the playground director said that day after tomorrow they would have milk in their soup, the children burst out into the most ridiculous cheer, in the shrill unnatural voice which is one of the results of famine. The city physician who was with us said to the playground director: "Are you sure you are going to have milk day after tomorrow?" The director replied: "No I am not sure, but there is a prospect for it, and the children must have something to hope for."

Of course all these children had bread at home. Each child was entitled to his own ration, but the mothers told us that they liked to save the bread for the children's supper because the hardest thing they had to endure was after the children had gone to bed at night, they would whimper, moan and cry with hunger for a long time before they went to sleep, and sometimes even after they were asleep. Many mothers, therefore, saved as much food as they could for the children's supper, hoping that the children would sleep through the night and forget their hunger. Over and over again in [creches], in orphanages and hospitals the [midday] meal we saw given to the children consisted of a pint of this war soup. All through Saxony the death rate was very high during what they call the turnip months. In the late winter and early spring of 1917 there was almost nothing to eat but turnips. They had exhausted the old crop of potatoes and grain; it was impossible to [page 10] get food from the outside, and before the new vegetables came in, they lived largely upon white turnips. Of course many old people, [delicate] people and above all little children had succumbed to such condition.

We went into a region along the Bohemian border called Erzgebirge. The people there are large top makers and lace makers. Work has never been very well paid and during the war they became desperately poor. In the villages we were met by the Mayor, the schoolmaster and the doctor or the apothecary. They would take us to the school where Dr. Hamilton, in order to judge the condition of the children, would have them pass in front of her. We would judge a boy to be six years old when the schoolmaster would tell us was nine or ten, or we would judge a boy to be ten who was really twelve or thirteen. They were all stunted and undersized. In the university town of Halle, Dr. Abderhalden told us that the school population was only half as large as it had been before the war. Some of the children had died, some of them had been sent into the country and still others were kept at home by their parents because they were so rachitic, their bones were so soft that there was danger of crippling them for life if they were allowed to use their limbs. So many children were kept at home as quiet as possible until there was a chance to feed them properly.

When we reached [Frankfurt am] Main we found American food was beginning to come in to the occupied territory. One day we were being taken about the city by a very dignified gentlemen in a tall hat, a frock coat and imposing manners which belonged to such garments, but when he saw a piece of American bacon hanging in a shop window, he suddenly left us and ran across the street to look at it. The window was already surrounded by a little crowd of thirty or forty people. All of the [little] food shops had their windows filled with empty biscuit tins or cans so that real food was an unusual sight. We were invited to supper in a charming suburb of [Frankfurt] [page 11] where [the] food consisted large of vegetables out of the garden and the tea was made of linden blossoms with raspberry leaves. The dessert was stewed cherries, also out of the garden, but around them had been placed a thin wall of rice which greatly interested everybody at the table. The host was asked "How did you get this rice? Do you think we can get some? Is the difficulty over about rice?"

An editor told us that since food had been coming in he had one night taken home a bottle of milk for his sick child. As he came up the steps of his house his little girl had seen him and rushed in to tell her mother that "Peace had come; father had brought home a bottle of milk." Another little girl had asked her mother "Is it true that there are countries in the world where people can eat all they want to?" She had heard this tale but she didn't quite believe it.

Throughout Europe tuberculosis had not only increased the number of its victims, but different types and kinds of tuberculosis have developed, some that have never been seen outside of savage countries, certainly not in Europe, such as tuberculosis of the skin or of inner joints. The doctors were beginning to say that tuberculosis was not so much a matter of infection as the result of malnutrition, that it could be combated only with sufficient food supplies. They differed very much in their opinion as to what would eventually become of this generation of children. Some of the doctors insisted that if they could begin feeding the children now they would have a chance to develop into normal adults. Other doctors were not so hopeful and believed that even if the children grew up they would succumb to the first hard strain of life. Their future, of course, yet remains to be determined. [page 12]

If the great war was fought to bring more democracy into the world, and if the newly created nations are to establish republics where monarchies have been, the people themselves must give it the stamina, moral energy and mental vigor before any of these things can be attained. The feeding of these millions of people is therefore important not only because it appeals to our humanitarian instinct, but because the present food situation may determine the entire future of Europe. All of the moral results of the war may slip through the hands which are too feeble to hold them. The death rate is not only abnormally high among little children but also among young people between the ages of twelve and twenty, upon whom the responsibility of the government will soon rest. Curiously enough this ↑latter↓ death rate is fast being [equaled] among the mothers of young children who, during the war, had evidently divided their rations and eaten so little themselves that after all these months they have no resistance and succumb to all sorts of diseases.

Such is the situation in many parts of Europe. It is primarily one which can only be relieved by providing more food and shelter and better health conditions. It is a challenge to all of us, and especially to women who, like yourselves, constantly give time and effort to the relief of distress.

To my mind, the best channel for the relief of these children is through The European Children's Relief Fund which was organized last July. The [personnel] made up of those from the American Food Administration and from the Shipping Board. They started with a fund of $22,900,000 and are now dispensing from various sources about $7,000,000 a month. They are feeding school children in those various young republics stretching from [Yugoslavia] on the Adriatic, including Austria, Hungary, [Czechoslovakia], Poland to Lithuania, Latvia and [Estonia] on the Baltic Sea. Of course they need more money and will have to have more before the winter is over. We must do what we can to urge Congress to make national loans, and also to collect from all possible sources. In this moment of strain and misunderstanding between the American [page 13] and the immigrant, do we not see an opportunity for [cooperation] in a straight humanitarian task. The Poles, the Armenians and many others are distressed over conditions at home and are grateful for sympathy and understanding. The headquarters of the European Children's Relief Fund is at 115 Broadway, New York City. All the money sent them goes directly into food as the purchasing and shipping arrangements have already been provided for. If you are interested in sending money to German children that must be done through the Quakers in Philadelphia, to whom Mr. Hoover also furnishes transportation and the advantage of food brought from his European warehouses.

When we recall the great sacrifices of the war and the sustained effort which America made to save food in order to send it abroad, one cannot but wish that we might continue this self sacrifice at least for one more winter, until the harvest of 1920 is garnered, more adequate commercial relations are established, the national loans are completed and life restored to a more normal basis. Unless help can come quickly millions of people may perish before the new adjustments are made.

The large body of women in all the belligerent countries who went into nursing during the war, who took care of the soldiers or relieved destitute civilians in the devastated districts, laid the foundations for a new profession, or at least they have made a new place in the world for an old profession. Nursing is more and more considered a matter of public obligation, something to be provided for from the taxes themselves. Governments are recognizing their obligations to those who are ill and crippled. I can think of no profession which has before it finer possibilities than this profession of public nursing, and I congratulate the City of Toledo which has made so fine a beginning through the association whose representatives are here this evening (applause). [page 14]

Question: How about the situation in Russia?

Answer: We did not go into Russia, but we met many people in Europe who had recently been there. In Paris we lunched with Kerensky and we also saw Mr. Steffens, Mr. Bullitt and others who were returning. They all felt that the [illegible] facts were not being put before the public, and whether they believed in the Soviet form of government or not they all agreed that news about actual conditions was being suppressed. We also heard much discussion of the Russian situation in England, where they contended that the use of starvation was not a legitimate public weapon and held many meetings addressed by distinguished Englishmen urging that the blockade be lifted. There is a marked difference between England and America in regard to freedom of speech, which seems to be much greater there.

Voice from the audience: You haven't scolded us for our extravagance in this country.

Answer: That wasn't my theme. Not the subject of this lecture.

Question: What are the future prospects of Poland?

Answer: I suppose no one can tell about Poland. All of these new countries will have to work out their own problems and it would take a very brave person to prognosticate. It was very touching the confidence they all had in President Wilson, which was illustrated in various ways. Two children in a hospital in the winter after the Armistice were heard talking together, and one little boy asked the older one whether they were going to have any Christmas presents. The older boy said: "No, because there was war." The younger one was quite unreconciled until his companion said: "Well, never mind, Wilson is coming." That is the sort of story one heard illustrating the wide-spread confidence that help would come to distracted Europe from the United States of America.

Question: Do you think free speech is being suppressed in this country?

Answer: I will have to say again that that is not my theme, but I shall be [page 15] glad to put myself on record that I think that it has been clearly demonstrated that to suppress free speech has always been unwise and dangerous. However, perhaps we would best consider the questions at an end and bring the meeting to an end.