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JAMES J. DAVIS, Secretary





Bureau Publication No. 127


Federal Reserve Bank of St. Louis








W A S H IN G T O N , D . C .

15 C E N T S P E R C O PY
Federal Reserve Bank of St. Louis




P R O F I T .— P U B . R E S . 5 7 , A P P R O V E D



11, 1922

u. s i ^

Letter of transmittal---------- ------- ,r---------------------------------- ----- -----------v
Introduction------------------------------------------------r-----------------------------------General conditions affecting child welfare-------------------------------------- — 5-29
Education___________________________________ __________________
Housing------------------------------------------------------------------------------ ------8
The fight against disease— ,--------------------------------------------------------15
Infant mortality-------------------------------------------------------------------------18
Public medical service and hospitals------------------------------------------20
M anufactures---------------------------------------------------------------------------23
Wages!----------------- ----------------------------------------- ----------------------------25
Poverty and charities---------------- -------------------------------------------------25
Juvenile courts--------------------------------------------------------------------------28
Activities of children’s year-------------------------------------------------------------- 31-73
Vacation camp---------------------- —-------------------------------------------------82
Health teaching---------------------------- -------------------------------------------83
Heights and weights of children-------- -----------------------------------------37
Physical examination in the schools— .-------- ------------ ------------------43
Traveling school physicians--------------------------------------------------------44
Infants’ and mothers’ clinics------------------------------------- ---------<-------45
Division of child hygiene----------- ------ -------------------- ------ ----- ------48
Prevention of blindness campaign------------------------------------------------49
Baby week------------------------------ —■
Homeless children------------------------------------------------------------------------ 54-63
Homeless b oys----- ;-------------------- *----------------------------------------55
Homeless g ir ls---------------------------------------------------------------------Abandoned mothers--------------------- \---------------------------------------------93
Games and athletics----------------------------------------95
Developments since 1922-------------------------------------------------------------------73

Comparative density of population and density of rural population
in Porto Rico and the States in 1920---------------General increase of imports and exports between Porto Rico and
the mainland of the United States and other countries, 1901-1922_
Average weights of Porto Rican boys 6 to 16 years of age, as com­
pared with Bowditch’s figures-------------------- -*------------------- -——Average weights of Porto Rican girls 6 to 16 years of age, as com­
pared with Bowditch’s figures----------------- ----------- —------------------Average heights of Porto Rican boys 6 to 16 years of age, as com­
pared with Bowditch’s figures--------------------Average heights of Porto Rican girls 6 to 16 years of age, as com­
pared with Bowditch’s figures--------------------------------------------------hi
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Facing page.
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0 to

Typical city school____ _____
Typical rural school___ 1____
Typical good and bad housing_____________ _____________________ _
Sugar-plantation housing______________ .___ __________ ________________
Houses built by the municipality of San Juan and sold on long terms
to workingmen_____________________ __________________ _______ £
Primitive methods, of work_________________________________ ,________
School dental clinic______________________ __________________________
Baby clinic conducted in schoolhouse_____________________________ 1
Children’s parade, Baby Week, San Juan__________ l______ _______ 1___
School lunches__________________ _____ _____________________________
Open-air toothbrush drill__________________ .__ _______ ____________ __




U n it e d S t a t e s D e p a r t m e n t o f L abor ,
C h i l d r e n ’s B u r e a u ,


Washington, September 19 1923.
S ir : There is transmitted herewith a report on Child Welfare in
the Insular Possessions, Part I, Porto Rico.
This study was undertaken at the request of the Department of
Education of Porto Rico and took the form of a Children’s Year
survey, in which demonstration was combined with investigation.
The survey was in charge of Helen Y. Bary, of the Children’s
Bureau staff, and she has also written the report.
As this report of developing activities shows, the interest in child
welfare touches every branch of the government as well as the
private organizations in Porto Rico. The Children’s Bureau has
never undertaken any piece of work in which the cooperation was
more genuine and desire for improvement greater than in Porto Rico.
Respectfully submitted.
G ra ce A b bo tt ,



am es

J . D a v is ,

Secretary of Labor.

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Porto Rico, in area the fourth and in population the third largest
of the West Indies, was acquired from Spain by the United States in
1898 following the Spanish-American War. Civil government was
organized by the Foraker Act in 1900; and in 1917, by the Jones
Act, the islanders were granted United States citizenship. The
island now has a limited degree of self-government. The legislature
and local officials are elected by popular vote, the governor is ap­
pointed by the President, and the insular officials are appointed
either by the President or by the governor. The island has an
elected Resident Commissioner in Washington who has a seat in the
House of Representatives but no vote.
Porto Rico 2 has the oldest European settlements now under the
American flag. The island was discovered by Columbus in 1493,
was conquered by Ponce de Leon early in the sixteenth century, and
remained Spanish territory until 1898. Under Spain the island was
governed mainly by military governors. During the periods when
Spain was under constitutional and not absolute rule (1812-1814,
1820-1823, 1870-1874, and 1877—1897) Porto Rico had direct repre­
sentation in the Spanish Cortes, and a few months before the island
was taken over by the United States the principle of autonomy was
extended to it.
The history of Porto Rico is comparatively uneventful. The
early Spanish records state that Ponce de Leon found the island
well populated by peaceful tribes of Indians, whom he enslaved in
the exploitation of its meager gold deposits. These deposits were
soon exhausted, and thereafter Porto Rico served mainly as a mili­
tary post to guard the Virgin and Mona Channels into the Carib­
bean Sea. Few settlements were made. Sugar cane was early
brought to the island, but this and other agricultural resources were
1 Historical data here given are from the Census of Porto Rico, 1899 (made by the
U. S. War Department) ; Historia de Puerto Rico, by Salvador B ra u ; and other sources
made available through the courtesy of the commissioner of education of San Juan.
2 The Indian name of the island is Boriquen. Originally the Spanish named the island
San Juan Bautista (St. John the Baptist) and the first settlement Puerto Rico (rich
port). When this settlement was moved across the bay the name of San .Tuan was applied
to the city and the island became known as Puerto Rico. By congressional act the name
<jf the island is offlaially, though incorrectly, spelled Porto Rico.

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very little developed until the arrival, beginning in 1815, of Spanish,
refugees driven out by revolutions in Venezuela, Colombia, and
other Spanish colonies, who brought to the island capital, industry,
and a knowledge of the cultivation of sugar and coffee.
The Spaniards who came to Porto Rico made the island their home
to a far greater degree than those who went to most of the other
Spanish-American colonies. After the early Castilian military men
came settlers from Andalusia, Galicia, the Asturias, and the Basque
Provinces, peaceful people devoted to the monarchy, the church, and
stable institutions. The purpose of ruthlessly amassing fortunes to
take back to Spain, which caused unrest and rebellion in the other
Spanish-American colonies, was held in less degree by the colonists
of Porto Rico. The general aspect of Porto Rican civilization was
that of a Catholic colony leading a patriarchal life. The attitude of
the Spanish Crown toward the island was liberal. With the excep­
tion of the gold which Ponce de Leon sent to the King and a few
grants to assist in times of war, Porto Rico made no contribution to
the mother country. In fact, for years Spain diverted revenue from
Mexico and Venezuela to defray the expenses of the government of
Porto Rico.
The United States census of 1920 gives the population of Porto
Rico as 1,299,809, this number including 948,709 whites, 301,816 mulattoes, and 49,246 negroes. No Indians, classified as such, exist on the
island at the present time.3 The early Spanish records state that
through war, disease, emigration, enforced labor, and intermarriage
the Indians as a distinct race had disappeared within 50 years 4 of the
coming of the Spaniards. Their influence still persists, however, and
the Indian cast of features is to-day by no means uncommon.
As early as 1530 a few negro slaves were brought to Porto Rico,
and their numbers were slowly increased. There resulted a consid­
erable mixture of races. In Porto Rico the proportion of colored
people is less, and relationships have been more free from racial
distinctions, than in any of the other West Indies.5 The Spaniards
permitted the negroes to purchase their freedom upon reasonable
conditions, and at the time slavery was abolished,6 in 1873, the
257,709 colored population included only 31,635 slaves.
To the Spaniards, Indians, and early negroes have been added
French, chiefly refugees from H aiti; a considerable number of
Corsicans; negroes from the Virgin Islands; and small numbers of
British, Germans, Syrians, Chinese, West Indians, and South Ameri3
The Federal census lists no Indians. Insular statistics occasionally classify persons
under this heading.
*• In 1542 the few remaining Indians were freed by royal decree.
6 For a considerable period few Spanish women were brought to Porto Rico.
By decree, with indemnification of owners (total paid 11,000,000 pesos), and with
the provision th at the freed slaves enter into contracts to remain in the employ of their
former owners or other persons or the State for three years.
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cans.* At the present time the commerce of the island is principally
with continental United States and this has brought continental
Americans, although the number in 1920 (1,617) was less than the
number in 1910 (2,303).
While some families have prided themselves upon preserving their
blood unmixed the population in general is a product of the mix­
ture of races. The prevailing type is Spanish, with occasional evi­
dence of the addition of Indian or negro blood.
The area of Porto Rico is 3,435 square miles, and its present
number of inhabitants makes it one of the most densely populated
sections of the country. The accompanying graph shows that of the
States only Rhode Island, Massachusetts, and New Jersey, whose
inhabitants are supported chiefly by manufacturing, are more thickly
settled.8 In respect to density of rural population the contrast is
especially striking. Virtually without industries, and with a high
birth rate, Porto Rico faces a serious problem of overpopulation.
The Porto Rican is not a wanderer, but the search for opportunities
has sent thousands to the States. A colony of 7,364 is located in
New York City, and 4,447 more are scattered through the States.
Colonies have been sent to the sugar-cane plantations of Hawaii
and Cuba, but not with entire success, as many were sent who had
not the pioneering strength to make their way in a new country.
Some have gone to Santo Domingo, which is not thickly settled and
whose resources have not been exploited. The total number who
have emigrated is small compared with the increase in population.
Porto Rico to-day is known to the American people mainly as a
tourist resort—an island of great beauty, quaint customs, and oldworld charm. The island is little more than 100 miles long and 35
miles wide, but the mountains cut it into picturesque, distinctive val­
leys and create greater diversity of climate and scenery than is
usually to be found in a far larger territory. Around the edge of the
island circles the railway. Across the island go splendid highways,
winding through the mountains and bringing the rural sections close
to the cities. Telegraph and telephone wires bind together the towns
and villages, and across the streams have been built bridges that
would do credit to any community.
Quickened evolution has made present-day Porto Rico a land of
sharp contrasts. Motors of the latest type drive past thatched huts
such as were described by the early Spanish explorers, and the finest
of continental culture may be found next door to tropical primitive­
7 In 1920, according to the
population of 8,167, and its
citizenship and 4,136 citizens
8 Figures for population per
are as follows: Porto Rico,
Island. 566.
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United States census, Porto Rico had a total foreign-born
total population included 8,858 persons claiming Spanish
of other nations.
square mile, according to the United States census of 1920,
378; New Jersey, 420; Massachusetts, 479; and Rhode


A tropical standard of values is necessarily very different from a
northern standard, and a Spanish background different from an
American background. In justice Porto Pico must be viewed in a
Chabt I. —Comparative density of population and density of rural population in Porto

Rico and the States in 1920.

Population Per cent
per square

Density of population per square mile.

Rhode Island.........
New Jersey...........
Porto Rico............
New York.............
Indiana............ .
West Virginia........
South Carolina......
North Carolina......
New Hampshire__
North Dakota........
South Dakota........
New Mexico..........










different light from a typical American community, with apprecia­
tion of the large cultural contribution the island can make to the
Nation as well as of the responsibility of the Nation to Porto Rico.
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From the time when Porto Rico came under American administra­
tion great efforts have been made to extend educational facilities as
rapidly as possible to all the people. In 1899 only 21,873 of the chil­
dren on the island were in school, there were no public-school build­
ings at all, 426 rural barrios (small districts) were without school
facilities of any kind, and the rate of illiteracy among those 10 years
of age and over was 79.9 per cent. By the year 1921-22 the school
enrollment had been increased to 188,959, 621 school buildings had
been built,1 and not a single barrio was without a school. According
to the latest available figures,2 the island’s expenditure on education
is larger in proportion to its resources than that of any of the States,
although, because of the comparatively small revenues of the island,
this represents a smaller amount per inhabitant than that of any of
the States.
Until 1921 all the commissioners of education were from the States.
They had small staffs of American supervisors and tea$h^l*T)ut the
great bulk of the work has been performed lw«P®^?Ricaçsii
The department of education was orgai&çed'às a s te 3 |^ y vcentralized unit, and this plan of c o n fe ^ ltill cqntagiesA'The island is
divided into 41 districts, ead^V^Bam^ ¿^S upervisor responsible to
the department. T h^osuper’d s ^ have charge of the general man­
agement of the schools,
rses of study, and the teachers, who
are appointed by the insular department. By means of this ma­
chinery it has been possible to establish schools and institute stand­
ards much more rapidly and effectively than if more initiative had
been expected of local groups. In addition to district supervisors
the department has special superintendents of different subjects—
such as agriculture, manual training, physical education, home eco­
nomics, and various academic studies—who travel from district to
district strengthening the teaching of their special subjects. In this
manner it has been possible to give supplementary training to the
teaching force, the majority of whom have not had normal-school
training, and gradually to raise the requirements of the profession.
1 In addition, the schools were renting 1,584 buildings.
2 Figures in regard to expenditures of the States in comparison to their wealth in
Biennial Survey of Education, 1917-18, U. S. Bureau of Education Bulletin, 1919, No. 90 ;
estimate of the per capita wealth of Porto Rico in 1911 in the Porto Rico Register of
1912 ; and figures as to the island’s expenditures on schools in 1912 in the Report of the
Governor, 1912.
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The effort to lift the mass of the people out of a state of illiteracy
has made the school system the center of a great impulse for progress.
The extension of education has been an adventure in service to the
people for which the States afford no direct parallel. Young men
and women went out into the rural districts, enduring many priva­
tions, and worked practically all their waking hours at a very low
rate of remuneration. Among the professional and business men,
and the women of the more prosperous class, the proportion who have
taught in the schools is very large. This has created among the
general public a keen interest in the activities and the conduct of the
schools, and has also tended to the development within the school
system or in close cooperation with it of social activities which in the
States are usually developed independently.
A t the present time school facilities are still far from adequate,
not only in the rural districts but in the towns and cities as well. A
compulsory education law has been enacted but can not be enforced
until funds are provided for additional buildings and teachers. All
over the island children asking for education have to be turned away.
For a time practically all applicants were admitted, but the classes
were so large that instruction was virtually impossible. Now the
double-enrollment plan is generally in use and the number of pupils
is limited to 40 for each session. Thorough instruction is not possible
under this arrangement, but the plan serves as a means of bringing
at least some opportunity for education to the maximum number of
In the United States as a whole the annual cost per pupil of pub­
lic-school education has more than doubled in 20 years.3 In Porto
Rico the cost per pupil per annum was $15.46 in 1900 and has not
been increased since that time.4 This difference is due largely to the
concentration of expenditures on elementary schools,5 low salaries,
and the increase of attendance by the double-enrollment plan. The
total amount spent yearly by the insular government on education
has been increased from $288,098 in 1899 to $2,929,944 in 1922.
The Federal census of 1920 showed 240,1916 children of school
age (5-17 years inclusive) in Porto Rico not in school and classed
55 per cent7 of the population 10 years of age and over as illiterate.
8 Biennial Survey of Education, 1917—18, p. 54. U. S. Bureau of Education Bulletin,
1919, No. 90.
4 Report of the Governor of Porto Rico, 1919, p. 540.
BEighty-five per cent of all educational funds are spent on elementary education. Re­
port of the Governor of Porto Rico, 1919, p. 539.
6 Fourteenth Census of the United States, Vol. Ill, p. 1208.
7 While 55 per cent of the total population 10 years of age and over were classed as
illiterate, the effect of the recent improvements in educational facilities is shown by the
proportions of the different age groups classed as illiterate, as follows: 10 to 14 years,
31 per cen t; 15 to 19 years, 38.2 per c en t; 20 to 24 years, 50 per cen t; 25 to 34 years,
01.9 per cent; higher age groups, over 70 per cent. The illiteracy rate was higher among
the female population than among the male, and higher among the colored than among
the white population.
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The present percentage of illiteracy is not high compared with those
of other Latin American populations, but it is far higher than that
of any of the States and is a grave handicap to the operation of
democratic institutions. For Porto Rico to provide elementary
education for all and advanced education according to accepted
American standards will necessitate greatly increased funds not
available from the present insular revenues.
The general plan of education organized in Porto Rico was
modeled after existing systems in the States. Whether this has
been the wisest method of attaining the purposes of education has
been questioned. Porto Rico is an agricultural country and will un­
doubtedly remain so. I t has three basic problems—poverty, dis­
ease, and illiteracy. Under the given conditions a system of educa­
tion aimed directly at eradicating disease, improving the mode of
life, and bettering the methods of farming, as well as at reducing
illiteracy, might accomplish greater results than the customary
academic training which deals with these other factors only in­
The school buildings in Porto Rico, whether large or small, are
as a rule the finest buildings in the community. There has been de­
veloped on the island a modern and practical type of building which
preserves the distinctive features of Spanish architecture, so well
suited to warm climates. Practically all these buildings have as­
sembly rooms which, used for community as well as for school pur­
poses, help to make the school the center of all community activities.
The spirit of the people is shown by the fact that in the erection of
school buildings land, service, and money have in many instances
been donated. In four years the number of sites donated was 58.
The general plan as to language medium in the Porto Rican schools
is as follows: In the first four grades instruction is given in Spanish,
and English is taught as a special subject; in the fifth grade the lan­
guage medium is sometimes Spanish and sometimes English; beyond
the fifth grade English is used and Spanish is taught as a special
subject. Occasionally criticism has been made of this preservation
of Spanish in the schools, but with limited funds for education it has
been necessary to give the children education in Spanish. All the
teachers have some knowledge of English, as have also a considerable
number of persons in the cities, although of the whole population
90.1 per cent are unable to speak English.8
Naturally, this inability to use English freely restricts communi­
cation and understanding between Porto Rico and the mainland.
With one exception the newspapers9 are published in Spanish, and
they reprint less from American journals than they would if trans8 Fourteenth Census of the United States, Vol. Ill, p. 1207.
6 Nine daily newspapers and several weeklies are published in Porto Rico,
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lation were not necessary. A large public library has been estab­
lished in San Juan and smaller public libraries are found in other
cities, in addition to a few excellent collections of books belonging to
private organizations. Excepting in the Carnegie Library, of San
Juan the books are mainly in Spanish. This situation has slowed
the process of social development, as the literature on social subjects
in Spanish is meager. Very few of the national organizations carry­
ing on public-health and other educational work include Porto Rico
in their programs, and their publications, being in English, are not
available for general use there; and of the foreign-language material
issued in the States very little is in Spanish. This obstacle of lan­
guage has kept Porto Rico from becoming an integral part of the
Nation and from being accepted in spirit as such. The development
of the island educationally will and should be along bilingual lines.
More English is very much needed; but with the cultural wealth of
the Spanish language and traditions and the commercial possibilities
of Latin connections, the sacrifice of the Spanish language would be
an irreparable loss.
The rural schools cover the first four grades. In the towns work
is continued to the eighth, ninth, or tenth grade, and 12 of the cities
have high schools. A t Rio Piedras is located the University of
Porto Rico, which, in addition to its main work‘as a normal school,
has departments of the liberal arts, education, pharmacy, and law,
and a college of agriculture and mechanic arts at Mayaguez.
For professional training, aside from pedagogy, young people from
Porto Rico are now going mainly to the States. A generation ago
the trend was to Spain and France. In 1921 the department of edu­
cation listed 386 students in American institutions, of whom 94 were
studying medicine, 58 business, 53 engineering, 30 dentistry, 21
pharmacy, 18 law, 13 the liberal arts, and 3 agriculture, the balance
being engaged in elementary, secondary, and miscellaneous collegiate
courses. A few years ago large groups of Porto Rican teachers were
sent to Harvard and Columbia for summer-school work. In 1922 a
large group of teachers of Spanish went from the States to Porto
Rico for summer work in Spanish.

For their better-class houses the Porto Ricans have adapted to
local needs the best features of Spanish and American architecture,
and the results are attractive and practical. The older houses, fol­
lowing the Spanish type, were constructed of solid masonry and cov­
ered with plaster in beautiful colors, with high ceilings, tiled floors,
and in the center of the house the characteristic patio. The newer
houses consist largely of modern bungalows. The majority of the
people, however, are primitively housed.
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Three-fourths of the people of Porto Rico live in rural districts
not even classed as villages, and very few own any land. Most of
them live on the land of some plantation, the great majority in
thatched huts, which they themselves build from material on the
plantation. So long as they work for the landowner they may have
possession of the huts and are considered owners, which explains the
census figures showing one home owned for every 10 inhabitants of
the island. The classification of virtually all of these homes as free
from mortgage does not indicate a condition of general prosperity,
but is due to the fact that these thatched huts are so cheap and perish­
able that they can not be mortgaged. The cost of a hut represents a
small amount of material and a few days’ labor, the total being
valued at about $20. As work in the principal crops is seasonal,
many families are forced to migrate at the end of a few months, and
their huts revert to the landowner. This system of housing the
workers on the plantation brings the worker nearer to his work and is
convenient for the landowner, as it gives him a greater measure of
control over the services of the people. On the other hand, with no
chance actually to own his home the worker has no sense of per­
manence and no incentive to improve or beautify his dwelling.
The commonest type of rural house is the thatched hut. The
thatch is made of long, tough grass or from the leaves of the palm,
the walls are of thatch or are made from the bark of the royal
palm, and the floor is of boards raised 1 or 2 feet from the ground.
The hut may be roughly partitioned into a sleeping room and a
living room, but often it has only one room. The cooking is done
on the ground in the rear of the hut, sometimes under shelter and
sometimes in the open air. The furniture usually consists of a
hammock or two instead of beds, and boxes for chairs. Sleeping on
the bare floor is not uncommon. Dishes and utensils are made from
gourds. When the huts are new they offer protection from heat
and rain, and being raised from the ground they are easily kept
clean. However, they are made from unsubstantial material, soon
become infested with insect life, and deteriorate rapidly. The
early Spanish priests in writing of the life of the Indians described
them as living in huts of this character. The Spanish settlers who
moved into the mountain districts—practically all of the inland
dwellers are white—took up the same mode of life, and have con­
tinued it to the present day.
The houses built by the sugar plantation owners for the workers
are usually made of more substantial material, sometimes of concrete
but commonly of lumber, with zinc roofs, and are usually painted.
Houses built by the landowners are placed close together, which
makes improvements in sanitation essential. These houses are
ordinarily given to the workers rent free. Recently some of the
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sugar plantations have been erecting excellent one-family houses of
concrete of two, three, or four rooms each. The multiple-family
plantation houses which were formerly built in order to house as
v many people as possible with the least expenditure are no longer
being constructed, but many are still in use.
Left to himself, the jibaro (country dweller) builds his hut away
from other dwellings in the isolation which alone has made it possible
for the people to exist without sanitary facilities. The development
of villages means a general improvement in the mode of life. Every
village has its school. Community life is started and contacts with
the outside world are established. To bring to the scattered popula­
tions education, sanitation, medical service, and other essentials of
modern existence, it will doubtless be necessary to make specific
efforts to organize village life.
Whenever he has any land around his house, the Porto Rican
usually plants some kind of garden, but very few make practical
use of this land. The gay flowers around the huts are very attrac­
tive, but too often the garden consists wholly of flowers. There are
several reasons for this. The people have not been educated to eat
the green vegetables, which would make a most desirable addition
to their present poorly balanced diet. Their sense of impermanence
deters them from sowing where they may not reap, and they have
no money to hire oxen for breaking the ground or to purchase proper
implements for working the soil.
In the larger cities, notably San Juan, the tenement house of three,
four, or five stories is found. Some of these old houses were for­
merly the dwellings of the wealthy. The rooms are large, the ceil­
ings high, and the floors laid with fine Spanish tiles, but now only
too often a whole family lives in a single room, cooking and wash­
ing in the central court. The usual dwelling of the poorer urban
dwellers, however, consists of the one or two room shack, seldom
larger than 10 feet square, made from cheap lumber, tin cans, and
soap boxes.
Formerly the landowner in the city as well as m the country al­
lowed laborers to occupy ground space without paying rent. In the
cities and larger towns a system has grown up among the working
classes of renting ground space on which to build their own shacks.
In the past 20 years there has been a considerable movement of
population from the rural districts into the cities. The landowners
began to charge rent for ground space and have found it highly
profitable. W ith the rapid changes in the cities land has acquired
great speculative value, and so long as the owners can obtain large
returns from renting they are unwilling to sell in small plots. This
temporary and speculative condition has resulted in various evils.
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S U G A R -P LA N T A T IO N H O U S IN G .

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The rents charged are often exorbitant. The land is frequently
managed by agents and subagents, all deriving profits from the poor
renter. The houses are frequently crowded together with virtually
no provision for sanitation, cleanliness, or order. The householder
usually rents from month to month with no security against un­
reasonable or even confiscatory increases of rent. He has no in­
centive to improve his dwelling, as only too often any improvement
means an increase in rent. If the landlord wishes to gain possession
of the tenant’s house he has only to issue an order to vacate the
premises, and the tenant must either move the house away or sell for
what the landlord chooses to pay.
Many of the municipalities own considerable land within their
limits. To meet the needs of the poorer people they began renting
this in plots at low prices, and in various instances they permitted
“squatting.” From this situation the island has advanced to the be­
ginning of a public policy with reference to housing.
In 1917 the legislature passed a law providing that on any public
land within a municipality there should be erected houses for work­
ing people, which should be built in accordance with all sanitary
requirements and rented reasonably or sold on a long-term basis.
The city of San Juan has availed itself of this opportunity to con­
struct a modern workingmen’s suburb. When these houses were com­
pleted the city attempted to abolish certain insanitary sections, but
the pressing shortage of houses made this practically impossible. In
more than one instance the condemned houses, tom down during the
day by the police, were put together again at night by the inhabit­
ants. Aguadilla also has built a workingmen’s district, and Ponce
has recently adopted a similar project. A cooperative building
society is helping the general housing situation by erecting for its
members many houses of a more expensive type.

Porto Rico is essentially an agricultural country, and the great
majority of the people depend for their living upon this type of
work. In the past 25 years the general condition of primitive dwell­
ing upon the soil has changed to one in which a large part of the
land has been converted to the highly specialized cultivation of sugar
and tobacco. This sudden evolution is graphically shown in the
accompanying chart of imports and exports.
Before the development of sugar and tobacco larger quantities of
sweet potatoes, yams, rice, corn, and bananas were grown, and the
grazing lands were much greater. Some sort of food could be had
for a little exertion, and money played a small part in the lives of
the people. Most of the rural dwellers were poor to the point of
54912°—23----- 2
Federal Reserve Bank of St. Louis



destitution, but they lived close to soil which produced food, where
hospitality was the rule and the sense of ownership in the necessities
of life not definitely established. ■With the development of sugar
and tobacco, land values increased. Thousands of small farmers sold
their lands10 for prices which seemed high, but with the sale of their
farms lost their means of subsistence and when their small capital
was gone found themselves in the ranks of day laborers.

• *
1 \
1 4 y,







Imports Exports
8,918.136 8,583967
13209.610 12,433956
14449286 15,08*09
13,168029 16265903
16,536259 18,709565
21,827,665 23,257530
I907| 29267.172 26396300
25825665 30.644490

4 3 0 2 ,7 6 2


The situation has been rendered more acute by the fact that while
the grazing and food-crop lands have been so much reduced the popu­
lation has greatly increased.11
As the exports of sugar and tobacco have increased the importation
of food has also increased.12 Foods, such as bananas, which formerly
could be obtained merely by a little exertion, have now become articles
of commerce. The agricultural worker must have money to purchase
10 The Porto Rican census of 1899, in which the cuerda (two-fifths of an acre) was
used as the measure of area, showed 34,247 farms of less than 20 cuerdas (8 acres). By
1919 the number of farms of less than 10 acres had been reduced to 15,981, according to
the United States census of 1920. The reduction in the number of farms owned by
colored people was especially marked.
11The population of Porto Rico grew from 953,243 in 1899 to 1,299,809 in 1920, an
increase of 346,566 in 20 years. Fourteenth Census of the United States, Vol. I ll, p.
ia In 1920 Porto Rico imported 133,449,140 pounds of rice, 372,028 bushels of beans
and dried peas, 30,182,518 pounds of meat and dairy products, and 29,383,671 pounds of
dried fish.
Federal Reserve Bank of St. Louis



his daily food, and unemployment means immediate privation and
Under existing conditions the cultivation of sugar and tobacco
partakes more of the nature of industry than of that of farming.
The development of these crops has taken place so rapidly that the
transition has been accompanied by hardships difficult to overcome.
Sugar is grown on the level lands around the edges of the island
and tobacco in the inland valleys. For the harvest sugar requires
approximately 150,000 workers and tobacco 40,000. For work be­
tween seasons the number of laborers required is far less. In periods
of slack work during the season no occupation is open to agricultural
workers in these districts on their idle days, and when these crops
are harvested at least half of the laborers must make a complete
change of residence in order to search for other work. Thousands of
Porto Ricans have thus become migratory workers, with no homes
and virtually no possessions. They are undoubtedly better off than
the previous generation, but they have acquired new desires and
higher standards of life. The education of children—impossible a
generation ago—is now a possibility, but migratory life makes school­
ing difficult, and in the overcrowded condition of the schools the
education of many children is completely neglected.
The development of sugar and tobacco has tended to the control
of great tracts of land by a few individuals and corporations, in
many instances by persons living away from the island. Congress
attempted to check this tendency with a law prohibiting anyone from
owning more than 500 acres; but sugar and tobacco plantations can
be operated to far better advantage in large units, and it has been
impossible to enforce the spirit of this law. In 1920 over one-third
of the farm land was held in units of 500 acres or over.13
The situation in regard to coffee is radically different from that
of sugar and tobacco. Coffee lends itself to small-farm cultivation.
I t is grown on hillside land which is comparatively cheap and the
ownership of which is distributed among thousands of small pro­
prietors. The industry in Porto Rico, as elsewhere, has been far
from prosperous since the overdevelopment in Brazil threw out of
balance the coffee industry of the world. In the past 10 years
coffee exports from Porto Rico have decreased nearly 50 per cent,
and among the coffee workers the utmost destitution exists.
Fruit growing is yearly becoming more important, particularly
the growing of oranges, grapefruit, pineapples, coconuts, and alliga18
Of a total of 2,022,404 acres of farm land, 201,694 acres were held in units of
between 500 and 1,000 acres, and 514,796 acres in units of 1,000 acres or over. (United
States census of 1920.) These figures include all land, improved and unimproved. The
percentage of improved land held in units of 500 acres and over is virtually identical.
In 1899 nearly two-thirds of the cultivated land was held in units of less than 40 acres.
(Census of Porto Rico, 1899, p. 355.)
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tor pears. These crops will provide more labor but little more food,
as they are grown for the export market.
The total land area of Porto Rico is nearly 2,200,000 acres, of
which 1,000,000 acres is essentially nonagricultural and is now either
idle or abandoned to brush. Officially much of this is classified as
“ timber and brush land,” but the amount supporting commercially
valuable timber is practically negligible. Originally Porto Rico was
a well-forested country, covered with laurel, cedar, satinwood, and
other valuable woods; but 400 years of unregulated exploitation has
brought upon the island the most acute timber and wood famine that
any country of the Western Hemisphere has suffered. All wood­
using industries of any size have disappeared, and the island is en­
tirely dependent upon importations of lumber for building. Almost
all the people rely upon charcoal for fuel purposes, and the scarcity
of this is such as to cause general and widespread privation. Much
of the now unused mountainous land was originally covered with
forests, and under a well-directed policy of reforestation these areas
could relieve the shortage of lumber and fuel and also furnish em­
ployment to thousands. A beginning has been made by the estab­
lishment of the Portó Rico Forest Service, to work in cooperation
with the United States Forest Service. Mangrove forest lands along
various sections of the coast and some mountainous, nonagricultural
lands have been set aside as insular forests.® The mangrove is now
being cut in a scientific manner and sold for fuel and other purposes,
for which it finds a ready market. Tree nurseries have been started
to provide stock for planting, and a considerable acreage has already
been set out. To reach the general population an educational cam­
paign has been started, chiefly through the rural teachers. In vari­
ous towns the highways are bordered with trees planted by school
children, and some school yards have been made into tree nurseries.
While sugar and tobacco are cultivated in an efficient manner
under the direction of men technically well trained and equipped,
general agriculture in Porto Rico has made comparatively little
progress. Three-fourths of the people live in rural areas not even
classed as villages. A large proportion of this rural population
are illiterate.14 A generation ago it was generally possible for them
to satisfy their simple needs by raising a few products in a crude
and inefficient fashion. To teach this scattered and uneducated
people to produce food in wider variety for a greatly increased
population on a decreased amount of land is a task for which no
“ The public lands of Porfo Rico include about 150,000 acres, most of which is moun­
tainous or swampy or otherwise nonagricultural.
14 A rural school census taken by the Porto Rico Department of Education in 1919
showed that 59,502 parents out of 84,546 were unable to read and write. The census did
not include those living in the less accessible districts. (Report of the Governor, 1920,
p. 419.) The United States census of 1920 gives the general rate of illiteracy for all
persons over 10 years of age in the rural areas of Porto Jtico as 61.6 per cent.
Federal Reserve Bank of St. Louis



adequate provision has yet been made. The leadership in scientific
agriculture has been taken by the experiment station established at
Mayaguez by the United States Department of Agriculture. The
College of Agriculture of the University of Porto Rico gives col­
legiate and subcollegiate courses, and its graduates are rendering
important service. The Porto Rico Department of Agriculture
reaches many people through lectures, pamphlets, and inspection,
and under its encouragement many farmers’ leagues have been
organized. The Porto Rico Department of Education has a gen­
eral supervisor of agriculture, and instruction in agriculture is given
in a large number of schools. Home gardens have been introduced
and now over 38,000 of them are under cultivation. This work re­
ceived great impetus under the food-conservation campaign during
the war, and the Junior Red Cross, which functions as a part of
the school system, has given hundreds of prizes to encourage these
gardens. The schools have the confidence of the people, and offer
the most advantageous machinery for reaching the parents.

The Porto Rican laborer has often been characterized as lazy and
thriftless, and his production is usually rated at not over 50 per
cent of that of a northern worker. However, those who have had
opportunities for knowing the agricultural workers have learned
that to a large degree actual physical unfitness is responsible.
The physical condition of a people is reflected, in a general way,
by the death rate. The death rate of Porto Rico in 1920 was 23.3
per 1,000 population,15 which was lower than the rates of earlier
years but is nearly twice as high as that the of United States
death-registration area for the same year (13.1). For the last 10
years of Spanish rule, 1888-1898, the average death rate was 30.2;
for the following 10 years, 1899-1909, the average rate was reduced
to 27.3, and for the 10 years 1909-1919 it was 24.1.16
To lower the death rate calls for fundamental improvement in the
mode of life of the people. Sanitation, more urgently necessary in a
tropical climate than in colder countries, has never been understood
by the masses. Twenty years ago most of the people were dependent
for water upon streams or cisterns subject to contamination, and
three-fourths of all dwellings had no provision for sanitary closets
or outhouses. The cities have progressed rapidly in providing water
and sewer systems, but such improvements require large public out­
lays and much remains to be done. To reach the rural inhabitants
and give them the necessary instruction so that they will understand
and continue to use the requisite sanitary measures after they are
16 Report of the Governor, 1920, p. 6.
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19 Report of the Governor, 1919, p. 133.



provided, will take much time. In this the sugar plantations have
helped very much, as the concentration of workers in camps has
made sanitation imperative.
The majority of the working people of Porto Rico live upon a diet
restricted to rice, beans, coffee, bananas, codfish, and a few starchy
root vegetables—of which all the codfish and most of the rice and
beans are imported, and consequently must be paid for in money.
Only too often the food of the poorer families consists entirely of
black unsweetened coffee and a few tubers. Practically all northern
vegetables can be grown in Porto Rico, as well as those peculiar to
the Tropics; but at the present time only a few varieties of vegetables
are used, including virtually none of the green or leafy ones. This
situation is serious for two reasons—thousands of small parcels óf
land which could produce food are now unused, and the health of
the people is suffering from a badly restricted diet. I t has been
found difficult to teach the people to use vegetables. Home-economics
instruction is helping in this direction, but it needs to be extended far
more widely.
The medical profession of Porto Rico are awakening to the in­
jurious effects of the one-sided diet, but they are handicapped by the
fact that few, if any, scientific studies have so far been made of food
values of tropical products, and material on the preparation of foods
comparable to that at the disposal of northern physicians is not avail­
able to them. The importance of diet has not been emphasized and
the people depend upon medicine, often patent medicine', under cir­
cumstances in which northern physicians would prescribe improved
Yellow fever—once the scourge of the island—has been eliminated,
and smallpox virtually so. Bubonic plague has appeared twice in
20 years, but has been controlled. Typhoid is now but little more
prevalent than in the States.
Of general diseases tuberculosis stands first as a cause of death,
with malaria, “ rickets,” and anemia 17 following in the order given.
“ Rickets ” as it appears in the official statistics is not true rickets
but usually marasmus or malnutrition, the confusion arising from the
popular use of the Spanish term “ raquítico ” to include any wasting
disease. The seriousness of these diseases is shown by comparing,
for the fiscal year 1919-20, the death rates per 100,000 population
in Porto Rico and those of the United States death-registration area:
Porto Rico. United States.

Í86.0114. 2
3. 6
“ Rickets ”____________________________________ 108. 9
Anemia — ---------------------------------------------79.0(18)
17 In Porto Rico the term “ anemia ” is used interchangeably with “ uncinariasis ” or
“ hookworm.”
18 Negligible.
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The death rate from tuberculosis is shown to be far higher in
Porto Rico than in the States; the death rate from malaria, unim­
portant in the States, is higher in Porto Rico than that of tuber-'
culosis in the States, and that from “ rickets ” only slightly lower.
In many districts virtually everyone has anemia, and many deaths
attributed to other causes are indirectly due to anemia caused by hook­
worm. In other sections malaria is equally prevalent. Far-reach­
ing experiments and demonstrations in the eradication of these two
diseases are being made under the International Health Board
(Rockefeller Foundation). The antimalarial work is still in the ex­
perimental stage. The antihookworm campaign is being conducted
by Dr. R. B. Hill, who with a staff of assistants and inspectors is
demonstrating the eradication of anemia in the northwestern corner
of the island.
Soon after the American occupation a campaign was made to
eradicate hookworm, under t(ie direction of Dr. (Col.) Bailey K.
Ashford. A t that time treatment was given to nearly 300,000 per­
sons. Facilities were not available for the necessary follow-up
work, adequate sanitation was not provided, and the populace became
reinfected. However, the treatment had lasting beneficial effects,
the disease is now not so virulent as previously, and fewer deaths19
are now reported as due directly to anemia. In the present cam­
paign, planned to cover a period of five years, sanitary conditions
of living are required before treatment is given, and thorough fol­
low-up work is done.
The improvement in general health and alertness of the school
children who have been given the anemia treatment has been marked.
Equal improvement has doubtless been made among the older popu­
lation. The treatment has met with no opposition, and as it has
progressed has gained the interest of the medical profession and the
support of employers and the general public.
The general condition of inadequate or poorly balanced diet and
overcrowded housing makes it particularly difficult for the health
authorities to combat the high rate of tuberculosis. For tuberculosis
patients the health department maintains a sanatorium at Ponce and
a hospital at Yauco, and has recently erected a model sanatorium
at Rio Piedras, for which many public-spirited citizens have con­
tributed cottages. A visiting tuberculosis nurse, to work in coopera­
tion with the Red Cross, has recently been procured in San Juan.
These measures are helping to alleviate and to define the situation,
but they are inadequate to control it. As an indication of the differ­
ence in resistance of Porto Ricans and continental Americans, Amer19
In 1900 uncinariasis was responsible for SO per cent of all deaths in Porto Rico,
according to Doctor Ashford. The F irst Report of the Porto Rico Anemia Commission,
pp. 127-128. Senate Documents, vol. 59. Washington, 1911.
Federal Reserve Bank of St. Louis



ican priests working among the poor report that they have found it
necessary to give the last sacrament to patients whom on the con­
tinent they would consider in early stages of the disease.

The infant mortality rate of Porto Rico is much higher than that
of any of the States. In 1922, out of every 1,000 babies born on the
island 162 died before reaching the age of 1 year.20 No special study
of infant mortality in Porto Rico has ever been made. The studies
made in various sections of the States have all shown that poverty
and ignorance are accompanied by a high infant death rate; so the
high rate in Porto Rico is to be expected, from the prevalence of
illiteracy and poverty. To demonstrate this point the commissioner
of health compiled separate figures for the poorest section of San
Juan and for the districts where most of the people were able to
provide fairly hygienic conditions. The infant death rate of the
poorest section was found to be far higher than that of the other
The main causes of the high death rate among babies less than
1 year of age are enteritis, congenital debility, infantile tetanus,
“ rickets,” 21 and acute bronchitis, most of which are indicative of
the lack of proper care and food.
The first month of life is always the most critical and shows by
far the highest death rate. After this period the death rate should
decline rapidly. In the States the death rate for the second year
is about one-fifth that for the first year. The rate in Porto Rico
shows no such rapid improvement, being nearly two-fifths as high
the second year as the first year. The largest numbers of deaths in
the second year of life are ascribed to diarrhea and enteritis and to
“ rickets,” indicating improper and inadequate food.
In 1920 among children under 5 years of age in Porto Rico 13,051
deaths occurred, which makes an average of over 65 deaths to each
1,000 children under that age.22 The seriousness of the situation is
indicated by the contrast between this rate of 65 and the correspond­
ing rate of less than 27 for the United States death-registration
20 Birth registration is required by law in Porto Rico and is considered by the depart­
ment of health to be nearly complete.
21 For an explanation of the term “ rickets,” as here used, see p. 16.
22 In the Fourteenth Census of the United States, Vol. I l l (p. 1199), the population of
Porto Rico under 5 years of age in 1920 is given as 200,255. The figure for deaths of
children under th at age in 1920 in Porto Rico is taken from the Report of the Governor,
23 On the basis of figures given in the Fourteenth Census of the United States, Vol. Ill,
the population of the United States death-registration area under 5 years of age July 1,
1920, is estimated at 9,175,421. In Mortality Statistics, 1920, of the U. S. Bureau of
the Census (p. 140), the figure for deaths of children under th at age in the deathregistration area during the year 1920 is given as 243,010.
Federal Reserve Bank of St. Louis



Various factors in this high rate of mortality have repeatedly been
pointed out by the insular health department. The island has, not
enough physicians24 to meet the demand for medical services, and
still the people, as a whole, can not pay even for what services they
receive. Traditionally confinement cases have been left to midwives,
and owing to the general shortage of medical service the physicians
have taken over little of this work. Most of the midwives are illiter­
ate and have had no training, and it has not been possible to enforce
standards of midwifery. Expectant mothers are not given the neces­
sary care and instruction. On account of these conditions the num­
ber of deaths of mothers from conditions related to pregnancy and
childbirth is much higher than in the States.25
On account of the inability of mothers to nurse their children it is
frequently necessary to feed the babies artificially at an early age.
The mothers have little knowledge of proper methods of infant
feeding, and milk is scarce, expensive, and frequently adulterated.
In view of the difficulty of educating the adult population, the in­
sular health department has recommended the instruction of school­
girls in the care of children and the hygiene of infancy. On the sub­
ject of the serious problem of milk the following is quoted from Dr.
Jaime Bague, of the Insular Experiment Station of the Porto Rico
Department of Agriculture and Labor:
Milk is the foundation of children’s welfare. The whole building up of the
health and vitality of man depends on the amount of milk that he may obtain
in his childhood. This is particularly so in the tropical climates, where light
foods are in order all the year around. The milk situation in Porto Rico de­
serves careful study, because the children of the island are not getting all the
milk that they need for their proper development.
Agricultural conditions affecting milk supply.—To understand the present
milk situation we must review, in a few lines, the agricultural status of the
country. From time immemorial sugar cane, tobacco, and coffee have been
the mainstay of our farms. Together with these crops, big live-stock enter­
prises were scattered all over the island, and we were supplying all the milk
and nearly all the butter and cheese that the inhabitants of the island were
consuming. We used to export our surplus supply of animals, and we provided
the Cuban market with plenty of steers for purposes of slaughter.
With the advent of the American flag quite a change took place in the agri­
cultural activities of Porto Rico. Promoters from Wall Street started to push
•-fcbe sugar interests of the country; factories were established; and, little by
little, our pastures faded away to give place to the big sugar-cane planta24
Figures given in the American Medical Directory (published by the American Medical
Association), 1921, as to the numbers of physicians in the States and Porto Rico indicate
that the island has less than one-fifth as many physicians, in proportion to its population,
as have the States.
28 Mortality Statistics, 1920, of the U. S. Bureau of the Census (p. 112), and the Report
of the Governor of Porto Rico, 1920 (the latter giving statistics for the fiscal year
1919-20), show the ratio of deaths from puerperal causes to total births and to total
population as follows: Per 1,000 births, Porto Rico 9.1, the United States birth-registra­
tion area 8 ; per 100,000 population, Porto Rico 35.6, the United States death-registration
area 19.2.
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tions. Our live-stock population has been reduced slowly and steadily. A study
of the following statistics is illuminating:
Table showing the actual increase m inhabitants and cane lands as compared
w ith the decrease in live stock in Porto Rico.1
Census year.

Cane lands
227' 815


Number of Number of
cows and
62' 298

1, Ü8' 012

1 From data furnished by the United States census.

The above figures need no further comment. They speak for themselves.
The decrease in live stock is in sharp contrast with the increase in population.
If we consider that the city of San Juan has a population of 70,707 inhabitants
and that only 15,000 liters (estimated) of milk come into the city daily, it is
an outstanding fact that the per capita consumption of this food is very low.
The report of the commissioner of health for 1918 makes this per capita con­
sumption come as far down as 31 cubic centimeters.
The lack of supply and the increase in the demand caused an increase in
price from 4 cents per quart, in 1875, to 25 cents in 1922, or an increase of 21
cents in 47 years. This increase in price is coupled with a heavy increase
in the importation of condensed and evaporated milk, amounting to $504,330
in 1919.
Handling and sanitation of milk.—It is impossible to study the present milk
situation without taking into consideration the infant mortality reports. A
perusal of the annual report (1917) of the commissioner of health, Dr. W. F.
Lippitt, shows that the diseases of the digestive apparatus are responsible
for the high rate of mortality among children. Doctor Lippitt lays particular
stress on the fact that “ the bad quality of the food supply ” is the main cause
of this alarming condition.
Dr. A. Ruiz Soler, commissioner of health, in his report for 1918 corrob­
orates Dr. Lippitt’s statement and calls special attention to the scarcity of
milk, the temptation to adulteration caused by this scarcity, and the necessity
for cleanliness and sanitation in dairies and depots for the sale of milk.
To meet the need for an adequate supply of good milk we should adopt the
following essential measures:
(1) Systematic improvement, through careful breeding, of our live stock
to raise our average daily production of 3 quarts per cow to 15 or 20 quarts.
(2) Scientific feeding and care of the herds, emphasizing tick eradication, on
which the Department of Agriculture of Porto Rico is at present working.
(3) Scientific, sanitary methods of handling milk to avoid contamination. ^
(4) Instruction of the people in the right use of milk and the many ways
in which it may be prepared.
(5) Encouraging every farmer to keep a few cows to balance the agriculture
of the island, which now is strictly one-sided.

In the attempt to eradicate disease over 50 public hospitals, some
mere shacks, have been established in the past 20 years, and medical
service, free t'o the poor, has been instituted. Most of the medical
Federal Reserve Bank of St. Louis



work on the island is done as charity by the ill-paid municipal doc­
tors. The working class does not and can not pay for medical serv­
ices. Until 1922, excepting for the period 1911 to 1917, the municipal
hospitals and services have been under the control of the separate
municipalities, without central supervision. Of the difficulties and
shortcomings of this work the commissioner of health says in his
report for 1920:26
The services rendered by the municipalities to the poor are: Medical assist­
ance, medicines to the sick poor, first-aid stations, help to the sick poor, and
Medical assistance.—The work of the physician is difficult because, first, he
lacks a list of the poor of the municipality so as to avoid that persons who are
not indigent receive the services that are only for the needy ; second, the lack of
hospitals, which does not permit the gathering in one place of serious cases
that require the constant care and frequent observation of the physicians ; third,
the poor conditions of the first-aid stations, not provided with the necessary
equipment and materials, with the consequent lack of facilities to cure even
the slightest wound without loss of time and without danger of infection ; and,
fourth, the meager amounts appropriated for medicines oblige the physician to
consider the cost of every prescription, so that the appropriation is not ex­
hausted before the end of the year, when the materials are supplied by admin­
istration, or, if supplied by contract, so that the contractor does not deliver a
smaller quantity than that prescribed or alters the formula, as it appears to
occur frequently. These deficiencies are the reasons why the position of
charity physician has excessive work and with few results.
Hospitals.—The hospital conditions in Porto Rico are deplorable. The build­
ings are not suited to the ends for which they are used, nor are they fitted
with the most essential equipment, sufficient material, nor are well attended.
Everything in them shows poverty, filth, and carelessness. As a rule, such are
the conditions of these charitable establishments all over the island.
First-aid stations.—In each town there is a first-aid station in general estab­
lished in the dirtiest room of the city hall. These first-aid stations are not in­
tended only to give attention to the healing of wounds and other emergency
cases, but also to receive sick persons and to serve as a refuge for invalids.
These establishments, as a rule, lack all conveniences, light, ventilation, clean­
liness, means for the sterilization of the instruments used in the minor opera­
tions performed, antiseptic material, water, etc. Very few first-aid stations are
properly installed and equipped and well attended.
Adm inistration of medicines.—The distribution of medicines to poor people
in each municipality is effected either by a contractor or by the administration.
By means of bids, the pharmacist engages to provide all the medicines pre­
scribed by the doctor to the sick poor for the sum appropriated in the budget,
except in some cases in which a limit of a certain number of prescriptions a
day is fixed. The service in this form seems to be more economical for the
municipality, but it has certain troubles. The medicines are prepared very
hastily, with very little care, and as a rule are delivered in dirty receptacles
uncovered. The appearance is such that sometimes the patient throws the
medicine away instead of taking it.
In regard to the quantity, the poor often go back to the doctor telling him
they have not received what he prescribed.
sa Report of the Commissioner of Health, 1920, pp. 148—149.
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Malaria patients return day after day to the doctor begging for medicines
and are never cured, although quinine is prescribed in proper doses. For these
reasons the poor have lost faith in the medicines provided them.
When the supplying of medicines is done by the administration the local drug
stores, if the municipality has not its own pharmacy, prepare the prescriptions
authorized or approved by the mayor at the regular prices, but in this way the
appropriation is soon exhausted.
There is a widespread negligence for the sufferings of our people. Much of
the population is born, grows up, and dies without having received any or
scarcely any medical assistance.
The country people of Porto Rico almost everywhere have no help from
science in their hours of pain and danger from illness, the result being many
premature deaths, unnecessary, completely avoidable.
Good w ill is not wanting, the kindly feeling of the physician is of no avail.
He, too, is a victim of the present state of things. He can not adequately
attend to such a countless number of persons without adequate means nor those
of surgery in such an environment as the homes of the poor can show without
medicines. He receives a meager pay.

A few excellent hospitals have been established in Porto Rico by
organizations in the States and have made notable contributions by
improving the standards of nursing. Among these are the Presby­
terian Hospital at San Juan, St. Luke’s (Episcopal) at Ponce, and
the Congregationalist Hospital at Humacao. On the whole, nursing
as a profession has received little recognition in Porto Rico. Num­
bers of nursing sisters who had received training abroad have come
to the island as members of the Servants of Mary and other Roman
Catholic orders. These sisters have rendered intelligent and devoted
service in their hospitals of limited capacity and also in doing bed­
side nursing among all classes of people. Porto Rico is mainly
Catholic, and the opportunities offered by the church to those who
wish to devote their lives to nursing have attracted the more earnest
class of applicants; but the work of the sisterhoods has not served to
improve the training and status of nurses in secular institutions.
The requirements of applicants for nurses ’ training have been low.
In many cases nurses have entered training with no more than ele­
mentary education, a foundation on which it is not possible to give
the technical training of high-grade hospitals. Some years ago the
Municipal Hospital of San Juan had a well-organized training
school, and the influence of its work is still felt.
Beginning with the year 1921-22, the advanced classes in home
economics in the public schools have been given instruction in home
hygiene and care of the sick, and it is hoped and expected that this
introduction to the subject of nursing may lead a better-educated
group of young woman to enter nurses’ training. Pioneer work in
public-health nursing was developed during Children’s Year, under
the Red Cross, and its extension will undoubtedly bring into publichealth activities the fine class of public-spirited women whose only
avenue for service hitherto has been the schools.
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Largely because of the absence of fuel, very little manufacturing
has been developed in Porto Rico. What are classed as the main
manufactures are the finishing processes in sugar, coffee, and tobacco.
The sugar mills, which convert the cane into raw sugar for ship­
ment, employ the largest number of persons. They are located in the
center of the cane fields and their season corresponds with the period
of the cane harvest. The sugar mills of the island employ a maxi­
mum of about 10,000 people in February and a minimum of about
one-fourth that number in July. Practically no women and no boys
under 16 are employed in the sugar mills. The customary workingday is 12 hours, the work being a continuous process.
The manufacture of cigars and cigarettes and the stripping of
tobacco for export ranks second, employing nearly 10,000 persons in
September and about 1,000 in March. This work consists of the
sorting and preparation of tobacco leaves and the making of the
cigars and cigarettes, all of which is handwork. Almost all of this
work is done in a few large establishments in the cities. There still
exist many small shops where a few workmen make cigars, but the
tendency is toward standardized production in large units. In the
past 10 years, although the value of the product has increased27 the
number of workers has decreased,28 the proportion of women em­
ployees has increased,29 and the general length of the working-day has
been increased from 8 hours to 9.
Practically all the coffee raised goes through a partial or complete
process of cleaning, hulling, polishing, and grading to prepare it for
the market. Formerly this work was done in small establishments,
but the use of modern machinery has concentrated most of the work
in a few large plants. Women workers have superseded men to a
great extent, and the general working-day has been reduced from 10 ~
hours to 8. A maximum of about 2,000 persons are employed in
December and practically none in August.
The remaining industries of Porto Rico consist chiefly of the nec­
essary bakeries to supply bread and similar food products, news­
paper and other printing, and miscellaneous and scattered work­
In addition to the recognized manufactures, during the past few
years a large number of women and girls have been engaged in the
making of blouses, underwear, and handkerchiefs, and other hand­
work. This work is given out by contractors from the States through
27 Value added by m anufacture: 1909, $4,002,848; 1919, $5,094,993. United States
census of 1920.
28 Average number in 1909, 7,025; in 1919, 5,098. United States census of 1920.
28 In 1909, 17.9 per cent of all workers were women; in 1919, 29.7 per cent. United
States census of 1920,
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agents and subagents located in the towns and mountain villages. I t
consists mainly of hemstitching and the plain sewing required in
blouse making. The number of women employed is dependent upon
the general demand for moderate-priced handmade garments, and
the demand fluctuates widely. A change in fashion stops one variety
of work and may or may not create another variety. No accurate
record of the number of workers is available, but estimates have
ranged from 20,000 to 30,000. Earnings vary with the individual
and the class of work; workers have reported earnings in some cases
as low as 15 cents and in others as high as $1.50 a day. Most of these
women and girls, apparently, receive about 40 or 50 cents for a full
day’s work. Hours are also indefinite, as this needlework is done at
home at times when the women are not engaged in their housework
and is subject to irregularity and interruption.
For a long time fine needlework has been taught by the Catholic
sisters to a limited number of girls, and the various Protestant mis­
sions have also taken up this instruction. Recently the public schools
have added such classes in an endeavor to raise the general standard
of sewing and to teach an occupation by which girls can earn their
The making of inexpensive embroidered underwear has not been
developed as it has been in the Philippines. While comparable fig­
ures as to earnings are not available, it appears that the prices paid
for work are higher in Porto Rico than in the Philippines. Porto
Rico has the advantage of being fairly close to the New York market,
so that it is practicable there to give out work of a more changeable
The teachers of needlework in the convents and missions have
made a specialty of Spanish drawn work, but' the market for elabo­
rate work has not been well developed. Lace making also has been
taught by the sisters, the missions, and the schools; but no large
amount has been made, as the work requires much skill and the earn­
ings are less than for other forms of fine handwork.
The weaving of hats and baskets provides employment for a lim­
ited number of people in certain sections of the island where the
raw materials are procurable. Some of the districts have introduced
after-school classes in this type of work. The native industries, how­
ever, are unstandardized, and the markets are not dependable. Up
to the present time these articles have been sold mainly to tourists
as souvenirs and have not been produced as articles of commerce.
An attempt was made to manufacture the finer types of baskets made
in the Philippines, but the raw materials were not at hand and the
importation and cultivation of the necessary plants involved more
time and money than were available.
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The wages of common field labor, which during the war rose as
high as $2.50 a day, were reduced by 1919 to a level of 50 cents to $1
a day. From this point they rose in 1922 to $1 or $1.25. Wages in
the cities have also been lowered from the war-time level, those for
the skilled trades averaging in 1922 about $3 a day. These reduc­
tions were accompanied by numerous strikes, but the large amount
of unemployment made it impossible to maintain better rates of
In 1919 a minimum-wage law was enacted by the legislature, fixing
a minimum of $1 a day for women 18 years of age and over. The
main purpose of the law was to meet the problem of the low wages
paid in the manufacture of blouses and other handwork. The intent
of the law has been evaded by the adoption of the home-work sys­
tem, which renders it very difficult to determine the earnings of
women in relation to hours. In general, work has been slack and
the tendency of wages has been to drop below the legal minimum.
The bureau of labor has prosecuted offending employers and secured
convictions and small fines in a large number of cases, but with its
limited staff it has not been able to maintain the legal standard in
the face of the generally lowered wage levels. *

Poverty is a condition far more general in Porto Rico than in the
States. There are persons of wealth on the island, but they represent
a very small minority. Only 1 person in 269 in Porto Rico paid an
income tax for the fiscal year 1921-22, whereas 1 person in 29 in the
States paid one for the calendar year 1921.30
Naturally, poverty does not entail the same hardships in the
Tropics as in a northern climate, but the general state of poverty in
Porto Rico renders difficult every effort for progress. Every crop
failure or disaster threatens starvation, so narrow is the margin of
resources. In 1898, a few months after the American occupation, a
storm which destroyed the crops of the eastern end of the island
made it necessary for the Government to care for 250,000 persons.
The earthquakes of 1918, while not severe in comparison with other
earthquakes, caused damage, much of which the owners were unable
The income-tax law of Porto Rico is not identical with the Federal law, but it allows
exemptions similar in effect, so th at the income statistics of the island may be compared
with those of the States. Both laws make a personal exemption of $1,000 for a single
person. The Federal law allows a personal exemption of $2,500 for a married person
living with wife or husband, or for a head of a family, with further exemption of
$400 each for other dependents. The Porto Rican law allows personal exemption of
$3,000 for a married person living with wife or husband, or a head of a family, and
$200 each for other dependents. The percentage of the population paying a tax in
Porto Rico is so much less than the percentage in the States th a t any difference in the
effects of the exemptions would not alter the general indications.
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to repair without government aid. The influenza epidemic closed the
schools. A storm in the western end of the island in 1921 brought
thousands to the verge of starvation. In 1922, a fire which destroyed
a block of houses in San Juan left over 400 persons dependent for
months upon the charity of the municipality, the Army, and the
Red Cross.
In everyday life the poverty of the mass of the people is shown
by the practices of selling food by the cent’s worth, of cutting loaves
of bread into penny pieces, and of pricing eggs individually rather
than by the dozen.
The northern visitor in Porto Rico is shocked at the institution
of begging. The mendicants have their stations along the sidewalks
or their regular routes through offices, restaurants, and residence dis­
tricts. Saturday is “ Beggars’ Day.” Shops and individuals put
aside small funds of pennies, and the beggars make their rounds
with businesslike regularity. The Latin spirit naturally tends
to personal rather than organized charity, but begging has reached
such proportions that its control has been repeatedly discussed—so
far with little result, as the prohibition of begging could not be ac­
complished without fundamental economic and industrial changes.
The public charities maintained by the insular government con­
sist of the Boys’ Charity School, with accommodations for 400 boys;
the Girls’ Charity School, with a capacity of 300; the Hospital for
the Insane, which cares for 500; the Leper Colony, which shelters
33; and the Asylum for the Blind, accommodating 100. In 1921 the
cost of operating these institutions was $346,358, or 27 cents per
inhabitant of Porto Rico, and public funds appropriated for the
care of tuberculosis patients amounted to about $100,000.31
Almost every group which meets for any purpose in Porto Rico
takes upon itself some charitable work. Wherever a few people
gather together some one usually brings up cases of persons in need
of employment or other assistance. How much assistance and charity
are given in this manner is beyond computation. This informal
handling of employment and aid has doubtless delayed the formal
organization of such services. Also, the Catholic Church, to which
most of the people on. the island adhere, has taken upon itself much
charitable work, and various orders of priests and sisters are working
in many of the poorer districts. Missions have been established by
several of the Protestant denominations, which, in addition to the
hospitals and classes in handwork referred to elsewhere, conduct
kindergarten and other school classes, dispensaries and clinics, and
district visiting, and during the past year have added public-health
31 Report of the Governor, 1921, p. 206.
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work and recreation. The American Red Cross started organized
family case work in San Juan in 1921, but has found it necessary
to restrict relief work to the families under the supervision of its
mothers’ and infants’ clinics.
The Junior Red Cross, organized by the department of education
in 1917, has headquarters at the department, and school officials act
as its executive board. In each district the supervisor of schools is
chairman of the local chapter. The Junior Red Cross thus func­
tions as an official part of the school system, utilizing the well-organ­
ized school machinery and- concentrating under one head the nonacademic activities of the schools. Most of the membership dues
are expended by the central board to promote activities supplemen­
tary to school work. In the past the “ Juniors ” have administered
charity to many persons in various sections. Much was accom­
plished in an individual way, but the Junior Red Cross activities
have now been restricted to definite lines of constructive work, such
as dental clinics, child-health centers, school gardens, and loan
A few years ago the school lunch—“comedor escolar ”•—was intro­
duced, and so many children were found to be in actual need of
food that the movement has spread very widely. The Junior Red
Cross, the Catholic Church, the Masons, and other organizations have
helped purchase equipment, and the current expenses are met by
public32 and private subscriptions. Motion-picture theaters often
give benefit performances, and many other entertainments help to
keep going this important aid to the schools. The Zapato Escolar—
Shoes for School Children—referred to elsewhere is also of funda­
mental aid to the schools. Both of these charities for school children
have been organized and are administered with the assistance of the
teachers in a well-systematized manner. The food and shoes are
given to a child only in accordance with the teacher’s report on the
condition and the needs of the family. As so much of all community
progress in Porto Rico is effected through the school system, the
organization of charity may well come about as an outgrowth of
these organized school charities.
Undoubtedly the money and effort now expended on general
charity do not bring the utmost results. Better system and organiza­
tion are necessary, but methods which have been found successful in
the States will not necessarily prove applicable unless modified with
understanding of the different conditions of Porto Rico and par32
The insular government appropriates $25,000 a year to assist the local school boards
in this work, and additional funds are given by many municipalities.
54912°—23----- 3
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ticularly with appreciation of the existing great resources of kind­
ness and personal ministration.

According to law the juvenile courts of Porto Rico have jurisdic­
tion over all dependent, neglected, or delinquent children under the
age of 16, and jurisdiction over children who have come before the
court continues until they become 21 years of age. The juvenile
courts (established in 1915) are not separate courts, but are juvenile
sessions of the seven district courts of the island, and the judges and
officials of the district courts serve as officials of the juvenile sessions.
The prosecuting attorneys and the judges of municipal courts are
ex officio probation officers, and the district judges have power to
appoint other persons as special probation officers. As the seven dis­
trict courts of the island have jurisdiction over rural areas as well as
cities and towns, all children in Porto Rico are within the jurisdic­
tion of the juvenile courts. The provisions of the act are liberal,
and no criminal precedent is established against children appearing
before the court.
The difficulties in the operation of the law are that the district
courts are already overworked and can ill spare the time for juvenile
sessions; the prosecuting attorneys can hardly be expected to develop
so different a field as probation, in addition to their other duties; and
the facilities for caring for children who have come before the courts
are discouragingly inadequate. An industrial school for delinquent
boys has been established at Mayaguez but is too small to accommo­
date all the boys who should be committed to such an institution.
Many times it is necessary to keep boys in penal institutions—al­
though in wards separate from the adult prisoners—because of lack
of any other institution to which they can be sent. For delinquent
girls there is no institution. The attorney general’s office has placed
some delinquent girls in a separate ward of the women’s jail at
Arecibo, and the department of education has provided teachers of
handicrafts as well as of elementary school subjects. The arrange­
ments are excellent, but quarters are limited and facilities are far
from adequate to meet the situation. The police, the juvenile courts,
and the attorney general’s office are constantly embarrassed by the
lack of facilities needed to take care of urgent cases. Neglected and
dependent children can be committed to the Boys’ Charity School
and the Girls’ Charity School, but there also accommodations are
far front adequate. There is no detention home in connection with
any of the district courts.
In most of the cases brought before the juvenile courts the charges
have been petty theft, neglect, and abandonment, offenses which are
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largely traceable to poverty. Many of the children involved were
homeless, and about one-third were illegitimate; about half had never
attended school. The responsibility of parents for illegitimate chil­
dren has not been definitely established, decisions on this point being
in conflict.
Considerable interest on the part of public-spirited men and women
has been shown in the development of the juvenile courts and par­
ticularly in that of probation work. It is hoped that regular proba­
tion officers will soon be appointed, or that the volunteers who now
assist at times in investigations and probation work will become a
regular part of the court and will also bring public opinion to bear
upon the matter of providing the adequate facilities for children for
which the attorney general’s office has been asking year after year.
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The second project included in the Children’s Year program—that
of cooperating with existing agencies in Porto Rico to stimulate
activities for children—was undertaken by the Children’s Bureau in
conjunction with the Porto Rico Department of Education and the
American and Junior Red Cross. Much general work was done in
connection with various groups, but the specific activities of the
year consisted of (1) the summer fresh-air camp, conducted by Miss
Beatriz Lassalle, the expenses of which were paid by the Junior Red
Cross, with assistance from the American Red Cross; (2) the en­
couragement of playgrounds, games, and athletics for boys and girls
by specialists on the bureau staff, continuing through the year; (3)
the introduction of health teaching in the schools by two Porto Rican
teachers on the staff of the Children’s Bureau, who worked practically
throughout the school year; (4) the physical examination of school
children by the municipal school authorities of San Juan; (5) thf*
extension of dental clinics by the Junior Red Cross; (6) the intro­
duction by the American Red Cross of mothers’ and infants’ confer­
ences under the direction of Miss Kathleen d’Olier; (7) a campaign
for the prevention of blindness by the bureau staff in cooperation
with the National Committee for the Prevention of Blindness and
the Porto Rico Association for the Blind; (8) the creation of the
child-hygiene division of the Porto Rico Department of Health; (9)
the celebration of Baby Week in San Juan by the bureau staff in co­
operation with the WOman’s Civic Club of San Juan, the municipal
officials, the American and Junior Red Cross, the United States
Army, and various other organizations; (10) the experiment made
by the Junior Red Cross of the treatment of children in the rural
schools by two traveling physicians; (11) a survey of homeless chil­
dren in San Juan, Ponce, Mayaguez, and other sections of the island
by Miss Lassalle, with the cooperation of the insular police; and (12)
a survey of abandoned mothers made by the bureau in cooperation
with the Woman’s Christian Temperance Union.
For invaluable suggestions and assistance through the year the
bureau staff was indebted to the following board of counselors:
Hon. Juan B. Huyke (chairman), commissioner of education.
Mrs. María A. de Pérez Almiroty, president Woman’s Civic Club.
Miss Kathleen d’Olier, supervisor American Red Cross Nursing Service.
Miss Rosa González, superintendent Presbyterian Hospital.
Mrs. Milagros Benet de Mewton, president Woman’s Suffrage League.
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Manuel V. Domenech, president Rotary Club.
Manuel Fernández Juncos, author and poet.
Dr. A. Fernôs-Isern, president Porto Rico Association for the Blind ; director
of school hygiene, department of education, San Juan.
Dr. José Gómez-Brioso, Porto Rico Department of Health.
Hon. Salvador Mestre, attorney general.
Hon. Martín Travieso, mayor of San Juan.
Carlos Vicente Urrutia, superintendent of physical education, Porto Rico
Department of Education.
Rev. Padre Vassallo.
Francisco Vizcarrondo, chairman Junior Red Cross.

The first vacation camp for children in Porto Pico was conducted
by the Junior Red Cross, under the direction of Miss Beatriz Lassalle, in Barranquitas during July and August, 1921. A hundred
girls and boys from the poorer district of San Juan, selected by the
nursing service of the American Red Cross as being most in need of
a vacation in the mountains, attended this first camp.
Porto Rico is fortunate in having within one or two hours’ ride
from any point of the island mountains high enough to afford a
complete change of air. This first experiment in camping was made
in cooperation with the school authorities of Barranquitas, who per­
mitted the use of the schoolhouse as a dormitory and the school lunch
accommodations as kitchen and dining room. Several teachers as­
sisted Miss Lassalle in the care of the children*. The American and
Junior Red Cross provided clothes and shoes for all children.
Physical examinations were given before the children left for camp,
and the local physician and dentist cooperated by attending the
minor ailments which developed in camp.
This experiment was beneficial to the children and valuable as a
pioneer effort. Experience with the obstacles encountered will assist
in directing future camps. One object of the camp was to try the
effects of a better-balanced diet than is customary among the poor,
particularly the addition of more green vegetables. In this the
camp was not successful, as practically no green vegetables were pro­
curable in the district and what could be bought were very expensive.
What the children wanted was bread and coffee in the morning and
rice, beans, and bananas for dinner and supper. The mountain air
gave them such appetites that the facilities of the kitchen were taxed
to the utmost to prepare enough of these foods, and the experiment
in adding green vegetables to their diet was postponed. Consider­
able milk was given them, as well as soups, eggs, and meat. Many
of the children came from families so poor that they had never had
enough food, and their improvement in health after only a few days
was plainly noticeable.
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The use of school buildings as dormitories was found to be un­
desirable in dealing with children who have not been taught careful

Health teaching was introduced into the public-school system of
Porto Pico during Children’s Year by two Porto Rican teachers on
the staff of the Children’s Bureau, who taught health as an official
part of the school program in the districts of Bayamon, Catano,
Ponce, Quebradillas, Comerio, and a small section of San Juan.
The work of these teachers was carried on in Spanish, as the great
majority of the children reached were in the first four grades of
school, in which Spanish is the medium of instruction. These health
classes were given in all the grades from first to eighth and in some
districts as far as the’ tenth. The ground covered was, in general,
that outlined in the bulletins on health teaching issued by the United
States Bureau of Education, with certain modifications of emphasis
required by local needs. In the development of special points of
emphasis the bureau received valuable assistance from Dr. (Col.)
W. F. Lippitt, commissioner of health; Dr. A. Ruiz Soler, former
commissioner of health; and Dr. (Col.) Bailey K. Ashford, head of
the Porto Rico Institute of Tropical Medicine and Hygiene, under
whose direction was carried out the first public-health campaign for
the control of hookworm on the island.
“ The Rules of thé Health Game,” in Spanish, were given to each
child in the schools on a card on which were noted the child’s height
and weight. In translating these rules only one modification was
made—that of changing the “ bath at least once a week ” to “ daily
bath.” The Porto Ricans are an unusually clean people. Along
every stream women are to be seen washing garments and bleaching
them in the sun, and dwellers in little huts hundreds of feet above
water think nothing of making the difficult descent to the river to
bathe. In fact, bathing is so frequent and cleanliness so thoroughly
the rule that in the local idiom one takes a bath u for refreshment ”
and not from the necessity of cleansing one’s self.
Classroom weight charts were posted in each schoolroom, and the
in te re t of the teachers and children was enlisted in repeating the
weighing at monthly intervals. Subsequent inspection showed that
the weighing was continued, and once the children’s interest in reach­
ing the “ ideal ” weight was aroused this matter no longer required
Scales have been purchased for some of the larger city schools, but
not for the smaller city schools nor for schools in the towns and rural
districts. The merchants can always be counted upon to cooperate
in any work pertaining to the schools, but their scales are not always
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suitable for weighing children. No general campaign for weigh­
ing and measuring children can be undertaken until proper scales
are provided.
The health teachers gave general instruction as to personal hy­
giene, diet, sleep, elimination, and play. In this great care and
patience were necessary in order to overcome such superstitions as
that of the dangers of night air. Most Porto Eicans sleep with all
the doors and windows closed, and the task of teaching the children
and their parents to have fresh air at night was no simple one. The
teachers also emphasized the need for drinking more milk, and, for
the purpose of increasing the milk supply, the care of goats. The
chief veterinary inspector assisted in this work by preparing a simple
leaflet on the milk goat (la cabra de leche). The chief of the experi­
ment station at Eio Piedras has made important experiments in the
breeding of goats, and his experience in improving the breed of goats
in Porto Eico will be made available to the schools.
The care of the teeth was particularly emphasized by the health
teachers through toothbrush and dental-floss drills. Teeth have been
greatly neglected in Porto Eico. It is not uncommon to see young
people with no front teeth, and among the poor the possession of
more than a very few teeth in later life is unusual. The common
habit of chewing a stick of sugar cane, as well as inadequacy of diet
in general, is probably responsible for much of this loss of front
teeth. The poorer class do not clean their teeth^and never have had
The most troublesome problem in health teaching was to procure
toothbrushes. The attempt was made to have the children provide
their own as far as possible. Brushes were bought at wholesale prices
(6 and 7 cents) and sold to the children on the installment plan, a
cent at a" time. Where the children were too poor to buy them, the
Junior Eed Cross assisted. In certain districts poverty was so wide­
spread that three-fourths of the pupils could not buy their brushes.
Handkerchief drills, which seemed to be as much needed as tooth­
brush drills, were given in all the grades.
In addition to their specific work the health teachers assisted the
people in the various districts to develop other activities for the
benefit of children. In Bayamon they helped in conducting the
weekly baby conference. This was held in a building adjoining the
school and was very much a school activity. Interesting the children
in the care of the babies spread the influence of the baby conference
and promoted closer relations between the parents and the school.
The physicians of the city became interested in the health work and
volunteered one day a week for physical examinations. These
examinations proved particularly important, as a serious prevalence
of trachoma was discovered. The insular department of health
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took charge of the situation and prevented what might otherwise
have been a dangerous spreading of the disease.
In Quebradillas the physician in charge of the International
Health Board’s demonstration of hookworm eradication had spread
the doctrine of sanitation. The town was conspicuously clean.
Hookworm, which had once been found in over 86 per cent1 of the
inhabitants, had been virtually eliminated, and the schools were
noticing the improvement among the children in alertness and
general health. Health teaching was made easier by this foundation
in sanitation, and the health teacher on her part was able to explain
and emphasize the necessity for not growing careless. The local
health officer of Quebradillas volunteered one day a week for
physical examination of children, and corrective treatment was
given free of charge to various children who were unable to pay.
In Ponce interest had been aroused in the need for a baby con­
ference, and when the health teacher began to draw attention to the
health needs of children the baby conference materialized. The
local health officer provided medical services, the insular department
of health furnished a full-time public-health nurse, the Red Cross
gave her special training in the health station in San Juan, and the
Junior Red Cross met the expense of equipment. The public officials,
as well as many private individuals, contributed services and funds.
Under the unofficial protection of the Masonic order the society
Zapato Escolar (Shoes for School Children) was organized for the
purpose of providing shoes for needy children to enable them to
go to school. There is no rule in the island that a child must wear
shoes to school, but the attempt has been made to set that standard.
A child can get along in Porto Rico without shoes, although the
cold rains of winter and the hot pavements of summer make it very
uncomfortable to do so. However, aside from the matter of comfort,
shoes are most important as a means of preventing hookworm in­
fection through the feet, and they have come to be a sign of progress.
The first society was formed in San Juan, but a similar society was
organized in Ponce by the health teacher.
The work of the Zapato Escolar has been developed in close coop­
eration with the teachers, who make recommendations as to needy
children and investigate family conditions. An allotment is made
to each school of so many pairs of shoes per week, and the teachers
designate which children shall receive the shoes. The children take
their tickets to the meeting held Sunday morning and are measured,
and on the following Sunday return and “ purchase ” their shoes for
5 cents. A t these meetings some public official or prominent citizen
usually talks to the children on citizenship or opportunities or a
1 Annual Report, International Health Board, 1921, p. 78.
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similar subject, or some one tells them stories. Holidays are espe­
cially commemorated, and in many thoughtful ways the children
are made to feel themselves a vital and responsible part of the com­
In Comerio health teaching immediately uncovered a condition of
conspicuously neglected teeth. The Junior Red Cross responded
promptly by engaging a dentist to remove all hopelessly decayed
teeth at once, and later arranged to establish a dental clinic in con­
nection with the schools to do systematic preventive work as well as
emergency work during the next school year, the municipality agree­
ing to continue the service after the first year.
Under the direction of the supervisor of schools the town cele­
brated a “ children’s week,” in which the educational and health
authorities, local and insular, assisted in drawing the community
together to consider the needs of children.
Monday was the “ day of little mothers.” All the schoolgirls above
the third grade were gathered for a talk and demonstration of the
proper bathing, dressing, and care of babies, conducted by nurses
from the department of health and the Red Cross. The interest was
so great that the demonstration had to be repeated with a second
infant. Almost all the little girls have younger children to care for,
and though they are uniformly kind they have only a very limited
knowledge of proper care. Raising these tasks to a dignified and
professional status was a new idea, but one which was received enthu­
siastically. After the demonstration health stories and the film “ Our
Children” were given. On this day the schoolboys canvassed the
town and posted a blue cross on every house containing a baby, with
a gold heart if the child’s birth had been registered. I f the birth
had not been recorded the boys explained the necessary steps, and in
some instances they personally escorted the parents to the recorder’s
Tuesday was “ mother’s day.” Under the direction of the division
of child hygiene of the Porto Rico Department of Health physical
examinations were given to babies. Of the 94 babies examined all
but 6 had defects. A committee of prominent citizens was formed
to assist in certain of these cases. (This committee later developed
into the Comerio Child Welfare League, whose efforts have been
greatly strengthened by the detailing from the insular department
of health of a public-health nurse for child-health conferences and
borne visiting.) In the evening a meeting of parents was addressed
by prominent health officials on different aspects of public health,
and films were shown. Hookworm is prevalent in this district, and
the people were especially interested in the film showing the develop­
ment of the hookworm and methods of eradication. During the
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week this film was shown over and over again by general request, and
the visualization of the hookworm problem made a profound impres­
Wednesday was “ clean-up day.” Under the supervision of several
sanitary inspectors from the insular department of health the older
schoolboys were organized into squads which cleared every alley and
back yard in the community. The damage done by rats, flies, and
mosquitoes was thoroughly explained and the breeding places of
these pests were cleaned up.
Thursday was the “ day of little children.” The domestic-science
classes, assisted by nurses from the department of health and the
Red Cross, gave an exhibition of what constitutes desirable and un­
desirable clothing for children. Demonstrations were given of the
preparation of artificial food for babies, the care and cleaning of
bottles and other utensils, and the laundering of baby clothes. These
demonstrations were for the mothers as well as for the older school­
Friday, “ school day,” closed the celebration with a parade of
school children, largely in costume, carrying banners with all man­
ner of health mottoes. A toothbrush drill and a calisthenic drill
were given in the historic plaza of the town, followed by other exer­
cises. In the evening another meeting of parents was held for the
discussion of other aspects of public health.
Throughout the week the schools were decorated with health post­
ers. Some of these were loaned from the States, but the most inter­
esting were the original posters which the children had made, using
illustrations cut from magazines to visualize well-selected or poorly
balanced diets, good and bad habits, and the general and specific needs
of children. The most significant feature of the week was the com­
plete cooperation of the health and educational authorities, the health
officials utilizing the school machinery for teaching the children, and
through them the parents, the fundamentals of health and sanitation.

As a part of their routine work, health teachers weighed and
measured all the children in the common schools of Bayamon, Catano, Comerio, Ponce, and Quebradillas, and a small number in San
Juan. To these records have been added records of measurements
taken by the examining physicians in San Juan schools. In all a
total of 7,632 measurements have been tabulated for comparison with
corresponding figures obtained in the States. The figures of aver­
age heights and weights of boys and girls from 6 to 17 years of age
are given in Table I.
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T able

I.—Average heights and weights of children 6 to 17 years of age, by sex
and age.


Number. stature Number. weight Number. stature Number. weight

6 years.....................
7 years.....................
8 years.....................
9 years.....................
11 years...................
14 years...................
15 years....................
16 years....................
17 years....................









The four accompanying graphs give comparisons of the heights
and weights of Porto Rican boys and girls with Bowditch’s 2 figures
for average heights and weights of Boston school children.
According to this comparison Porto Rican boys average about 1
inch less in height and Porto Rican girls average from ^ to 1 inch
less in height, respectively, than boys and girls of the same ages in
the States. The comparison of weights shows the Porto Rican chil­
dren averaging from 5 to 8 pounds lighter than children of the same
ages in the States, the girls more nearly approaching the standards
of children of the States than do the boys.
A comparison of the heights and weights of the boys and girls
in the different communities was made, and is shown in Table II.
According to this table children of Bayamon, Catano, and Quebradillas average less in height and weight than the whole group. The
children of Ponce and Comerio were both taller and heavier than
the average—which was to be expected, as these communities have a
generally higher standard of living conditions. The San Juan boys’
average weights exceeded the general Porto Rican for their ages,
but their heights were under the average, as were both the heights
and weights of the girls of San Juan. The figures for San Juan
were taken in schools in the poorer districts attended by children
from homes below the general standard of the city. Complete
figures for San Juan would undoubtedly show higher averages.
I t is interesting to note in connection with the averages for the
children of Quebradillas that this is the district where the Inter­
national Health Board has been conducting its campaign against
hookworm. More than 86 per cent of all the people of that com­
munity were found to have the disease, and this may be a cause
contributing to the lower average in heights and weights.
2 Bowditch’s figures include weights of clothing without shoes, as do the Porto Rico
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C h a b t


III.—Average weights »f Porto Rican boys 6 to 16- years of age, as compared with
Bowditch’s figures.


Porto Rico
Bowditch •
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—Average weights of Porto Rican girls 6 to 16 years of age, as compared wi
Bowditch’s figures.






































Porto Rico
Bowditch •
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Ch a r t V.—Average


Years. 6


heights of Porto Rican boys 6 to 16 years of age, as compared with
Bowditch’s figures.






Porto Rico -----------------B o w d itc h -------------------
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Chabt VI.—Average heights of Porto Rican girls 6 to 16 years of age, as compared with
Bowditch’s figures.

Porto Rico
Bowditch ■
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T able I I .— A v e ra g e differen ces b e tw e e n h e ig h ts a n d w e ig h ts o f b o y s a n d g ir ls in
d iffe re n t c o m m u n ities a n d th e a v e ra g e h e ig h ts a n d w e ig h ts o f a ll b o ys a n d
g ir ls o f th e sa m e a g e s w h o w e r e w e ig h e d a n d m ea su red .



Excess or deficiency in average.

Excess or deficiency in average.

Height for age.


Weight for age.

Height for age.

Weight for age.

Number excess or Number excess or Number excess or Number excess or
of cases. deficiency of cases. deficiency of cases. deficiency of cases. deficiency
Quebradillas.. . ........
San Juan.................









Table I I I gives the average weight for height of the total group
T able I I I .— A v e ra g e w e ig h t fo r h e ig h t o f a ll b oys a n d g ir ls 6 to 17 y e a r s o f
age, w h o w e r e w e ig h e d an d m ea su red .


Num­ Average
weight Num­
ber. (pounds).
ber. (pounds).








42. 5
43. 3
51. 5
56. 3
64 9









62- 3

64. 3


72 .........

Num­ Average
weight Num­
ber. (pounds).
ber. (pounds).






Physical examination of school children was started in the city of
San Juan by the municipal commissioner of education, who realized
the serious handicap of poor physical condition in preparing the
children for life. Three physicians were employed to make these
examinations, and school nurses were appointed to assist and to
follow up the children who needed attention. hTo attempt was made
54912°— 23----- 4
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to administer treatment. The parents were notified of the report
of the physician and their attention was called to defects which
could be remedied. In many cases in which the parents could not
afford to pay for treatment services were given gratis by the physi­
cians of the city.
The primary object of these examinations was to discover existing
conditions so that, upon this basis of knowledge, an adequate policy
might be formulated. The need for dental attention was imme­
diately shown, and three dental clinics were established with the
assistance of the Junior Red Cross. The general condition of the
school children is indicated by the following figures for the 7,681
children examined in 1921-22:
Number of

Treatment needed_______________________
Defects of respiratory system------------------------------------------5,394
Defects of teeth_______________________________________ _ 4, 770
Defects of skin and scalp________________________________ 2, 695
Defects of vision------------------------------------------------------------1,214
Defects of digestive system____ ,-------------- ----------------------Defects of heart------------------------------------------------------------61
Defects of hearing______________________________ :---------60
No d efects_____________________________________________ 1,082

The findings of these examinations have resulted in a greatly en­
larged program of school medical and dental service. An eye, ear,
nose, and throat specialist has been added to the staff, the dental
clinics have been increased, and the volunteer treatment of poor
children has been systematized and extended.
Similar physical examination of school children was extended
during Children^ Year to Bayamon, Quebradillas, Ponce, Utuardo,
Aguadilla, and Comerio, but the findings have not yet been tabulated.

During Children’s Year the Junior Red Cross made the experiment
of sending two traveling physicians, each with an assistant, through
rural districts to make physical examination of the school children
and to prescribe treatment in isolated sections which had no
The experiment was continued through the school year. A t the
end of that time the plan was changed, and one physician continued
on a more detailed program. The chief difficulty lay in the extent
and seriousness of these problems. I t was hoped that the physicians
could give the teachers instruction covering the basic points of prac­
tical hygiene, which the teachers in turn could pass along to the chil­
dren; that they could prescribe for children needing medical assist­
ance ; and that they could complete their task by a return visit. The
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experience of the physicians showed great prevalence of such dis­
eases as hookworm and malnutrition, which require far-reaching
education of the parents as well as of the teachers and children in
sanitation and hygiene. The physicians could prescribe for minor*
ailments, but to touch basic conditions was impossible under the plan
of work adopted. To give instructions in practical hygiene which
the teachers could transmit effectively to their pupils involved more
time than had been expected. To prescribe for children without
knowing their home conditions and without follow-up work was
found to be of little avail. To remain in a community long enough
to make a satisfactory demonstration called for different equipment
and plan from those adopted.
Much valuable information was secured by this experiment. Its
chief value, however, lay in showing the educational authorities the
handicapped physical condition of a large proportion of the children
living in isolated districts and the need of formulating some plan
for raising the general standard of health. The percentage of re­
tardation and failure to be promoted3 in the schools is high, and
this is undoubtedly due in large measure to the poor health of the
children. Whether, with the same appropriations, the educational
authorities could not actually achieve greater results in academic
work by spending a portion of their revenues on direct health work
is a question to be considered seriously. The present waste of hav­
ing one-third of the pupils repeating their work is too great to be
overlooked, and the general community benefits of a stronger race of
children are incalculable.

When the Children’s Year activities were being planned the Ameri­
can Red Cross agreed to send to Porto Rico a supervising nurse, who
would develop mothers’ and children’s conferences, visiting nursing,
and public-health work. The first baby clinic was opened in May,
1921, in Puerta de Tierra, the poorest section of San Juan. The
work was developed in close cooperation with the municipal authori­
ties. The clinics were opened in the building of the municipal
pharmacy, but later larger quarters were needed and secured. At
first the municipal physicians made the examinations both of mothers
(prenatal) and of infants. Subsequently a woman physician made
the examinations in the mothers’ clinics, as this was found to be more
in accordance with the Porto Rican point of view.
In the general survey of conditions are discussed the high rate of
infant mortality and the limitations in the facilities for the training of
8 In 1920, 33 per cent of the pupils in rural schools were not promoted. Report of the
Governor, 1920, p. 441.
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nurses. With the obstacle of language, it is necessary in Porto Rico
to employ Spanish-speaking nurses wherever nurses must deal di­
rectly with the poorer people. The first task of the supervising nurse
was to train assistants in the essentials of public-health nursing,
and to teach them how best to meet the general handicap of dire
poverty and ignorance. For emergency illness beds could usually be
obtained at some hospital, but for the general situation of poverty,
unemployment, and bad housing no organized relief was available.
The Red Cross gave aid as far as possible, but its resources were
totally inadequate to meet the needs of the situation.
From the day the conferences were opened the mothers came and
brought their babies. The Porto Kicans are most appreciative of
anything done for their children, and no grants of milk or other
inducements were needed to secure regular attendance at these, con­
The nurses made regular follow-up visits and taught the mothers
how to prepare food for their babies, and other elements of child
care. The difficulties of the situation are hard to visualize. Many of
the families have only one room, not over 10 feet square, in which the
family of at least six persons dwells, often with one or more lodgers.
The mother cooks on a charcoal fire on the ground. She owns, per­
haps, one iron pot, and .uses tin cans to help out. The baby, fre­
quently, has not more than one dress and has no diapers. Their
cleanliness under the circumstances is little short of marvelous.
The Porto Kican mothers frequently find breast feeding impossible.
Pure milk is expensive andr difficult to obtain and pasteurization is
little understood. The poorer families commonly feed babies on
family food at an early age. This is so generally true that in cases
of infants only a few months old brought for treatment the best
hospitals have found it advisable to accustom the babies to family diet
before returning them to their homes. The prenatal clinic laid
special emphasis on building up the mother’s strength so that she
could nurse her baby adequately, and the results obtained were most
The Children’s Bureau translated into Spanish its dodgers on the
care of the mother and baby, simplifying them and adapting them
with the assistance of island physicians to the special needs of Porto
Rico. These were supplied to the mothers to emphasize the oral in­
structions given at the conferences. In addition, a leaflet was pre­
pared by the chief of the veterinary bureau on the care of the milk
goat to encourage the poor people to increase the production of milk
by proper care of goats.
The results obtained in Puerta de Tierra, in spite of all the
difficulties, led to the establishment of a baby clinic in Bayamon in
October, This was organized in one of the schools, and the expenses
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B A B Y C L I N I C C O N D U C T E D IN S C H O O L H O U S E .
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were paid largely by the Junior Red Cross. A nurse for follow-up
work was trained in the Puerta de Tierra clinic, and the Red Cross
supervising nurse continued to assist and guide. Several physicians
volunteered their services in the clinic and much assistance was
given by the women of the community.
In December a baby clinic was opened by the Red Cross in
Barranquitas as an experiment in trying to educate mothers in an
isolated district. This district was found to present peculiar diffi­
culties—the -people were extremely poor, many of the roads in the
mountains were impassable during rains (and rains were' unusually
heavy at that period), and virtually no medical assistance could be
obtained to supplement the nurse’s efforts. With no means of
relieving the general need of food and in view of all the difficulties
it was considered advisable to discontinue this rural visiting nursing.
The experiment indicated, however, that in such districts a better
approach to public-health work could undoubtedly be made by be­
ginning with conferences and classes for the better-educated
mothers and extending the service as rapidly as it created its place
in the community.
In December, also, a babies’ conference was opened at Ponce, to­
ward which the insular department of health and the municipality
assisted the Red Cross by providing a nurse and medical assistance.
The conference in Ponce was established in a better section of the
city than was the one in San Juan, and received the understanding
and hearty support of the community from the start.
In February a babies’ conference was opened at the plant of the
Central Aguirre, the second largest sugar refinery on the island,
where the International Health Board is making its tests in malaria
control. The company provided amply for the needs of the clinic,
which was the best equipped on the island. The physician in
charge had worked with the employees for years, and being
thoroughly conversant with their needs was able to make more
rapid progress than was made in the other clinics. The “ central ”
had imported a large herd of thoroughbred Guernsey cows and was
selling milk to the employees at a very low price, a factor of great
assistance to the work of the clinic. I t also raised a large variety
of vegetables, primarily for the Americans in its employ but also
influencing the diet habits of the Porto Ricans.
In April two additional baby conferences were opened in San
Juan, in the Barrio Obrero, the workingmen’s suburb, and La Perla,
a poor section outside the city walls.
Conferences were later established in Mayaguez and Comerio. The
expenses for all of these clinics have so far been met by coopera­
tive arrangements between the American Red Cross, the Junior Red
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Cross, the Porto Rico Department of Health, and the local authori­
ties. All the conferences remain under the direction of the super­
vising Red Cross nurse.
Standard records have been kept in all the clinics, but no tabula­
tions have as yet been made of the data.

In February, 1922, the Porto Rico Department of Health created
a division of child hygiene and began a special study of the condi­
tion of children in the poorer sections of San Juan. The investiga­
tion was based upon a realization of the underlying social and eco­
nomic conditions affecting the child. A census was made of all
the dwellings in the district. A family folder was filled out con­
taining detailed information as to each house and its inhabitants, the
material of the structure, condition, painting, cleanliness, water
supply, garbage disposal, proximity of domestic animals, stagnant
water, and sanitary facilities. Within this folder were placed in­
dividual cards showing the findings of careful physical examina­
tions of all children under 5 years of age and all pregnant ,women.
To the findings of the physical examinations were added informa­
tion as to the economic status of the family, the employment of the
mother, and the marital status of the parents. In the case of in­
fants artificially fed information was recorded as to the methods of
the preparation of food, the utensils used, and the care and cleanli­
ness of bottles and nipples.
The census and housing inspection were made by a sanitary in­
spector. The mothers and children were directed to the doctor’s
temporary headquarters in the district for physical examination,
and follow-up visits to the homes were subsequently made by a
nurse to insure compliance with suggested changes. In this respect
the investigation was broadened to partake more of the nature of
regular child health center work. The insular department of
health had at the time of the study detailed eight nurses to stations
established under the supervision of the Red Cross, in various sec­
tions of the island. I t was not possible for the department to con­
centrate its nurses in San Juan to provide continuing service cen­
ters for all children and mothers covered in the investigation, but it
endeavored to render enough service in the course of its investiga­
tion to demonstrate to the local authorities and citizens the ad­
vantages of maintaining the work.
The findings of this investigation when completed will provide
unique and invaluable data on the conditions affecting child welfare
in a tropical city. Among the conditions shown by the findings of
one section were incomplete birth registration and a widespread
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neglect of vaccination. Before the American occupation smallpox
was a periodical scourge. The results obtained by the complete
vaccination of the population have been so successful that vaccina­
tion has recently been neglected. A large number of the children
had glandular affections possibly indicating pretuberculosis, and
many were receiving nourishment inadequate to their needs, either in
quantity or in quality. The need of dental attention was general.
The investigation produced immediate improvement in sanitary
conditions. Garbage was disposed of more promptly, standing
water—breeding spots for mosquitoes—was drained, and the people
were given many object lessons in more hygienic living.

I t is estimated that there are in Porto Rico about 2,000 blind
persons—proportionately twice as many as among the popula­
tion of the United States.4 Blindness resulting from smallpox, a
disease common prior to the American occupation, was stopped with
the virtual eradication of smallpox, but the other causes of blindness
have been given little attention.
The discovery of cases of trachoma among children in various
places in Porto Rico resulted in 1914 in an examination of over 4,000
school children under the direction of Dr. W. W. King, surgeon of
the United States Public Health Service and member of the Insti­
tute of Tropical Medicine and Hygiene of Porto Rico. These ex­
aminations were made in 13 different localities, presumably offering
a typical picture, of conditions on the island. The proportion of
cases varied widely in the different schools, but no locality was found
to be free from the disease. Of all the children examined 9.5 per
cent were reported as having positive cases. The disease was not
confined to the poor nor to any special ages. Negroes apparently en­
joyed a partial racial immunity, which, however, was lost by mixture
with other blood. The origin of trachoma in the island is not clear;
it was evidently introduced during the Spanish regime—probably by
immigration from Spain and Syria, in both of which countries it is
prevalent. The report of this survey called for a constructive pro­
gram of cure and prevention to be continued over a period of years,
but no special funds were made available for this work and the
matter was dropped.
To reduce ophthalmia neonatorum the commissioner of health
secured in 1921 a small appropriation for packages of prophylactics
to be used on the babies’ eyes at birth. However, the department was
4 In taking the 1920 census enumeration of the blind was not made in Porto Rico. In
the census of 1910 it was estimated that the ratio of the blind to the total population
was 62.3 per 100,000 in the States and 143.4 per 100,000 in Porto Rico. The Blind in
the United States, p. 20. U. S. Bureau of the Census, 1917.
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given no funds for the necessary education of mid wives and the gen­
eral public. Besides these two attempts to reach the problem little
had been done to educate the public to the possibility of preventing
A t Ponce the Porto Rico Department of Health maintains the
Asilo de Ciegos (asylum for the blind), an institution for the care
of the indigent blind, to whose functions has been added the treat­
ment of eye cases referred by public authorities. The asylum has a
capacity of about 100. For the blind children in the asylum the de­
partment of education in 1919 established a small school, under the
direction of a well-trained teacher of the blind. The attendance at
the school has averaged between 20 and 30, a number limited by the
capacity of the school and of the children’s living quarters in the
asylum. The school is meagerly equipped and badly overcrowded,
but its work has been important as a demonstration of the possibility
of educating the blind, a subject which has received little attention
in Latin America. Its work has been given publicity and assistance
by the Porto Rico Association for the Blind, an organization with a
small but strong membership among health and education officials
and individuals interested in the problem.
In 1921 the legislature appropriated $60,000 for a school for blind
children, but complications have prevented the immediate erection of
this much-needed school. The Junior Red Cross donated $15,000 for
a cottage to be erected as soon as the matter of a site was settled.
As a part of the Children’s Year program, the Children’s Bureau
made it possible for the National Committee for the Prevention of
Blindness to assist in an intensive campaign of education, which was
made in close cooperation with the Porto Rico Association for the
Blind and the insular departments of health and education. The
committee’s posters on babies’ sore eyes were issued in Spanish, and
selections from the committee’s publications were translated and
adapted to the special needs of Porto Rico. Stories to interest chil­
dren in the care of the eyes were translated and published in the
Porto Rico School Review, which goes to all teachers on the island,
and republished in the newspapers. All this material was placed
in the hands of every physician, health officer, pharmacist, and school
supervisor in Porto Rico, and the posters were sent to every school.
To assist in the campaign the national committee sent its secretary
and managing director and the New York State Commission for the
Blind sent a special eye nurse. Meetings were held in Aguadilla,
Arecibo, Bayamon, Caguas, Catano, Cayey, Gurabo, Humacao, Juncos, Lares, Manati, Mayaguez, Ponce, Rio Piedras, San Juan, Santurce, and Yauco. At these meetings motion-picture films on the
care of the eyes, the prevention of blindness, and the education of
the blind were shown, and short talks were given. In every town the
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local officials and the local committees of the Porto Rico Association
for the Blind participated. In Arecibo one session of the annual
convention of teachers was given over to the subject of the pre­
vention of blindness. In Rio Piedras a meeting was held especially
for the normal-school students, emphasizing the work which they
could organize in the rural districts. In San Juan a special meet­
ing was held for girls in the upper grades.
In the larger cities conferences were held with the local health
officials and physicians. Group conferences were held with nurses
of the various baby clinics, and home visits with these nurses were
made by the eye nurse to instruct them in the care of the eyes of the
newborn. A conference on eye conditions was held with the hospital
nurses in San Juan, and the school nurses were assisted in class­
room inspection and home visiting.
At the conclusion of the campaign the National Committee for the
Prevention of Blindness reported to the Porto Rico Department of
Health the results of its observations and offered suggestions for a
program of work. From its observations and conferences with
health officers and private physicians the committee concluded that
a large proportion of the blindness on the island resulted from
remediable causes. The shortage of physicians, the fact that very
few physicians on the island have specialized in eye conditions, the
^ ery limited facilities for skilled refraction, and the general employ­
ment of ignorant midwives at childbirth are handicaps which must
be overcome if blindness is to be prevented.
The committee urged the importance of a detailed investigation
of the blind and the causes of blindness. As a remedial measure,
and one which also would yield valuable data, the committee recom­
mended a traveling eye clinic, with a staff of one oculist and two
nurses, to visit all parts of the island. Follow-up work and return
visits would be necessary, and to reach all sections of the island plans
should be made to carry on the work for at least three years.
In reference to the education of the blind the committee advised
the economy of establishing a single school for the entire island, for
which purpose sufficient land should be set aside in the beginning to
permit natural expansion, and the buildings should be planned
with a view to later additions.
B A B Y W EE K .

The first “ Baby Week ” in Porto Rico was celebrated in San Juan
January 1-7, 1922, under the general direction of the Woman’s Civic
Club, aided by the mayor and other municipal and insular officials,
the United States Army post, and many other organizations.
Early in the week the Boy Scouts canvassed the city house by
house to check up on birth registration. The general impression
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c h il d w e l f a r e




had prevailed that birth registration in San Juan was virtually com­
plete. The canvass, however, showed that about 10 per cent of the
births were not registered.
The program for the week’s celebration included “ baby Sunday,”
“ demonstration day,” “ fathers’ day,” “ little mothers’ day, “ school
day,” “ three kings’ day,” and “ mothers’ day.”
In the Sunday services the churches gave appropriate messages.
In the afternoon three special band concerts were held for children,
the United States Army band, the municipal band, and the Boys’
Charity School band playing music particularly interesting to chil­
On demonstration day the municipal theater was decorated with
posters concerning all phases of child welfare. This exhibit was
open all day and during the following days. In the afternoon was
given a program of motion pictures and talks.
On fathers’ day eight school auditoriums were used as forums
for discussion of the duties and responsibilities of fathers for the
care and education of their children. Thirty-four speakers made
addresses and 14 poets read original poems on this theme, which were
later published in the newspapers.
On the morning of little mothers’ day the high-school girls were
given a lecture—illustrated with motion pictures—on the care of
children, with particular emphasis on the care of the eyes of the
newborn and the prevention of blindness. In the afternoon demon­
strations were given in the three high schools, by a physician and a
nurse, of the proper manner of bathing and dressing a baby. Talks
were given by the physician and the supervising Red Cross nurse
on the essentials of child care.
School day was celebrated by a parade of 4,000 school children,
in which the United States Army band and other bands assisted,
and which was reviewed by the governor and other officials. The
schools competed for prizes offered by the Junior Red Cross for the
best exhibit. The children were dressed in great variety of effective
costumes and carried banners with appropriate mottoes. After the
parade addresses were given in the municipal theater.
Friday (January 6) was three kings’ day, the Porto Rican
Christmas. A committee of prominent women headed by the wife
of the mayor took charge of this day. Regular Christmas celebra­
tions were held in three districts, and candy and gifts were dis­
tributed to 3,500 children selected with the assistance of the teachers.
The final day of Baby Week was celebrated as mothers’ day. Nine
clinics for examining children were kept open that day to call the
attention of the parents and the community to the state of health
of the rising generation. For these temporary stations the United
States Army post loaned tents.
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Thirty-four physicians volunteered their services for these
stations, the Red Cross and hospitals sent nurses to assist, and many
women of the community helped with weighing and measuring the
babies and filling out the records. I t had been planned to compile
and analyze all the records taken in the various stations. However,
many of the physicians found it imperative to explain to the mothers
in careful detail the needs of the children, and this required so much
time that the records were not filled out as completely as necessary
for careful analysis.
The following figures analyzed by the physician in charge deal
with the facts as they were shown in the clinic at La Perla, a district
of San Juan situated just outside the ancient city walls. This
district has narrow streets and poor housing, but its health conditions
are greatly improved by the strong sea breeze which blows con­
tinually. At this clinic 77 children were examined, of whom 33 were
less than 1 year of age, 14 from 1 to 2 years, 25 from 2 to 5 years,
and 5 over 5 years of age. Of the children less than 1 year of age
15 were classed as well and 18 as not well; 28 were of normal weight
and 5 were under weight. Of the 18 who were classed as not well
the following conditions were indicated:
Gastrointestinal disorders.
Skin diseases____________
Glandular affections_|§_9
Malnutrition___________ |f
Nasal catarrh__________ >.
Enlarged tonsils_________
Otorrhea ________________
Pulmonary catarrh______
Pulmonary tuberculosis!!;
Whooping cough.__ ______
Inflamed navel_______ ___
Deformity of the chest__






Of the second group, between 1 and 2 years of age, 13 were
classed as not well and only 1 as well. Eight were of normal
weight and 6 under weight. As will be noted, the number of those
suffering from malnutrition was greater than in the first age group—
the result of inadequate and improper feeding.
Among the 13 children classed as not well the following defects
were found:
Skin diseases_______ ,______________ ______,_______________
Glandular affections____________ ____________________ ______
Gastrointestinal disorders__ _______ f ____ ________________
Defective tonsils_____ m l______ _________ .____ _______ $ ____
Nasal catarrh_______ L _____ ___________ ___ .___ _______ __
Rickets______________________ __________________________ 1
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In the third group, between 2 and 5 years of age, 3 children were
classed as well and 22 as not well. Twelve were of normal weight
and 13 below weight. I t will be noted that the percentage of those
under weight increased as the age increased. The following defects
w er e fo u n d :
Defective tonsils----- ----------------------------------------------------- —
Defective teeth ---------------------------------p-------- 8
Gastrointestinal disorders____________________________ 4
Defective eyes— ---------- 4:4-------- -------------- ^ ------ | y — ©---- >9
Nasal catarrh___ _________ —.— -—.-------- ife*—
— ------Grandular affections--------- ------ —^---------- ----------------------- Lung affections___ ------------------------------- ——----- —------Ear defects-- ----------------- ------ ----------- -—£m-----------— ---------Acute malnutrition----- -------- ---------—| A i — ---t— — ---------Adenoids_______________________________ - _________ —Skin diseases_________________ r .---------------------i-------- — —
Tuberculosis______________________ ____________ __________
Heart affections------------------------------j----------------- —-------------H ernial________________________
— --



In the fourth group, between 5 and 7 years of age, 1 was well and
4 were not well. One was of normal weight and 4 were under
weight. Among the 4 the following defects were found:
Defective teeth___________________________________________
Defective ears-------- .------------------— —----------------------- -------Defective lungs------------------------H ern ia------------


Acute gastrointestinal affections were found more often among the
younger children; what is an acute condition among the youngest
children develops into a chronic and less noticeable condition as
the child grows older.
At the time these examinations were made there was no epidemic
and no special diseases were prevalent which might account for the
generally poor condition of the children.
Later, after a regular health conference had been established in
La Perla, the nurses who had worked in other sections of San Juan
reported that that district had better health conditions than were
found elsewhere.

Some time ago the chief of police of Porto Rico, on the basis of
more than 10 years’ observation, estimated that there were in the
island at least 10,000 homeless children. No enumeration has been
made of such children in Porto Rico, but after checking up on the
numbers in selected districts the chief of police stated that the total
number on the island was probably at least double his original esti­
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The great mass of homeless children work as servants in private
families. Such servants are found in almost every household, and
it is only by such work that many of these children escape starvation.
The typical Porto Rican lady does not go marketing nor run her own
errands. Whether a regular servant is hired or not there is always
sure to be some child about to run errands. Largely because of the
difficulty of keeping food in a warm climate the householder buys
only enough food for the day or for one meal at a time, which neces­
sitates a constant running of errands. The child servant also
entertains and looks after the children of the family. Very seldom
are these child servants given any education. When they grow up
they are paid wages, or leave either to establish homes of their own
or to obtain paid positions as servants.
This system is partly an outgrowth of the transition from slavery,
which was abolished in Porto Rico by decree in 1873. This abolition
of slavery was brought about at the request of Porto Ricans and was
accomplished without the bitterness of any struggle. In a large
number of cases the former slaves continued to live as previously and
their children grew up loosely attached to the family of the former
In Porto Rico there is a small class of highly educated persons of
means, but the great majority of the population is very poor and
Formerly marriage fees were very high and for the mass of the
poor people legal marriage was impossible. In many cases these
people established their little homes in exactly the same way as
though legally married, but in other cases the lack of legal bpnds
has resulted in more indefinite and impermanent relationships.
Fathers have not considered themselves responsible for the support
of their children. As a rule the mothers make every effort to keep
their children together, but frequently poverty makes this impossible.
Family life has been vague and in many cases the children have been
given away to anyone who could provide food and shelter. In other
cases the children have wandered away of their own volition.

A study was undertaken of homeless boys encountered on the
streets of the three largest cities of the island—San Juan, Ponce,
and Mayaguez. A large number of these boys were interviewed and
investigated. Most of them were found to have come to the city
from the country districts. The majority had some form of home
tie, but the records taken in the study include 161 boys who were
without any protection from their families, although in only 51
cases were both of the parents known to be dead. Of these boys 87
were white and 74 were colored. Many of the boys were not certain
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as to their exact age, but their ages computed as definitely as possible
w er e a s f o llo w s :
Total___ ______________________________________________ 10 1


y e a r s ----- ------------- -----------------------^____ _______________ 26
y e a r s ----------------------- ---------- :__ ______ ________________ 30
y e a r s _________________________________________________ 21
y e a r s -------------------- _.----------------- ;________________ _
y e a r s ___________________ p |_______________ _______ ^__ 15
y e a r s _______________________________ S _ . ___ £____ ___ _ 3 1
y e a r s ________ _____ .____ *_____ ________ ,____ __________
y e a r s _____________ ___________________ M_____ 1________
y e a r s __ __________________
y e a r s ---------------------------------\__ ________ ________________

Thirty of these boys knew absolutely nothing about their parents.
They had been given away when very young and had only vague
recollections of having come to the cities from the country districts.
Eighty-five of the boys believed their mothers to be dead. Of the
mothers who were still living 6 were washerwomen, 2 were seam­
stresses, and 2 were cooks. In various instances the mother was
living with a man not the boy’s father and the boy had left home
largely for this reason.
The great majority of poor families in Porto Eico live in houses
consisting of one or two small rooms, and in these crowded condi­
tions a boy often prefers to leave his mother rather than live with
an uncongenial stepfather. As a rule the man does not assume any
responsibility for the children of previous relationships and the
boy has to provide for himself. In many instances he also has to
provide for younger brothers and sisters.
Of their fathers 30 of the boys had no knowledge, and 76 under­
stood that their fathers were dead. Among the fathers who were
known to be living were 3 farm laborers, 2 longshoremen, 2 car­
penters, 1 cigarmaker, and 3 peddlers.
Of the 161 boys in this study 38 were servants; 104 were engaged in
street trades, of whom 24 were bootblacks, 18 newsboys, 7 street
vendors, and 55 odd jobbers; 6 were farm, workers; and 13 were
engaged in miscellaneous work. The most lucrative trades in the
streets are the selling of newspapers and bootblacking. Most of the
regular bootblack salons employ only grown men. The younger boys
have small portable outfits which they carry through the streets and
into the office buildings, restaurants, and other places. Most of the
newsboys were found in San Juan. In the other cities the news­
papers were distributed chiefly to subscribers and very few were sold
on the streets. In San Juan some of the newsboys were not in busi­
ness for themselves but were paid a fixed amount by some news-stand
proprietor. The street vendors who sell sweets, gum, and other small
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articles usually are given a percentage on the sales made. In some
cases they are employed directly at a fixed daily wage. The odd
jobbers support themselves by running errands and carrying pack­
ages around town, the least profitable of the street trades.
Just how much the boys earn is difficult to state accurately, but
according to computations the boys in the street trades averaged
about 35 cents a day. Out of this small amount of money 33 of the
boys, according to their reports, contributed to the support of other
persons. Four of them were keeping younger brothers and sisters in
school, although in none of these four cases had the boy himself ever
attended school. Ten of the boys were attending school and earning
enough to cover their expenses. In many cases the earnings of the
boys were barely enough to meet their simplest needs and provide for
an occasional motion-picture show. The majority of the boys at­
tended the rear of a motion-picture theater where for 5 cents they
could see the reverse side of the screen. Since in most cases they
were unable to read, the fact that the legends were reversed was not
a matter of consequence.
Of the 161 boys whose cases were investigated 102 had never at­
tended school, 7 were attending night school, 2 were in regular day
school, and 57 had previously attended day school. The numbers who
had attained the different grades were as follows:
Total_____________ _____________ 2___I.________ 57
First grade__
Second gradeThird grade_
Fourth grade _
Fifth grade__
Seventh grade


Five years is the legal age for admission to the public schools of
Porto Rico. However, the school facilities are not adequate for all the
children who wish to enter and the preference is given to older chil­
dren. From this condition it results that in many cases the boys be­
come used to the freedom from restraint which the street offers be­
fore they have a chance to be admitted to school, and later on it is
difficult to get them to give up that freedom. The 7 boys who were
attending night school were doing so as a result of the investigation.
Among the boys investigated 106 expressed a desire to attend night
school, but the crowded conditions made it impossible for more than
7 to be enrolled. The night schools of Porto Rico are organized pri­
marily for the purpose of teaching adults the principles of reading,
writing, and civics. The courses are not designed for children, and
they do not offer much encouragement to boys who have learned the
first principles of reading and writing. The schools of the island
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have shown the greatest desire to cooperate so far as their limited
funds will permit in meeting any need of the people, and adequate
night schools for this class of boys will be established as rapidly as
possible. Most of these street boys have come to realize the great
advantage of learning English, and their eagerness for education is
noteworthy. Only four expressed a positive dislike for school.
The general living conditions of these boys were haphazard.
Thirty-nine of them were sleeping at the houses of their employers,
59 slept at the houses of friends, 3 rented rooms, 23 slept in cheap
boarding houses when they had the money to pay for such accommo­
dations, and 37 reported that they slept u anywhere.” The boys who
reported sleeping with friends—who were in most cases no better off
than the boys themselves—received merely the privilege of sleeping
in some corner of the house, which usually consisted of only one
small room. Needless to say, there was no bed for the boy, who
merely curled himself up in the corner and considered himself lucky
to sleep indoors. Although the climate is very mild and there is no
danger from snakes or animals, the Porto Rican is very reluctant
to sleep out of doors, and the gratitude of the boys for permission
to sleep on a bare wooden floor was pathetic. The family which
shelters a boy at night flas little if any control over him. Thirtyseven boys reported sleeping “ anywhere,” which means that if
they earned sufficient money to pay for a bed or for space on the
floor at some cheap rooming house they did so, otherwise they slept
at the wharves, in doorways, on park benches, or in other public
places. One boy had been sleeping for months at the railroad sta­
tion in an empty car, but a new superintendent had refused to per­
mit him to continue doing so, and the boy was at his wits’ end to
decide what to do. Another boy slept under the house of his sister,
who was a prostitute, but he seemed very grateful for this amount
of protection. Still another boy was sleeping in an automobile at a
garage through the kindness of the night watchman. In outlying
districts it is not at all uncommon for a boy to be hired to sleep in
an automobile in the open, as garage facilities are extremely limited.
The police are well acquainted with most of these homeless boys and
exercise great leniency and kindness toward them. Only 6 of the
161 boys had “ records.” Most of the boys on the streets had de­
veloped a combative spirit and were considered troublesome and
mischievous, but they had not shown vicious or destructive tendencies.
One had served a term in the reform school for petty thefts.
The city of San Juan has a small refuge for homeless boys, which
at the present time shelters 20 boys in space originally provided for
10. In Mayaguez the poorhouse extends its hospitality to all wander­
ing children. At the time of the investigation 60 girls and 30 boys
were receiving shelter in the institution and the director had ar
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ranged a classroom where some Catholic sisters were giving these
children the rudiments of reading and writing.
In their haphazard form of existence the irregularity of the boys’
meals is a matter of course* There are restaurants in the cities where
a boy can obtain rice and beans for 10 cents, and those who are able
to pay for such a meal once a day consider themselves fortunate.
A t other times they have to content themselves with very scanty
rations, often consisting of no more than a piece of bread. The
generosity of friends can always be counted upon; those who go to
friends for food will always get something, although that something
is not, m many instances, what the appetite and healthy growth of
a boy demand.
Outlines of some interesting cases of homeless boys follow:
Luis.— White. He did not know his age, but looked about 12 years old- did
not know where he was bom. He knew his mother was somewhere in a certain
inland town, but had not seen her since he was 2 months old. She had other
children. His mother had given him to his aunt and uncle when he was 2
months old, and he had lived with them until two years before the investiga­
tion, when he came to San Juan to look for work.
For awhile he had been on a coasting vessel and helped the cook around the
kitchen. But when the boat was about to go to Santo Domingo he had to leave
it, because he did not know how to get a passport and nobody was interested
in getting him one. He was fond of sea life and would have liked to go back
Luis had never gone to school. H e was very dirty, and at the time when he
was interviewed w as in the habit of sleeping in a motion-picture house.
Pepe. Colored. He did not know his age, but looked about 10 years old:
had no parents. He slept and ate with friends. He made his living by selling
newspapers, earning from 50 to 60 cents a day. This youngster did not keep
ns savings in a stocking, as is the custom among the boys, but gave his money
to a policeman, who kept it for him
Pepe had never been to school. He was very dirty and was wearing clothes
that must have been made for a boy two years his senior.
Mario. Colored. Age, 14. His mother was dead and his father was living
in another town with another woman. After his mother’s death Mario had left
home, and his sister had been placed out in a free foster home. He did odd
jobs for a living, earning about 40 cents a day. He slept in an automobile
which he was hired to look after, and ate at a restaurant. He w as dirty and in
CormeZo. Colored. Age, 13. Both parents were living. The mother had three
other children, all by different fathers. Carmelo’s father w as a carpenter and
earned good wages, but he lived with another woman and had other children
and did not contribute to the boy’s support. Carmelo had stayed in school up
to the third grade, but had been expelled. He had been arrested several times
or fighting. He earned about $7 a week and gave much of it to his mother
though he maintained a separate and independent existence.
Ramon. Colored. Age, 12. Both parents were living in another town.
Seven brothers and sisters were at home with the parents. Ramon had attended
54912°—23----- 5
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school up to the third grade and then come to the city to work. He was selling
papers, for which he was paid $8 per month and given board and room.
Ramon’s earnings went to his family, his mother buying the necessary clothes
for him.
Angel.—White. Age, 8 . Angel had come from the country with his mother
and older brother after the death of his father. The mother had found work
at a hotel, but the boys were not allowed to stay with her. Angel had gone
from house to house asking to be allowed to work for his board and room.
He was taken in by a family to run errands and entertain the children, but
was found to be too naughty and was discharged. He started the rounds a
second time to find himself another home and had succeeded for the time being.
Vietorio.—White. Age, 10. His mother had committed suicide and his father
had several other children, all by different women. Vietorio was found lead­
ing a blind woman beggar, who paid him $1 a month. He w as talkative and
gave a very picturesque description of his life, which he seemed to enjoy. He
had never been to school and did not want to go.
Alfredo.—White. Age, 12. Alfredo was one of a large family of children.
Both parents were living, but they had hookworm and were unable to work.
Following the lead of his older brother he had come to the city to work as a
servant. He stayed with an uncle for a little while and then found work
with a family who agreed to pay him $1.50 a month. Some disagreement fol­
lowed at the end of the month and he had to appeal to the police to get his
wages. He went back to his uncle and w as taken ill. When he w as able to
be about his uncle told him he could not stay in the household because it was
already too large. When the investigator found him he was aimlessly walking
around the streets, sick, hungry, dirty, and discouraged to the point of not car­
ing what might happen to him. The idea of going back to his parents did not
appeal to him.

Of the large number of homeless girls in Porto Eico almost all live
as servants in families. In many cases they are treated very kindly,
although it is seldom that these children are given any schooling.
When a baby is born it is not unusual for the family to take a child
of from 7 to 12 years of age who becomes the personal servant of the
infant, and poor families in the hills are only too glad to find homes
for their children where they can be certain the children will receive
enough to eat and a place to sleep. Girls of 6 or 7 often show a
matured sense of responsibility more pitiful than other more obvi­
ous evidence of the lack of happy carelessness in childhood. This
seems all the more remarkable when the child is underdeveloped
physically and appears even younger than she is.
Up to the present time there has been no social conscience against
this practice. In many cases the child’s services are not really needed
and she is taken into the house more in charity than for any selfish
motive. Often she is a relative of some other servant and comes be­
cause she has no other place to go. However, where servants are
cheap and plentiful duties are multiplied to fill their time, and the
household feels that it must have services which people in the States,
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in similar conditions, would not expect. To have three or four ser­
vants is not unusual for a family of moderate means. The servants’
duties are light. They often sleep in their own homes, and any occa­
sion of family illness or other need is sufficient excuse for their nonappearance at work.
Among the Porto Ricans social relations are strongly personal,
and many things are done by custom which are governed elsewhere
by legal right. Kindness and consideration, as well as all the forms
of courtesy, are the rule. However, any system under which the
welfare of children is dependent upon the kindness of persons not
legally responsible for them is liable to abuse. The problem of these
thousands of children who are kept or passed along without any
guaranty of protection is one that calls for much more consideration.
The race problem inevitably has had much to do with a careless
attitude toward the education of these child servants, almost all of
whom are of mixed blood. While Porto Rico was fortunately spared
bitterness and civil war in the freeing of its slaves, a wide gulf
has existed between the highly educated Porto Ricans of Spanish
blood and continental culture and the simple, illiterate colored
people. Toward those of mixed blood the islanders have been far
more sympathetic than the people of the States have been. They
have recognized individual merit and have accorded high honors to
many colored persons, but they have considered it not unsuitable that
the colored people should remain servants and therefore have thought
it unnecessary for them to receive education.
As education spreads responsible Porto Ricans are coming to
realize and to advocate the right of all children to the fundamentals
of education. Compulsory education is doubtless the broadest ap­
proach toward a solution of the many problems involved in the
situation; but at present education is a privilege, and not a right,
in spite of a compulsory education law enacted by the legislature.
Until sufficient funds are found to provide school facilities for all
children the compulsory education law can not be enforced.
The general education of public opinion in regard to the homeless
children is going on. The Woman’s Civic Club of San Juan, the
W. C. T. U., and other organizations are giving the matter careful
consideration, and the- large influence of former teachers among the
membership keeps education constantly in mind as the method of
solving the problem.
In addition to the general problem of these children, for whom no
one is considered responsible, there is an acute problem of delinquent
and neglected girls for whom no institutional care is provided.6
Subsequent to the investigation of homeless boys the chief of the
insular police cooperated with the Children’s Bureau in gathering
6 See p. 28.
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data concerning girls in need of institutional or other care because
of delinquency or neglect. Questionnaires were sent to all district
chiefs of police asking them to list girls who had come under their
observation as being in need of such care. Data were received con­
cerning a very large number of girls in dire need. In most cases
these girls were living with their families or relatives and their
condition was one of extreme family poverty but did not otherwise
call for change from existing living arrangements. The notations
of the district police officials showed personal knowledge and concern
and their eagerness to find some help for the children was touching.
The original lists sent by the officials were turned over to the
American Bed Cross to see if aid might not be found in individual
cases, and to be used to assist the attorney general’s office in its appeal
to the next legislature for funds for an institution for girls.
Of the larger number of forms filled out, 119 were taken as a
basis of study, as indicating the need of removal from existing
conditions. Of these girls 65 were classed as “ homeless,” “ vaga­
bonds,” or “ delinquent,” and 54 as “ servants,” but under conditions
which called for immediate change. In gathering this information
no attempt was made to draw any sharp lines between cases of
neglect and delinquency. All the girls were under 16 years of age
and all were living under conditions of extreme moral hazard. Of
the servants several had notations such as Kprostitutes ” or “ often
found on the streets at very late hours.” Some had appealed to the
police for help because of intolerable moral conditions. One girl
only 7 years old was living with three sisters, all prostitutes. One
13 years old was living in a recognized house of prostitution. One
of 8 years and another of only 4 without parents or regular abode
were classed by the police as “ moral delinquents.” Another girl of
13, who had first come to the attention of the police as a victim
of rape, was now a prostitute. Various others were listed as being
under observation for moral laxness. Twelve of the girls made
begging a regular occupation, several of them because of the illness
of a parent but under conditions which offered little hope for the
future of the child.
Of the 119 children the parents of 70 were either dead or unknown.
Eleven had both parents living and 38 had one parent, but many of
the parents living were classed as beggars or ill, and were considered
by the police a hindrance rather than a protection to the children,
Of these 119 girls 67 had never been in school, 20 had reached the
first grade, 16 the second, 7 the third, 7 the fourth, and 2 the fifth.
Two of the girls, 13 and 14 years old, were attending night school
(first grade) at the time of the investigation. The parents of both
were dead. One girl eked out a precarious existence sewing blouses
and the other lived in a family as a servant. Both were trying
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without help or guidance to lift themselves out of hopeless and
illiterate poverty, with nearly every probability against their success.
Four of the girls had police records for theft.
The ages of the girls were as follows:
4 years
6 years
7 years
8 years
9 years
10 years
1 1 years
12 y e a r s13 years
14 years
15 years






As a sidelight on the matter of homeless children, the W. C. T. U.
undertook a study on a limited scale of mothers, married or un­
married, who had been abandoned by the fathers of their children.
As has been stated, among the educated classes marriage is as
strictly observed in Porto Rico as in any other section of the United
States, but among the poor and ignorant unlegalized relationships
are common.6 In many cases these relationships are of a stable char­
acter, but in many others they are of short duration.
The “ fam ily” and the “ home” do not exist among the poorer
classes of Porto Ricans in the sense in which these terms are used
ordinarily. The degree of poverty which prevents a family from
having more than one small room, and that virtually without furni­
ture—with perhaps a hammock or a poor bed for the man, no chairs
and no other conveniences—makes of the “ home ” only a room where
the family sleeps in a mass on the floor at night. Privacy does not
exist. Life is lived on the street, and only a people of unusual
kindness and clean instincts could make of the situation one in
which sordidness was not the rule.
The lack of a feeling of responsibility for their children on the
part of the fathers is in peculiar contrast to their invariable kindness
and fondness for children. This is probably rooted in the combina­
tion of geographical and social conditions—the mild climate in
which shelter is not necessary to existence and, until recently, nature
6 The United States census of 1920 lists 48,697 men and 52,593 women as living in
consensual unions. The figures for 1910 are practically the same: Men, 50,113; women,
Federal Reserve Bank of St. Louis



supplied food without labor, circumstances relieving the parents of a
responsibility taken for granted among northern races; and the
former condition of slavery or dependence with its attendent irre­
sponsibility for self-support and its tendencies towards irregular
The mothers ordinarily take more than their share of the respon­
sibility for the children, working in the tobacco factories, washing,
sewing, cleaning, and doing other housework, when they can get
work to do. They bear the brunt of providing for the children in
the majority of cases, so that desertion by the father does not necessi­
tate so sudden a readjustment in their lives as it would if the fathers
were customarily the sole providers. When the mother is young and
has some means of earning a living the shifting of relations may not
cause physical hardships to the children, but it breaks up any rem­
nant of the care and protection of children which is associated with
any form of family life. I f the mother is no longer young and at­
tractive, or if her strength has failed, the situation often becomes
pitiful. The kindness of neighbors is extraordinary, and they will
literally share their last crust of bread,, but often they have nothing
to share. The children wander off or are given away without any
assurance that they will have care or consideration.
Determination of the cause of desertion is often very difficult, par­
ticularly if the deserted wife is the only source of information. The
prevailing opinion of the women who made this study was that the
basic trouble was economic conditions—low wages, uncertainty of
employment, and long periods of unavoidable idleness with its break­
ing up of regularity and good habits and its hardships under which
many men desert their children rather than see them suffer.
Some typical cases which help to visualize the situation are here
Concha, aged 25, married to a man 20 years older than herself, had 4 chil­
dren—9i, 8, 6J, and 5 years of age. Her husband was a clerk, employed irregu­
larly. He had deserted her a year before, after a long period of unemploy­
ment. She had no resources nor occupation; was living on the charity of
neighbors, but this could not continue indefinitely.
Carmen, aged 22, not married, had four children—aged 6, 4, 3, and 1. Her
man was a policeman, who left her to live with another woman. She worked
in the tobacco factory when there was work.
Maria,, aged 25, married 10 years before to a carpenter, had four children, of
whom only one was living. Her husband had had many affairs. He had left
her finally a year before the investigation. She supported herself by washing.
Dolores, aged 29, married to a man who worked in an office, had three chil­
dren—7, 6, and 3 years of age. Her husband had deserted her two years before.
She and her mother made blouses, and with difficulty supported the family.
The Red Cross located the man in New York, and he sent a little help. He said
he went north to get better opportunities, but had not earned enough to bring
the family north.
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Juana, aged 26, not married, had one child of 2 years, by a servant. He had
left her a year before. An aunt supported her and the baby. The man was be­
lieved to have gone to New York.
Mercedes, aged 30, not married, had three children living—15,12, and 9 years
old—and had lost four others by death. Her man was a carpenter, who worked
irregularly and gambled. At the time of the study he was living with another
woman. He contributed a little money occasionally to Mercedes, and also to
another woman besides the one with whom he was living. The oldest boy was
in the reform school.

Games and athletics, as they are known in the States, in Porto
Rico date from the American occupation. Previous to that time
sports meant horse racing, cockfighting, and other activities in which
the gambling feature was prominent.
Baseball came in with the troops and has been as popular as it
has been wherever else it has obtained a foothold. Track and field
athletics were introduced by some of the first school-teachers from
the north, and interest in them has grown steadily, although many
boys of better-class families at first felt that it was out of place for
them to take an actual physical part in strenuous contests.
A few years ago the Y. M. C. A. introduced basket ball, and this
game was played in a few of the schools. During Children’s Year
it was adopted by many more schools and for the first time made
real progress as an activity for girls. Under the direction of the
insular supervisor of home economics the home economics clubs
(numbering 68) all over the island have taken up basket ball. Here­
after as part of the course of study every girl taking home economics
will make for herself an athletic costume, which will naturally en­
courage the girls to wider participation in games. Some of the
schools have tennis courts, but this game is not practical, as few can
play at a time and the equipment is expensive. Volley ball is
played as a playground sport only, but appreciation of this game is
growing, and it will eventually take its place as a competitive sport.
Soccer football has been played to some extent, but not in the schools.
I t is doubtful if it will ever be popular, as it is too strenuous for the
Physical training and playground work were introduced in 1908.
For a time a special supervisor was employed, but the position was
eliminated in 1914. At that time there was a general impression that
a playground meant an open-air gymnasium; considerable money
was spent on swings, giant strides, seesaws, and other apparatus, but
nothing for supervision, with the result that most of the money was
wasted. In the general curtailment of appropriations in 1915 the
supervision of physical education was discontinued, but it was again
instituted in 1921.
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Prior to 1921 the possibilities of play and games without apparatus
had not been developed on the island. Although a few supervisors
and teachers had made beginnings along this line, their work had
not reached beyond their own districts. Partly because of the tropi­
cal climate and partly because of inheritance and traditions different
from those of northern races, the children of Porto Rico have played
few games. They have largely missed the play which is taken for
granted in the upbringing of the American child and which develops
health, teamwork, and the spirit of fair play.
The specialist in recreation sent to Porto Rico by the Children’s
Bureau worked with the department of education in establishing a
system of organized play in the schools. Demonstrations were given
at teachers’ institutes held in Guayama, Cabo Rojo, and Yauco, and
instructions for playground and schoolroom games, adapted to the
special needs of Porto Rico, were widely distributed. For several
months classes to teach games to the teachers of San Juan were held
weekly in the various schools. Schoolroom as well as playground
games were taught and emphasis was laid on the selection of games
as exercises in developing alertness, concentration, observation, and
similar faculties. There are no schools in Porto Rico for backward
or subnormal children. In several schools the teachers discovered
in games a means of developing backward children. The play period
has replaced an unprofitable recess time in certain* districts, and in
San Juan, Mayaguez, and Manati regular play periods have been in­
cluded in the schedule. San Juan and Mayaguez have had special
women teachers to supervise the work. Classes were started for
normal students at the University of Porto Rico, and this work was
later extended by the department of education into an intensive
summer-school course in physical training, games, and athletics for
rural teachers, principals, and physical-education instructors.
The Porto Rican teachers, already carrying a very heavy burden,
were at first reluctant to add another duty to the day’s work, but this
attitude changed after a short trial demonstrated that the playing of
games taught the children to see and hear and think more quickly
and that they carried back to their studies a new alertness. To the
pleasure of wholesome games was added the beginning of group
spirit. Discipline and attendance improved and the children ap­
proached their work with new interest.
The educational system of Porto Rico has strained to overcome the
neglect of past centuries, and academic work has necessarily absorbed
every effort. But wherever games have been introduced the children,
and the teachers and principals as well, have entered into the spirit
and have played with an eagerness surprising and touching. The
function of organised play in the schools in the transition from
the old tradition of Spanish aristocracy to that of American
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democracy—of universal participation and responsibility in com­
munity life—was immediately recognized by leading educators of
Porto Rico.
Special interest was shown in the singing games and the simpler
folk dances. The Porto Ricans are a dramatic people, and the “ play
acting” as well as the physical movement and the music makes a
strong appeal to them. Fundamentally folk-song games are founded
upon the life and spirit of a people, their customs, and their na­
tional activities. For generations Porto Rico has borrowed her
customs, her mode of dress, her music and dance from Spain and
has ignored her natural inheritance of traditions from the Indian.
Since 1898 Porto Rico has looked to the States to satisfy a longing
for national customs, and has too hastily discarded much that was
well worth preserving. Teaching Porto Ricans the traditions of
other countries was an opportunity of awakening a pride in their
own. The teachers and the children caught the spirit of the simple
Old World games. Very often a teacher or pupil would say, “ We
have something almost like that game.” Whenever a Porto Rican
version was found an effort was made to encourage its appreciation.
In addition to the woman recreation director, the Children’s Bu­
reau sent a man to assist the Porto Rico Department of Education
in raising the standards of school athletics, in promoting wider
participation, and in making these activities assist- in community
The insular department of education was encouraged to replace the
former complicated system of calisthenics in the schools with one
much simpler and calling forth' much more spontaneous activity.
Calisthenic drills have proved interesting to the parents and the gen­
eral public, and have stimulated the formation of athletic clubs and
classes for older men quite apart from the school. At Mayaguez
were held two field days, contests between different schools, in which
the most keenly contested features were competitive calisthenic ex­
hibitions participated in by all the children from each school. Simi­
lar exhibitions have been given in various towns, as, for example, at
Comerio, where on “ school day ” of “ children’s week ” an exhibition
of the “ daily dozen ” to the music of the phonograph was given by
250 children in the historic plaza.
The Boy Scout movement is a possible source of great good if it
can be properly launched and directed. Attempts have been made
to organize scout work on the island, and at one time there existed
an excellent organization centering in the Y. M. G. A. Ten or twelve
troops of scouts were organized and the boys were enthusiastic.
The Y. M. C. A., however, found itself unable to carry on the work
in addition to its regular program, and as no other organization was
found to take up the work the movement lapsed. Its influence, how
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ever, has persisted. At various times during the Children’s Year
activities former scouts offered their services. During Baby Week
in San Juan they made a house-to-house canvass of the city and its
suburbs, and collected a mass of material regarding birth registra­
tion that awakened a realization of the incompleteness of registration
under the system in use. They kept order during the parade of the
schools in which 4,000 children marched through the streets without
a teacher in line. They acted as ushers at field meets and served as
volunteer “ police ” on several occasions.
Practically nothing has been done to arouse interest in the Girl
Scout movement, except by a small group at Mayaguez.
Baseball on the island has generally been played under adverse
conditions. Before 1922 the department of education had never
taken control of school games; consequently so-called school teams
were made up largely of outsiders, and no one was responsible for
their conduct. Town or club organizations played on a semiprofes­
sional basis without any controlling body. This had resulted in
many evils, such as stopping games in the middle to save gambling
money, wholesale desertion of teams by players, throwing of games,
and all sorts of trickery and unfair practice. The particularly bad
feature of this had been that many of these teams were composed in
part of schoolboys, who acquired an entirely wrong point of view on
the whole question of athletics. A large proportion of the athletes
in the schools were playing baseball for money, and too often the
accepted standard of conduct was “ anything to win.” The depart­
ment of education through the Porto Rico Interscholastic Athletic
Association, which it controls, has made a stand against profes­
sionalism in track athletics, but has not accepted the playing of base­
ball for money as a cause for disqualification, on the ground that if
this were made a reason for barring a player there would be no track
The general standard of athletic performance has been low, for
the same reason that the athletic spirit has been of the wrong
kind—that is, lack of competent instructors. By this is meant
not only men able to teach the boys the form and technique of sports,
but men who are themselves sportsmen, able and eager to instill
into their pupils the amateur idea of playing a game for its own
sake. The only men available have been the graduates of the system
in vogue, who naturally carried it on. A few men from the States
have tried to raise the standard, and their work is gradually having
its effect. Better feeling is growing up, with games on a more
wholesome basis and with a better class of boys taking part.
The fact that there was no background of sporting tradition,
combined with the gambling atmosphere that surrounded all games,
created conditions that paralleled very closely those of a few years
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ago in some schools and colleges in the States, when star athletes
from preparatory schools were offered substantial inducements to
enter this or that college and a f* crack ” baseball or football player
could always find a convenient “ scholarship ” somewhere. Although
conditions in the States have improved greatly, there are still
enough instances of this kind to make possible an understanding
of the difficulties which the Porto Rico Department of Education
has been obliged to overcome in building up the spirit which it has
desired to establish on the island.
When the Children’s Bureau began its campaign to increase in­
terest in physical development through games and athletics the
department of education appointed 12 special instructors, who were
assigned to districts in various parts of the island. Through the
intensive work of these instructors far wider participation was
obtained during the year than was ever obtained before.
One of the greatest obstacles to the development of athletics in
the island is the lack of grounds. Porto Rico is small, densely
populated, and in some sections so hilly that it is practically im­
possible to obtain any level ground near schools. There is one
excellent athletic field in the island, at Ponce, but that needs greatly
enlarged seating capacity in order to accommodate the crowds that
are anxious to attend the field days and festivals held there. San
Juan has two tracts of land suitable for athletic fields, one belong­
ing to the city and one to the schools, which will soon be made ready
for use, and the San Juan budget for next year carries provisions
for playgrounds in connection with six of the schools. Mayaguez,
Caguas, Fajardo, Humacao, and Rio Grande have athletic fields
ample for their needs, all but that of Mayaguez having been obtained
during Children’s Year. Yauco has obtained land, which will
soon be put into condition. Plans are under way for establishing
in Arecibo a field larger and better equipped than any other on the
island, a gift from a prominent citizen to the children of the city.
Manati has acquired a field. Isabela and Quebradillas at present
have the use of vacant land, and may be able to continue on the
same basis. An excellent field in Catano, between San Juan and
Bayamon, used occasionally for professional sports, is to be given
for the use of the schools. In addition, many smaller playgrounds
have recently been acquired. The special attention which has been
given by the department of education to the physical development
of children has met with generous response on the part of publicspirited citizens, who have donated land or given the use of it to
the schools, and have assisted in paying for necessary grading and
the building of fences and grandstands. Many of the rural schools
use the roads for playgrounds if there is little traffic, but the difficulty
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of obtaining adequate space is very real and its solution will require
much work and money and no little time.
As a means of promoting better understanding and of increasing
interest local athletic associations were formed during Children’s
Year in 29 towns and districts. The exact form of organization
varies according to local conditions, but the general rule of giving
the pupils of the schools a certain amount of responsibility and initi­
ative has been followed throughout. In some districts one associa­
tion has been formed, in others a separate one in each school; in
others a high-school association exists in addition to the general
organization. In some towns, regular meetings of the high-school
associations have been conducted in English, and the scope of
activities has not been confined to athletics but has taken on a more
general character, the athletic association serving as an additional
opportunity of practicing English. A number of the associations
have promoted entertainments to raise money for the purchase of
equipment and for other needs, and have developed into more general
community clubs.
During Children’s Year hundreds of games of baseball and basket­
ball were played by the school children. In the larger towns every
school had its team, and in many of the schools each class, also, had
its own team. This meant the participation of thousands of boys,
instead of the very limited participation of previous years. Permis­
sion to play on teams was made dependent on satisfactory school
work, and the teachers found this feature a decided help in the gen­
eral conduct of their classes.
The annual interscholastic track and field meet for the champion­
ship of Porto Rico was held in Ponce at the end of March. Nearly
500 boys, from every district of the island, took part—an entry list
double that of any previous field meet in Porto Rico. The contests
consisted of the events customarily scheduled in interscholastic track
meets in the States. Baseball, girls’ basket-ball, and boys’ basket­
ball championships were played off at the same time. Considering
the handicaps, the standard of performance was excellent. Porto
Rico will undoubtedly make a place for itself in national competition
in the very near future.
During the spring of 1922 the Y. M. C. A. conducted a series of
basket-ball games to determine the championship of San Juan. The
teams competing were composed largely of men from the States,
Army men, and ex-college players, but the winning team, it is inter­
esting to note, was made up entirely of Porto Ricans, and the San
Juan High School team, the lightest and youngest of the teams, fin­
ished in third place. This series led to greatly increased interest in
the game among the schoolboys, and it is certain that as a result
there will be much more basket ball in the schools hereafter.
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Some of the men on the island most interested in baseball are now
trying to create a controlling body to take charge of professional base­
ball. This would result in keeping the schoolboys from mixing with
the professionals. Also the Porto Rico Interscholastic Athletic As­
sociation under its new constitution will prohibit the boys from play­
ing club baseball. However, unless rectified, the bad influence of the
present professional system will continue. I t will be hard to raise
the standards of the boys’ teams if they see all manner of unsports­
manlike practices followed by the outside clubs. Any responsible
controlling body which will force the players to keep their engage­
ments, and prevent throwing of games, mobbing of Umpires, and dis­
putes over gate receipts, will be a great help to the men who are try ­
ing to raise standards among the boys.
The Y. M. C. A. is planning to organize a body comparable to the
Amateur Athletic Union, which will register all amateur athletes in
the island and conduct track meets and other contests. In connection
with this they will, if possible, organize an association of officials, to
bring together all men who are capable of acting as baseball umpires,
basket-ball referees, and track officials. In view of the need of good
officials, this will be a great help to better sport. The plan is not only
to make use of all present officials but to develop new men to take up
the work.
What is needed in Porto Rico to bring games and athletics to their
point of greatest service in the development of the people is more ade­
quate control and direction by the department of education and
better training of instructors. To meet both these needs the depart­
ment has taken important steps.
Under the provisions of the constitution of the Porto Rico Inter­
scholastic Athletic Association, as recently rewritten, all athletics are
directly controlled by the department of education, which does away
with the irregularities that have existed with respect to baseball. The
rules regarding professionalism and scholarship requirements are
made much more stringent and their enforcement is made easier. A
new system of grouping the schools into classes will be used by which
competition will be equalized and a much larger participation will be
The question of instructors is receiving serious attention. A course
was given at the summer school of the University of Porto Rico for
the benefit of men wishing to qualify as instructors of physical
training. Not only students desirous of devoting themselves entirely
to this work but all those in the summer school were admitted to this
course, which thus reached a large number of the rural teachers.
The rural schools have the greatest need of this work; whatever will
bring physical training to rural children will reach a field hitherto
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The department has funds to pay only 12 to 15 special teachers of
physical education, but many municipalities are willing to pay part
of a teacher’s salary for this work. These special teachers have in
many instances been mistakenly regarded as coaches paid to train
track, baseball, or basket-ball teams, and some of them have done prac­
tically nothing else. This has been partly the fault of the instructors,
who thought their work would be judged solely on the showing that
the teams made in contests, and partly the fault of their supervisors,
who encouraged them in this attitude. The course at the normal
school was designed to make them realize that the pupils who really
need their attention are not the athletes but the nonathletes, and that
the main task of the instructor is to obtain universal participation
in activities which will add to the health and education of all the
children and promote community well-being.
The new constitution of the athletic association provides for com­
petition among pupils in the lower grades and in the rural schools,
who so far have been overlooked. During Children’s Year a begins
ning was made toward conducting athletic games for the rural
schools. In Isabela an interesting program of games was held at the
time of the annual agricultural exhibit. Six rural schools sent track
teams, and two others were represented by baseball teams. Another
rural-school field meet was held in Ponce, in which 46 rural schools
took part. Over 150 boys participated, and 15 different teams suc­
ceeded in scoring points. The interest in this track meet was re­
markable; hundreds of people from the country filled the grand­
stand, and for the first time in their lives saw their boys running and
jumping and playing games in competition. Some of these people,
and some of the participants as well, had walked as far as 15 miles
in order to be present, and had to walk home afterwards.
In the development of rural-school meets it will probably be best
to modify the events, substituting informal and amusing “ stunts ”
for certain contests, such as pole vaulting, which require a high de­
gree of technical skill.
A rural baseball series was later held in the Ponce district in
which 12 teams were entered, a notable showing considering the diffi­
culties ; not one of these schools had a baseball ground, and the boys
practiced on the roads and in rough fields, with only the most primi­
tive equipment.
This eager participation by the children of the rural schools in
games and contests, and their willingness to make sacrifices in order
to take part, refute the careless and sweeping statements sometimes
made as to their indolence and lack of interest in wholesome recrea­
tion. They have been handicapped by the lack of facilities as well
as by the long-time tradition against group activities, but with only
slight encouragement they have made rapid strides toward over­
coming these disadvantages.
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In the spring of 1923 the Children’s Bureau made a brief follow­
up study of conditions in Porto Rico, which showed that the childwelfare activities initiated during the previous year had gone forward
in a most encouraging manner. Play and athletics had been given
greater importance throughout the school system, and the training
of teachers in play had established those activities upon a firm founda­
tion. Classes in organized play were again given for the teachers
of San Juan and Santurce. Their work with the children had been
greatly strengthened, and the benefits of organized play periods
had completely overcome the first difficulties of adding to a schedule
of work already crowded. A Manual of Games prepared by the bu­
reau for use in Porto Rico was distributed through the Porto Rico
Department of Education to all the grade teachers on the island,
giving instructions, programs of games, and suggestions which have
made the work of the teachers more definite. The general increase
in play activities throughout the island is indicated by the statement
of the commissioner of education in his annual report for 1922, that
within that year the number of urban school playgrounds increased
from 50 to 179 and that of rural school playgrounds from 16 to 261,
the number of municipalities having community playgrounds from
4 to 18, and the number of recreation and athletic associations from
15 to 39.
Participation in athletics has increased very much in the last year.
The number of entries for the annual field meet, which in 1922 was
double that of any preceding year, again doubled in 1923, necessitat­
ing the division of the meet into three sections. Participation in
baseball and basket ball was increased fully as much.
The 1923 session of the legislature created a bureau of social
welfare under the Porto Rico Department of Health, with an ap­
propriation of $60,000, and with provision for flexibility in develop­
ing this work. This bureau will have supervision of public health,
infant hygiene, and charities, the last having been delegated to the
health department by the organic act. Two years ago the supervision
of municipal charities was brought under the Porto Rico Department
of Health, but without adequate means for carrying out the work.
With the means now provided, great progress should be made in the
near future. During the last year the number of child-health centers
established by the insular and municipal departments of health
working in cooperation with the Red Cross has been increased, their
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service has been strengthened, and public interest in their work has
become widespread. The program of Baby Weeks has been con­
tinued, and an institute on infant welfare and other aspects of public
health has been conducted most successfully.
The 1923 legislature also appropriated $50,000 for a training school
for nurses in connection with the Municipal Hospital of San Juan,
under the insular department of health, and accepted the cooperation
of the Red Cross in providing the supervising staff of the school.
A t the present time public-health work is held back by the lack of
an adequate number of trained nurses, and this provision for in­
creasing the number of nurses and raising the general standards of
nursing is of basic importance to the development of all health work
on the island.
The 1923 legislature also provided $60,000 for the establishment of
an insular puericultural and maternity institute for promoting the
hygiene of maternity and infancy. The institute is to have consulta­
tion centers for expectant mothers and for children, besides hospital
facilities for women during confinement.
During the last year the United States Public Health Service
made a survey of tuberculosis in Porto Rico, working in connection
with the insular department of health so that the most practical
benefits might be achieved from its study. The findings of the
survey have called further attention to the need of general education
toward better standards of sanitation, diet, and housing. A health
crusade has been started in the schools to emphasize these aspects of
health conditions.
The summer courses at the University of Porto Rico in home
hygiene and the care of the sick were continued, with special
emphasis on infant and child care. These courses were given to the
home-economics teachers of the island, and it is planned to have a
supervising nurse go over the island during the next school year
to strengthen the class work on these subjects.
During the regular term of the university an experimental course
in social service was offered. Lectures were given by persons rep­
resenting the various social activities so far developed, and supervised
field work was planned. The first half of the course was required
and the second was elective, but no falling off in attendance oc­
curred after the required period was completed.
The dental clinics supported by the Junior Red Cross and the
municipalities have been increased in number and have adopted
standard forms and methods. Health teaching has been continued
in the schools. The school for the blind has been moved to larger
and better quarters pending the completion of a new building, and
another assistant trained in the States has been added to the staff.
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In the difficult period of transition, the fostering of wholesome
recreation is most important. To further the program of health and
social progress for girls, the department of education is cooperat­
ing with the Girl Scouts. The Girl Scouts are now giving special
training to an organizer who will work through the school system
in developing scout work for girls.
In the homeless boys of San Juan the business men’s organizations
have shown a continuing interest. They have raised several thou­
sand dollars for constructive work for these handicapped children.

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