In this excerpt, a well known pediatrician made the case against orphanages and for family foster care. Henry Dwight Chapin began with statistical findings about infant mortality, but also suggested that institutional child care was damaging even for those children lucky enough to survive it. At risk, according to Chapin, was the long-term mental and emotional development of children in orphanages or asylums. Especially interesting is his emphasis on infants’ need for affection, which anticipated later research on attachment and loss, such as Harry Harlow’s monkey love experiments.

According to my experience, the earlier the age the greater the undesirability of handling children in mass. While it is often difficult to get exact figures, there is a heavy mortality and morbidity in most institutions caring for babies. It is of comparatively recent date that any really intelligent investigation of this problem has been attempted.

Mortality in Institutions

The information given in the reports of infants’ institutions is usually meager and unsatisfactory. In 1914 the then American Association for Study and Prevention of Infant Mortality attempted a study of this question. In their review the New York State Department of Charities is quoted as presenting the statistics from 1909 to 1913 of eleven institutions in the State in which the death rate for babies under two years, during this period, based on the total number of children cared for, varied in the different institutions from 183 to 576 per 1,000, with an average mortality rate for the eleven of 422.5 per 1,000. During these same years the death rate for children under two years, based on the estimated population for the state at that age, was 87.4 per 1,000 or about one-fifth of that in institutions. . . .

Very little accurate study has been made as to what effect the institution has upon the mental development of children. Three years ago the Bureau of Jewish Social Research undertook a careful and exhaustive study of this subject. It was made in connection with the children of the Hebrew Home for Infants, the Hebrew Orphan Asylum, and the Hebrew Sheltering Guardian Society, the first an institution for infants, the two latter for older children. In a study of mental development as determined by school grade among 311 children that had been done at one time or another under the care of the Hebrew Home for Infants it was found that about 20 per cent were retarded three terms or more in school. Against this, it was found that among the children of the Hebrew Orphan Asylum and the Hebrew Sheltering Guardian Society who had not previously been under the care of the Hebrew Home for Infants only about 12 per cent were retarded three terms or more. . . .

While the numbers concerned in this investigation are limited, they certainly show a distinct trend. There has never been as careful and exhaustive a study, as this of the Bureau of Jewish Social Research. As far as its findings go, they show that a longer residence in an asylum for infants may have an effect on the later mental life. . . .

It may also be noted that the very young infant craves and responds to affection, which seems to have a stimulating effect, particularly when there is drooping and lack of vitality. That close human observer Jane Addams, with sympathetic vision, puts it thus,

We are told that the will to live is aroused in each baby by his mother’s irresistible desire to play with him, the physiological value of joy that a child is born, and that the high death rate in institutions is increased by the discontented babies whom no one persuades into living.

Such persuasion to life runs all through nature. This is one of the reasons why the young thrive best under individual care and attention. We have here a biological law: all animals respond to affection. . . .

Most workers in this field. . .have found that carefully regulated boarding out is the best method of handling abandoned babies. In 1902 the writer started the Speedwell Society, the method of which consists in boarding out babies in carefully supervised units. . . .

There are few studies that statistically show the comparative results of institutional care and boarding out, especially with babies of the atrophic type. One of the most illuminating comparisons is found in a report of studies made ten years ago by the Sage Foundation and Dr. Josephine Baker of the New York Department of Health. A number of babies were taken from the marasmus [malnutrition] ward of the New York Foundling Hospital. This ward receives only the chronic cases of extreme atrophy that in spite of the best care have always ended in death. In boarding out a number of these babies, an extra bonus was given to selected women and a doctor and a nurse furnished for every ten babies. As a result there was an eventual mortality of 46 per cent. Thus nearly half of the babies were saved in the home who in spite of the greatest care were bound to die in the institution. This is the method employed by the Speedwell Society. . . .

The magnitude and importance of the problems raised by abandoned children have not been sufficiently realized. In New York state alone over 30,000 dependent children are being housed and trained in institutions. Are these little lives being warped by unnatural surroundings? . . .

Children are brought into the world singly and not in droves and their physical, mental and moral health should be conserved in the family unit. . . . The institution as a stop gap represents a failure along the normal lines that development should take place in child life. This truth must be spread abroad in the hope that wealthy and well-meaning people will lose the common obsession of endowing asylums.

Is the family or the institution best suited to conserve the child as a valuable asset? To ask such a question is to answer it in favor of the family. In the past much unselfish work has been done in institutions and there is no reason for trying summarily to close them all. But their future work should lie in the direction of clearing houses or centers where the dependent child may be studied and classified as to the direction of future effort. In the future let the family and home be stressed while institutions take a secondary and retiring place.