For a candid, complete criticism of the _Civics and Health

June, 1908, consult the report of the Bureau of Municipal Research,

presented to the Washington Congress of Public Education Associations

in October, 1908, by Commissioner of Health, Dr. Darlington. The

bureau's study is entitled _A Bureau of Child Hygiene_, and, in

addition to the story of medical examination in New York City schools,

gives the blank forms adopted for use in September, 1908. Important as

are the facts given in this study, its greatest value, its authors

declare, is in its account of "the method of intelligent self-criticism

and experiment which alone enables a public department to keep its

service abreast of public needs."

The Bureau of Municipal Research made its study for the purpose of

learning whether the disappointing results emphasized by the school

authorities were due to "dual responsibility in the school--that of the

board of education and that of the department of health"--and to "lack

of power or inclination to compel parents to remedy defects," or to

_deficient administration_ of power and inclination by health

officials. Coöperating with school physicians and nurses in three

schools, 1442 children were examined, of whom 1345, or 93.2 per cent,

had 3458 defects that needed treatment. The postal-card notice was

followed by an interview with the parent either at school or at home.

Only 4.2 per cent of the total number of parents refused to act, 81 per

cent secured or permitted treatment for one or more defects, while 15

per cent promised to take the proper steps at the earliest possible

date. Three fourths of the parents acted after one personal interview.

"The net average result of a day's work by a nurse was the actual

treatment of over five children, three of them completely, and two of

them for one or more defects,"--sixty cents per child!

[Illustration: A PHOTOGRAPH OF MOUTH BREATHING MAY MAKE

COMPULSION UNNECESSARY]

Having established the willingness--even eagerness--of parents to do

all in their power to remove defects that handicapped their children,

it was obviously the duty of the health department so to organize its

work that it could insure the education of parents. The new Bureau of

Child Hygiene gives foremost place to instruction of parents in care of

babies, in needs of school children, and in the importance of physical

examination when enlisting in the industrial army. Whether this work is

well done is learned by result tests applied at headquarters, where

work done and results are reported daily and summarized weekly. No

longer will it be possible, without detection, for one physician to

find only eye trouble and to neglect all other defects; for two

inspectors examining different children in the same school to report

results differing by 100 per cent; for physicians in different schools

to find one 18 per cent, another 100 per cent with defects; for two

inspectors examining identical children to agree on 51 out of 101 cases

of vision, on 49 out of 96 cases of adenoids, or 3 out of 10 cases of

skin disease.

So conclusive were the results of follow-up work efficiently supervised

by the department of health, that school officials are, for the

present, inclined to waive the demand for the transfer of physicians

and nurses to the board of education, and to substitute education for

compulsion with parents who obstinately refuse to take proper remedial

measures for their children when reported defective.

This present plan requires the entire working time of inspectors and

nurses for school work. Thus New York has for the present definitely

abandoned the plan of having the district inspection for contagious

diseases done by school physicians. The purpose of the change is not to

reduce danger of infection, which was negligible, but to increase the

probability of scientific attention to school children.

Before a final settlement is made for New York City there should be

tests showing what the school authorities would do if physicians and

nurses were subordinate to them. It is conceivable that one physician

working from nine to five would accomplish more than six physicians

working the alleged three hours a day. So imperative are the demands of

school hygiene that it seems probable that in New York and in other

large cities school physicians, whether paid by the board of health or

the board of education, must be expected to be at the service of school

children, subject to the call of school officers, during as many hours

of the day as teachers themselves must give. It is even conceivable

that effective use of the knowledge gained by physical examinations of

school children, and by those responsible for school hygiene, will

require evening office hours or evening visits to homes, and regular

Saturday office hours and Saturday visits by school physicians and

nurses. Finally, it must be expected that the programme for school

hygiene will need the special attention of physicians and nurses during

the summer months, and other vacation periods when children and parents

alike have time to receive and to carry out their instructions.

One danger in New York City is that the board of education, like the

board of health, when compelled to choose between so-called standard,

necessary, traditional duty and school hygiene, will sacrifice the

latter. The school authorities, without any more funds and without

physicians and nurses, could already have made, had they desired, eye

tests and breathing tests sufficiently accurate to detect the majority

of children needing attention. The outcome of the discussion as to the

jurisdiction of the two boards will undoubtedly be to interest both in

their joint responsibility for children's welfare, and to increase the

attention given by both to the physical condition of the child when he

presents himself for registration as a wage earner.

CHAPTER XXIX

OFFICIAL MACHINERY FOR ENFORCING HEALTH RIGHTS

The argument for _getting things done_ presumes adequate active

machinery, official and private, for _doing things_ that schools are

being urged to do. The chapter on Departments of School Hygiene

suggests local, county, state, and national machinery necessary (1) to

protect the child from injuries due to school environment, school

methods, and school curriculum; (2) to getting those things done for

the child at home and on the street, need for which is disclosed by

physical and vitality tests at school. It is unreasonable to confine

the school to the activities above outlined unless health machinery,

adequate to the demands placed upon it by school and other community

needs, is devised and kept in order.

Generally speaking, adequate health machinery is already provided for

by city charters and by the state laws under which villages, townships,

and counties are organized. Quite as generally, however, machinery and

methods of adequate administration are undeveloped. How much machinery

has already been set to work by New York City is shown by the

accompanying chart. A useful exercise for individuals or school classes

wishing to study health administration would be to chart in this way

the machinery actually at work in their locality, county, and state.

Even for New York it should be remembered that this chart does not

include national quarantine, the state protection of the port, the

state dairy and health commissions, or the state and national food

inspection. To get an idea of the vast amount of attention given

to health in New York City there should be added to this chart the work

of many departments other than the department of health. The building

bureau, tenement-house department, board of water supply, sewage

commission, street cleaning, public baths and comfort stations, the

department of water, gas, and electricity, and finally the department

of hygiene and physical training in the public schools.

[Illustration: CHART SHOWING HOW NEW YORK CITY'S DEPARTMENT OF

HEALTH EXERCISES IT'S AUTHORITY

Courtesy of Bureau of Municipal Research]

Five elements of adequate machinery are generally lost sight of:

1. The voter.

2. The nonvoter, subject to health laws and often apt to violate

them.

3. The mayor, governor, or president who appoints health officers.

4. The council, board of aldermen, legislature, or congress that

enacts health laws.

5. The police courts and the judiciary--police, circuit and

supreme--that decide whether society has suffered from violation

of law and what penalties should be inflicted for such violation.

Legislative bodies have hitherto slighted their responsibilities toward

public health. The chairman of a committee on public health of a state

legislature was heard to remark, "I asked for that committee because

there isn't a blooming thing to do." If voters, nonvoters, and health

officials will follow the suggestion of this book to secure school and

health reports that will disclose community and health needs, it will

be increasingly difficult for legislators to refuse funds necessary to

efficient health administration.

To the courts tradition has required such deference that one hesitates

to find out in how far they have been responsible in the past for the

nonenforcement of health laws. Yet nothing is more obstructive of

sanitary progress than the failure of magistrates to enforce adequate

penalties for truancy, adulteration of milk, maintaining a public

nuisance, defiling the air with black smoke, offering putrid meats for

sale, running an unclean lodging house, defying tenement-house or

factory regulations, working children under age and overtime, spitting

in public places, or failing to register transmissible diseases.[16]

The appointing officer cannot, of course, be held responsible unless

voters and nonvoters know in how far his appointees are inefficient,

and in how far he himself has failed to do his utmost to secure funds

necessary to efficiency. Too frequently appointments to health

positions have been made on political grounds, and catastrophes have

been met by blundering incapacity. The political appointee has been

made the scapegoat, and the appointing officer, whether mayor,

governor, or president, has regained public confidence by replacing an

old with a new incompetent.

In order to have health machinery work properly, the appointing officer

should not be allowed to shift responsibility for failure to his

subordinates. For example, it was recently found in New York City that

while the tenement-house commissioner was being condemned for failing

to enforce the law, he had turned over to the corporation counsel, also

appointed by the mayor, for prosecution ten thousand "violations" to

which no attention whatever had been paid!

The voter, nonvoter, appointing officer, legislative officer, and

judicial officer determine the character and purpose of machinery and

are analogous to the surveyors, stock-holders, directors, and

constructors who provide railroads with tracks and with running stock.

The actual running force of health department or railroad is what is

meant by its official machinery. What this machinery should be depends,

of course, upon the amount of business to be done, and differs with

the size of the district and the character of population to be served.

[Illustration: FOR PUSH-CART FOOD, INSPECTION IS PARTICULARLY

NEEDFUL]

Local health machinery should guarantee protection against the evils

mentioned in preceding chapters. In general, one man is better than

three to execute, although three may be better than one to legislate.

Where small communities do not wish to have the entire state sanitary

code rigidly administered, they can adopt New York's method of a

legislative board of three members, headed by an executive, whose

business it is to act, not talk; to watch subordinates, and to enforce

rigidly and continuously ordinances passed by the board. The National

Bureau of Census places under the general heading Health and Sanitation

the following activities: health administration, street cleaning and

refuse disposal, sewers and sewage disposal. Sanitarians generally

emphasize also the health significance of efficient water service.

A community's health programme should be clearly outlined in the annual

budget. Where health work is given funds without specification of the

kinds of work to be done, serious evils may be overlooked and lesser

evils permitted to monopolize the energies of health officers. Again,

after money has been voted to prevent an evil, records should be made

of work done when done, and of money spent when spent, so that any

diversion will be promptly made known. The best present guides to

budget making, to educational health reports, and to records that show

efficiency or inefficiency of health administrators are the budget and

report of the department of health for New York City, and the story of

their evolution told in _Making a Municipal Budget_, by the Bureau of

Municipal Research.

To find out whether local machinery is adequate, the reader must

enumerate the things that need to be done in his community, remembering

that in all parts of the United States to-day there are sanitary laws

offering protection against dangers to health, excepting some dangers

not understood until recently, such as child labor, dangerous trades,

lack of safety devices. Adequate local protection, however, will not

become permanent until adequate state machinery is secured.

State health machinery should be of two kinds,--fact-gathering and

executive supervision through inspection. The greatest service of state

boards of health is to educate localities as to their own needs, using

the experience of all communities to teach each community in how far

its health administration menaces itself and its neighbors. In addition

to registration of contagious diseases, facts as to deaths and births

should be registered. State health boards should "score" communities as

dairies and milk shops are now being scored by the National Bureau of

Animal Industries and several boards of health. When communities

persist in maintaining a public nuisance and in failing to enforce

health laws, state health machinery should be made to accomplish by

force what it has failed to accomplish by education.

[Illustration: NATIONAL MACHINERY HAS STIMULATED LOCAL MILK

INSPECTION AND STATE DAIRY INSPECTION]

States alone can cope adequately with dangers to milk and water sources

and to food. The economic motive of farmers has developed strong

veterinary boards for the protection of cattle. Similar executive

precaution must soon be taken by cities for the protection of babies

and adults of the human species. It is far more economical to insure

clean dairies, clean water sources, and wholesome manufactured foods by

state inspectors than by local inspectors. At present the task of

obtaining clean milk and clean water falls upon the few cities

enlightened enough and rich enough to finance the inspection of

community foods. Once tested, it would be very easy to prove that

properly supported state health authorities will save many times the

cost of their health work in addition to thousands of lives.

County or district machinery is little known in America. For that

reason rural sanitary administration is neglected and rural hospitals

are lacking. In the British Isles rural districts are given almost as

careful inspection as are cities. Houses may not be built below a

certain standard of lighting, ventilation, and conveniences.

Outbuildings must be a safe distance from wells. Dairies must be kept

clean. Patients suffering from transmissible diseases may be removed by

force to hospitals. What is more to the point, rural hospitals have

proved that patients cared for by them are far more apt to recover than

patients cared for much more expensively and less satisfactorily at

home, while less likely to pollute water and milk sources or otherwise

to endanger health.

With national machinery the chapter on Vital Statistics has already

dealt. We shall undoubtedly soon have a national board of health. Like

the state boards, its first function should be educative. In addition,

however, there are certain administrative functions where inefficiency

may result in serious losses to nation, state, and locality. National

quarantine, national inspection of meats, foods, and drugs are

administrative functions of vital consequence to every citizen.

Authorities are acquainted at the present time with the fact that the

sanitary administration of the army and navy is unnecessarily and

without excuse wasteful of human energy and human life. In the Spanish

American War 14 soldiers died of disease for 1 killed in battle; in the

Civil War 2 died of disease to 1 killed in battle; during the wars of

the last 200 years 4 have died of disease for 1 killed in battle. Yet

Japan in her war with Russia, by using means known to the United States

Army in 1860, gave health precedence over everything else and lost but

1 man to disease for 4 killed in battle. Diseases are still permitted

to make havoc with American commerce because the national government

does not apply to its own limits the standards which it has

successfully applied to Cuba and Panama.

"The Japanese invented nothing and had no peculiar knowledge or skill;

they merely took occidental science and used it. The remarkable thing

is not what they did, but that they were allowed to do it. It is a

terrible thing that Congress should choose to make one of its rare

displays of economy in a matter where a few thousand dollars saved

means, in case our army should have anything to do, not only the

utterly needless and useless loss of thousands of lives, but an

enormous decrease of military efficiency, and might, conceivably, make

all the difference between victory and defeat."

FOOTNOTES:

[16] The technic and principles of municipal engineering have been

treated in detail in _Principles of Sanitary Science and the Public

Health_, by William T. Sedgwick, and in _Municipal Sanitation in the

United States_, by Charles N. Chapin, M.D.

CHAPTER XXX

SCHOOL AND HEALTH REPORTS

For every school-teacher or school physician responsible for the

welfare of children at school, there are fifty or more parents

responsible for the physical welfare of children at home. Therefore it

is all important for parents to know how to read the index for their

own children, for their children's associates, and for their community.

School reports and health reports should tell clearly and completely

the story of the school child's physical needs.

[Illustration: NECESSARY TO EFFICIENT DEMOCRACY]

It is impracticable at the present time to expect a large number of men

and women to be interested in the reports published by school and

health boards, for, with few exceptions, little effort is made to write

these reports so that they will interest the parent. Fortunately, a

small number of persons wishing to be intelligent can compel public

officials to ascertain the necessary facts and to give them to the

public. So backward is the reporting of public business that at the

present time there is probably no service that a citizen can render his

community which would prove of greater importance than to secure proper

publicity from health and school boards.

Generally speaking, these published reports fail to interest the

citizen, not because officials wish to conceal, but because officials

do not believe that the public is interested. A mayor of Philadelphia

once furnished a notable exception. He called at the department of

health and complained against publishing the number of cases of typhoid

and smallpox lest stories in the newspapers "frighten the city and

injure business." A sanitary inspector who was in the room asked if

Philadelphia's business was more important than the health of

Philadelphia's citizens. As a result of her "impertinence" the

inspector was removed. That same year an epidemic of smallpox spread

through all the rural districts and cities of Pennsylvania, because

physicians thought it would be kinder to the patients not to make known

to their neighbors the presence of so disagreeable a disease. Almost

all health and school authorities, however, can be made to see the

advantage of taking the public into their confidence, because public

confidence means both public recognition and greater success in

obtaining funds. With more funds comes the power to do more work.

Other details with regard to health reports will be found in the

chapter on Vital Statistics. As to school reports, little thought has

been given in the past to their educational possibilities. A book was

recently published--_School Reports and School Efficiency_--by the

Committee on the Physical Welfare of School Children, which tells the

origins of school reports; contains samples of reports from one hundred

cities; gives lists of questions frequently answered, occasionally

answered, and never answered; and shows how to study a particular

report so as to learn whether or not important questions are answered.

The United States commissioner of education has organized among state

and city superintendents special committees on uniform and adequate

reporting. His aggressive leadership is welcomed by school men

generally, and promises vast benefits.

Just because the physical welfare of the school child is an index to

health needs, the school report can put into one statement for a city

or a state the story told by the index. The accompanying card tells

facts that the individual teacher and individual parent want to know

about a child, what a superintendent wants to know about all children,

and what a community wants to know about all children. A modification

of this card will soon be adopted in New York City. It is both a card

index and a card biography of the individual boy or girl. It is

expected to follow the child from class to class, each teacher telling

the story of his physical welfare and his progress. When the boy goes

to a new school or new grade, his new teacher can see at a glance not

only what subjects have given him trouble, but what diseases or

physical defects have kept him out of school or otherwise retarded his

progress. With this card it is easy to take a hundred children of the

same age and the same grade, to put down in one column those who have

eye defects, and in another those who have no eye defects, for every

school, every district, and for the schools as a whole. Schools that

use these record cards are enabled, by thus classifying the total, to

learn where the defects of children are, how serious the problem is,

how many days children lose from school because of preventable defects,

and in what section of the city the defects are most prevalent.

The mere reporting of facts will stimulate teachers, principals, and

parents to give attention. For example, assume a table:

FIELD OF INSPECTION

Total number of public schools 7

Public schools under inspection 3

Public schools not under inspection 4

The reader wonders why four schools are neglected and which particular

schools they are. Let the next table read:

EXAMINATION

Total registration in all schools 1500

Number of children examined 500

Number of children not examined 1000

Parents begin to wonder whether or not their children were examined,

and why the taxes spent for school examination of all children go to

one third of the children. The next table arrests attention:

TREATMENT

Number needing treatment 200

Number known to have been treated 50

Number not known to have been treated 150

We ask, at once, if examination is worth while, and if treatment really

corrects the defects, saves the pupil's time and teacher's time,

discovers many defects; and we want to find out whether the one hundred

and fifty reported not treated have since been attended to.

[Illustration: PUPIL'S RECORD]

[Illustration: DEPARTMENT OF HEALTH CITY OF NEW YORK REPORT]

Again, if three out of five of those examined need treatment, people

will wonder whether among the thousand not examined there is the same

proportion--three out of five, or six hundred--who have some trouble

that needs attention. Having begun to wonder, they will ask questions,

and will expect the board of health or the school physicians to see

that the questions are answered. As has been proved in New York,

taxpayers and the press will go farther and will demand that the annual

budget provide for making general next year the benefits found to

result last year from a test of health policies.

The story of the prevalence of contagious diseases in school children

could be told by a table such as is now in use by New York's department

of health:

TABLE XII

PREVALENCE OF CONTAGIOUS DISEASES IN SCHOOL CHILDREN

(Case rate schools)

KEY:

A: In School

B: Among Absentee

=========+========================================+======================

| | COMMUNICABLE

| GENERAL COMMUNICABLE DISEASES[1] | DISEASES OF EYE

SCHOOL | | AND SKIN[2]

+----------------------------------------+----------+-----------

| NUMBER | | |

+----------+-----------+-----+ Number per| |Number

+-----+----+ Attending + + in Schools+Inspectors|in Schools

---------+-----+----+-----------+-----+-----------+----------+-----------

A | | | | | | |

B | | | | | | |

C | | | | | | |

=========+=====+====+===========+=====+===========+==========+===========

[1] Smallpox, diphtheria, scarlet fever, measles, chicken pox, mumps,

and whooping cough; excluded when found.

[2] Trachoma and other contagious eye diseases, ringworm, impetigo,

scabies, favus, and pediculosis; excluded only for persistent

nontreatment.

Another table shows the following facts for each disease:

TABLE XIII

CONTAGIOUS DISEASES FOUND IN SCHOOLS BY INSPECTORS AND NURSES

(Number and disposition of cases)

KEY:

A: Diphtheria J: Other

B: Scarlet fever K: Ringworm

C: Measles L: Impetigo

D: Smallpox M: Scabies

E: Chicken pox N: Favus

F: Whooping cough O: Pediculosis

G: Mumps P: Miscellaneous

H: Total Q: Total

I: Trachoma

===================+=======================+===========================

| GENERAL | COMMUNICABLE DISEASES

| COMMUNICABLE | OF EYE AND SKIN

| DISEASES |-----+---------------------

| | EYE | SKIN

+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+---

| A| B| C| D| E| F| G| H| I| J| K| L| M| N| O| P| Q

-------------------+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+--+---

===================+==+==+==+==+==+==+==+==+==+==+==+==+==+==+==+==+===

The story of noncontagious physical defects found and treated is set

forth in the following table:

TABLE XIV

MEDICAL EXAMINATION OF SCHOOL CHILDREN: NONCONTAGIOUS PHYSICAL DEFECTS

FOUND AND TREATED, 1906

==============+=============================+=============================+

| SCHOOL A | SCHOOL B |

|--------------+--------------+--------------+--------------|

|-----+--------+-----+--------+-----+--------+-----+--------|

DEFECTS | No. | % of | No. | % of | No. | % of | No. | % of |

--------------+-----+--------+-----+--------+-----+--------+-----+--------+

| | | | | | | | |

==============+=====+========+=====+========+=====+========+=====+========+

==============+=============================+

| SCHOOL C |

|--------------+--------------|

| Found | Reported |

| | Treated |

|-----+--------+-----+--------|

DEFECTS | No. | % of | No. | % of |

--------------+-----+--------+-----+--------+

| | | | |

==============+=====+========+=====+========+

The effect of a report telling what schools have enough seats, proper

ventilation, adequate medical inspection, safe drinking water, ample

play space, and what schools are without these necessities is to cause

the reader to rank the particular school that he happens to know; i.e.

he says, "School A is better equipped than School B; or, School C is

neglected." County and state superintendents in many states have

acquired the habit of ranking schools according to the number of

children who pass in arithmetic, algebra, etc. It would greatly further

the cause of public health and, at the same time, advance the interest

of education if state superintendents would rank individual schools,

and if county superintendents would rank individual schools, _according

to the number of children found to have physical defects, the number

afflicted with contagious diseases, and the number properly treated_.

It is difficult to compare one school with another, because it is

necessary to make subtractions and divisions and to reduce to

percentages. It would not be so serious for a school of a thousand

pupils as for a school of two hundred, to report 100 for adenoids. To

make it possible to compare school with school without judging either

unfairly, the state superintendent of schools for Connecticut has made

tables in which cities are ranked according to the number of pupils,

average attendance, per capita cost, etc. As to each of these headings,

cities are grouped in a manner corresponding to the line up of a

battalion, "according to height." A general table is then shown, which

gives the ranking of each city with respect to each important item.

Applied to schools, this would work out as follows:

TABLE XV

TABLE OF RANKING-SCHOOLS ARRANGED ALPHABETICALLY

=============================================================

SCHOOL | RANK IN

-------+----------+----------+----------+----------+---------

-------+----------+----------+----------+----------+---------

A | 10 | 11 | 11 | 12 | 6

B | 20 | 22 | 22 | 24 | 12

C | 30 | 33 | 30 | 36 | 18

=======+==========+==========+==========+==========+=========

Such a table fails to convey its significance unless the reader is

reminded that rank 18 in children not treated is as good a record for a

school that ranks 30 in register as is rank 6 for a school that ranks

10 in register.

The Connecticut report makes a serious mistake in failing to arrange

schools according to population. If this were done, schools of a size

would be side by side and comparison would be fair. When, as in the

above table, schools are arranged alphabetically, a school with four

thousand pupils may follow or precede a school with four hundred

pupils, and comparison will be unfair and futile.

Where, on the other hand, schools are arranged in order of register, a

table will show whether schools confronted with practically the same

problems, the same number of defects, the same number of children

needing treatment, are equally successful, or perhaps equally inactive,

in correcting these defects. The following table brings out clearly

marked unequal achievement in the face of relatively equal need.

TABLE XVI

TABLE OF RANKING-SCHOOLS ARRANGED ACCORDING TO REGISTER, NOT

ALPHABETICALLY

=============================================================

| RANK IN

SCHOOL +----------+----------+----------+----------+---------

-------+----------+----------+----------+----------+---------

A | 9 | 9 | 9 | 9 | 9

X | 10 | 10 | 10 | 14 | 6

H | 11 | 11 | 11 | 17 | 3

=======+==========+==========+==========+==========+=========

If the number of schools in a state is so large that it is unlikely

that people will read the table of ranking because of the difficulty of

finding their own school, an alphabetical table might be given that

would show where to look in the general ranking table for the school or

schools in which the reader is interested.

Experience will demonstrate to public school superintendents the

strategic advantage of putting together all the things they need and of

telling the community over and over again just what needs there are,

what penalties are paid for want of them, and what benefits would

result from obtaining them. If health needs of school children were

placed side by side with mental results, the relation would come out so

clearly that parents, school boards, and taxpayers would realize how

inextricably they are bound together and would see that health needs

are satisfied. To this end superintendents should require teachers to

keep daily reports of school conditions.

TABLE XVII

WEEKLY CLASS-ROOM SCHEDULE

===========+================+========================+==============

| Temperature | Cleaning | Exercise

+-----+-----+-----+-----+-----+------------+------+-------

| | | | | | | In |Out of

|10.30|12.00| 2.00| Dry | Wet |Disinfecting| Room | Room

----------+-----+-----+-----+-----+-----+------------+------+-------

==========+=====+=====+=====+=====+=====+============+======+=======

The teacher's daily report of the temperature of a schoolroom, taken

three times a day, tells the parent exactly what is the efficiency of

the ventilating and heating apparatus in the particular school in which

he is interested; whereas the report of the department of buildings

gives only the number of schools which have an approved system of

ventilation and steam heat. School authorities may or may not know that

this system of ventilation is out of order, that the thermometer in the

indoor playground of School A stood at forty degrees for many days in

winter. But they must know it when the principal of School A sends in a

daily record; the school board, the parents, or the press will then

see that the condition is remedied. If the condition is due to lack of

funds, funds will never be forthcoming so long as the condition is

concealed.

Similar results will follow publicity of overcrowding, too little play

space, dry cleaning of school buildings, etc. The intent of such

reporting is not to "keep tabs" on the school-teacher, the school

child, the janitor, the principal, superintendent, or board, but to

insure favorable conditions and to correct bad conditions. This is done

best by giving everybody the facts. The objective test of the

efficiency of a method throws emphasis on the method, not on the motive

of those operating it. The blackboard method of publishing facts

concentrates attention upon the importance of those facts and enlists

aid in the attainment of the end sought.

CHAPTER XXXI

THE PRESS

The president of Princeton University declares that for several decades

we have given education that does not instruct and instruction that

does not educate. Others tell us that because we read daily papers and

magazines our minds become superficial, that our power to concentrate

or memorize is weakened,--that we read so much of everything that we

learn little of anything. As the habit of reading magazines and

newspapers is constantly increasing, I think we must assume that it has

come to stay. If we cannot check it, we can at least turn it to good

advantage, systematize it, and discipline ourselves.

Among the subjects continually described in newspapers and magazines,

and even on billboards and in street-car advertising, is the subject of

hygiene. No greater service can be rendered the community than for

those who are conducting discussions of health to teach people how to

read correctly this mass of information regarding health, to separate

misinformation from information, and to apply the lessons learned to

personal and public hygiene. There is no better way of doing this than

to teach a class or a child to clip out of magazines and newspapers all

important references to health, and then to classify these under the

subject-matter treated. A teacher, parent, or club leader might

practice by using the classification of subjects outlined in the

Contents of this book. It is surprising how rapidly one builds up a

valuable collection serviceable for talks or papers, but more

particularly for giving one a vital and intelligent interest in

practical health topics.

Interested in comparing the emphasis placed on health topics in a

three-cent paper having a small circulation with a penny paper having

twenty times the circulation, I made during one week thirty-eight

clippings from the three-cent paper and ninety-five from the penny

paper. The high-priced paper had no editorial comment within the field

of health, whereas the penny paper had three columns, in which were

discussed among other things: _The Economics of Bad Teeth_; _Need for

Individual Efficiency_; _"Good Fellows" Lower Standard of Living by

Neglecting their Families_. The penny paper advertised fifty-two foods,

garments, whiskies, patent medicines, or beautifiers urged upon health

grounds. In the three-cent paper twenty-six out of thirty-eight items

advertised food, clothing, patent medicine, or whisky. One issue of a

monthly magazine devoted to woman's interests contained twenty-eight

articles and editorials and fifty-five advertisements that concern

health,--thirty-seven per cent of total reading matter and thirty-seven

per cent of total advertisement.

Excellent discipline is afforded by this clipping work. It is

astonishing how few men and women, even from our better colleges, know

how to organize notes, clippings, or other data, so that they can be

used a few weeks later. There is a satisfaction in seeing one's material

grow, as is remembered by all of us, in making picture scrapbooks or

collections of picture postal cards and stamps. "Collections" have

generally failed for want of classification,--putting things of a kind

together. Chronological arrangement is uninteresting because

unprofitable. One never knows where to find a picture, or a stamp, or a

health clipping. Clippings, like libraries, will be little used if not

properly catalogued so that use is easy. If a health-clipping collection

is attempted, there are four essentials: (1) arrangement by topic; (2)

inclusion of advertisements; (3) inclusion of items from magazines; (4)

cross references.

For classification, envelopes can be used or manila cards 10×12 inches.

The teacher, parent, or advanced student will probably think the

envelope most useful because most easily carried and filed,--most

likely to be used. But clippings should be bound together in orderly

appearance, or else it will be disagreeable working with them.

Children, however, will like the pasting on sheets, which show clearly

the growth of each topic. Envelopes or cards should not have clippings

that deal with only one health topic. Unless a test is made to see how

many health references there are in a given period, it should be made a

rule not to clip any item that does not contain something new,--some

addition to the knowledge already collected.

Advertisements will prove interesting and educative. When newspapers

and magazines announce some new truth, the commercial motive of

manufacturer or dealer sees profit in telling over and over again how

certain goods will meet the new need. Children will soon notice that

the worst advertisements appear in the papers that talk most of

"popular rights," "justice," and "morality." They will be shocked to

see that the popular papers accept money to tell falsehoods about fake

cures. They will be pleased that the best monthly magazines contain no

such advertisements. They will challenge paper or magazine, and thus

will be enlisted while young in the fight against health advertisements

that injure health.

To clip articles from magazines will seem almost irreverent at first.

But the reverence for magazines and books is less valuable to education

than the knowledge concealed in them. Except where families preserve

all magazines, clippings will add greatly to their serviceability.

The art of cross-referencing is invaluable to the organized mind. The

purpose of classifying one's information is not to show how much there

is, but to answer questions quickly and to guide constructive thinking.

A clipping that deals with _alcoholism_, _patent medicine_, and

_tuberculosis_ must be posted in three places, or cross-referenced;

otherwise it will be used to answer but one question when it might

answer three. If magazines may not be cut, it will be easy to record

the fact of a useful article by writing the title, page, and date on

the appropriate index card, or inclosing a slip so marked in the proper

envelope.

While it is true that the most important bibliography one can have in

his private library is a classification of the material of which he

himself has become a part while reading it, there are a number of

health journals that one can profitably subscribe for. In fact, it is

often true that the significant discoveries in scientific fields, or

the latest public improvements, such as parks, bridges, model

tenements, will not be appreciated until one has read in health

journals how these improvements affect the sickness rate and the

enjoyment rate of those least able to control their living conditions.

The physician and nurse in their educational work for hospitals are

distributors of health propaganda.

Wherever there is a local journal devoted to health, parents, teachers,

educators, and club leaders would do well to subscribe and to hold this

journal up to a high standard by quoting, thanking, criticising it. In

New Jersey, for example, is a monthly called the _New Jersey Review of

Charities and Corrections_ that deals with every manner of subject

having to do with public health as well as with private and public

morality and education.

A similar journal, intended for national instruction, is _The Survey_,

whose topical index for last year enumerates two hundred and thirty-two

articles dealing with subjects directly connected with public hygiene,

e.g.:

Schools, 6; school inspection, 3; eyes,--school children, 1; sex

instruction in the schools, 2; psychiatric clinic, special

children, 2; industrial education, 5; child labor, 18;

playgrounds, 26; alley, crap, playing in streets, 3; labor

conditions, 18; industrial accidents, 10; wage-earner's

insurance, 4; factory inspection, 1; consumer's league, 3; women's

work, 6; tuberculosis, 23; hospitals, dispensaries (social), 5;

tenement reform, 10; living conditions, 2; baths, 1; public

comfort stations, 2; lodging houses, 1; clean streets, 6; clean

milk, 6; smoke, 1; noises, 1; parks, 1; patent medicines, 2;

sanitary code, 1; mortality statistics, 2; social settlements and

public health, 1; midwives, 1; children's bureau, 1; juvenile and

adult delinquent, 25; dependent, defective, and insane, 7; blind,

5; cripples, 1; homes for aged, 1; inebriates, 3; Traveler's Aid

Committee, 1; infant mortality, 2; social diseases, 2.

* * * * *

_The National Hospital Record_, the _Dietetic and Hygienic Gazette_,

the _Journal of Nursing_, are three other magazines primarily intended

for nurses and physicians, but full of suggestive material for

unprofessional readers. National magazines concerned with health, but

seeking popular circulation, are _Good Health_ and _Physical Culture_.

In England there is a special magazine called _Children's Diseases_,

which could be of great help to a school library for special reference.

The same can be said of the _Psychological Clinic_, _Pediatrics_, and

other technical journals published in this country. For many persons,

to make the best use of any one copy of these magazines, clipping is of

course impossible, but noting on a card or envelope is practicable.

Of late many of the national popular magazines have several columns

devoted to health. We have not appreciated the educational

possibilities of these columns. In most large cities there are monthly

book reviews which may be profitably consulted in learning the new

thought in the health field. If teachers would either write their

experience or ask questions, if children knew that in a certain

magazine or newspaper questions as to ventilation, bathing, exercise,

would be answered, they would take a keen interest in the progress of

discussions. The large daily papers make a great feature of their

health hints. It is not their fault if questioners care more about

cosmetics and hair bleaches than about the fresh-air cure of headaches.

They will coöperate with teachers and parents in securing more general

discussion of other problems than beauty doctoring.

Finally, persons wanting not only to have intelligence as to matters

promoting health, but actually to exert a helpful influence in their

community, ought to want the published reports of the mayor, health

department, the public schools, and other institutions, noting

carefully all that is said about conditions relating to health and

about efforts made to correct all unfavorable conditions. The best

literature of our day, with regard to social needs, appears in the

reports of our public and private institutions and societies. Of

increasing value are the publications of the national government

printing office. Because it is no one's business to find out what

valuable material is contained in such reports, and because no

educational museum is comparing report with report, those who live

nearest to our health problems and who see most clearly the health

remedies, are not stimulated to give to the public their special

knowledge in an interesting, convincing way.

Teaching children how to find health lessons in public documents will

advance the cause of public ethics as well as of public health. At the

New York State Conference of Charities, of 1907, one official

complained that the physicians made no educational use of their

valuable experience for public education. He stated that a study of

medical journals and health articles in popular magazines revealed the

fact that the number of papers prepared by physicians in state

hospitals averaged one to a doctor for every five or six years of

service. This state of affairs is even more exaggerated in strictly

educational institutions. Columbia University has recently instituted a

series of lectures to be given by its professors to its professors, so

that they may have a general knowledge of the work being done in other

fields besides their own at their own university. This is equally

important for teachers and heads of departments in elementary schools.

It is now admitted by most educators that elementary schools and young

children present more pedagogical difficulties and pressing biological

problems than higher schools. If teachers and parents would realize

that their method of solving the health problems that arise daily in

the schoolroom and in the home would interest other mothers and

teachers, their spirit of coöperation would soon be reflected in school

journals, popular magazines, and daily newspapers.

PART V. ALLIANCE OF HYGIENE, PATRIOTISM, AND RELIGION

CHAPTER XXXII

DO-NOTHING AILMENTS

"Men have died, from time to time, and worms have eaten them, but not

for love"--_nor for work_. Work of itself never killed anybody nor made

anybody sick. Work has caused worry, mental strain, and physical

breakdown, only when men while working have been deprived of air, sun,

light, exercise, sleep, proper food at the proper time, opportunity to

live and work hygienically. Fortunately for human progress, doing

nothing brings ailments of its own and has none of the compensations of

work. As the stomach deprived of substantial food craves unnatural

food,--sweets, stimulants,--so the mind deprived of substantial,

regular diet of wholesome work turns to unwholesome, petty, fantastic,

suspicious, unhappy thoughts. This state of mind, combined with the

lack of bodily exercise that generally accompanies it, reacts

unfavorably on physical health. An editor has aptly termed the

do-nothing condition as a self-inflicted confinement:

A great deal of the misery and wretchedness among young men that

inherit great fortunes is caused by the fact that they are

practically in jail. They have nothing to do but eat, drink, and

enjoy themselves, and they cannot understand why their lives are

dull.

We have had the owner of a great railroad system pathetically

telling the public that he is unhappy. That is undoubtedly true,

because with all his race horses, and his yachts, and all the

things that he imagines to be pleasures, he is not really doing

anything.

If he were running one little railroad station up the road,

handling the freight, fussing about dispatches, living above the

railroad station in two rooms, and buying shoes in a neighboring

village for fifteen children he would be busy and happy.

But he cannot be happy because he is in prison,--in a prison of

money, a prison that is honorable because it gives him everything

that he wants, and he wants nothing.

A New York newspaper that circulates among the working classes where

young men and women are inclined to associate health and happiness with

doing nothing recently gave two columns to "Dandy Jim," the richest dog

in the world. Dandy Jim's mistress left him a ten-thousand-dollar

legacy. During his lifetime he wore diamonds. Every day he ate candy

that cost eighty cents a pound. The coachman took him driving in the

park sunny afternoons. He had no cares and nothing to work for. His

food came without effort. He had fatty degeneration of the vital

organs. He was pampered, coddled, and killed thereby. Thousands of men

and women drag out lives of unhappiness for themselves and others

because, like Dandy Jim, they have nothing to work for, are pampered,

coddled victims of fatty degeneration. When President Butler of

Columbia University finds it necessary to censure "the folly and

indifference of the fathers, vanity and thoughtless pride of the

mothers" who encourage do-nothing ailments; and when the editor of the

_Psychological Clinic_ protests that the fashionable private schools

and the private tutor share with rich fathers and mothers

responsibility for life failures,--it is time that educators teach

children themselves the physical and moral ailments and disillusions

that come from doing nothing.

Ten years ago a stenographer inherited two hundred and fifty thousand

dollars. Her dream of nothing to do was realized. She gave up her

strenuous business life. Possessions formerly coveted soon clogged her

powers of enjoyment. She imagined herself suffering from various

diseases, shut herself up in her house, and refused to see any one. She

grew morbid and was sure that every person who approached her had some

sneaking, personal, hostile motive. Though always busy, she

accomplished little. Desultory work, procrastination, and

self-indulgence destroyed her power of concentration. She could not

think long enough on one subject to think it out straight, therefore

she was constantly deceived in her friends and interests. She first

trusted everybody, then mistrusted everybody. Infatuation with every

new acquaintance was quickly followed by suspicion. For years she was a

very sick woman, a victim of do-nothing ailments.

Doing nothing has of late been seriously recommended to American

business men. They are advised to retire from active work as soon as

their savings produce reasonable income. It is true, this suggestion

has been made as an antidote to greed rather than for the happiness of

the business man. What retiring from business is apt to mean, is

indicated by a gentleman who at the age of sixty decided to sell his

seat on the New York Stock Exchange and to enjoy life. He became

restless and very miserable. He threw himself violently into one thing

after another; in less than a year he became an ill, broken old man,

after trying vainly to buy back his business.

Both mind and body were made to work. The function of the brain is to

think to a purpose, just as the function of the heart is to pump blood.

The habit of doing nothing is very easily formed. The "out-of-work"

soon become "the work-shy." Having too little to do is worse for the

body and mind than having too little to eat. Social reformers emphasize

the bad effect on society of vagrancy. Evils of indiscriminate relief

to the poor are vividly described year after year. The philanthropist

is condemned, who, by his gifts, encourages an employee's family to

spend what they do not earn, and to shun work. Yet the idleness of the

tramp, street loafer, and professional mendicant is a negligible evil

compared with the hindrance to human progress caused by the idleness of

the well-to-do, the rich, the educated, the refined, the "best" people.

It is as much a wrong to bring up children in an atmosphere of

do-nothingism, as to refuse to have their teeth attended to or to have

glasses fitted to weak eyes.

From the point of view of community welfare it is far more serious for

the rich child to be brought up in idleness or without a purpose than

for the poor child to become a public charge. Not only has society a

right to expect more from rich children in return for the greater

benefits they enjoy, but so long as rich children control the

expenditure of money, they control also the health and happiness of

other human beings. Unless taught the value and joy of wholesome work

they cannot themselves think straight, nor are they likely to want to

understand how they can use their wealth for the benefit of mankind. To

quote President Butler again:

The rich boy who receives a good education and is trained to be a

self-respecting member of the body politic might in time share on

equal terms the chance of the poor boy to become a man of genuine

influence and importance on his own account, just as now by the

neglect, or worse, of his parents the very rich boy is apt to be

relegated to the limbo of curiosities, and too often of decadence.

Nervous invalids make life miserable for themselves and for others,

when often their sole malady is lack of the right kind of work to do.

Suiting work to interest and interest to work is an economy that should

not be overlooked. The energy spent in forcing oneself to do a

distasteful task can be turned to productive channels when work is made

pleasurable. The fact is frequently deplored that whereas formerly a

man became a full-fledged craftsman, able to perform any branch of his

trade, he is now confined to doing special acts because neither his

interest nor his mind is called into play. Work seems to react

unfavorably on his health. He has not the pride of the artisan in the

finished product, for he seldom sees it. He does a task. His employer

is a taskmaster. He decides that work is not good for him as easily as

when a school-boy he grasped the meaning of escape from his lessons. By

failing to fit studies to a student's interest, or by failing to insure

a student's interest in his studies, schools and colleges miseducate

young men and young women to look upon all work as tasks, as

discipline, necessary but irksome, and to be avoided if possible. Just

as there is a way of turning all the energy of the play instinct into

school work, so there is a way of interesting the factory and office

worker in his job. However mechanical work may be, there is always the

interest in becoming the most efficient worker in a room or a trade.

Routine--accurate and detailed work--does not mean the stultification

of the imagination. It takes more imagination to see the interesting

things in statistical or record work than to write a novel. Therefore

employers should make it a point to help their employees to realize the

significance of the perfection of each detail and the importance of

each man's part. The other day a father said to me, "I want my boys to

be as ashamed to do work in which they are not interested as to accept

graft." When interest in work and efficiency in work are regarded as of

more importance than the immediate returns for work, when it is as

natural for boys and girls to demand enjoyment and complete living in

work as it is to thrill at the sight of the Stars and Stripes,

do-nothing ailments will be less frequent and less costly.

Work--that one enjoys--is an invaluable unpatented medicine. It can

make the sick well and keep the well from getting sick. It is the chief

reliance of mental hygiene. "I should have the grippe if I had time,"

said a business woman to me the other day; but she did not have time,

hence she did not have the grippe.

If you're sick with something chronic,

And you think you need a tonic,

Do something.

There is life and health in doing,

There is pleasure in pursuing;

Doing, then, is health accruing--

Do something.

And if you're seeking pleasure,

Or enjoyment in full measure,

Do something.

Idleness, there's nothing in it;

'Twill not pay you for a minute--

Do something.

CHAPTER XXXIII

HEREDITY BUGABOOS AND HEREDITY TRUTHS

One of the red-letter days of my life was that on which I learned that

I could not have inherited tuberculosis from two uncles who died of

consumption. For years I had known that I was a marked victim. Silently

I carried my tragedy, suspecting each cold and headache to be the

telltale messenger that should let others into my secret. He was a

veritable emancipator who informed me that heredity did not work from

uncle to nephew; that not more than a predisposition to consumption

could pass even from parent to child; that a predisposition to

consumption would come to nothing without the germ of the disease and

the environmental conditions which favor its development; and that if

those so predisposed avoid gross infection, lead a healthy life, and

breathe fresh air they are as safe as though no tuberculous lungs had

ever existed in the world. Some years later I learned to understand the

other side of the case; I realized how I had been in real danger of

contracting consumption in the darkened, ill-ventilated sick room of

the uncle who taught me my letters and gave me my ideal of God's

purpose in sending uncles to small boys.

There are two distinct things which make each individual life: the

living stuff, the physical basis of life, handed down from parent to

child; and the environmental conditions which surround it and play upon

it and rouse its reactions and its latent possibilities. It is like the

seed and the cultivation. You cannot grow corn from wheat, but you can

grow the best wheat, or you may let your crop fail through careless

handling.

It is well that we should think seriously about the part played by

heredity, for the living stuff of the future depends upon our sense of

responsibility in this regard. The intelligent citizen would do well to

read such a book as J. Arthur Thompson's _Heredity_ (1908), in which

the latest conclusions of science are clearly and soundly set forth.

The main problem of to-day, however, is to use well the talents that we

have. Here two things should always be kept in mind: First, the

inherited elements which make up our minds and bodies are complex and

diverse. Health and strength are inherited as well as disease and

weakness; they have indeed a better chance of survival. In the most

unpromising ancestry there are latent potentialities which may be made

fruitful by effort. No limit whatever can be set to the possibilities

of improvement in any individual.

In the second place, if science has shown anything more clearly than

the importance of heredity, it is the importance of environment. This

influence upon human lives is within our control, and it is a grave

error to neglect what lies clearly within our power and to bemoan what

does not. Science has wrought no benefits greater than those which

result from drawing a clear line between heredity bugaboos and heredity

truths. An overemphasis on the hereditary factor in development at the

expense of the environmental factor, I call a heredity bugaboo; and it

is a tendency which cannot be too strongly condemned. To fight against

the sins and penalties of one's grandfather is a forlorn task that

quickly discourages. To overcome diseases of environment, of shop and

street, of house and school, seems, on the contrary, an easy task.

Heredity bugaboos dishearten, enervate, encourage excesses and neglect.

Heredity truths stimulate remedial and preventive measures.

We may well watch with interest the progress of eugenics, that new

science which biologists and sociologists hope will some day remake the

very living stuff of the human race. But meanwhile let us take up with

hope and courage and enthusiasm the great hemisphere of human fate

which lies within our grasp. Good food and fresh air, well-built

cities, enlightened schools and well-ordered industries, stable and

free and expert government,--given these things, we can transform the

world with the means now at our disposal. We can reap, if we will,

splendid possibilities now going to waste, and by intelligent

biological and sociological engineering we can hand on to the next

generation an environmental inheritance which will make their task far

easier than ours.

"Physical deterioration" is a bugaboo that is discovered by some in

heredity and by others in modern industrial evils. The British director

general called attention a few years ago to the fact that from forty to

sixty per cent of the men who were being examined for military service

were physically unfit. A Commission on Physical Deterioration was

appointed to investigate the cause, and to learn whether the low

physical standard of the would-be Tommy Atkins was due to inherited

defects. The results of this study were published in a large volume

called _Report on Physical Deterioration, 1904_, in which is set forth

a positive programme for obtaining periodically facts as to the

physique of the nation. In the course of the commission's exhaustive

investigation there was found no evidence that any progressive

deterioration was going on in any function of the body except the

teeth. "There are happily no grounds for associating dental degeneracy

with progressive physical deterioration." The increase in optical

defects is attributed not to the deterioration of the eye, but to

greater knowledge, more treatment, and better understanding of the

connection between optical defects and headache.

[Illustration: Testing Environment--House Score]

+--------------------------------------------------------------------+

| DEFINITIONS OF TERMS USED IN HOUSE SCORE CARD |

| |

| LIGHT--Light enough to read easily in every part. |

| |

| GLOOMY--Not light enough to read easily in every part, but enough |

| readily to see one's way about when doors are closed. |

| |

| DARK--Too dark to see one's way about easily when doors are |

| closed. |

| |

| WELL VENTILATED--With window on street or fair-sized yard (not |

| less than 12 ft. deep for a five-story tenement house not on a |

| corner), or on a "large," "well-ventilated" court open to the sky |

| at the top: "large" being for a court entirely open on one side to |

| the street or yard in a five-story tenement, not less than 6 ft. |

| wide from the wall of the building to the lot line; for a court |

| inclosed on three sides and the other on the lot line in a |

| five-story tenement, not less than 12×24 ft., "well ventilated" |

| meaning either entirely open on one side to the street or yard, or |

| else having a tunnel at the bottom connecting with the street or |

| yard. |

| |

| FAIRLY VENTILATED--With window opening on a shallow yard or on a |

| narrow court, open to the sky at the top, or else with 5×3 inside |

| window (15 ft. square) opening on a well-ventilated room in same |

| apartment. |

| |

| BADLY VENTILATED--With no window on the street, or on a yard, or |

| on a court open to the sky, and with no window, or a very small |

| window, opening on an adjoining room. |

| |

| IN GOOD REPAIR--No torn wall paper, broken plaster, broken |

| woodwork or flooring, nor badly shrunk or warped floor boards or |

| wainscoting, leaving large cracks. |

| |

| IN FAIR REPAIR--Slightly torn or loose wall paper, slightly broken |

| plaster, warped floor boards and wainscoting. |

| |

| IN BAD REPAIR--Very badly torn wall paper or broken plaster over a |

| considerable area, or badly broken woodwork or flooring. |

| |

| (Rooms not exactly coinciding with any of the three classes are to |

| be included in the one the description of which comes nearest to |

| the condition.) |

| |

| SINKS: GOOD--Iron, on iron supports with iron back above to |

| prevent splashing of water on wall surface, in light location, |

| used for one family. Water direct from city water mains or from a |

| CLEAN roof tank. |

| |

| BAD--Surrounded by wood rims with or without metal flushings, |

| space beneath inclosed with wood risers; dark location, used by |

| more than one family; water from dirty roof tank. |

| |

| FAIR--Midway between above two extremes. (Sinks not exactly |

| coinciding with any of the three classes are to be included in the |

| one the description of which comes nearest to the condition.) |

| |

| WATER-CLOSET: GOOD--Indoor closet. In well lighted and ventilated |

| location, closet fixture entirely open underneath, abundant water |

| flush. |

| |

| FAIR--Indoor closet, poor condition--badly lighted and ventilated |

| location, fixture inclosed with wood risers, or poor flush. |

| |

| POOR--Yard closet--separate water-closet in individual compartment |

| in the yard. |

| |

| BAD--School sink--sewer-connected privy, having one continuous |

| vault beneath the row of individual toilet compartments. |

+--------------------------------------------------------------------+

The commission hoped "that the facts and opinions they have collected

will have some effect in allaying the apprehensions of those who, as it

appears, on insufficient grounds, have made up their minds that

progressive deterioration is to be found among people generally." In

regard to the facts which started the fear, the report says: (1) the

evidence adduced in the director general's memorandum was inadequate to

prove that physical deterioration had affected the classes referred to;

(2) no sufficient material (statistical or other) is at present

available to warrant any definite conclusions on the question of the

physique of the people by comparison with data obtained in past times.

[Illustration: THE BEST INHERITANCE IS A MOTHER WHO KNOWS HOW TO

KEEP HER BABY WELL]

The topics dealt with in the report refer to only a partial list of

conditions that need to be carefully studied before we can know what

environment heredity we are preparing for those who follow us:

I. AS TO BABIES

Training of mothers, provident societies and maternity funds,

feeding of infants, milk supply, milk depots, sterilization and

refrigeration of milk, effect of mother's employment upon infant

mortality, still births, cookery, hygiene and domestic economy,

public nurseries, crèches.

II. AS TO CHILDREN

Anthropometric measurements, sickness and open spaces, medical

examination of school children, teeth, eyes, and ears, games and

exercises for school children, open spaces and gymnastic

apparatus, physical exercise for growing girls and growing boys,

clubs and cadet corps, feeding of elementary school children,

partial exemption from school, special schools for "retarded"

children, special magistrate for juvenile cases, juvenile smoking,

organization of existing agencies for the welfare of lads and

girls, education, school attendance in rural districts, defective

children.

III. AS TO LIVING AND WORKING CONDITIONS

overcrowding, building and open spaces, register of owners of

buildings, unsanitary and overcrowded house property, rural

housing, workshops, coal mines, etc., medical inspection of

factories, employment of women in factories, labor colonies,

overfatigue, food and cooking, cooking grates, adulteration, smoke

pollution, alcohol, syphilis, insanity.

IV. AS TO HEALTH MACHINERY

Medical officers of health, local, district, and national boards,

health associations.

Scientists of the next generation will continue to differ as to

heredity truths and heredity bugaboos unless records are kept now,

showing the physical condition of school children and of applicants for

work certificates and for civil service and army positions. The British

investigators declared that "anthropometric records are the only

accredited tests available, and, if collected on a sufficient scale,

they would constitute the supreme criterion of physical deterioration,

or the reverse.... The school population and the classes coming under

the administration of the Factory Acts offer ready material for the

immediate application of such tests." In addition to the physical tests

proposed in other chapters, there is great educational opportunity in

the records of private and public hospitals. Every nation, every state,

and every city should enlist all its educational and scientific forces

to ascertain in what respects social efficiency is endangered by

physical deficiencies that can be avoided only by restricting

parenthood, and the environmental deficiencies that can be avoided by

efficient health machinery.

The greatest of all heredity truths are these: (1) the deficiencies of

infants are infinitesimal compared with the deficiencies of the world

with which we surround them; (2) each of us can have a part in

begetting for posterity an environment of health and of opportunity.

CHAPTER XXXIV

INEFFECTIVE AND EFFECTIVE WAYS OF COMBATING ALCOHOLISM

Wherever the Stars and Stripes fly over school buildings it is made

compulsory to teach the evils of alcoholism. For nearly a generation

the great majority of school children of the United States have been

taught that alcohol, in however small quantities, is a poison and a

menace to personal and national health and prosperity. Yet during this

very period the per capita consumption of every kind of alcoholic

beverage has increased. Whereas 16.49 gallons of spirituous liquors

were consumed per capita of population in 1896, 22.27 gallons were used

in 1906. Obviously the results of methods hitherto in vogue for

combating alcoholism are disappointing.

Why this paradoxical relation of precept to practice? Why is this, the

most hygiene-instructed country in the world, the Elysium of the

patent-medicine and cocaine traffic? If we have only the expected

divergence of achievement from ideal, then there is nothing for us to

do but to congratulate ourselves and posterity upon the part played by

compulsory legislation in committing all states and territories to

hygiene instruction in all public schools. If, on the other hand, our

disappointment is due to ineffective method, then the next step is to

change our method.

The chief purpose of school hygiene has hitherto been not to promote

personal and community health, but to lessen the use of alcohol and

tobacco. Arguments were required against whisky, beer, cigars, and

cigarettes. As the strongest arguments would probably make the most

lasting impression upon the school child and the best profits for

author and bookseller, writers vied with one another in the rhetoric

and hyperbole of platform agitation. What effect would it have upon you

if you were exhorted frequently during the next eight years to avoid

tobacco because a mother once killed a child by washing its head in

tobacco water? What is the effect on the mind of a boy or a girl who

sees that the family doctor, the minister, the teacher, the judge, the

governor, the President, and the philanthropist use tobacco and

alcoholic beverages, when taught that "boys who use tobacco and

alcoholic beverages will find closed in their faces the doors to

strength, good health, skill in athletics, good scholarship, long life,

best companions, many business positions, highest success"? It is

probably true that "a boy once drank some whisky from a flask and died

within a few hours." But that story is about as typical of boys and of

whisky as that a boy once drank whisky from a flask and did not die for

ninety years afterwards, or that George Washington drank whisky and

became the Father of his Country.

How special pleading has dominated the teaching of school hygiene is

illustrated by a recent book which, for the most part, successfully

breaks away from the narrow point of view and the crude methods

hitherto prevailing. It presents the following facts concerning New

York City:

Saloons 10,821

Arrests 133,749

Expense of police department $10,199,206

Police courts, jails, workhouses, reformatories 1,310,411

Hospitals, asylums, and other charities 4,754,380

It is fair to the author to state that she does not declare in so many

words that the shutting up of the saloons would obviate all the arrests

and all the hospital, jail, and charity bills. Instead of _wipe out_

she says _shrivel_. No truth would have been lost by avoiding all

misrepresentation.

The author probably felt as I did when I took my total abstainer's

protest to a celebrated scientist who had exposed certain misstatements

regarding the effect of small quantities of alcohol: "Is not the

untruth of these exaggerated statements less dangerous than the untruth

of dispassionate, scientific statement? So long as the child mind takes

in only an impression, is it not better to write this impression

indelibly?" He sadly but indulgently replied, "And in what other

studies would you substitute exaggeration for truth?"

The reaction has already begun against exaggeration in hygiene

text-books, against drawing lessons from accidental or exceptional

cases of excessive use of alcohol, against classing moderate drinking

and smoking with drunkenness as sins of equal magnitude, and against

overlooking grave social and industrial evils that threaten children

far earlier and more frequently than do tobacco and alcohol. Instead of

adding an ell to the truth, text-book writers are now adding only an

inch or two at a time. No longer do we favor highly colored charts that

picture in purple, green, and black the effect of stimulants and

narcotics upon the heart and brain, the stomach, the liver, the knee,

and the eardrum, _assuming that all resultant evils are concentrated in

one organ_. Menacing habits, such as overeating and indulgence in

self-pity, are beginning to receive attention. It is also true that

physiology and anatomy are progressively made more interesting.

Publishers are looking for the utmost originality compatible with the

purpose of the present laws and with the only effective public

sentiment that has hitherto been interested in the interpretation of

those laws.

A score of improvements in the method of carrying out a small ideal

will not take the place of enlarging that ideal. If existing laws stand

in the way of broadening the purpose of school hygiene, let the laws be

changed. If text-book publishers stand in the way, let us induce or

compel them to get out of the way. If we fear rumsellers, their money,

and the insidious political methods that they might employ to bring in

undertruth if overtruth is once sacrificed, let us go to our

communities and locate the rumseller's guns, draw their fire, tell the

truth about their opposition, and educate the public to overcome it.

If, on the other hand, misguided teetotalism stands in the way, then,

as one teetotaler, I suggest that we prove, as we can, in our

respective communities that there is a better way of inculcating habits

of temperance and self-restraint than by telling untruths, overtruths,

or half truths about alcohol and tobacco. Let us prove, as we can, that

a subject vital to every individual, to every industry, and to every

government is now prevented from fulfilling its mission not by its

enemies but by its friends. We can learn the character of hygiene

instruction in our schools and the interest taken in it by teachers,

principals, and superintendents. We can learn how teachers practice

hygiene at school, and how the children of our communities are affected

by the hygiene instruction now given. Finally, we can compel a public

discussion of the facts, and action in accordance with facts. Without

questioning anybody's avowed motive, we can learn how big that motive

is and how adequate or inadequate is the method of executing it.

Alcohol and tobacco really occupy but a very small share of the

interest and attention of even those men and women by whom they are

habitually used. Hygiene, on the other hand, is of constant,

uninterrupted concern. Why, therefore, should it be planned to have

alcohol and tobacco displace the broader subject of personal and public

hygiene in the attention and interest of children throughout the school

life? Beyond the text-book and schoolroom a thousand influences are at

work to teach the social evils, the waste of energy, and the

unhappiness that always accompany the excessive use--and frequently

result from a moderate use--of stimulants and narcotics. Of the many

reasons for not drinking and smoking, physiology gives those that

least interest and impress the child. The secondary effects, rather

than the immediate effects, are those that determine a child's action.

Most of the direct physiological effects are, in the majority of

instances, less serious in themselves than the effects of overeating,

of combining milk with acids, of eating irregularly, of neglecting

constipation. Were it not for the social and industrial consequences of

drunkenness and nicotinism, it is doubtful if the most lurid picture of

fatty degeneration, alcoholic consumption, hardened liver, inactive

stomach lining, would outweigh the pleasing--and deceiving--sensations

of alcoholic beverages and cigarettes.

The strong appeal to the child or man is the effect these habits have

upon his mother, his employer, his wife, his children. The vast

majority of us will avoid or stop using anything that makes us

offensive to those with whom we are most intimately associated, and to

those upon whom our professional and industrial promotion depends.

Children will profit from drill in and out of school in the science of

avoiding offense and of giving happiness, but unless the

categories--_acts that give offense_ and _acts that give

happiness_--are wide enough to include the main acts committed in the

normal relations of son, companion, employer, husband, father, and

citizen, those who set out to avoid alcohol and tobacco find themselves

ill equipped to carry the obligations of a temperate, law-abiding

citizen.

Things do not happen as described in the early text-book. Other things

not mentioned hinder progress and happiness. The child at work resents

the mis-education received at school and suspects that he has been

following false gods. The enemies that cause him trouble come from

unexpected sources. He finds it infinitely easier to eschew alcohol and

tobacco than to avoid living conditions that insidiously undermine his

aversion to stimulants and narcotics. The reasons for avoiding

stimulants in the interest of others are more numerous and more cogent

than the reasons for avoiding stimulants and narcotics for one's own

sake. The altruistic reasons for shunning stimulants and narcotics

cannot be implanted in the child unless he sees the evil of excess _per

se_ in anything and everything, and unless he becomes thoroughly

grounded in the life relations and health relations to which he must

adapt himself.

Unclean streets, unclean milk, congested tenements, can do more harm

than alcohol and tobacco, because they breed a physique that craves

stimulants and drugs. Adenoids and defective vision will injure a

larger proportion of the afflicted than will alcohol and tobacco,

because they earlier and more certainly substitute discouragement for

hope, handicap for equal chance. Failure to enforce health laws is a

more serious menace to health and morals than drunkenness or tobacco

cancer.

If it is true that we must attack the problem of alcohol from the

standpoint of its social and industrial effects, we are forced at once

to consider the machinery by which cities and governments control the

manufacture and sale of alcohol. It is not an exaggeration to say that

courses in regulating the traffic in alcohol are more necessary than

courses in the effects of alcohol upon digestion and respiration.

If Sunday closing of saloons, local option, high license, and

prohibition have failed, there is no evidence that the failure is due

to the principles underlying any one of these methods. Until more

earnest effort is made to study the effects of these methods, the

results of their enforcement and the causes of their nonenforcement, no

one is justified in declaring that either policy is successful or

unsuccessful. It is very easy to select from the meager facts now

available convincing proofs both that prohibition does not prohibit and

that high license leads to increased drunkenness. The consequence is

that the movements to control, restrict, or prohibit the use of alcohol

are emotional, not rational.

It is impossible to keep emotion, sensation, sentiment, at white heat.

Most extremists worship legislation and do not try to keep interest

alive by telling every week or every month new facts about the week or

the month before. No new fuel is added to the anti-saloon fire, which

gradually cools and dies down. Not so, however, with those who make

money by the sale of intoxicants. The greater the opposition, the more

brains, the more effort, the more money they put into overcoming or

circumventing that opposition. Fuel is piled on and the bonfire is fed

freely. Every day the anti-restriction bonfire becomes larger and

larger, and the anti-saloon bonfire becomes smaller and smaller. By

carefully selecting their facts, by counting the number of arrests for

drunkenness and the number of saloons open on Sunday, by reiteration of

their story the pro-saloonists gradually win recruits from the

opposition, and, when the next election comes, their friends outnumber

their enemies and the "dry" policy of a city, county, or state is

reversed.

The failures attributed to prohibitive or restrictive measures are

probably no more numerous than the failures of government in other

respects. The present ambassador from England, James Bryce, writing his

_American Commonwealth_, declared that municipal government was

America's "most conspicuous failure." The mayor of Toledo, writing in

1907, says, "There has been a pessimism, almost enthusiastic, about the

city." These failures are due not to any lack of desire for good

government, not to any fundamental evils of cities, but to the fact

that municipal reform, like the crusade against alcohol, has been based

upon emotionalism, not upon definite proof. Reformers have been unable

to lead in the right direction, because they have looked at their

lantern instead of their road. Not having cumulative information as to

government acts, they have been unable to keep their fires burning. To

illustrate: in November, 1907, the governor of New York state, the

mayor of New York City, and reformers of national reputation eulogized

the tenement-house department; yet this department, whose founding was

regarded as a national benefaction, was the only department of the city

government that did not receive an increase for 1908. It is in the

position of temperance legislation, the facts of whose enforcement or

nonenforcement are not promptly and continuously made public.

Fear of the negro victim of alcoholism, social evils of intemperance,

whether among white or black, industrial uncertainty and waste due to

alcoholism, are the three chief motives that have swept alcohol traffic

out of the greater part of the South. Knowledge of physiological evils

has had little influence, except as it may have rendered more

acceptable the claim that alcoholism is a disease against which there

is no insurance except abolition of alcohol as a beverage. Religious

revivals, street parades by day and by night, illustrated banners,

personal intercession, lines of women and children at the polls, made

it necessary for voters to make known their intention, and made it

extremely difficult for respectable men, engaged in respectable

business, to vote for saloons. Some states have gone so far as to

prohibit the manufacture of alcoholic stimulants, even though not

offered for sale within state limits. In Georgia wine cannot be used at

the communion service, nor can druggists sell any form of liquor except

pure alcohol. In Louisiana it is illegal for representatives of "wet

districts" to solicit orders for liquor in any of the "dry districts."

In Texas the sale of liquor in dining cars is forbidden, and the

traveler may not even drink from his own flask. Congress is being urged

by senators and congressmen, as well as by anti-saloon advocates, to

pass laws prohibiting common carriers from delivering alcoholics to any

"dry" community. The more optimistic anti-saloon workers believe it is

but a matter of a short time when Congress will pass laws prohibiting

the manufacture or sale of alcoholic beverages within any limits

protected by the United States Constitution.

Southern states have been warned that they could not afford the

depreciation of real estate values, of rents, and of business that

would surely follow the "confiscation of capital" and "interference

with personal liberty." This warning has been met by plausible

arguments that the buyers of legitimate and nonpoisonous commodities

could pay better rents, better profits on business and on real estate,

if freed from the uneven fight against temptation to drink. The

argument that schools and streets and health must suffer if the license

money was withdrawn, has been met by the plausible argument that the

ultimate taxpayer--the family that wants clothing, food, and

shelter--will save enough money to be able to spend still larger sums

than heretofore upon education, health, and public safety.

For the first time dealers in alcohol recognize the possibility of a

great national movement and of national prohibition. Both the defects

in methods hitherto used to oppose saloon legislation and the reasons

for meeting the present situation by new methods are presented in the

May issue (1907) of the _Transactions of the American Brewing

Institute_. Under the title, "Social Order and the Saloon--the Measure

of the Brewer's Responsibility," Mr. Hugh F. Fox, known throughout the

Union as a defender of child rights, advocate of probation and

children's courts, promoter of health and education, outlined a plan

for research that is indispensable to the proper settling of this great

question. Whether brewer or anti-saloon leaguist, total abstainer or

moderate drinker, employer or trade unionist, it is necessary to the

intelligent control of alcohol that each of us approach this momentous

question of control or abolition of the saloon in the spirit expressed

in this paper, whose thoroughness and whose social point of view would

do credit to a church conference. The address is quoted and its

questions copied because both show how much depends upon knowing

whether laws are enforced and how much greater is the difficulty of

coping with a conciliatory antagonist who professes willingness to

submit to tests of evidence.

The regulation of the liquor business involves fundamental

questions of the function and scope of government, and there is

hardly any department of organized human activity that has been

the subject of so much experiment and futile tinkering.... The

only people who are perfectly consistent are the prohibitionists,

whose policy is abolition. Let us, however, try to detach

ourselves from any personal interest that we may have in the

subject, and consider it impartially as a matter of public

concern.

What the brewer as an individual cannot do, the brewers as an

organization have done successfully in many places in spite

sometimes of official negligence, corruption, or incapacity. The

Texas Brewers' Association is reported as having successfully

prosecuted two thousand cases against keepers of disreputable

resorts during the past three years. The object of their campaign

was to purify the retail liquor trade from unclean and law-defying

elements.

The greatest gain that has come to society, as distinguished from

the individual, through the temperance movement is its effect in

unconsciously informing the public that the regulation and

administration of licensing is in itself a great and vital

problem; and as a secondary result of such agitation, I should

cite the growing sensitiveness of all persons in the business to

the power of public opinion.

The recognition by brewers of the force of public opinion is a

recent affair. In former years they were totally indifferent to

it, if indeed they did not openly flout it. Even now their appeal

to public sentiment is mainly a special plea for defensive

purposes, and has little or no educational value. Brewers have

opposed practically every effort to effect a change in excise

laws, often without any convincing reason, but simply because the

proposed change involved temporary inconvenience and uncertainty,

and perhaps a temporary loss. The brewing trade has utterly failed

to develop a constructive programme in connection with the public

regulation of its affairs. It does not seem to have any fixed

principles or positive convictions as to excise methods and liquor

laws. Its policy has been that of an opportunist, at the best,--or

an obstructionist, at the worst. As in all other industries which

affect the welfare of the people, reforms have been forced from

the outside, with no help from within. Of course this is equally

true of insurance and railroad corporations, of food purveyors,

mine owners, cotton merchants, and a score of other interests. It

is due not merely to human selfishness but to shortsightedness; in

other words, to a lack of statesmanship.

To call your opponents hypocrites, cranks, fakirs, and fanatics

may relieve your feelings, but it doesn't convince anybody, and

only hurts a just cause. It is foolish to question the motives of

men who, without thought of personal gain, are trying to remedy

the evils of inebriety.

The church is perfectly right in urging total abstinence upon the

individual. The only path of safety lies in abstinence for some

individuals....

The recognition of the right of a community to establish its own

licensing conditions carries with it the right of the community to

determine whether there shall be any licenses at all!

To make the discussion of this subject as fruitful as possible, I

venture to submit the following questions for your consideration.

None of them involve any direct moral issue, but there is an

honest difference of opinion about each one of them, and they are

certainly of vital importance in determining the course of wise

and just administration.

What has been the effect of high license?

How much public revenue should the traffic yield?

Does high license stimulate unlawful trade?

How much license tax should be imposed upon local bottlers and

grocers? Should they be allowed to peddle beer or to sell it in

single bottles?

Should the place or the individual be licensed?

Should the licensing authorities be appointive or elective? By

whom should they be appointed, and for what term of office?

Have the courts made good or bad licensing authorities? Where the

courts issue licenses, what has been the effect on the court?

Should the licensing authority alone have the power to revoke a

license, and discretion to withhold a license?

How can the licensing authority enforce the law? Should it not be

independent of the police?

What should be the penalty for breach of the law? Do not severe

penalties miscarry?

On what plea, and under what conditions, should licenses be

transferred?

What has been the effect of limiting the number of saloons?

Should limitation be according to area or to population?

Is there any relation between the number of saloons and the volume

of consumption?

What should be the limit to the hours of selling?

Should saloons be allowed to become places of entertainment?

How can the sale of liquor by druggists be controlled?

How can spurious drinking clubs be prevented or controlled?

How can the operation of disreputable hotels be prevented? What

should be the definition of a hotel? Who should define it? By whom

should it be licensed? What special privileges should be given to

it?

How can the "back-room" evil be stopped? Is it legal (i.e.

constitutional) to prohibit the sale or serving of liquor to

women?

Has the removal of screens reduced the volume of consumption? Has

it improved the character of saloons? Has it solved the problem of

Sunday prohibition for any length of time? What has been the

general effect of it in the tenement districts?

Should the state undertake to regulate the liquor business or to

enforce liquor laws?

Is it possible to devise any working plan which will apply with

equal effectiveness and equity in communities of compact and of

scattered population?

Should, or should not, the principle of self-government be

carefully preserved in the whole scheme of legislation to regulate

the liquor business?

Whether the present prohibition wave shall wash away the legalized

saloon, as ocean waves have from time to time engulfed peninsulas,

islands, and whole continents, depends upon the power of American

educators and American officials to answer right such questions as the

foregoing. The great danger is that we shall, as usual, over-emphasize

lawmaking, underemphasize lawbreaking, and go to sleep during the next

two or three years when we should be wide-awake and constantly active

in seeing that the law is enforced. Unless exactly the same principles

of law enforcement are applied in "dry districts" as we have urged for

eradication of smallpox, typhoid, scarlet fever, and adenoids, local

and city prohibition are doomed to failure. There must be:

1. Inspection to discover disease centers--"blind pigs," "blind

tigers," etc.

2. Compulsory notification by parents and landlords, and by police

and other officials.

3. Prompt investigation upon complaint from private citizens.

4. Prompt removal of the disease and disinfection of the center.

5. Segregation of individual units that disseminate disease,

whether bartender, saloon keeper, owner of premises, or

respectable wholesaler, none of whom should be permitted to shift

to another the responsibility for violating liquor laws.

6. Persistent publicity as to the facts regarding enforcement and

violation, so that no one, whether saloon leaguist or anti-saloon

leaguist, shall be uninformed as to the current results of "dry"

laws.

It is perfectly safe to assume that none of these things will be done

consistently unless funds are provided to pay one or more persons in

each populous locality to give their entire time to the enforcement of

laws, just as the improvement of other ills of municipal government

require the constant attention of trained investigators. Cogent

arguments for such funds have recently appeared in the _New York

Evening Post's_ symposium on "How to Give Wisely," by Mrs. Emma Garrett

Boyd, of Atlanta, and Miss Salmon, of Vassar College.

If the saloon is here to stay, we must all agree that it is a frightful

waste of human energy and of educational momentum to be appealing for

its abolition when we might be hastening its proper control. On the

other hand, if the saloon is destined to be abolished as a public

nuisance and a private wrong, as a menace to industry and social order,

is it not a frightful, unforgivable waste of energy to permit

prohibition laws to fail, and thus to discredit the principle of

prohibition? Philanthropists have provided millions for scientific

research, for medical research, for the study of tuberculosis, and for

the study of living conditions. It is to be hoped that a large

benefaction, or that an aggregation of small benefactions, will apply

to governmental attempts to regulate the sale of alcohol those methods

of scientific research which have released men from the thraldom of

ignorance and diseases less easily preventable than alcoholism.

CHAPTER XXXV

IS IT PRACTICABLE IN PRESENTING TO CHILDREN THE EVILS OF ALCOHOLISM TO

TELL THE TRUTH, THE WHOLE TRUTH, AND NOTHING BUT THE TRUTH?

If children are taught that the most effective way of combating

alcoholism is to insure the enforcement of existing laws and to profit

from lessons taught by such enforcement; if children are taught that

the strongest reasons for total abstinence are social, economic, and

industrial rather than individual and physiological,--there is much to

be gained and little to lose from telling them the truth, the whole

truth, and nothing but the truth about alcohol. To stimulate a child's

imagination by untruths about alcohol is as vicious as to stimulate his

body with alcohol. Whisky drinking does not always lead to drunkenness,

to physical incapacity, to short life, or to obvious loss of vitality.

Beer drinking is not always objected to by employers. Neither crime,

poverty, immorality, lack of ambition, nor ignorance can always be

traced to alcohol. On the contrary, it is unquestionably true that the

majority of the nation's heroes have used alcoholics moderately or

excessively for the greater part of their lives. It is probably true

that among the hundred most eminent officials, pastors, merchants,

professors, and scientists of to-day, the great majority of each class

are moderate users of one or more forms of alcoholics. Overeating of

potatoes or cake or meat, sleeping or working in ill-ventilated rooms,

neglect of constipation, may occasion physiological and industrial

injuries that are not only as grave in themselves as the evils of

moderate drinking, but, in addition, actually tempt to moderate

drinking.

All of this can be safely admitted, because whether parents and

teachers admit it or deny it, children by observation and by reading

will become convinced that up to the year 1908 the noblest and the most

successful men of America, as well as the most depraved and least

successful, have used alcoholics. To be candid enough to admit this

enables us to gain a hold upon the confidence and the intelligence of

children and youth that will strengthen our arguments, based upon

social and industrial as well as physiological grounds, against running

the risks that are inevitably incurred by even the moderate use of

alcohol.

Other things being equal, the same man will do better work without

alcohol than with alcohol; the same athlete will be stronger and more

alert without alcohol than with alcohol; the clerk or lawyer or teacher

will win promotion earlier without alcohol than with alcohol; man or

woman will grow old quicker with than without alcohol. Other things

being equal, a man of fifty will have greater confidence in a total

abstainer than in a man of identical capacity who uses alcohol

moderately; a mother will give better vitality and better care to her

children without than with alcohol; a policeman or fireman or

stenographer is more apt to win promotion without than with alcohol.

Whatever the physical ailment, there is in every instance a better

remedy for an acute trouble, and infinitely better remedies for

deep-seated troubles, than alcoholics.

The percentage of failure to use alcoholics moderately is so high, the

uncertainty as to a particular individual's ability to drink moderately

is so great, as to lead certain insurance companies, first, to give

preference to men who never use alcoholics, and later, to refuse to

insure moderate drinkers. Life insurance companies have the general

rule that habitual drinkers are bad risks, as the alcohol habit is

prejudicial to health and longevity; but they have no means of studying

the risk of moderate drinkers, because, except where alcohol has

already left a permanent impression upon the system, the indications

are by no means such as to enable the medical examiner to trace its

existence with certainty. For this reason the life insurance companies

have little effect in _preventing_ alcoholism. Though they are agreed

that habitual drinkers ought to be declined altogether, only a few

companies have taken the decided stand of declining them. "Habitual

drinkers, if not too excessive, are admitted into the general class

where the expected mortality, according to the experience of the

Pennsylvania Mutual Life Insurance Company, is 80 per cent, as against

56 per cent for the temperate class. Though it is only necessary to

look over the death losses presented each day to see that intemperance

in the use of liquors, as shown by cirrhosis of the liver, Bright's

disease, diseases of the heart, brain, and nervous system, is the cause

of a large proportion of the deaths, these companies prefer to grade

the premiums accordingly rather than to decline habitual drinkers

altogether. While this is partly due to the difficulty and expense of

diagnosis, it is more probably due to an objection to take a definite

stand on the temperance question."

Thus the insurance companies' rules touch only the confirmed drinker,

whose physique is often irreparably injured. One company writes: "Men

who have been intemperate and taken the Keeley or other cures are never

accepted until five years have elapsed from the date of taking the

cure, and only when it can be conclusively shown that during the whole

period they have refrained entirely from the use of alcoholic liquor,

and that their former excesses have not in any way impaired the

physical risk."

Thus far American insurance companies are doing little preventive and

educational work on the alcohol question, though they have the very

best means at their command for so doing. According to the Metropolitan

Life Insurance Company nine tenths of the school children in New York

City are insured by them, and an even greater proportion of workingmen.

Even though this is done "at twice the normal cost," the most cursory

medical examination is given and no attempt is made to instruct them in

the relation of their physical condition to their working power, or in

the evils of the alcohol and the smoking habits.

Naturally the moderate drinker is first rejected for positions where an

occasional overindulgence would be most noticeable and most serious.

The manager of a large factory tells his men: "You cannot work here

unless you are sober. If you must drink at parties, stay at home if

necessary until 12 o'clock the next day and sleep it off, but don't

come here till you are straight. We cannot afford it." Occasionally his

men stay at home and not a word is said, but the minute they are found

at work in an unsteady condition they are summarily discharged. From

this position it is but a step to that of an upholsterer in New York

City, who prints on his order blanks, "No drinking man employed." His

company recently discharged a man after twenty years of service because

a customer for whom this man was working detected a whisky breath. Men

reported to trade unions for frequent intoxication are blacklisted. A

certain financial corporation permits no liquor on its grounds or in

its lunch rooms. The head of one of its large branches was heard to say

recently that he would discharge on the spot a man who showed evidences

of drinking, even though he had previously worked faithfully for years.

Rejection of moderate drinkers by business houses is not done on moral

grounds alone, but because experience has proved the danger of

employing men who have not their faculties fully under control _all_

the time they are at work. The rules are especially strict for men

working for a railroad or street railway company. The Pennsylvania

Railroad Company replied to my inquiry as to their custom of

discriminating against drinking men in these words: "We have no printed

rules in regard to this except in a general way,--that no employee is

allowed to go into a saloon during his hours of work or wearing the

company's uniform. Of course the men are promptly discharged or

disciplined if they show the effects of liquor while on duty, and the

whole tendency of the administration of the rules is to get rid of any

men who are habitual drinkers, but the administration of the rules and

discipline is left to the superintendent of each division." The

Interborough Rapid Transit Company of New York has these printed rules

for the physical standard required for applicants for employment:

1. _Examination of heart and arteries._ Rejection of candidates

showing excessive or long-continued use of tobacco and alcohol,

with explanation of condition, causes, and dangers of continued

use. Warning to chiefs of departments regarding those accepted who

show tendency to drink at times, but whose physical examination

does not disclose sufficient evidence to warrant their

disqualifications. Foremen and chiefs of departments to be

notified and to carry out the policy of employing only men who are

at all times sober and not under the influence of alcohol at all.

2. _On reëxamination of employees._ Warning to or rejection of

those showing, on physical examination, indulgence to excess of

alcohol, tobacco, or drugs. Warning to chief of department of

evidence of such habits on part of any employee examined for any

reason, but retained in service of the company with injunction to

chief of department to speak with such employee and have him under

proper supervision.

The blacklisting of habitual drinkers by their union, and the growing

tendency on the part of large corporations, factories, and business

houses to take a decided stand against drinking, are having a marked

effect in reducing drunkenness where it does most harm. This practice

has been declared by John Bach McMasters, the noted American historian,

to have exerted a stronger influence in promoting temperance and total

abstinence than all the temperance crusades from Hartley's time to the

prohibition wave of 1907. The school, by instructing children how the

alcohol habit will affect their chances of business success, future

usefulness as citizens, and enjoyment of life, will inevitably reduce

the evils of alcohol. By teaching based on facts that intimately

concern the life of the child, as well as by caring for his health and

his environment, the schools can help supplant the desire for alcohol

with other more healthy desires.

No truth about alcohol is more important than that the craving for

alcohol or something just as bad will exist side by side with imperfect

sanitation, too long hours of work, food that fails to nourish, lack of

exercise, rest, and fresh air. Conditions that produce bounding

vitality and offer freedom for its expression at work and at play will

supplant the craving for stimulants. Finally, the great truth contained

in the last chapter must be taught, that success in coping with

alcoholism is a community task requiring efficient government above all

else.

CHAPTER XXXVI

FIGHTING TOBACCO EVILS

"It is not necessarily vicious or harmful to soothe excited nerves."

This editorial comment explains, even if it condemns while trying to

justify, the tobacco habit. To soothe excited nerves by lying to them

about their condition and by weakening where we promise to nourish, is

vicious and harmful just as other lying and robbery are vicious and

harmful. Yet two essential facts in dealing with tobacco evils must be

considered: tobacco does soothe excited nerves, and the harm done to

the majority of smokers seems to them to be negligible. For these two

reasons the tobacco user, unless frightened by effects already visible,

refuses to listen to physiological arguments against his amiable

self-indulgence. Cheerfully he admits the theoretical possibility that

by its method of soothing nerves tobacco kills nerve energy. But in all

sincerity he points to men who have found the right stopping point up

to which tobacco hurts less perhaps than coffee or tea, candy or

lobster, overeating or undersleeping. Therefore the physician, the

bishop, the school superintendent, candidly run the necessary risk for

the sake of nerve soothing and sociability.

Less harm would be done by tobacco if it were more harmful. Like so

many other food poisons, its use in small quantities does not produce

the prompt, vivid, unequivocal results that remove all doubt as to the

user's injuries and intemperance. As inability to see the physiological

effect upon himself encourages the tobacco user to continue smoking or

chewing, so failure to identify evil physiological effects upon the

smoker encourages the nonuser to begin smoking or chewing. A very few

smokers give up the habit because they fear its results, but too often

the man who can see the evil results would rather give up almost

anything else. The one motive that most frequently stops inveterate

smoking--fear--is the least effective motive in dissuading those who

have not yet acquired the habit; every young man, unless already

suffering from known heart trouble, thinks he will smoke moderately and

without harm. Unfortunately, every boy who begins to smoke succeeds in

picturing to himself the adult who shows no surface sign of injury from

tobacco, rather than some other boy who has been stunted physically,

mentally, and morally by cigarettes.

For adult and child, therefore, it behooves us to find some other

weapons against tobacco evils in addition to fear of physiological

injuries. Among these weapons are:

1. Enforcement of existing laws that make it an offense against society

for dealer, parent, or other person to furnish children under sixteen

with tobacco in any form; and raising the age limit to twenty-one, or

at least to eighteen.

2. Enforcement of restrictions as to place and time when smoking is

permitted.

3. Agitation against tobacco as a private and public nuisance.

4. Explanation of commercial advantages of abstinence.

For a candid, complete criticism of the medical examination work up to