INSTRUCTIVE INSPECTION[19]
[19] Read before the American Public Health Association at
Richmond, Va., October, 1909.
The checking of wastes of all description is much in the air, but
there is less discussion about WASTE OF EFFORT than might be expected.
Yet effort means time, and saving of time saves lives as well as
money.
Nearly every investigation of sanitary evils leads back to the family
home (or the lack of one), and a great deal of the health authorities'
work is saving at the spigot while there is a hundred times the waste
at the bunghole. The medical inspection of the schools was found to
have little effect without the visiting school nurse, for the parents
did not know how to better conditions and in the majority of cases did
not believe in the need.
Such experience should give the health authorities a cue. Rules and
Regulations should be enforced, but enforced with instruction as to
the means of doing. The WHY is not so easily understood as the student
of sanitary science seems to think. Germs and microbes are empty air
to the street urchins until they have been shown on a screen in a
lecture hall or until cultures have been made in the sight of the
children in a schoolroom. One whole school district of intelligent
parents was converted, many years ago, by giving the children in one
class two Petri dishes each with sterile prepared gelatine, with
directions to open one in the sitting room while it was being swept,
and two hours after the room had been thoroughly dusted to open the
other in the same place for the same time. These "dust gardens," as
the children called them, "took the place of the family album" for
callers, and spread knowledge.
Hundreds of similar experiences should convince any intelligent,
earnest Board of Health that a teacher by nature or training should be
in their employ, to be sent WITH POWER, like any other inspector,
wherever ignorance--usually diagnosed as stubbornness--is found.
The health officer whose mother was a good housekeeper, not afraid of
work, has no idea of the attitude of half the housewives of his
district. Having been made as a boy "to get the dustpan and brush and
sweep up his whittlings," he does not realize that these houses in the
tenement district have no dustpans, and that no one would bend his
back to sweep up litter if there were. It is all swept into the alley
or the street. Cheap, long-handled dustpans would be valuable sanitary
implements. As has been elsewhere suggested, the garbage question in
the tenement house needs study and must be solved by a practical
housewife. There are such, and Boards of Health are wasting effort and
the town's money until they avail themselves of this help in the
enforcement of their rules.
All Health Boards use the strong arm of the law, _i. e._, a police
inspector's club, to drive the ignorant and careless householder to
keep his premises from becoming a nuisance. The newly-arrived,
prospective citizen, or more often citizeness, fails to understand
what it is all about--neither the words nor the pantomime convey an
idea, except that this country is topsy-turvy anyway, for everything
is different in this new land.
In the process of learning what not to do, the dwellers in the alleys
flee when the health officer appears, and oppose a stubborn
indifference to his threats. When his back is turned, matters go on as
before and nothing is gained, but an opportunity is lost. Law is a
potent educator when rightly applied, but it may work more harm than
good.
Rules of action clearly explained are soon accepted--like traffic
rules, notification of contagious diseases, disinfection, etc.
The placing on the force of each town of at least one specially
trained "Explainer" would result in cleaner back yards and less
illness and, better than all else, a more friendly feeling between the
officials and those they honestly wish to help; for I do not think
there is often justification for such remarks as were made to me by a
shrewd California countryman when I was showing him about in the
traveling exhibit, the sanitation car: "Oh, this is all to get a job.
It's another form of graft--to get some money to spend."
It is true that the value of many health measures does not appear on
the surface. Sometimes it is necessary to wait for vital statistics to
prove a gain.
It is beginning to be thrown in the faces of sanitary authorities that
the laboratory wisdom does not reach the street; that there is not
enough, or rapid enough, improvement in general conditions. Newspapers
are ready, for the most part, to disseminate information and
benevolent societies write tracts, but we must remember how little
WORDS mean--especially printed words--to those unaccustomed to
acquiring information that way.
The actual showing in an alley of the process of cleaning up; the
going into a house and opening the windows at the top and tacking on a
wire netting to keep out the flies; the actual cleaning of the garbage
pail, perhaps, or at least the standing by and seeing that it is
properly done--all such actual doing, even if it is done only in one
house on a street, will spread the information all over the
neighborhood.
One of the most helpful offices is to tell the woman where she can
get the special article needed, and what it will cost, and to show her
the thing itself, in a friendly spirit. Such visits would soon
revolutionize the sanitary condition of any community.
Villages need this help even more than cities, for there they have
fewer chances to know about inventions and perhaps are less
resourceful in making them.
There may be races, as there are individuals, whom persecution drives
to progress--who do find means to execute unjust commands--but the
people a health officer has to deal with can be better led by kindness
and will learn from teachers, if the teaching is in the form of
example or demonstration.
It is an incontrovertible fact that to hasten sanitary reform it is
only necessary to hold out the helping hand; to encourage the ignorant
citizen to ask for instruction and direction, instead of placing upon
him the task of making bricks without either clay or straw. There are
times and seasons and individuals at which and on whom the bludgeon
must be used--the greater good covering the lesser evil; but such
cases are less common than present practice would seem to indicate.
The tenement house mother who has only one pan for all her needs and
one broken pitcher for all fluids does not readily understand why she
must keep her milk bottle for milk only. Who is to tell her so that
she will understand?
The men may be shamed into cleaning up the back yards and alleys by
pictures of such conditions in contrast to what might result with a
little effort. [The famous Cash Register yards were started in this
way.] Neglected spots have been cleaned up all over the country by
similar influences. Why does not the health officer take a leaf from
this book of recorded good work and show conditions known to him? Is
he afraid of hard words from the owner? He will have the approval and
support of all good citizens.
Health Board regulations may be left at a house AFTER they have been
explained, and a firm insistence on obedience may then have an
effect.
Why should there not be a constant exhibit of the conditions found
within the boundaries of a district, with the changes for the better
indicated as soon as they occur?
The Health Board office is now in some out-of-the-way place, where few
people ever go and where those who do go are frequently not welcomed.
Has the Board ever asked itself why it is often so misunderstood, so
hampered in its work? What Board will be the first to take an office
on a busy street and put pictures and samples with clearly printed
legends in the windows--examples of the evasion of the plumbing laws
on a T-joint pipe; photographs of a dairy barn; photographs of a
street at daybreak, showing the few open windows, and the one or two,
if any, open at the top--these would serve as texts for the
newspapers' sermons, sure to be preached, and back-alley conversations
thereon.
Why not? Rival water companies are allowed to show filters to prove
their claims.
The basis of all successful sanitary progress is an intelligent and
responsive public.
The problem is to visualize cause and effect to the ordinary
individual, too absorbed in his own affairs to study out the principle
for himself.
The success of the street cleaning brigade, tried for one season in
Boston; the improvement in the condition of parks wherever receptacles
for wastes have been placed; the tidy condition of corner lots where
civic improvement leagues have taken the matter up with the children,
all point to a means neglected by the officials, and hence to wasted
opportunity and delayed obedience to regulations.
For the position of instructive inspector, it goes without saying that
a trained woman will be worth more than a man, since most of the
regulations affect or would be controlled by women.
A gain in the speed of adoption of sanitary reforms would be
comparatively rapid under a thoroughly qualified woman as instructive
inspector, and that there will not be any great gain until such a
measure is adopted is the firm belief of the writer.
Mrs. von Wagner's work in Yonkers, begun in 1897 under the Civic
League, is well known. After three years' trial the Board of Health
established her in the position of Sanitary Inspector. Her work in the
tenement districts has been most successful. Several other cities have
followed the example of Yonkers, but the practice is by no means
general. Yet there is no doubt that it would add efficiency to any
Board of Health.
The most recent experiment was the employment, the past summer, of an
inspector provided by the Women's Municipal League of Boston, to
inspect and devise means for bettering conditions in a district of
small shops where food is sold. The district had been found by the
Market Committee of this organization to be in need of such help. A
graduate of the School for Social Workers was chosen, who carried on
her campaign with the spirit of helpfulness fostered by her training.
She was given a badge by the Board of Health, who have been most
sympathetic and cordial in their support. The experiment has been
justified by the results and especially by the reception accorded the
inspector by the people of the district. It has proved that there is a
responsive desire to fulfill the law wherever its provisions are
understood.
Inspection cannot fulfill its purpose until it is instructive. Man and
the law will be in accord when the benefits of the law to man are
appreciated.
It is incumbent upon the sanitary authorities to see to it that their
efforts are not wasted on an inert, partially hostile clientele.
EUTHENICS, OR THE SCIENCE OF CONTROLLABLE ENVIRONMENT
Human efficiency and welfare due to
Heredity (See Eugenics) and
Environment
1. Natural, cosmical--climate--
2. Natural, modified by human effort
Wet and dry soil
Waterways and forests
Food supplies
3. Artificial
Housing--clothing--sanitation
EUTHENICS--Conscious acquisition and application of scientific knowledge
I. Science in the laboratory
Discovery of laws of science
Knowledge of cause and effect
II. Dissemination of scientific knowledge
Education
III. Application of science
Habits of living
Technique
Stimulus to civic improvement
Constructive legislation
I. Science acquired through laboratory and field research
Universities
Johns Hopkins, Clark, etc.
Research institutes
Rockefeller Institute
Carnegie Institute
Henry Phipps Institute
Sage Foundation, etc.
Sanitary Science = Application of acquired laws to
1. National welfare
Hook worm, Pellagra, Yellow fever, etc., in Panama,
The Philippines, Cuba, Porto Rico, etc.
2. Individual health of body and mind
The people are reached by
II. A. Dissemination of scientific knowledge through
1. Schools
2. Publicity
a. Bulletins
Boards of Health
Department of Agriculture
b. Lectures
Municipal
Endowed
c. Magazines and newspapers
d. Placards
e. Commercial advertising
Inventions of manufacturers
Food fairs, electrical exhibitions, etc.
3. Expositions for limited purposes
Mary Lowell Stone Exhibit
"Boston 1915"
4. Health Campaigns
Tuberculosis classes, etc.
B. Legislation
Restrictions
III. Application of science to living
A. 1. Unconsciously acquired habits of the CHILD, through imitation
in the home, the school, the street
2. Conscious endeavor of
a. the trained parents in the home
b. the teacher in the school
c. the policemen in the street
B. Conscious personal effort of the ADULT to better conditions
for himself and the community
1. Pioneer leading public opinion by
a. Personal example in right living
b. Precept and persuasion
C. Community progress
1. Semi-public agencies for guarding itself and the individual
a. Remedial measures
Endowed hospitals, sanatoria, dispensaries, day camps and
hospital schools
Charity organizations--material relief
b. Preventive measures
Endowed schools (model and outdoor), extension movements,
settlements, model tenements, model factories, garden cities
Both are developed by social organizations, civic clubs,
women's clubs, museums, libraries, lectures, exhibits,
statistical inquiries, etc.
2. Private agencies leading to legislation
Special hospitals and schools
Health organizations--sanitary inspection at model
dairies--private water supply
Consumer's league
3. Legislation. Temporary paternalism (protection).
Interpretation by individual becomes constructive.
The people work out freedom under law
a. City
(1) Schools
Grade and trade and outdoor
(2) Police
Building laws
(3) Board of Health
(a) Shelter
Sanitary laws
{ Drainage
Air--light--refuse { Garbage
{ Ashes
(b) Food
Milk--water--foods { Food values
{ Adulterations
(c) Sanitary laws for public places
Buildings
Streets
Sewer
Ice on sidewalk
Spitting
(4) Beauty
Height of buildings, bill boards, telegraph wires,
parks
(5) Amusements
Playgrounds, municipal music, parks, aquarium
(6) Other municipal activities
(a) Traffic regulation
(b) Medical inspection
(c) Public baths
b. State
Education
Board of Health
Factory legislation
Water supply (advisory power)
Interstate commerce
Food (advisory)
Park reservations
Textile laws
Forest
c. Federal
Sanitation
(a) Pure food laws
(b) Quarantine
(c) Immigration restriction
(d) Future needs
Textile laws, etc.