[Illustration: (By permission of the Pittsburgh Bureau of Health).
WHERE HUMAN LIFE IS CHEAP.] alleviate such a status? Nothing:
the problem is too big for official solution. Either a sense of
responsibility on the part of the mill owner toward his employes
who must live near the mills will start a housing movement that
will do away with the present outrageous rentals for disgraceful
accommodations, or an aroused public conscience will, by one means
or another, make a clean sweep of these pest holes. Or, a third, and
ugly alternative. London's East End is open for the inspection of
travelling Pittsburghers. There they may see in its fullness the crop
of pauperism, dependence, and degeneracy which is bred in the third and
fourth generations, of conditions no worse than their own average, and
not so bad as their own worst.
As an escape from the slum there is the school. Here again Pittsburgh
is in the dark ages of hygiene. Every public school is a law unto
itself. The principal, always a layman, and not unusually an ignorant
one in health matters, decides when a pupil shall be isolated for a
contagious or suspicious ailment. Is it surprising that a short time
ago a certain skin disease infected an entire institution, or that eye
and scalp ailments are often widely diffused among the scholars? From
an inspection of buildings and pupils Dr. Goler draws these conclusions:
The school buildings are in many cases crowded, dark, dirty,
often of three stories, and bad fire risks. The condition of
the children in these schools good and bad, rich and poor,
may be shown by the large proportion having defective teeth,
reduced hearing, imperfect vision. An excessively large number
of them are mouth breathers, partially so because they are
unable to breathe through their noses in the smoky air of
Pittsburgh, and a very considerable number are below stature
for weight of that determined for the average child. In a large
percentage, the defects of teeth, nose and throat, bring them
below the physical normal. These are the children that wear out
in childhood.
[Illustration: PSEUDO-RELIGIOUS 10-CENT LODGING HOUSE.
In cellar of river-front building; flooded out every year. Dilapidated,
unsanitary and unventilated, this and similar lodging houses were
breeding place of disease. Closed by Bureau of Health, following
investigation and report for Pittsburgh Survey, by James Forbes,
mendicancy expert of the New York Charity Organization Society. A
lodging house code has since been established.]
In no manner of justice, can the Bureau of Health be held to account
in this matter. In co-operation with the Civic Club, settlements,
physicians and school principals, Dr. Edwards sought to establish a
medical inspection of public schools, such an inspection as would,
for example, undoubtedly have checked almost at its inception the
disastrous onset of measles of last year. But the measure never got
past the legal department of the city administration. In view of the
present conditions in the schools, Dr. Goler's closing and pregnant
suggestion has a special force:
_"Ought not the Pittsburgh schools to be closed and the
children repaired?"_
Semi-public institutions in Pittsburgh are quite independent of
hygienic control or inspection. This seems to me one of the crying
evils of the present status. Let me give a few examples: An inmate
of an institution for children was infected by another child who had
virulent skin disease and soon afterward he became totally blind. This
was a repetition of a past experience of the same institution in which
a child contracted trachoma within the institution walls, is totally
blind in consequence and a charge upon the state.
Last spring an institution was found in charge of a matron whose
special qualification for her care of very young children was
experience. She had had ten of her own, all of whom died of intestinal
disease and rickets in early childhood. She was feeding the little ones
in her care on coffee and other food suited only to robust grownups.
Every child in a certain charitable institution, a short time ago,
was suffering from skin and scalp disease. Lack of arrangements for
effective isolation, in case of contagious disease, is more common than
provision for isolation. A refuge for fallen women has, naturally,
a large percentage of inmates suffering from venereal disease. The
women of one refuge work in the laundry which gets a certain amount
of outside trade. Among other things it washes towels for a hotel.
Contraction of gonorrhea or syphilis from infected towels or garments
is a well-recognized medical fact. A laundry with infected women on its
working force cannot but be a public peril.
Grim facts are piling up on the records of the Pittsburgh Tuberculosis
Dispensary as to advanced cases of tuberculosis among the little
charges of charitable institutions.
Instances such as these might be multiplied. As in the case of the
public schools the authorities are helpless. Even over the city's
own institution, the Municipal Hospital, the Bureau of Health has no
control. It has been transferred to the Bureau of Charities within the
last year. It receives only contagious diseases, and is too small for
the requirements in time of epidemic, having proper accommodation for
only eighty, with a crowded capacity of 125. Dr. Booth of the Bureau
of Health, who acts as visiting physician by special appointment to
the Bureau of Charities, tells me that up to 1905 the plant was housed
in buildings erected in the seventies. The furnishings were beds and
bedding from the fire and police departments, regarded as being no
longer fit for use by the city's paid servants, and therefore proper
charity for the city's helpless sick. Two years ago, Dr. Booth put
an end to this system by burning the last consignment of furnishings
(for reasons principally entomological); and announcing that he would
admit to the hospital no more equipment, discarded as unfit by the
police and fire forces. Now the plant has its own furnishings. The
building is modern but of an obsolete and unsatisfactory type, and has
not sufficient grounds for its convalescents. All the other hospitals
in the city are private institutions. There is no co-ordination
of hospital work among them, and their distribution is such that
localities where there are the most ambulance calls are without easily
available hospital plants.
To sum up, these are some few of Pittsburgh's immediate needs, if it is
to fight its battle successfully for fewer deaths and a better living
product:
Autonomy of the official health authorities (preferably a department
of health, not a bureau) under the executive and administrative control
of a physician or sanitarian.
A tuberculosis hospital for advanced cases which are now spreading
infection throughout the city. More visiting nurses and more sanitary
inspectors. Eventually a hospital for the incipient cases that can be
saved.
Municipal collection and disposal of the rubbish which accumulates
everywhere, seriously hampering efforts to make the city hygienically
clean and which must now be removed at private expense.
A general hospital of sufficient size, proper equipment, and adequate
surroundings.
Some reasonable division and co-ordination of effort on the part of the
private hospitals.
Authority to condemn and destroy unsanitary buildings.
Authority to condemn and destroy, upon its entrance to the city,
or upon discovery within the city limits, unclean, infected, or
adulterated milk, and to refuse and revoke milk licenses. Establishment
of a standard for milk.
Medical inspection of schools and school children.
Medical and sanitary inspection of hospitals, and of all public or
semi-public chartered institutions.
These authorizations to be embodied in a city code. At present the
health officials work almost wholly under the state law.
* * * * *
[Illustration: GERM HATCHERIES. THESE FRONT ON THE GRANT BOULEVARD.]
What is Pittsburgh going to do about it? Though the foregoing rather
general survey may suggest pessimistically "the little done, the
undone vast," yet there is not lacking, in the view, definite promise
as well as progress. Many and diverse agencies are helping the cause.
The monthly reports of the bureau keep a public, which has for years
been in a state of Egyptian darkness as to the how and wherefore
of its mortality, fully informed. A Civic Improvement Commission has
been appointed by Mayor Guthrie, one of the sub-committees of which
will deal with needed hygienic reforms. The Chamber of Commerce has
appointed a special committee to co-operate with the Health Bureau for
the betterment of housing conditions, and another to aid in improving
the milk supply. For the protection of the communities downstream, a
sewage disposal plant has been voted; and badly needed it is, as is
shown by the fact that, at the present writing, two thousand people
are ill in the suburb of Bellevue, from drinking water polluted
by Pittsburgh's sewage. The Allegheny County Medical Society has
constituted a committee on public instruction in health matters; also
a milk commission. The Tuberculosis Commission will soon be in the
field with its broad campaign. Municipally there has been an important
step forward in the establishment of a disinfection corps which
sterilizes and makes safe, at the public expense if necessary, the
premises from which a consumptive has been removed. Anti-tuberculosis
education by the various corps of visiting nurses is extending into
every corner of the city that harbors a dangerous consumptive. The
state school commission has recommended medical inspection of schools.
City ordinances providing for milk standards, and rubbish disposal,
are in prospect. The Bureau of Health, only a short time ago a rusted
and ineffectual machine fed by incompetents from other departments,
has, under its new head, developed an _esprit de corps_, and is now
welded into a compact, dependable organization. And this organization
will constantly have a supply of better trained men to draw upon, since
the University of Pittsburgh and the Carnegie Technical Schools have,
at Dr. Edwards's suggestion, arranged for special courses in sanitary
engineering and practical hygiene.
Yes; Pittsburgh is awake to the needs of the situation. But the
true test is yet to come. Thus far it has been but the laying out
of the lines of battle and a few preliminary, and, on the whole,
victorious skirmishes. For when hygienic and sanitary reform impinges,
in its advance, as it needs must, upon the private purse of some,
the political purposes of others, and the industrial and commercial
license of the whole, then will come the tug of war. Then, according as
shortsighted selfishness shall prevail over, or succumb to, civic pride
and patriotism, the victory will be to the germ or to the city.
[Illustration: A SLUM IN THE OPEN.]
* * * * *
Life Insurance satisfies the conscience, eases the mind, banishes worry
and gives old age a chair of contentment.
[Illustration]