forty-nine years old. Lead poisoning crippled him and deprived him of
his trade at the age of thirty-three. He used to be a "ground layer."
That is, he rubbed lead colors with a short brush into the surfaces to
be decorated. In the course of fifteen years he had eight or ten severe
attacks. In the last one, sixteen years ago, both arms were paralyzed.
For two years he had to be clothed and fed. Now his arms have recovered
their flexibility, but his hands still hang shrivelled and powerless to
open or straighten themselves. For a livelihood he has been forced to
take up an unskilled job requiring no manual work, but seven days' labor
a week.
A color mixer in a tile works began after ten years to suffer from
cramps in the stomach, nausea and biliousness. A number of physicians
told him it was lead colic. He grew steadily worse, and four years later
he died. The death certificate gives pulmonary tuberculosis as the
cause, but the physicians on the case agreed in stating that lead formed
at least a considerable complication.
So run the records of a few of the cases.
There are about 21,000 potters, the makers and enamelers of iron
sanitary ware in the United States. Of these, 2,500 or over 10 per cent
are declared by Dr. Alice Hamilton in her report to the United States
government to be exposed in the regular course of their work to the risk
of lead poisoning. Within two years 510 cases of poisoning were found.
It is now generally accepted that the one word "cleanliness" sums up the
requirements for the abolition of such occurrences. Yet the workshops in
the pottery and allied industries are at present almost without
exception run with utter disregard of this fundamental consideration.
They are as a rule dusty, ill-ventilated and poorly lighted. Washing
facilities are almost unknown.
In New Jersey and in seven other states the legislatures have now
pending before them the aptly christened "cleanliness bill," drafted by
the Association for Labor Legislation after careful study to counteract
just these conditions. The proposed measure establishes strict sanitary
provisions in potteries and all works making or handling lead salts. It
takes a leaf from successful English and German legislation by
establishing "duties of employees" as well as "duties of employers," and
by fixing a fine for failure to comply. The bill has passed the lower
house in Missouri, and has been reported favorably by the lower house
committee to which it was referred in Ohio and in New Jersey. A similar
law has been in force in Illinois for two years with excellent results.
Many progressive manufacturers admit the wisdom of these regulations and
will not oppose them. Others are actively in favor.
[Illustration: WHY IS THE PAUPER]
SUGGESTIVE FACTS AS TO CAUSES AND PREVENTION OF DESTITUTION REVEALED BY
A STUDY OF A MID-WESTERN ALMSHOUSE[5]
[5] In taking the rather exhaustive social histories of the 200 inmates
of the Sangamon County Poor Farm, I was assisted by Mary Humphrey and
Mary Johnson, without whose intelligent and enthusiastic co-operation
this preliminary study could not have been made.
GEORGE THOMAS PALMER, M. D.
SUPERINTENDENT HEALTH DEPARTMENT, SPRINGFIELD, ILL.
Drawings by Alfred S. Harkness
Poorhouse it was, this mid-western abode of unfortunates, regardless of
the resolution of the Conference of Charities and Correction
recommending that it and its host of fellows be known as "county homes."
[Illustration]
This particular poorhouse was comfortably perched upon a hill,
surrounded by elms and oaks and walnuts, overlooking a land of plenty--a
"prosperous-looking" poorhouse it was with well-bred Holstein cows
wading knee-deep in clover on land worth $250 an acre. The verdant
pastures, the fields of grain, the white fences, the silo and the barns,
the splendid old brick house, might have belonged to a delightful
country estate so apparently did they bespeak good farm management. Good
order and spick-and-spanness also characterized broad veranda and hall,
the living rooms of the superintendent, and almost might the same terms
have been applied to the dwelling place of the inmates.
This, seemingly, was no place to come for the ugly story of
destitution--for the revolting facts which force us, almost against our
wills, to paint our picture in glaring yellow. But the destitution was
there. You could see it in the expression, the gait and the posture of
the inmates; you could smell it in the unmistakable smell of poverty and
you could feel it in the indefinable something which grips you and
oppresses you in an institution of this kind.
It was a poorhouse and nothing but a poorhouse--a good poorhouse, if
there is such a thing, but a poorhouse none the less. Like thousands of
similar institutions, it stood ready to receive the individual when he
strikes the very bottom of the toboggan slide of life, to house him and
to feed him humanely enough, but with the saving of dimes and nickels
regarded as the cardinal virtue of efficient management. It was an
"asylum of poverty"--no more what such an institution might be than the
lunatic asylum of twenty years ago is like the hospital for the insane
of the present day. Like thousands of others, it was one of those places
where we receive the unfortunate; where we label him a pauper; where we
tolerate his presence until death reduces the county expense or until he
goes out into the world again not a whit better off, physically,
mentally or morally, on account of his association with us.
We had come to the place for the purpose of ascertaining to what extent
tuberculosis prevailed among the two hundred inmates and to ascertain
the degree of protection afforded these unfortunates against infection
from the disease. As our work progressed this question came to me more
and more insistently: "Why are these men and women dependents? What, if
anything, could be learned if they were permitted to tell their own
stories of misfortune?"
[Illustration]
Social history blanks were prepared, and two intelligent young women
were set at the task of supplementing physical examinations with a
series of questions relative to the past lives of the inmates. Due
allowance was made for natural exaggeration when a person told of the
glories of his past, and like allowance was made for the faulty memory
which had lost its record of personal faults, vices and dissipations. As
far as possible the reliability of the story was determined by checking
up with certain definite and obtainable facts.
At the outset of the work, a wave of fear spread over the place born of
the belief that we were cataloging the inmates to send them to an
"asylum"; but when this was quieted, the history taking was uneventful.
Eliminating those who were mentally incapable of being interviewed, we
were able to prepare 137 quite complete records. Of those interviewed,
32 were women and 105 men. Practically all the women, incidentally, were
there on account of insanity, drug addiction or actual illness. There
were 131 white inmates, 5 Negroes and one who claimed to be an Indian.
Sixty-nine were single, that is 60 per cent of the males and but 27 per
cent of the females. Nineteen had living husbands or wives and 47 were
widowed. Of those who had married, 42 had married once only; 13 stated
that they had married twice and 4 that they had married three times or
more.
[Illustration]
To the penny-wise county official it is of practical interest to note
that 34 of the inmates, or about 25 per cent, had living children and
that even casual inquiry showed many instances in which the children
were financially able to take care of these unfortunates, as the laws of
Illinois provide that they shall do.
Thirty of the inmates were born in Illinois; 36 in the United States
outside of Illinois; while Ireland and Germany came next with 21
representatives each. There was no Jew in the almshouse.
Three of the inmates admitted that their parents had been dependent upon
public charity; 24 admitted alcoholism or drug addiction on the part of
their parents; 4 were the children of the insane and one was the
daughter of a criminal. The fathers of 106 came from laboring and
agricultural classes, while the fathers of 6 were professional men.
[Illustration]
Nineteen of the inmates had had no education whatever; 12 claimed to be
able to read and write but had never gone to school; 4 had attended
school less than one year; 15 had attended less than five years; 71
claimed a complete "common school" education and 7 had gone to high
school or college. Four had been compelled to earn a living under ten
years of age; 12 from ten to twelve years; 41 from twelve to fifteen
years and 31 had begun work between the ages of fifteen and twenty-one
years.
With this showing, the question naturally arises: Is there any
connection between lack of education, child labor and the poorhouse?
One of the male inmates had been a pharmacist, one a civil engineer; 28
had learned trades and 53 were laborers. Of the females, 17 were house
servants and one a teacher.
To ascertain something of the past financial condition, we inquired as
to the highest wage each had made, the amount he had inherited and the
greatest amount he had ever accumulated. Six had never made more than
$10 to $20 per month; 21 had made from $20 to $50 per month and 28
claimed to have made over $100 per month. Fourteen had inherited
property worth less than $500; 11 had inherited from $500 to $1,000; 5
from $1,000 to $5,000, and one had inherited from $5,000 to $10,000.
Thirty-five of the inmates had never accumulated as much as $500 at any
one time; 22 had possessed from $500 to $1,000; 20 had owned from $1,000
to $5,000; 7 from $5,000 to $10,000, and four had had over $10,000.
[Illustration]
As to their habits, vices and dependence, 88 were users of alcohol and
35 of these had been heavy drinkers. Four females and one male were
addicted to drugs. Thirty-nine had been arrested once, and four more
than once. The causes of arrest were drunkenness and disorderly conduct
22; vagrancy 10; theft 1; assault 4 and participation in a strike 1. Two
of the inmates had been in other almshouses; 7 had occupied beds in
charity hospitals; 2 had grown up from orphan asylums and 4 had been
helped by lodges and unions. Many had received county orders before
coming to the almshouse.
What light such data as the foregoing, if collected in large numbers of
similar institutions, would throw upon the underlying causes of
destitution, is, of course, speculative. It seems to me, however, that
they might give us a more intelligent idea of the connection between
pauperism and the marriage of the unfit; lack of education; child labor;
lack of trade or definite vocation; poor mentality; lack of religious
influence; divorce or failure to marry; alcohol and drugs; vice and
preventable disease.
If these remote influences lie beyond the imaginative possibilities of
the average almshouse superintendent and county official, there were
certain other facts brought out in this study which should appeal to the
most practical and hard-headed. These facts seem to point the way to the
rehabilitation of the unfortunate; the way of placing him on his feet
again. They also point directly to the reduction in the almshouse
population and the consequent decrease in public expense.
Getting at the direct causes of dependence, it was found that old age
was the chief factor, 47 of the inmates being over 70 years of age. This
number of dependents, incidentally, could be materially reduced by
tracing out near relatives legally responsible for their care.
[Illustration]
Drugs and alcohol were responsible for 25 dependencies--a less
encouraging group until we have intelligent public treatment for these
cases. Twenty-five of the inmates were crippled while 18 were there on
account of general illness. Doubtless many of these cases would be
amenable to treatment if properly studied and diagnosed.
Six were victims of advanced tuberculosis, and it may be assumed that
the nature of the illness was unrecognized as the patients were housed
in dormitories with the uninfected. There were unquestionably other
tuberculosis cases undiagnosed who were not only losing their chance of
cure; but were exposing and infecting others. I am impressed,
incidentally, that almshouses, with their armies of transients going to
the crowded, unventilated quarters of the poor, are very considerable
spreaders of tuberculosis.
The insane, feeble-minded and epileptic aggregated perhaps 50--an
almshouse population which should be and must be decreased by more
adequate state provision for these afflicted.
Syphilis was responsible for 3 dependencies, and probably many more
would respond to the Wassermann test and could be restored to health by
specific treatment.
The 4 blind and aged inmates might be made to see by simple cataract
operations.
Many of the inmates expressed the wish that they might be restored to
health that they could go out into the world again upon their own
resources. But 58 replied, when asked what they wanted to do in the
future, that they wanted to stay where they were, under the friendly
roof of the poorhouse.
This does not imply hopeless pauperism, however. Sick, neglected, weak
and despondent--of course, they want to stay in some place, even in the
poorhouse, where they are not eternally ordered to move on by the
police; viewed with suspicion or fear by self-respecting citizens or in
constant danger of arrest for vagrancy. Such forlorn men not
infrequently commit petty crimes to guarantee their being housed in jail
during a cold winter.
I am optimistic enough to believe that if the physical conditions of
each inmate were studied; if his ills were cured and he was made
stronger in body, he would be given courage, more ambition and more
purpose in life. To this extent pauperism is directly curable.
True, there are among the destitute those who are hopelessly
marked--branded by heredity; cursed by environment; wrecked by disease;
deficient in body and in mind, with little or nothing to work upon. By
the same token there are those in other branches of medicine who are
hopelessly sick--those who are beyond the reach of the surgeon's knife
or the physician's prescription. There are those among the insane who
give no ray of hope to the most enthusiastic alienist.
But when we progress to the point of classifying our paupers; of
studying intelligently the various causes of destitution; of endeavoring
to make our almshouses places of cure rather than mere asylums for the
victims of poverty, our percentage of "recoveries" will be surprisingly
high.
[Illustration]
The difference in methods between the modern insane hospital and the
almshouse is striking. A man is admitted to an institution for the
insane in a thoroughly irrational and excitable condition. His case is
studied and it is found that he has cerebral syphilis. Proper treatment
is instituted and, in all probability, the patient is returned to his
family cured and a useful member of society.
In another case, syphilis has rendered a man physically inefficient,
dissipated and despondent. He drifts to the poorhouse where he is
catalogued simply as a "pauper." The chances are that the cause of his
pauperism is not detected. If he announces it himself, he may receive
the hurried, occasional visit of a contract doctor. Even the drugs that
are given him may be crude and impure, bought by contract from the
lowest bidder. Little or no provision is made for his intelligent and
systematic treatment. He may be drugged with mercury until he is
salivated; he may be neglected until his open sores cause him to be
housed in the basement away from the other inmates. He is merely a
syphilitic pauper and the rough fare of the poorhouse is looked upon as
better than he deserves.
As a matter of fact, he is a sick man; sick of a curable disease and his
cure may restore him to useful citizenship and remove him from the
county expense.
Or again, there comes to the almshouse a man who is tired--a man who
will not work. Perhaps he is losing a little weight and he is known to
have been drinking more whiskey than he did when he worked harder. You
are tempted to compel him to work; to drive him to earn his meager board
and bed. The superintendent has no time to note that he has a little
fever at night or to see that he clears his throat from time to time.
Without physical examination, we have no way of knowing that we are
dealing with an incipient consumptive. The average superintendent knows
nothing of the deadly weariness of this disease; the weariness that
invades every muscle of the body; which makes work impossible; which
prompts men of higher moral fiber to drink whiskey or seek other
stimulation.
This "lazy devil" is begrudged our poorhouse food, when, as a matter of
fact, he ought to have, and at public expense, better food than we have
ever thought of giving him. With fresh air, milk, eggs, nourishing food,
intelligent treatment and perfect rest, this man can get well and resume
a place in the world. With ordinary almshouse care and almshouse fare,
we are signing his death warrant while we are guaranteeing his prolonged
dependence upon public charity.
We receive old men who have worked hard and who have made an honest
living before their eyesight failed and they became almost blind. We
label these men as paupers and do not stop to question if a simple
operation for cataract would not restore them to useful occupation.
The spirit of the average almshouse is illustrated in this--one Illinois
county has a contract with a dentist to pull the teeth of poor farm
inmates. There is no provision for saving teeth. If the inmate is
writhing with toothache, he must take his choice; lose a good tooth on
contract, or grin and bear the pain. The supervisors can see no reason
why a pauper should want to save his teeth or why he should be permitted
to do so. And yet a cheap filling would cost little more than the
primitive and mutilating operation of extraction.
These are mere instances of the obvious curative possibilities in the
almshouse--instances where the county's duties are so apparent, in which
the right and humane way is so clearly the cheap and economical way that
the matter should require no discussion. It is the line of direct cure
which the county, as a matter of sound administration, should make it
possible to carry out. It means first the careful physical examination
of every inmate of every almshouse, not by the medical man who bids
lowest to get the contract, but by the most capable diagnostician
available.
[Illustration]
But this is only the beginning. The big possibility is what the
almshouses of the nation can do to ascertain the more remote causes of
poverty and destitution, for, as in the case of the insane, when we know
the causes of destitution, we can carry out our most effective work
before the pauper becomes a pauper--before he comes slinking, wretched
and despondent, to the door of the county farm.
Tuberculosis will never be eradicated by merely treating the sick;
yellow fever could not have been stamped out by simply caring for the
afflicted; pauperism will never be materially affected by what we do
when the pauper has reached his last ditch. We must fight tuberculosis
by striking at its causes; we have already eliminated yellow fever by
the same sane process. We would have gone further in our battle against
pauperism, perhaps, were it not that pauperism is the only disease that
has never invaded the home of the rich. No multi-millionaire has ever
endowed a research laboratory for the study of destitution in memory of
a petted child struck dead by its poisonous fangs.
But every almshouse has its clinic in poverty and I am convinced that if
every inmate in every poorhouse throughout the nation could be made to
tell the story of how he came to be there; if every one could be
examined for physical and mental causes, and if all these data could be
gathered together in systematic form, a great stride would have been
made in formulating an intelligent campaign against dependence.
COMPENSATION FOR OCCUPATIONAL DISEASES
JOHN B. ANDREWS
SECRETARY AMERICAN ASSOCIATION FOR LABOR LEGISLATION
The introduction in Congress of a bill which extends the workmen's
compensation principle to embrace occupational diseases places before
the American people an entirely new range of problems in the field of
social insurance.
The federal government since 1908, and fifteen states during the past
two years, have recognized the wisdom and justice of the compensation
principle in dealing with the victims of industrial accidents. Now comes
the demand that the American people, through Congress, adopt exactly the
same principle in dealing with federal employees who are incapacitated
for work by occupational diseases.
What is the present situation?
"The government gives no compensation for lead poisoning because,
technically, it is not an accident, which is true, for under the
circumstances it is a dead certainty."
--This quotation from the report of an investigator for the New York
State Factory Investigating Commission is neither a playful nor an
exaggerated statement. On the contrary, we now have complete
confirmation of its truth in the official report and in the sober legal
phrase of the solicitor for the Department of Commerce and Labor.[6]
[6] Opinions of the Solicitor for the Department of Commerce and Labor
dealing with Workmen's Compensation. 1912.
It all came about in this way. A man named Schroeder went to work in the
federal navy yard at Brooklyn. One of our big war ships, the Ohio, came
to the dock and Schroeder was sent down into the water-tight
compartments called "coffer-dams" to burn off the old coat of paint in
preparation for a new. As a result of breathing the fumes of the lead
paint, Schroeder was incapacitated for work by acute lead poisoning. He
lost thirty-seven days on this account, and he applied to the government
for the payment of compensation equal to the wages he had lost.
This statement was made by the attorney for the United States
government:
"The question in this case is whether acute lead poisoning
contracted in the course of employment is an injury within the
meaning of the compensation act. If the inhalation of noxious gases
is a necessary incident to the workman's employment, there can be
nothing accidental in the injury resulting therefrom. This latter
consideration disposes of the present case....
"It cannot be said that these fumes were inhaled by accident. The
fumes were necessarily produced by the work he was engaged upon.
The inhalation of such fumes was to have been expected and probably
could not have been avoided. Lead poisoning, under the
circumstances, was the natural, if not the inevitable, result."
Schroeder got not one penny.
Aside from the fact that lead poisoning in this case was really
preventable; aside from the fact that several enlightened nations have
absolutely prohibited the use of poisonous lead paints for the interior
of their war ships, and aside from the fact that there was no one to
warn Schroeder of the dangerous nature of his occupation, there is one
big final reason why this decision of Uncle Sam's Attorney was even more
unfortunate than it was necessary. The financial cost of this
unnecessary case of acute lead poisoning, in addition to the personal
suffering, fell upon poor Schroeder. Most men will agree that such
financial losses should fall upon the employer. In this case the
employer was the nation, which means all of us, you and me.
We owe Schroeder something more than an apology. While the federal
government is publishing excellent reports on lead poisoning in the
factories of private employers and is translating and distributing in
fat volumes the workmen's compensation laws of European countries, can
the United States afford to do less than make provision for reasonably
safe work places in the government service? And can this country afford
to ignore the good example of these European laws which provide
compensation for such victims of occupational diseases?