and their condition ascertained. Tenement conditions in many instances have been found to be so bad as to be indescribable in print; vile privies and vile sinks; foul cellars full of rubbish, in many cases of garbage and decomposing fecal matter; dilapidated and dangerous stairs; plumbing pipes containing large holes emitting sewer gas throughout the houses; rooms so dark that one cannot see the people in them; cellars occupied as sleeping places; dangerous bakeries without proper protection in case of fire; pigs, goats, horses and other animals kept in cellars; dangerous old fire traps without fire escapes; disease-breeding rags and junk s ɔred in tenement houses; halls kept dark at night, endangering the lives and safety of the occupants; buildings without adequate water supply the list might be added to almost indefinitely.

before the

The cleansing of the Augean stables was a small task compared The task to the cleansing of New York's 82,000 tenement houses, occupied department. by nearly three millions of people, representing every nationality and every degree in the social scale. The task that confronted the department was not, however, limited to this. Without organization, without employees, with all its problems before it, it was on the very day that it came into existence confronted with an organized and vigorous attack in the Legislature upon the fundamental principles of the law for whose enforcement it was created. Without previous records, with almost no information in regard to the condition of the existing tenement houses, it was called upon to carry out an important and far-reaching scheme for their improvement, involving the structural alteration of over 40,000 buildings.

ment of a

force.

In the period under consideration in this report a new branch The developof the city government has been organized, its machinery created and a force of about 400 employees trained, disciplined and educated; far-reaching and important advances in legislation have been secured as a result of the department's action, and radical and vicious attempts to break down the tenement laws defeated. Living accommodations for 16,768 families, or 83,840 persons,

complished.

Reforms ac have been provided in sanitary, comfortable, and decent houses, each one of which has been built according to law: notorious evasion of and non-compliance with the laws has given place to their complete, uniform and impartial enforcement; the evil of prostitution has been practically abolished in the tenement houses; 337,246 inspections have been made; 55,055 violations filed; 21,584 repairs made to plumbing; 13,617 water-closets cleaned; 11,611 accumulations of filth removed from cellars and other parts of such buildings; 13,732 ceilings cleaned; 15,364 walls cleaned; 10,060 unsafe wooden floors removed from fire escapes and new iron floors substituted; 1,701 fire escapes erected on buildings that before were without this protection.

Registration of owners.

Results of the work.

The registration of 44,500 owners' names has been secured, thus fixing the responsibility for bad conditions in the tenements; contagious disease has been checked and prevented; 32,825 citizens' complaints have been investigated and the conditions complained of remedied; and an important tabulation and presentation of the population in every tenement house block in the Borough of Manhattan has been prepared that will be of incalculable value to the city.

The existing tenement houses have been frequently and systematically inspected; foul cellars have had the accumulated filth of years removed; defective and unsanitary plumbing which had apparently existed for long periods has been remedied; houses unfit for human habitation vacated; hundreds of houses have been radically reconstructed and improved; light has been let into dark rooms; vile yard privies and privy sinks have been removed and the whole sanitary condition of the city raised to a higher standard. The results of this work are clearly reflected in the reduced death rate, which in 1902 was 18.7 as compared with 20.0 in 1901, and in the first eight months of 1903 has been reduced to 18.0.

211. The Health Department of a City *

Some notion of the multifarious activities of a municipal health bureau can be gathered from this extract from a recent departmental report published by the City of Cleveland, Ohio:

of the milk

supply.

There are about 3,500 farms which furnish milk for Cleveland. Supervision Since the establishment of dairy inspection last August to the end of the year 630 dairies have been inspected and scored according to the direction and on the score cards used by the Department of Agriculture. The average score was 44 points, which means a farm that ought not to be allowed to send milk to Cleveland. The number of cows which furnish milk to Cleveland is estimated at about 30,000; 427 have been tested with tuberculin and 109 of these or 25.52 per cent reacted, were killed and shown by post mortem to have been tubercular. If this ratio should hold then 7,656 tubercular cows are furnishing milk to the Cleveland market at the present date. The danger is obvious. How to avert it? If we average a cow at forty dollars, it would take $306,240.00 to pay for all these cows and to get rid of them. The sum is not so large as to make the solution of the problem an impossibility.

In the great struggle with tuberculosis which is going on now The fight all over the civilized world, Cleveland is not behind time. The city tuberculosis against possesses a sanitarium on the City Hospital grounds and another in Warrensville. Both are of the approved type of modern structures, especially designed for the treatment of this disease. Without them we would be greatly handicapped in our efforts to retrench the ravages of the White Plague. The more patients can be induced to seek treatment in them, the better it will be for both patients and city. The patients' chances for recovery are greatly enhanced. They are kept in pure air day and night and learn, in a practical way, how to take care of the sputum lest they become dangerous to their fellow men. The city is delivered from a continual source of infection, the family receiving the greatest benefit. The money spent for the maintenance of these hospitals is a

Clinics for the poor.

The economic advantage of the fight.

The de

mand for a contagious disease

hospital.

good investment. The amount of danger taken and kept away from all citizens is incalculable. The educational feature of these institutions is not the least important, for the practical demonstration of the need of precaution and how to take it to avoid selfinfection and infection of others is most fruitful of beneficial results.

As not all tubercular patients can go to the hospitals, clinics become a necessity for the care of the poor unfortunates who must stay in the harness as long as there is an atom of strength left in them. These clinics should be held at convenient hours so that the patients can come to them in the mornings before they go to work and in the evening after their day's labor is over. As long as these poor people, in their very infirmity, which was brought upon them without any fault of their own, strive to the utmost to take care of themselves and their families, the benevolent attention of the community must keep a watchful eye over them. To stretch out a helping hand to them is not an act of charity but the mandate of duty.

Then the economical side has to be considered: Keep these people self-supporting and we accomplish a great deal. Last, not least, is the sanitary aspect. If we could get hold of all our poor tubercular and instruct them how to live in order to regain the road to health, what a blessing we could bestow upon them. If we could prevail upon them to be careful with their sputum, what a danger we could take away from their families, their coworkers and the citizens in general. Just to help these poor people along, who have to work, but on account of their physical weakness are not able to earn enough wages to consult a physician, I established a tubercular clinic in the City Infirmary Office, spending out of my office hours from two to three hours daily in examining and treating patients.

The necessity of a contagious disease hospital becomes every year more apparent. If we should have an epidemic of scarlet fever or diphtheria, forced hospitalization of patients would frequently become necessary, as it is impossible to keep an infected

family in a crowded tenement house strictly isolated. In New York City all such cases are taken to the hospital, by force if necessary. In Chicago they just passed through a serious outbreak of scarlet fever, having as many as sixteen hundred cases a week. The disease did not come on suddenly. It developed rather slowly, and the health officials informed me that the lack of a hospital for contagious diseases was one of the main factors in its spreading. The Cook County Hospital took as many patients from the city as it could, but it was soon filled up and every case had to be left where it developed. That was the way the disease got beyond control. In Cleveland we have no county hospital. We have practically nothing. In case of an epidemic we would be in a deplorable state and would be criticized by the whole United States, and justly so. The erection of a contagious disease hospital ought not to be delayed another season.

street cars.

People do not crowd because they like to, they crowd because Crowded they have to in order to reach their destination. The problem cannot be solved by preventing people from boarding an already filled car, but by putting more cars on the tracks. There have never been enough cars running during the so-called crowded hours to convey all passengers in a decent way. This can be shown by a very little figuring. In the morning people have to reach their work at the appointed hours and the tendency of people to hurry home after their day's work is done is laudable and needs encouraging rather than checking. I do not think it would be wise to prevent people from boarding cars and to make them wait for hours around the cold street corners without protection from rain and snow. The city must ultimately force the street car management to keep up with the growth of the city in number of lines and cars needed for the sanitary conveyance of the passengers.

212. Municipal Parks*

The way in which a modern city attempts to provide healthful recreation for the people is illustrated by this statement recently made by the director of parks in Cleveland, Ohio: