Care of the sick poor.

vice the community is relieved of those tramps who do not wish to find employment.

254. Other Forms of Charity.

There is perhaps no set of persons so deserving of sympathy and help as the sick poor. Needing skilled care, delicate food, expensive medicines, or still more costly surgical attention, they are unable to protect themselves against the ills which, if unchecked, will cause death or lives of invalidism. For the care of

Work of dis

school clinics.

such unfortunates, public hospitals are maintained in most cities and by many counties and towns. Physicians and nurses are paid by the public to look after the inmates of the hospitals. Visiting physicians, in addition, may spend a large part of their time without pay in attendance on the needy sick in their own homes.

Those whose ailments are not serious can often obtain pensaries and treatment gratis at the dispensaries, which are to be found in most of our large cities. Almost all medical schools maintain out-clinics in which patients receive the best of treatment at a very low cost. Most progressive school systems

are doing a preventive work by examining all school children. Frequently the relief of some apparently minor defect, e.g. in the teeth or nasal passages, has changed a sickly or apparently dull pupil into a vigorous, intelligent student. This work of school clinics may be one of the first duties of a school system; it is not a matter of charity.

HEALTH AND GENERAL WELFARE

255. Conservation of Human Life.

The removal of the

causes of poverty, as distinct from the relief of pauperism, is closely related to the problems of reducing the amount of sickness, conserving public and private health, and prolonging useful human life. Modern science, better education among the people, and the protective regulations of government have saved millions of infants and little children who would have died in infancy had they been born a generation or a century earlier. Although some children may be saved only to be a burden to themselves and society, this slight checking of the wholesale "slaughter of the innocents " has been a gain to society as well as a credit to modern civilization.

There is good reason to believe that the boy or girl who lives to the age of five years will live nearly twice as long as did his ancestors a few centuries ago. It does not require much study to perceive the increased value of prolonging the working life of any man or woman from fifteen or twenty years to twenty-five or thirty. The early years necessarily form a period of preparation, in which little is earned, and nothing is added to the wealth of society. To prolong human life ten years means therefore that two or three additional years may wisely be taken for better preparation. This will increase the efficiency of the worker, not only during the seven or eight additional years in which he labors, but for every year of his working life. Surely this is worth while to the normal human being and to society.1

1 Little has been done under public supervision in this country through sickness insurance. The spread of this form of health preservation in Europe would indicate that it is satisfactory; in time America also will adopt measures

Saving of the

lives of little

children.

Value of pro

longing the working life of citizens.

Reduction of death rates in cities.

Quarantine regulations for epidemics.

256. General Health Regulations. During the last fifty years, and particularly since the opening of the twentieth century, there has been a great improvement in the means used for the protection of public health. The annual death rate in some English factory towns in the middle of the nineteenth century was as high as fifty-three per thousand. Even within twenty years some American cities have had death rates of more than thirty per thousand, and the number of deaths among little children in the tenements during hot weather has been appalling (§ 9). Recent regulations which have protected public health include laws preventing the introduction or spread of contagious or infectious diseases, requiring the adoption of strict sanitary regulations, especially in cities, prescribing standards for milk, meats, and other foods, as well as regulating the sale of drugs and the practice of medicine.

There is comparatively little danger from great epidemics as serious as those in the past1; first, because people realize that these diseases have been fostered by filth, which is proscribed by modern health regulations; secondly, because at all seaports strict quarantine is established if there is a possibility of the introduction of any plague.

257. Disposal of Waste. Clean streets are necessary for the health of city dwellers, since every wind carries multitudes of germs from the dust or filth of pavements.2 The by which at least the poorest paid workers will be relieved of the extra losses and expenses of sickness. Certainly it is better to help directly the worthy laborer who is really sick and in need than to relieve poverty due to sickness or to encourage shiftlessness and imaginary sickness through forms of charity.

1 It is customary to isolate all cases of contagious or infectious diseases in cities. If an epidemic starts within a city, a more or less general quarantine is established for the section affected. So successful have these sanitary regulations become that the death rate from the more common infectious diseases is now much lower than a few years ago, while the terrible curse of smallpox has almost died out, as a result of vaccination and isolation.

2 Marvelous improvements were wrought in New York, 1894-1898, by one man, Colonel Waring, with his "white angels." Waring's work in Havana and Colonel Gorgas' sanitary achievements in the Canal Zone have been even more remarkable. In cleaning the streets of American cities care is taken to have the work done as much as possible by mechanical sweepers at night and if possible after the pavements have been wet to avoid the raising of dust.

clean streets and good systems for handling

rubbish and garbage.

collection and disposal of rubbish and garbage is one of the Need of most perplexing problems of American cities. Although this necessary sanitary work is performed usually by city agents, it is frequently performed in an unsanitary manner. Some cities have established incinerators, which dispose of all combustible wastes. This method is somewhat more expensive than others. A few cities are following the European plan of separating the solids in refuse and garbage and using the residue as treatment for fertilizer, but this system can be used advantageously only on a large scale. The most important of the city's sanitary problems from The sewage the engineering and health points of view is the disposal of problem. sewage. Practically every large city has adopted a network

of sewers connected with an outfall sewer to some place at

a distance.

258. Pure Milk and Meats.

Good health is impossible Pure milk without pure water (§ 180) and pure milk. Particularly in regulations.

the tenements there is a close connection between the character of a city's milk supply and infant mortality. Almost all modern cities have definite standards for the quality of milk which may be sold within their limits. Health officers inspect at regular intervals all dairies in order to see that the cows are healthy and the quarters are clean. Ordinances as well as food laws prohibit the use of preservatives in milk.1 Local food inspectors examine meat as well as milk, seek- Meat, fruit, ing to prevent the sale of spoiled meats or meat which has and weight been kept by the use of preservatives. Local, state, and national inspectors usually supervise carefully the slaughter and packing houses. A similar work is performed by fruit

1 The milk campaigns carried on in Rochester, New York, and other cities have resulted in a decreased infant death rate. In some communities model milk depots have been established which not only are cleanly but seek to distribute milk at a low margin above cost. In a few cities in the tenement districts during hot weather ice has been sold at cost or below to preserve the children's supply of food.

2 National inspectors may condemn meats which are unsatisfactory, the approved product being marked "United States inspected and passed." In the canning and preserving rooms of packing houses and food factories especial care is taken to maintain cleanliness and to encourage the use of up-to-date methods.

inspectors.

National and state laws.

Successes and failures of

the pure food laws.

Conditions

inspectors, who condemn perishable foods which have been kept too long. State or local inspectors examine weights and measures to see that scales give honest weight and that the boxes have no false bottoms and are of the size advertised. 259. Pure Food Laws. In 1906 public indignation was aroused against the products turned out by packing houses and manufacturers of foods. The national government and a majority of states at once passed pure food laws. Most of these laws require the manufacturers of foods and drugs to mention certain ingredients of the product, giving in detail the amount of substances which are poisonous or might be considered injurious. Coal tar dyes, a form of coloring matter which is misleading rather than harmful, can now be used at drug stores and in foods only when the words "artificial coloring" are conspicuous. Certain preservatives are prohibited altogether; others, such as benzoic acid, must not be used except in very minute quantities. Oleomargarine may no longer be sold as butter and must pay a tax of ten cents a pound. Patent medicine labels must declare the amount of certain ingredients.

There can be no doubt that foods to-day are much purer than they were fifteen or twenty years ago. Although it is true that the new laws have not attained their object of explaining to the customer the real nature of the article which he is purchasing, to some extent they prevent his buying ingredients or commodities which he does not want. Even the original laws would not have guaranteed the excellence of any food or drug; as intrepreted by the courts some regulations which were supposed to have been enacted originally no longer limit the unscrupulous manufacturer of foods or drugs. We still need laws which will protect not only the public but the honest manufacturers from the dishonest producers of foods.

260. Control of the Liquor Business. As intoxicating and forms of liquors injure health and are held responsible for a large part of the poverty and crime in existence, government control of the liquor business is less for the development of public

control.