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THE HEALTH OF THE CITIES

By

F. C. WALSH. M. D.

SUPPOSE little Johnny, your sole son and heir, were taken desperately ill in the middle of the night. "Never mind, dear," you say, to quiet the mother's alarm. "Don't be frightened. I'll send across the street for Jones, the cigar-maker. He's a good fellow, a hard party worker, controls the Third Ward."

Or suppose several members of your family successively come down with typhoid. With astonishing perspicacity you begin to suspect that sanitary conditions are bad. Send for the amiable cigar-maker again! Turn the situation over to him!

Idiotic! Of course. But what no sane individual would dream of doing a city of 50,000 presumably intelligent people actually did! They hired a cigar-maker to see that they were protected from the ravages of measles, diphtheria, typhoid, small-pox and tuberculosis! Inevitably the death-rate was needlessly and wickedly high. Hundreds of little children, adult men and women in their prime, were sacrificed to the common stupidity and ignorance.

The city which put a cigar-maker in charge of its health department was Springfield, capital of the great state of Illinois.

But Springfield's citizens were no more open to blame,—nor was the unfortunate cigar-maker, — than are thousands of others who are living in a state of dangerous bliss in various cities scattered throughout our country. Those worthy citizens of the Illinois city didn't know that anything was especially wrong; no one had taken the trouble to arouse them to a knowledge of their plight, and the instance is here used merely as a horrible example.

One main trouble with Springfield was

that it had never thought it necessary to have a medical man in charge of its health-office. Of course it would have been very much surprised indeed if a cigar-maker had been forced on its shoulders to occupy, say, the position of city attorney. That would have been a bitter pill,—or a "horse of another color," as the Cigar-Maker City Doctor might have aptly said, for he was a "good-fellow," and as wise as the average of his kind. Before he took office the death-rate was high; after he entered on his professional duties it continued to soar, with an alarming number of cases and deaths due especially to typhoid,—but still no one so much as dreamed that anything was different from what it should be; everybody was used to it, and the city slept! No, one man was awake, though he has little to do with this story. In talking to me about the situation, he told me he thought it was all due to some peculiar, local, climatic influence! I don't know what his condition was, but I will say right here that Springfield's deplorable plight was largely due to the three most baneful influences of American city life,—ignorance, self-satisfaction, and politics!

Springfield has come to its senses, but its story is well worth following a little further as an illustration of what may and does occur in almost any one of our cities, from the metropolis down to the remotest of villages. But to continue, Springfield was sleeping. And then, somehow or other, by one of those rare chances of fortune, a medical man happened to be appointed to look after the city's health. There was much to be done besides mere drawing a salary; the situation required a good deal of head-work and the bringing to bear of expert knowledge. The appointive Power recognized this by making the salary of its first and only medical .health-officer equal to that

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of the police patrolman, who measured up to his office by sheer weight in pounds avoirdupois, and the requisite height when measured in his stocking feet!

But this new health-officer, this man who made the story of Springfield worth telling, went to work at once systematically, not knowing, however, just what he was going to find, and he himself was the first to awaken to the real truth of the situation.

He first turned his attention to the city's water-supply, and found it good. There was no typhoid from that source. Then he did something which no one before had thought of, and certainly the cigar-maker would have required more than the inspiration of a good Havana if he were ever to think of such a thing. With untiring patience he carefully plotted out on a map the location and source of water-supply of every house in Springfield, and then began to work on the resulting figures. The consequences were startling and of tremendous importance to at least two-thirds of the city's dwellers. City officials, and others who were supposed to know, had long thought that about seventy per cent of S p r i n gfield's dwelli n g s obtained their water from the city's source of supply, and that about— be it understood, — the same per cent of houses were connected wi th the city's system of sewage. For years they had been harboring this delusion. But the facts fell wildly short of this vague

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One of numerous helpful bulletins issued by Chicago's City Health

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estimate, and that's an important point, for instead of seventy per cent using city water, it was found that two-thirds of the dwellings used water from weHs on or near their own premises, and instead of sewage connections, it was learned that these two-thirds were making use of obnoxious cess-pools. The taxpayers had put in a system of water and sewage at a cost of $400,000, and only one-third of the population was profiting from this outlay! But this is a health story, and we must come to the point. It was quickly discovered that a large proportion of these cess-pools were contaminated with typhoid, and, horrible fact, were draining into adjoining private wells!

This condition had evidently existed for years, unknown to any one, and Springfield was properly shocked when the facts became known. But the source of the high annual death-rate was explained, and action was taken to remedy the malodorous conditions as quickly as possible.

But to their credit be it said, the people of Springfield did not try. to hide this blot on their 'scutcheon; on the contrary,

they acknowledged their negligence, voted thanks to the man who revealed the ob j ectionable conditions, and were glad to know where their weakness lay. As a consequence of this awakening from a long sleep, the deathrate has diminished to a surprising extent, and the city has become alive to other health needs.

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But no city should rest satisfied with merely reducing the deaths due to any one disease; all preventable diseases should be prevented in actual fact as well as in fine-spun theory. In other words, there is no excuse nowadays for a city's population being afflicted with epidemics like diphtheria or typhoid. And yet Chicago, as an instance, had 792 deaths from diphtheria for the year 1911. Could these deaths have been prevented? Undoubtedly, if antitoxin could have been administered on the first day of the disease. The effectiveness of this remedy was proven by the records of the Philadelphia Hospital for Contagious Diseases from 1904 to 1910. During that time antitoxin was administered to 256 on the first day of the disease. All recovered! Why can't Chicago, why cannot other cities, show results as brilliant as this Philadelphia record?

The obstacles are many. The people themselves are often to blame, either through ignorance or a lack of interest in their own welfare, or both. Then again, health-officers, even medical ones, are occasionally incompetent, and sometimes gain office through skill in politics, while the funds at the disposal of the worthy ones are far too often sadly insufficient. We will pay for police protection; we will perhaps more gladly pay for fire protection; but we—or is it our neighbor—seem to have a natural aversion to pay for health protection. It resolves itself into this: rather than pay a little bit more, or urge the officials to

appropriate a little bit more toward the health fund, the average American prefers to run the risk of contracting a contagious disease. But does he? Is not this rather perplexing question made more perplexing by that familiar monster, rotten politics? Why else do the mayors of our cities, in such a majority of instances, refuse sufficient appropriations? Is it because they are pledged by tradition to look after job-seekers, and by past customs in politics they are bound to find places on the pay rolls of the police and fire departments for the friends of influential henchmen? Perhaps no,— perhaps yes! At any rate, according to a bulletin recently issued by the government, the appropriations for forty-seven cities were as follows:

No. Amt.

rmployed. appropriation.

Firemen 4,899 $4,632,497

Policemen 4.822 4,262,322

Health Inspectors.. 247 842,842

These figures tell their own story, and show the relative importance the average city official places on property protection as compared with health protection. These figures are the total of forty-seven cities with a population of between 50,000 and 100,000 each.

In Chicago medical inspectors receive $66.66 a month, while the salary of a police patrolman is $1,320 a year. The salaries of plumbing inspectors were recently raised from $1,440 to $1,716 a year. The hundred or more medical inspectors petitioned a short time ago for a raise from $66.66 to $88.88 a month, and a rumor got afloat that they would strike if they did not receive the raise. This rumor reached the ears of Mayor Harrison. "Let them strike," he is reported

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to have said, "these positions were created for medical students just starting out. No one supposes that the positions are high salaried ones, and no one supposes that a doctor who can't make more than $66 a month is much of a physician." By the same token apprentices should suffice for plumbing inspection! But the mayor's remark would seem to indicate that a city's health was not of sufficient importance to pay more and get better men. Perhaps that attitude of mind explains the 792 deaths from diphtheria in Chicago for the year 1911. The fact is that an epidemic of diphtheria was raging in Chicago at the time the alleged remark was made!

And yet hundreds of thousands of lives and millions of money could be saved every year by attacking disease on scientific principles. Millions of money! Just so, for disease is expensive, not only to the individual, but to the city and state as well. We are compelled to take care of the sick and indigent after they have become diseased and helpless ; we are not unwilling to build hospitals and asylums for the insane and incurable; but,— strange fact—we do not like to spend sufficient money to keep them out of these places by averting disease by proper public health precautions. We are liberal enough after the horse is stolen, but too cheap by far to buy a lock before the deed is done. Health can be counted in dollars and cents, if it must be counted in that way.

Money still talks. Show a man how to save his health and he is apt to turn a deaf ear; show him how to save a dollar and watch him listen. Mr. Brandeis recently showed the railroads how they could save millions of dollars a day, and the world sat up and took notice; another man, in the name of that magic word,— Efficiency, told us a short time ago how we could make one brick-layer do the work of two, and everybody but the brick-layer threw his hat in the air. But how are we going to make a man efficient if he is half-sick half of the time? Won't this half-time sickness just about discount his newly discovered double-efficiency? If we must have efficiency,

well and good, but let us be sensible about it and begin at the bottom of things, for the shortest road to efficiency is good health, and it is the duty of city and state to conserve that.

To what extent are the cities making good in this respect? Let us take the matter of pure food,—the subject is not yet a dead issue! For in spite of the protection which the pure food law is supposed to exercise over the welfare of the people, conditions relating to it are far from perfect. Many big companies have been fined during the past year for comparatively slight offenses. But it is not always the big fellows who are the most guilty. The littie fellow is harder to watch, and his offense is often more serious. Sometimes he is able to evade the law. And so it follows, that if the big fellow is a national problem, the lesser one is more often than not a problem to be solved by the city itself.

As there were more violations of the Federal food law in Illinois than in any other state during the past year, Illinois' chief city is therefore selected to illustrate the smaller offender. Chicago contains manufactories whose deplorable condition is almost unbelievable, and there is plenty of authority for any presentation of examples in this regard. John B. Newman, assistant food commissioner for Illinois, had the following to say in recently commenting on the situation: "In the Greek district of Chicago a dealer sells cotton-seed oil for olive oil. In the Greek language he calls it olive oil. In English he labels it correctly, because his Greek customers cannot

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A Series Op Warnings To Parents.

Suggestive measures to prevent blindness, preserve health and save lives.

THERE'S DEATH IN THE DIRTY BOTTLE

oT table km been killed throcgh the use of dirty bottles

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Pointers About The Baby's Bottle:

Flrat: Get the right kind of a bottle—one without a tube, one easily washed. The best kind is one with large opening at top, the removable rubber cap and nipple forming the top of the bottle.

Second: Keep the bottle and nipple very clean. After each feeding remove the nipple and boil both bottle and nipple for ten minutes. Before using again rinse the bottle and nipple in boiled water— about a quart of water in which a teaspoonful of baking soda has been dissolved—or keep them in a pan of water containing a little soda when Dot in use

Parents Are Beginning To Heed This Hint.

read the language. Thus he complies with the law and fools the Greeks." But the following is a far more serious offense. "We visited a mince-meat factory," he said, "and found that the only ingredients were currants, apple-peelings and suet. The currants were kept in bins alive with white worms. We asked the manufacturer how he got rid of the worms. He said he soaked the currants in boiling water and that the worms came to the top and were skimmed off." In another instance the inspectors went to a tomato factory where catsup was made. They found that the stuff was composed of tomato pulp, apple-peelings and water, the bulk of which was soaked up with

corn meal, and the whole mess preserved with benzoate of soda. The dirt over the entire floor of this factory was an inch and a half thick!

The city of Boston recently lost a case in the courts in which it was trying to enforce a very good ordinance in favor of pure milk. As a result of this adverse decision, Bostonian babes yet unborn will lose their lives through feeding on filthy milk, laden with tubercular and other death-dealing germs, while even adults will swell the death list as victims of typhoid. This is an instance in which flimsy laws often work against the greater good.

Corrupt political influence also shows its evil claws in this problem of the health of the cities. It has no respect for such sacred matters as life and death. In St. Paul, for example, this ghoulish influence has permitted dairies condemned by the health department to continue in business, unrestrained and unmolested. And in the same city this familiar disintegrating force has more than once retarded legislation which would have secured for the people more favorable sanitary conditions. Not long ago an ordinance for bottled milk was agitated. The health of the city would have gained by its passage. But the health of the many was permitted to continue endangered by the interests of the few,—namely, the milk-venders. In the opinion of the health-commissioner, the passage of the ordinance was hindered by unfavorable political influence. "Of course," he remarked, in speaking on the subject, "bottling dirty milk does not make it clean; but bottling clean milk does keep it clean and removes the great danger of contamination by handling after it leaves the dairy, and even bottling of filthy milk prevents it from

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