Dr. Lederle, Health Commissioner of New York City, says that while
typhoid vaccination is likely to prove of untold benefit, other
specific improvements should be made. There should be a more
perfect control of the milk-supply. At present there is no central
testing-station. He recommends also an improved method of sewage
disposal, either by treatment or by carrying it farther out to sea,
thus preventing pollution of the harbor. There should be a drainage
of surrounding land to do away with mosquitos; improved methods
of street-cleaning that would result in the prevention of flying
dust-clouds; and the open garbage receptacles and dumps should be
abolished in favor of cremation of all refuse. The campaign against the
fly must be carried on more vigorously every year, and immediate steps
are to be taken for the protection of all foods from fly contamination.
This will be an extension of the control of food, together with
the proper filtration of the public water-supply. Dr. Lederle says
further that increased hospital facilities for contagious diseases are
needed. There will be further popular education in sanitary matters,
special stress being laid on the need of fresh air in homes, schools,
factories, offices, theaters, and churches; and a comprehensive
publication will be made, chiefly for the aid of the poorer classes,
of the comparative nutritive and cost values of foods; and further
changes in the customs of the time, due to these plans and to other
activities, will result in a simpler manner of living. This should
render overeating less frequent and reduce the consumption of alcohol
and medicines.
Finally, in addition to these efforts, which are under the direction
of public officers, the health commissioner declares that if the
death-rate is to be further reduced, there must be in the immediate
future two changes: first, a definite advance in bacteriological
knowledge; and, second, a change in the attitude toward the health of
our adult population.
“Save the babies!” was the cry of the last decade. “Save the
middle-aged!” will be the cry of this. The real race suicide is not
in the insufficiency of births, but in the inadequate knowledge of
the diseases of maturity, and in the inadequate care and prevention
of these diseases. Deaths from arterio-sclerosis, apoplexy, kidney
affections, stomach disorders, and cancer are continuously on the
increase, and have been for ten years past. Of the 75,000 persons that
died in New York in 1911, 17,000 died of “middle-age complaints.”
The intense life of New Yorkers, their intemperance in eating,
drinking, and working, contributes chiefly to the increase in the
middle-age death-rate. However, Bright’s disease, diabetes, and cancer
are not more a mystery than diphtheria was before antitoxin was
discovered. Bacteriology has its fields of further effort well laid out
in those directions.
It is the contention of those that give their lives to the study of the
subject that “public health is a purchasable commodity.” The struggle,
then, is between the death-rate and the dollar rate. Contribute more
money to the cause of public health, and the death-rate will go down.
Forty thousand babies were saved in 1910 at an average cost of eighteen
dollars. It would have cost more to bury them, as the cheapest sort of
funeral costs twenty-five dollars.
The appropriation for the care of the public health in New York is not
niggardly; it is larger than in most cities. Still, it is not enough.
Where the health officers ask for a dollar and a half, they get a
dollar. The excuse is that the rest of the desired money is needed to
improve parks and streets, for the police and fire departments, for
the city government, the water-fronts, etc. Besides, the people of
this city are absolutely obliged to spend about $100,000,000 a year
on automobiles, candy, theaters, alcoholic drinks, tobacco, diamonds,
and such other urgent needs of life. What is left over, after those
necessities are provided for, goes toward the preservation of health!
The average expectation of life for man varies in different countries
in direct proportion to the application of efficient principles of
hygiene and sanitation. In India, for instance, where sanitation is low
and the majority of the population live, like Kim, on “the ravellings
of circumstance,” the average duration of life is less than twenty-five
years. In Sweden and Denmark, where life is methodical and ideals are
high, and the Government takes up the ash-heaps regularly, a normal man
may expect to live more than seventy years. In Massachusetts, which
is the only one of our States to furnish us with reliable statistics,
the average duration of life is forty-five years. Wherever sanitary
science is active, the length of life is steadily increasing. In India
it is stationary; in Europe it has doubled in the last 350 years; in
New York, as we have seen, it has doubled within the last half-century.
Despite the many obstacles, it seems likely that when the next general
census is taken the death-rate of the metropolis will be down to
thirteen per thousand. With such a rate, every person in the city may
expect to live to be seventy years old. And most of them will say,
“Isn’t that old enough?”
[Illustration]
[Illustration]