Part 5
Within eight years, twenty-nine tuberculosis clinics have been established, and several day camps have been built where sufferers can recuperate without expense and without leaving the city. In all these thorough blood and sputum tests are made with modern scientific apparatus. At the same time, it has been widely made known that to recover from the dread disease it is not necessary to leave the city, which, situated between two bodies of water, is swept constantly by fresh air, the chief necessity in the treatment of tuberculosis.
SAVING THE BABIES
But the really remarkable work in the reduction of the death-rate within the last few years has been done among the children. It is here that the war worth waging has been carried on most effectively. If, as Ellen Key says, this is the century of the child, New York proved it in its first decade by concentrating the health battalions on infant mortality.
“A baby that comes into the world has less chance to live one week than an old man of ninety, and less chance to live a year than a man of eighty,” Bergeron, the French authority on children’s diseases, said ten years ago. Within five years those chances have been increased by a third in New York. In 1911, throughout the United States one death in every five was that of a child under one year of age, while in New York only one death in every eight was that of a child under one year of age. Yet five years before that time New York’s average of infant mortality had been equal to that of the rest of the country. And in 1912 the infant mortality was further decreased by six per cent., a greater decrease than that of any other city.
[Illustration: Drawn by Jay Hambidge. Half-tone plate engraved by H. C. Merrill
WEIGHING THE BABIES AT AN INFANTS’ MILK STATION IN NEW YORK]
What has accomplished this result? Primarily, two causes: first, the attention of the Board of Health, whose department of child hygiene now receives a larger annual appropriation than any other (in 1913 it will have more than $600,000, a fifth of the entire budget); and, second, the work of the New York Milk Committee, a semi-public organization composed of many of the chief physicians and philanthropists of the city.
Eight years ago there was not one infants’ milk station in New York. The babies of the poor were obliged to live on what milk could be found easily for them. Few could afford and still fewer could find what is known as “Grade A” milk, which sells in the commercial market for from fifteen to twenty-five cents a quart, and which is thoroughly inspected and certified. At the close of 1912 there were seventy-nine such stations in the city. At every one Grade A milk was sold at the nominal price of eight cents a quart, so as to be in easy competition with ordinary commercial milk. Every day thousands of mothers with their babies throng these stations. However, their chief purpose is not the mere selling of pure, rich milk. They serve principally as dispensaries. The milk is used by the city as a lure by means of which ignorant mothers are brought within the reach of the physicians of the Health Department. With the milk, thorough instruction and advice as to the care of infants is given gratis. The old idea that mothers know entirely how best to care for their own children has been proved erroneous. Not all mothers in a large city know how to care for their children. Many of them are virtually as helpless as the children themselves. They have to be taken in hand, trained, and taught in the care of their offspring as completely as the children themselves are taken in hand a few years later in the public schools.
In addition to the seventy-nine dispensaries of milk and medical knowledge, the city maintains a large corps of trained nurses who make visits, especially during the summer, to the homes to complete the instruction. In the poorer districts, every child under a year old is visited by a city nurse at least once in ten days. The average cost is fifty cents a month for each child. At the same time the inspection of the general milk-supply has become thorough. The city’s inspectors now cover all farms within two hundred miles from the city hall, and the sources of supply are thus kept in proper sanitary condition.
The city also gives ice in summer to those families (with children) that are unable to buy it. In the summer of 1912, 900,000 pounds were thus distributed. This is in addition to the accepted efforts to secure better playgrounds, better ventilated schools, etc.
A decade ago the summer death-rate among children in New York was from two to three times as high as the winter death-rate. For the last four years it has been steadily decreasing, and in 1912 it was almost as low as the winter death-rate. Deaths from diarrheal diseases among children have been reduced to a minimum through the concentrated efforts of a few years. The next work to be taken up will be the winter deaths from respiratory diseases. This is a more difficult problem.
Yet the greatest problem in infant mortality has still to be solved. This is the care of the “institution” baby. As in England and in France, the largest number of deaths among New York children occur among the illegitimate and those lacking a mother’s care during the early months of life. In 1911 more than forty per cent. of the deaths of infants under one year in Manhattan occurred in institutions.
The institutions that receive foundlings are too few and too poorly equipped. One day Mr. J. Pierpont Morgan saw in the street, within a block of his home, a poor woman hugging despairingly to her breast a new-born infant. In consequence, he caused to be built the million-dollar lying-in hospital on Stuyvesant Square, which has already been the means of saving many an innocent life. But that superb hospital, large as it is, has not the facilities for taking care of more than a small number of the infants that require such an institution.
The material agencies, efficient and marvelous as they have become, have not been the chief aid in the reduction of the death-rate, especially among children. Public education has really had more to do with it. Even those in direct charge of the work in infant mortality do not assert that the entire credit for the satisfactory progress should be given to the milk stations, the dispensaries, and the hospitals. Pamphlets, lectures, newspaper articles, and school-room instruction are at the base of the advance. Publicity has proved to be a greater force than milk inspection. Certain popular newspapers in New York have the power to achieve definite radical reforms in modes of living whenever they choose to prosecute a vigorous campaign. Just as the newspapers can expose corruption in any of the city’s departments, so almost as readily they can uproot or at least substantially lessen certain sanitary evils. A case in point is their campaign against the fly last summer. By means of wide-spread and vigorous news articles and editorials they succeeded in so rousing the mass of the people that the fly pest was visibly reduced. Health Department officials testify readily to this.
The work of the social settlements, of the mothers’ clubs, of the neighborhood nursing associations, of the diet-kitchens, all contribute to the general education that is bringing about a condition of excellent public sanitation. This work is necessarily of slow growth. Its effect is not nearly so evident as that of vaccination, of smallpox segregation, or of typhoid diagnosis. It is not so simple as establishing proper sewers or purifying the water-supply; but it is no less important.
THE STUDY OF SEX HYGIENE
In all this tremendous volume of public sanitary education, no one feature stands out more clearly than the work being done in sex hygiene. Prudery is passing; there can be no doubt of that. Within the last five years every public school in New York has introduced a course of teaching in its physiology or biology department the aim of which is to acquaint the growing boy and girl with the essential facts of sex life, to open their eyes to sexual evils, and to prepare them to treat with sexual diseases intelligently. Ignorant mothers, both foreign-born and native, or those whose false modesty is worse than their ignorance, are day by day being taught by their daughters of twelve and fourteen, who have learned their lessons in school or in neighborhood classes, certain essential facts of sex life, ignorance of which has brought about pitiful conditions of disease and death.
The effect of this is not yet fully apparent in a decreased death-rate, but there can be little doubt that within a very few years it will have its result. For instance, one third of the infant mortality is due to prenatal conditions, congenital diseases which afflict the child at birth, and which mean either speedy death or a lingering, crippled life. The larger part of these untoward prenatal conditions are due to sexual diseases. To eliminate them will require two sustained efforts: the further abolishing of prudery, with consequent rigorous sex hygiene, and the enactment and enforcement of laws that will require proper medical examination before marriage.
A physician told me recently that in his opinion within a decade laws will be enacted providing that every man and woman desiring to marry can do so only with a doctor’s certificate that shall carry with it a clean bill of health. Once that is done, it is confidently believed that the death-rate among infants will fall off perhaps by a quarter, and surely by a fifth or a sixth. The educational work in this field is being done for the future. With present adults there is little hope; but the fathers and mothers of the next generation will be much better equipped.
THE FIGHT AGAINST TYPHOID GERMS
In one more campaign the immediate future seems likely to yield great results perhaps almost as important as those resulting from the discovery of antitoxin. This will be from the use of the new anti-typhoid serum, which the Department of Health in December, 1912, decided to use as extensively as possible in New York. This decision followed close on the War Department’s public declaration that the anti-typhoid serum had proved a success, virtually eliminating the disease from the army. In 1909 there were more cases of typhoid in the United States than of the plague in India, despite the fact that India’s population is two and a half times that of the United States. In 1907 there were more cases of typhoid in New York than of pellagra in Italy, though Italy’s population is six times that of New York. In this work, as in children’s diseases and in tuberculosis, New York is a pioneer, and yet New York is better off regarding typhoid than many other American cities, for it has a lower typhoid death-rate than Boston, Chicago, Washington, or Philadelphia; yet its typhoid death-rate is higher than that of London, Paris, Berlin, or Hamburg.
Last spring when Wilbur Wright, the aviator, died of typhoid fever at the age of forty-five, several newspapers were honest enough to speak of it as a murder--a murder by the American people, through neglect and ignorance, of a genius who, had he been allowed, might have lived to be of still more distinguished service to the world.
In the last two years the New York Department of Health has been able to trace definitely several typhoid-fever outbreaks. In nearly every instance it was found that the disease could be traced to a “carrier.” A carrier is a person who has recovered from an attack of typhoid, but who remains infected. One outbreak of four hundred cases was traced to the infection of a milk-supply by a typhoid carrier who had had the disease forty-seven years before. In another outbreak of fifty cases the contamination was traced to a man who had the disease seven years before.
Within the last few months the case of “Typhoid Mary” has received much attention. This woman has recently brought suit against the Department of Health for damaging her career as a cook. For more than six months she was kept in a sort of exile by the department. Before that time she had been a cook in many households, and wherever she went typhoid fever followed her. Although she had suffered with the disease many years before she was apprehended, the germs were said to be still very lively in her system. The authorities asserted that her blood tests revealed that she was likely to communicate typhoid to any one at any time; and therefore Mary did no more cooking.
There is no telling how many carriers are loose in New York at present, and the only known way of averting the danger is by the use of the serum which the army has found efficacious. It is estimated that about three per cent. of those recovering from typhoid become bacillus-carriers. As yet typhoid vaccination is not compulsory among the public at large, as in the army; but a strong movement is felt in the city to make it so. When typhoid-fever becomes as thoroughly controlled as smallpox, or even as diphtheria, the death-rate will drop another point or two. It will be the last of the filth diseases to go. It is asserted by competent authorities that eighty-five per cent. of the cases are preventable.
OPINIONS OF AN EXPERT
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]
THE ILLUSION OF PROGRESS[2]
BY KENYON COX
In these days all of us, even Academicians, are to some extent believers in progress. Our golden age is no longer in the past, but in the future. We know that our early ancestors were a race of wretched cave-dwellers, and we believe that our still earlier ancestors were possessed of tails and pointed ears. Having come so far, we are sometimes inclined to forget that not every step has been an advance, and to entertain an illogical confidence that each future step must carry us still further forward; having indubitably progressed in many things, we think of ourselves as progressing in all. And as the pace of progress in science and in material things has become more and more rapid, we have come to expect a similar pace in art and letters, to imagine that the art of the future must be far finer than the art of the present or than that of the past, and that the art of one decade, or even of one year, must supersede that of the preceding decade or the preceding year, as the 1913 model in automobiles supersedes the model of 1912. More than ever before “To have done, is to hang quite out of fashion,” and the only title to consideration is to do something quite obviously new or to proclaim one’s intention of doing something newer. The race grows madder and madder. It is hardly two years since we first heard of “Cubism” and already the “Futurists” are calling the “Cubists” reactionary. Even the gasping critics, pounding manfully in the rear, have thrown away all impedimenta of traditional standards in the desperate effort to keep up with what seems less a march than a stampede.
But while we talk so loudly of progress in the arts we have an uneasy feeling that we are not really progressing. If our belief in our own art were as full-blooded as was that of the great creative epochs, we should scarce be so reverent of the art of the past. It is, perhaps, a sign of anemia that we have become founders of museums and conservers of old buildings. If we are so careful of our heritage, it is surely from some doubt of our ability to replace it. When art has been vigorously alive, it has been ruthless in its treatment of what has gone before. No cathedral builder thought of reconciling his own work to that of the builder who preceded him; he built in his own way, confident of its superiority. And when the Renaissance builder came, in his turn, he contemptuously dismissed all medieval art as “Gothic” and barbarous, and was as ready to tear down an old façade as to build a new one. Even the most cock-sure of our moderns might hesitate to emulate Michelangelo in his calm destruction of three frescos by Perugino to make room for his own “Last Judgment.” He at least had the full courage of his convictions, and his opinion of Perugino is of record.
Not all of us would consider even Michelangelo’s arrogance entirely justified, but it is not only the Michelangelos who have had this belief in themselves. Apparently the confidence of progress has been as great in times that now seem to us decadent as in times that we think of as truly progressive. The past, or at least the immediate past, has always seemed “out of date,” and each generation, as it made its entrance on the stage, has plumed itself upon its superiority to that which was leaving it. The architect of the most debased baroque grafted his “improvements” upon the buildings of the high Renaissance with an assurance not less than that with which David and his contemporaries banished the whole charming art of the eighteenth century. Van Orley and Frans Floris were as sure of their advance upon the ancient Flemish painting of the Van Eycks and of Memling as Rubens himself must have been of his advance upon them.
We can see plainly enough that in at least some of these cases the sense of progress was an illusion. There was movement, but it was not always forward movement. And if progress was illusory in some instances, may it not, possibly, have been so in all? It is at least worth inquiry how far the fine arts have ever been in a state of true progress, going forward regularly from good to better, each generation building on the work of its predecessors and surpassing that work, in the way in which science has normally progressed when material conditions were favorable.