_Home exercise._--How to ventilate my bedroom.
_Demonstration._--Effect of use of duster and damp cloth
upon bacteria in schoolroom.
_Home exercise._--Luncheon dietaries.
_Home exercise._--Sanitary map of my own block.
_Demonstration._--The bacterial content of milk of various
grades and from different sources.
_Demonstration._--Bacterial content of distilled water, rain
water, tap water, dilute sewage.
_Laboratory exercise._--Study of board of health tables to
plot curves of mortality from certain diseases during
certain times of year.
The Purpose of this Chapter.--In the preceding chapters we have traced the
lives of both plants and animals within their own environment. We have seen
that man, as well as plants and other animals, needs a favorable
environment in order to live in comfort and health. It will be the purpose
of the following pages first to show how we as individuals may better our
home environment, and secondly, to see how we may aid the civic authorities
in the betterment of conditions in the city in which we live.
[Illustration: How I should ventilate my bedroom.]
Home Conditions.--The Bedroom.--We spend about one third of our total time
in our bedroom. This room, therefore, deserves more than passing attention.
First of all, it should have good ventilation. Two windows make an ideal
condition, especially if the windows receive some sun. Such a condition as
this is manifestly impossible in a crowded city, where too often the
apartment bedrooms open upon narrow and ill-ventilated courts. Until
comparatively recent time, tenement houses were built so that the bedrooms
had practically no light or air; now, thanks to good tenement-house laws,
wide airshafts and larger windows are required by statute.
Care of the Bedroom.--Since sunlight cannot always be obtained for a
bedroom, we must so care for and furnish the room that it will be difficult
for germs to grow there. Bedroom furniture should be light and easy to
clean, the bedstead of iron, the floors painted or of hardwood. No hangings
should be allowed at the windows to collect dust, nor should carpets be
allowed for the same reason. Rugs on the floor may easily be removed when
cleaning is done. The furniture and woodwork should be wiped with a damp
cloth every day. Why a _damp_ cloth? In certain tenements in New York City,
tuberculosis is believed to have been spread by people occupying rooms in
which a previous tenant has had tuberculosis. A new tenant should insist on
a thorough cleaning of the bedrooms and removal of old wall paper before
occupancy.
Sunlight Important.--In choosing a house in the country we would take a
location in which the sunlight was abundant. A shaded location might be too
damp for health. Sunlight should enter at least some of the rooms. In
choosing an apartment we should have this matter in mind, for, as we know,
germs cannot long exist in sunlight.
[Illustration: This map shows how cases of tuberculosis are found recurring
in the same locality and in the same houses year after year. Each black dot
is one case of tuberculosis.]
Heating.--Houses in the country are often heated by open fires, stoves or
hot-air furnaces, all of which make use of heated currents of air to warm
the rooms. But in the city apartments, usually pipes conduct steam or hot
water from a central plant to our rooms. The difficulty with this system is
that it does not give us fresh air, but warms over the stale air in a room.
Steam causes our rooms to be too warm part of the time, and not warm enough
part of the time. Thus we become overheated and then take cold by becoming
chilled. Steam heat is thus responsible for much sickness.
Lighting.--Lighting our rooms is a matter of much importance. A student
lamp, or shaded incandescent light, should be used for reading. Shades must
be provided so that the eyes are protected from direct light. Gas is a
dangerous servant, because it contains a very poisonous substance, carbon
monoxide. "It is estimated that 14 per cent of the total product of the gas
plant leaks into the streets and houses of the cities supplied." This forms
an unseen menace to the health in cities. Gas pipes, and especially gas
cocks, should be watched carefully for escaping gas. Rubber tubing should
not be used to conduct gas to movable gas lamps, because it becomes worn
and allows gas to escape.
[Illustration: During the summer all food should be protected from flies.
Why?]
Insects and Foods.--In the summer our houses should be provided with
screens. All food should be carefully protected from flies. Dirty dishes,
scraps of food, and such garbage should be quickly cleaned up and disposed
of after a meal. Insect powder (pyrethrum) will help keep out "croton bugs"
and other undesirable household pests, but cleanliness will do far more.
Most kitchen pests, as the roach, simply stay with us because they find
dirt and food abundant.
Use of Ice.--Food should be properly cared for at all times, but especially
during the summer. Iceboxes are a necessity, especially where children
live, in order to keep milk fresh. A dirty icebox is almost as bad as none
at all, because food will decay or take on unpleasant odors from other
foods.
[Illustration: The wrong and the right kind of garbage cans.]
Disposal of Wastes.--In city houses the disposal of human wastes is
provided for by a city system of sewers. The wastes from the kitchen, the
garbage, should be disposed of each day. The garbage pail should be
frequently sterilized by rinsing it with boiling water. Plenty of lye or
soap should be used. Remember that flies frequent the uncovered garbage
pail, and that they may next walk on your food. Collection and disposal of
garbage is the work of the municipality.
[Illustration: The culture (_A_) was exposed to the air of a dirty street
in the crowded part of Manhattan. (_B_) was exposed to the air of a
well-cleaned and watered street in the uptown residence portion. Which
culture has the more colonies of bacteria? How do you account for this?]
School Surroundings.--How to Improve Them.--From five to six hours a day
for forty weeks is spent by the average boy or girl in the schoolroom. It
is part of our environment and should therefore be considered as worthy of
our care. Not only should a schoolroom be attractive, but it should be
clean and sanitary. City schools, because of their locations, of the
sometimes poor janitorial service, and especially because of the
selfishness and carelessness of children who use them, may be very dirty
and unsanitary. Dirt and dust breed and carry bacteria. Plate cultures show
greatly increased numbers of bacteria to be in the air when pupils are
moving about, for then dust, bearing bacteria, is stirred up and circulated
through the air. Sweeping and dusting with dry brooms or feather dusters
only stirs up the dust, leaving it to settle in some other place with its
load of bacteria. Professor Hodge tells of an experience in a school in
Worcester, Mass. A health brigade was formed among the children, whose duty
was to clean the rooms every morning by wiping all exposed surface with a
damp cloth. In a school of 425 pupils not a single case of contagious
diseases appeared during the entire year. Why not try this in your own
school?
Unselfishness the Motto.--Pupils should be unselfish in the care of a
school building. Papers and scraps dropped by some careless boy or girl
make unpleasant the surroundings for hundreds of others. Chalk thrown by
some mischievous boy and then tramped underfoot may irritate the lungs of a
hundred innocent schoolmates. Colds or worse diseases may be spread through
the filthy habits of some boys who spit in the halls or on the stairways.
Lunch Time and Lunches.--If you bring your own lunch to school, it should
be clean, tasty, and well balanced as a ration. In most large schools
well-managed lunch rooms are part of the school equipment, and balanced
lunches can be obtained at low cost. Do not make a lunch entirely from cold
food, if hot can be obtained. Do not eat only sweets. Ice cream is a good
food, if taken with something else, but be sure of your ice cream. "Hokey
pokey" cream, tested in a New York school laboratory, showed the presence
of many more colonies of bacteria than _good_ milk would show. Above all,
be sure the food you buy is clean. Stands on the street, exposed to dust
and germs, often sell food far from fit for human consumption.
[Illustration: A sensible lunch box, sanitary and compact.]
If you eat your lunch on the street near your school, remember not to
scatter refuse. Paper, bits of lunch, and the like scattered on the streets
around your school show lack of school spirit and lack of civic pride. Let
us learn above all other things to be good citizens.
[Illustration: Dust exhausts on grinding wheels protect lungs of the
workmen.]
Inspection of Factories, Public Buildings, etc.--It is the duty of a city
to inspect the condition of all public buildings and especially of
factories. Inspection should include, first, the supervision of the work
undertaken. Certain trades where grit, dirt, or poison fumes are given off
are dangerous to human health, hence care for the workers becomes a
necessity. Factories should also be inspected as to cleanliness, the amount
of air space per person employed, ventilation, toilet facilities, and
proper fire protection. Tenement inspection should be thorough and should
aim to provide safe and sanitary homes.
Inspection of Food Supplies.--In a city certain regulations for the care of
public supplies are necessary. Foods, both fresh and preserved, must be
inspected and rendered safe for the thousands of people who are to use
them. All raw foods exposed on stands should be covered so as to prevent
insects or dust laden with bacteria from coming in contact with them. Meats
must be inspected for diseases, such as tuberculosis in beef, or
trichinosis in pork. Cold storage plants must be inspected to prevent the
keeping of food until it becomes unfit for use. Inspection of sanitary
conditions of factories where products are canned, or bakeries where foods
are prepared, must be part of the work of a city in caring for its
citizens.
Care of Raw Foods.--Each one of us may cooperate with the city government
by remembering that fruits and vegetables can be carriers of disease,
especially if they are sold from exposed stalls or carts and handled by the
passers-by. All vegetables, fruits, or raw foods should be carefully washed
before using. Spoiled or overripe fruit, as well as meat which is decayed,
is swarming with bacteria and should not be used.
An interesting exercise would be the inspection of conditions in your own
home block. Make a map showing the houses on the block. Locate all stores,
saloons, factories, etc. Notice any cases of contagious disease, marking
this fact on the map. Mark all heaps of refuse in the street, all uncovered
garbage pails, any street stands that sell uncovered fruit, and any stores
with an excessive number of flies.
In addition to food inspection, two very important supplies must be
rendered safe by a city for its citizens. These are milk and water.
[Illustration: Clean cows in clean barns with clean milkers and clean milk
pails means clean milk in the city.]
Care in Production of Milk.--Milk when drawn from a healthy cow should be
free from bacteria. But immediately on reaching the air it may receive
bacteria from the air, from the hands of the person who milks the cows,
from the pail, or from the cow herself. Cows should, therefore, be milked
in surroundings that are sanitary, the milkers should wear clean garments,
put on over their ordinary clothes at milking time, while pails and all
utensils used should be kept clean. Especially the surface exposed on the
udder from which the milk is drawn should be cleansed before milking.
Most large cities now send inspectors to the farms from which milk is
supplied. Farms that do not accept certain standards of cleanliness are not
allowed to have their milk become part of the city supply.
Tuberculosis and Milk.--It is recognized that in some European countries
from 30 to 40 per cent of all cattle have tuberculosis. Many dairy herds in
this country are also infected. It is also known that the tubercle bacillus
of cattle and man are much alike in form and action and that _probably_ the
germ from cattle would cause tuberculosis in man. Fortunately, the
tuberculosis germ does not _grow_ in milk, so that even if milk from
tubercular cattle should get into our supply, it would be diluted with the
milk of healthy cattle. In order to protect our milk supply from these
germs it would be necessary to kill all tubercular cattle (almost an
impossibility) or to pasteurize our milk so as to kill the germs in it.
Other Disease Germs in Milk.--We have already shown how typhoid may be
spread through milk. Usually such outbreaks may be traced to a single case
of typhoid, often a person who is a "typhoid carrier," _i.e._ one who may
not suffer from the effects of the disease, but who carries the germs in
his body, spreading them by contact. A recent epidemic of typhoid in New
York City was traced to a single typhoid carrier on a farm far from the
city. Sometimes the milk cans may be washed in contaminated water or the
cows may even get the germs on their udders by wading in a polluted stream.
Diphtheria, scarlet fever, and Asiatic cholera are also undoubtedly spread
through milk supplies. Milk also plays a very important part in the high
death rate from diarrhoeal diseases among young children in warm weather.
Why?
[Illustration: A diagram to show how typhoid may be spread in a city
through an infected milk supply. The black spots in the blocks mean cases
of typhoid. _A_, a farm where typhoid exists; the dashes in the streets
represent the milk route. _B_ is a second farm which sends part of its milk
to _A_; the milk cans from _B_ are washed at farm _A_ and sent back to _B_.
A few cases of typhoid appear along _B_'s milk route. How do you account
for that?]
Grades of Milk in a City Supply.--Milk which comes to a city may be roughly
placed in three different classes. The best milk, coming from farms where
the highest sanitary standards exist, where the cows are all tubercular
tested, where modern appliances for handling and cooling the milk exist, is
known as certified or, in New York City, grade A milk. Most of the milk
sold, however, is not so pure nor is so much care taken in handling it.
Such milk, known in New York as grade B milk, is pasteurized before
delivery, and is sold only in bottles. A still lower grade of milk (dipped
milk) is sold direct from cans. It is evident that such milk, often exposed
to dust and other dirt, is unfit for any purpose except for cooking. It
should under no circumstances be used for children. A regulation recently
made by the New York City Department of Health states that milk sold
"loose" in restaurants, lunch-rooms, soda fountains, and hotels must be
pasteurized.
Care of a City Milk Supply.--Besides caring for milk in its production on
the farm, proper transportation facilities must be provided. Much of the
milk used in New York City is forty-eight hours old before it reaches the
consumer. During shipment it must be kept in refrigerator cars, and during
transit to customers it should be iced. Why? All but the highest grade milk
should be pasteurized. Why? Milk should be bottled by machinery if possible
so as to insure no personal contact; it should be kept in clean, cool
places; and no milk should be sold by dipping from cans. Why is this a
method of dispensing impure milk?
Care of Milk in the Home.--Finally, milk at home should receive the best of
care. It should be kept on ice and in covered bottles, because it readily
takes up the odors of other foods. If we are not certain of its purity or
keeping qualities, it should be pasteurized at home. Why?
[Illustration: New York City is spending $350,000,000 to have a pure and
abundant water supply. This is the tunnel which will bring the water from
the Catskill Mountains to New York City.]
Water Supplies.--One of the greatest assets to the health of a large city
is pure water. By pure water we mean water free from all _organic_
impurities, including germs. Water from springs and deep driven wells is
the safest water, that from large reservoirs next best, while water that
has drainage in it, river water for example, is very unsafe.
The waters from deep wells or springs if properly protected will contain no
bacteria. Water taken from protected streams into which no sewage flows
will have but few bacteria, and these will be destroyed if exposed to the
action of the sun and the constant aeration (mixing with oxygen) which the
surface water receives in a large lake or reservoir. But water taken from a
river into which the sewage of other towns and cities flows must be
filtered before it is fit for use.
[Illustration: The city of Lowell in 1891 took its water _without
filtering_, _i.e._ from the Merrimack River at the point shown on the map.
Typhoid fever broke out in North Chelmsford and about two weeks later cases
began to appear in Lowell until a great epidemic occurred. Explain this
outbreak. Each black dot is a case of typhoid.]
Typhoid fever germs live in the food tube, hence the excreta of a typhoid
patient will contain large numbers of germs. In a city with a system of
sewage such germs might eventually pass from the sewers into a river. Many
cities take their water supply directly from rivers, sometimes not far
below another large town. Such cities must take many germs into their water
supply. Many cities, as Cleveland and Buffalo, take their water from lakes
into which their sewage flows. Others, as Albany, Pittsburgh, and
Philadelphia, take their drinking water directly from rivers into which
sewage from cities above them on the river has flowed. Filtering such water
by means of passing the water through settling basins and sand filters
removes about 98 per cent of the germs. The result of drinking unfiltered
and filtered water in certain large cities is shown graphically at right.
In cities which drain their sewage into rivers and lakes, the question of
sewage disposal is a large one, and many cities now have means of disposing
of their sewage in some manner as to render it harmless to their neighbors.
[Illustration: Filter beds at Albany, N. Y.]
[Illustration: Cases of typhoid per 100,000 inhabitants before filtering
water supply (solid) and after (shaded) in _A_, Watertown, N. Y.; _B_,
Albany, N. Y.; _C_, Lawrence, Mass.; D, Cincinnati, Ohio. What is the
effect of filtering the water supply?]
Railroads are often responsible for carrying typhoid and spreading it. It
is said that a recent outbreak of typhoid in Scranton, Pa., was due to the
fact that the excreta from a typhoid patient traveling in a sleeping car
was washed by rain into a reservoir near which the train was passing.
Railroads are thus seen to be great open sewers. A sanitary car toilet is
the only remedy.
[Illustration: This chart shows that during a cholera epidemic in 1892
there were hundreds of cases of cholera in Hamburg, which used unfiltered
water from the Elbe, but in adjoining Altona, where filtered water was
used, the cases were very few.]
[Illustration: Stone filter beds in a sewage disposal plant.]
Sewage Disposal.--Sewage disposal is an important sanitary problem for any
city. Some cities, like New York, pour their sewage directly into rivers
which flow into the ocean. Consequently much of the liquid which bathes the
shores of Manhattan Island is dilute sewage. Other cities, like Buffalo or
Cleveland, send their sewage into the lakes from which they obtain their
supply of drinking water. Still other cities which are on rivers are forced
to dispose of their sewage in various ways. Some have a system of filter
beds in which the solid wastes are acted upon by the bacteria of decay, so
that they can be collected and used as fertilizer. Others precipitate or
condense the solid materials in the sewage and then dispose of it. Another
method is to flow the sewage over large areas of land, later using this
land for the cultivation of crops. This method is used by many small
European cities.
[Illustration: Collecting ashes.]
The Work of the Department of Street Cleaning.--In any city a menace to the
health of its citizens exists in the refuse and garbage. The city streets,
when dirty, contain countless millions of germs which have come from
decaying material, or from people ill with disease. In most large cities a
department of street cleaning not only cares for the removal of dust from
the streets, but also has the removal of garbage, ashes, and other waste as
a part of its work. The disposal of solid wastes is a tremendous task. In
Manhattan the dry wastes are estimated to be 1,000,000 tons a year in
addition to about 175,000 tons of garbage. Prior to 1895 in the city of New
York garbage was not separated from ashes; now the law requires that
garbage be placed in separate receptacles from ashes. Do you see why? The
street-cleaning department should be aided by every citizen; rules for the
separation of garbage, papers, and ashes should be kept. Garbage and ash
cans should be _covered_. The practice of upsetting ash or garbage cans is
one which no young citizen should allow in his neighborhood, for sanitary
reasons. The best results in summer street cleaning are obtained by washing
or flushing the streets, for thus the dirt containing germs is prevented
from getting into the air. The garbage is removed in carts, and part of it
is burned in huge furnaces. The animal and plant refuse is cooked in great
tanks; from this material the fats are extracted, and the solid matter is
sold for fertilizer. Ashes are used for filling marsh land. Thus the
removal of waste matter may pay for itself in a large city.
[Illustration: The upper picture shows the stables where millions of flies
were bred; the lower picture, the disinfection of manure so as to prevent
the breeding of flies.]
An Experiment in Civic Hygiene.--During the summer of 1913 an interesting
experiment on the relation of flies and filth to disease was carried on in
New York City by the Bureau of Public Health and Hygiene of the New York
Association for improving the condition of the poor. Two adjoining blocks
were chosen in a thickly populated part of the Bronx near a number of
stables which were the sources of great numbers of flies. In one block all
houses were screened, garbage pails were furnished with covers, refuse was
removed and the surroundings made as sanitary as possible. In the adjoining
block conditions were left unchanged. During the summer as flies began to
breed in the manure heaps near the stables all manure was disinfected. Thus
the breeding of flies was checked. The campaign of education was continued
during the summer by means of moving pictures, nurses, boy scouts, and
school children who became interested.
At the end of the summer it was found that there had been a considerable
decrease in the number of cases of fly-carried diseases and a still greater
decrease in the total days of sickness (especially of children) in the
screened and sanitary block. The table and pictures speak for themselves.
If such a small experiment shows results like this, then what might a
general clean-up of a city show?
[Illustration: In the upper picture a little girl can be seen dumping
garbage from the fire escape. She was a foreigner and knew no better. The
picture below shows the result of such garbage disposal.]
Public Hygiene.--Although it is absolutely necessary for each individual to
obey the laws of health if he or she wishes to keep well, it has also
become necessary, especially in large cities, to have general supervision
over the health of people living in a community. This is done by means of a
department or board of health. It is the function of this department to
care for public health. In addition to such a body in cities, supervision
over the health of its citizens is also exercised by state boards of
health. But as yet the government of the United States has not established
a Bureau of Health, important as such a bureau would be.
The Functions of a City Board of Health.--The administration of the Board
of Health in New York City includes a number of divisions, each of which
has a different work to do. Each is in itself important, and, working
together, the entire machine provides ways and means for making the great
city a safe and sanitary place in which to live. Let us take up the work of
each division of the health board in order to find out how we may cooperate
with them.
[Illustration: Comparison of cases of illness during the summer of 1913 in
two city blocks, one clean and the other dirty. What are your conclusions?]
The Division of Infectious Diseases.--Infectious diseases are chiefly
spread through _personal contact_. It is the duty of a government to
prevent a person having such a disease from spreading it broadcast among
his neighbors. This can be done by _quarantine_ or _isolation_ of the
person having the disease. So the board of health at once isolates any case
of disease which may be communicated from one person to another. No one
save the doctor or nurse should enter the room of the person quarantined.
After the disease has run its course, the clothing, bedding, etc., in the
sick room is fumigated. This is usually done by the board of health.
Formaldehyde in the form of candles for burning or in a liquid form is a
good disinfectant. In disinfecting the room should be tightly closed to
prevent the escape of the gas used, as the object of the disinfection is to
kill all the disease germs left in the room. In some cases of infectious
disease, as scarlet fever, it is found best to isolate the patients in a
hospital used for that purpose. Examples of the most infectious diseases
are measles, scarlet fever, whooping cough, and diphtheria.
Immunity.--In the prevention of germ diseases we must fight the germ by
attacking the parasites directly with poisons that will kill them (such
poisons are called _germicides_ or _disinfectants_), and we must strive to
make the persons coming in contact with the disease unlikely to take it.
This insusceptibility or _immunity_ may be either natural or acquired.
Natural immunity seems to be in the constitution of a person, and may be
inherited. Immunity may be acquired by means of such treatment as the
antitoxin treatment for diphtheria. This treatment, as the name denotes, is
a method of neutralizing the poison (toxin) caused by the bacteria in the
system. It was discovered a few years ago by a German, Von Behring, that
the serum of the blood of an animal immune to diphtheria is capable of
neutralizing the poison produced by the diphtheria-causing bacteria. Horses
are rendered immune by giving them the diphtheria toxin in gradually
increasing doses. The serum of the blood of these horses is then used to
inoculate the patient suffering from or exposed to diphtheria, and thus the
disease is checked or prevented altogether by the antitoxin injected into
the blood. The laboratories of the board of health prepare this antitoxin
and supply it fresh for public use.
[Illustration: Antitoxin for diphtheria prepared by the New York Board of
Health.]
It has been found from experience in hospitals that deaths from diphtheria
are largely preventable by _early use_ of antitoxin. When antitoxin was
used on the first day of the disease no deaths took place. If not used
until the second day, 5 deaths occurred in every hundred cases, on the
third day 11 deaths, on the 4th day 19 deaths, and on the 5th day 20 deaths
out of every hundred cases. It is therefore advisable, in a suspected case
of diphtheria, to have antitoxin used at once to prevent serious results.
Vaccination.--Smallpox was once the most feared disease in this country; 95
per cent of all people suffered from it. As late as 1898, over 50,000
persons lost their lives annually in Russia from this disease. It is
probably not caused by bacteria, but by a tiny animal parasite. Smallpox
has been brought under absolute control by vaccination,--the inoculation of
man with the substance (called _virus_) which causes cowpox in a cow.
Cowpox is like a mild form of smallpox, and the introduction of this virus
gives complete immunity to smallpox for several years after vaccination.
This immunity is caused by the formation of a germicidal substance in the
blood, due to the introduction of the virus. Another function of the board
of health is the preparation and distribution of vaccine (material
containing the virus of cowpox).
Rabies (Hydrophobia).--This disease, which is believed to be caused by a
protozoan parasite, is communicated from one dog to another in the saliva
by biting. In a similar manner it is transferred to man. The great French
bacteriologist, Louis Pasteur, discovered a method of treating this disease
so that when taken early at the time of the entry of the germ into the body
of man, the disease can be prevented. In some large cities (among them New
York) the board of health has established a laboratory where free treatment
is given to all persons bitten by dogs suspected of having rabies.
Vaccination against Typhoid.--Typhoid fever has within the past five years
received a new check from vaccination which has been introduced into our
army and which is being used with good effect by the health departments of
several large cities.
The following figures show the differences between number of cases and
mortality in the army in 1898 during the war with Spain and in 1911 during
the concentration of certain of our troops at San Antonio, Texas.
1898--2nd Division, 7th Army Corps, Jacksonville, Florida.
June-October, 1898
Mean strength, 10,759.
Cases of typhoid certain and probable, 2693.
Death from typhoid, 258.
Death from all diseases, 281.
Manoeuver Division, San Antonio, Texas. March 10-July 11, 1911.
Mean strength, 12,801.
Cases of typhoid, 1.
Death from typhoid, 0.
Deaths all diseases, 11.
[Illustration: Comparison of cases of and death from typhoid in 1898 and
1911. What have we learned about combating typhoid since 1898?]
During this period there were 49 cases of typhoid and 19 deaths in the
near-by city of San Antonio. But in camp, _where vaccination for typhoid
was required_, all were practically immune. In the army at large, since
typhoid vaccination has been practiced, 1908-1909, the death rate from
typhoid has dropped from 2.9 per 1000 to .03 per 1000, a wonderful record
when we remember that during the Spanish-American War 86 per cent of the
deaths in the army were from typhoid fever.
[Illustration: The best cures for tuberculosis are rest, plenty of fresh
out-of-door air, and wholesome food.]
[Illustration: A sanitarium for tuberculosis. Notice the outdoor sleeping
rooms.]
How the Board of Health fights Tuberculosis.--Tuberculosis, which a few
years ago killed fully one seventh of the people who died from disease in
this country, now kills less than one tenth. This decrease has been largely
brought about because of the treatment of the disease. Since it has been
proved that tuberculosis if taken early enough is curable, by quiet living,
good food, and _plenty_ of fresh air and light, we find that numerous
sanitaria have come into existence which are supported by private or public
means. At these sanitaria the patients _live_ out of doors, especially
sleep in the air, while they have plenty of nourishing food and little
exercise. The department of health of New York City maintains a sanitarium
at Otisville in the Catskill Mountains. Here people who are unable to
provide means for getting away from the city are cared for at the city's
expense and a large percentage of them are cured. In this way and by
tenement house laws which require proper air shafts and window ventilation
in dwellings, by laws against spitting in public places, and in other ways,
the boards of health in our towns and cities are waging war on
tuberculosis.