Part 22

WHERE HUMAN LIFE IS CHEAP.] alleviate such a status? Nothing: the problem is too big for official solution. Either a sense of responsibility on the part of the mill owner toward his employes who must live near the mills will start a housing movement that will do away with the present outrageous rentals for disgraceful accommodations, or an aroused public conscience will, by one means or another, make a clean sweep of these pest holes. Or, a third, and ugly alternative. London's East End is open for the inspection of travelling Pittsburghers. There they may see in its fullness the crop of pauperism, dependence, and degeneracy which is bred in the third and fourth generations, of conditions no worse than their own average, and not so bad as their own worst.

As an escape from the slum there is the school. Here again Pittsburgh is in the dark ages of hygiene. Every public school is a law unto itself. The principal, always a layman, and not unusually an ignorant one in health matters, decides when a pupil shall be isolated for a contagious or suspicious ailment. Is it surprising that a short time ago a certain skin disease infected an entire institution, or that eye and scalp ailments are often widely diffused among the scholars? From an inspection of buildings and pupils Dr. Goler draws these conclusions:

The school buildings are in many cases crowded, dark, dirty, often of three stories, and bad fire risks. The condition of the children in these schools good and bad, rich and poor, may be shown by the large proportion having defective teeth, reduced hearing, imperfect vision. An excessively large number of them are mouth breathers, partially so because they are unable to breathe through their noses in the smoky air of Pittsburgh, and a very considerable number are below stature for weight of that determined for the average child. In a large percentage, the defects of teeth, nose and throat, bring them below the physical normal. These are the children that wear out in childhood.

In no manner of justice, can the Bureau of Health be held to account in this matter. In co-operation with the Civic Club, settlements, physicians and school principals, Dr. Edwards sought to establish a medical inspection of public schools, such an inspection as would, for example, undoubtedly have checked almost at its inception the disastrous onset of measles of last year. But the measure never got past the legal department of the city administration. In view of the present conditions in the schools, Dr. Goler's closing and pregnant suggestion has a special force:

_"Ought not the Pittsburgh schools to be closed and the children repaired?"_

Semi-public institutions in Pittsburgh are quite independent of hygienic control or inspection. This seems to me one of the crying evils of the present status. Let me give a few examples: An inmate of an institution for children was infected by another child who had virulent skin disease and soon afterward he became totally blind. This was a repetition of a past experience of the same institution in which a child contracted trachoma within the institution walls, is totally blind in consequence and a charge upon the state.

Last spring an institution was found in charge of a matron whose special qualification for her care of very young children was experience. She had had ten of her own, all of whom died of intestinal disease and rickets in early childhood. She was feeding the little ones in her care on coffee and other food suited only to robust grownups. Every child in a certain charitable institution, a short time ago, was suffering from skin and scalp disease. Lack of arrangements for effective isolation, in case of contagious disease, is more common than provision for isolation. A refuge for fallen women has, naturally, a large percentage of inmates suffering from venereal disease. The women of one refuge work in the laundry which gets a certain amount of outside trade. Among other things it washes towels for a hotel. Contraction of gonorrhea or syphilis from infected towels or garments is a well-recognized medical fact. A laundry with infected women on its working force cannot but be a public peril.

Grim facts are piling up on the records of the Pittsburgh Tuberculosis Dispensary as to advanced cases of tuberculosis among the little charges of charitable institutions.

Instances such as these might be multiplied. As in the case of the public schools the authorities are helpless. Even over the city's own institution, the Municipal Hospital, the Bureau of Health has no control. It has been transferred to the Bureau of Charities within the last year. It receives only contagious diseases, and is too small for the requirements in time of epidemic, having proper accommodation for only eighty, with a crowded capacity of 125. Dr. Booth of the Bureau of Health, who acts as visiting physician by special appointment to the Bureau of Charities, tells me that up to 1905 the plant was housed in buildings erected in the seventies. The furnishings were beds and bedding from the fire and police departments, regarded as being no longer fit for use by the city's paid servants, and therefore proper charity for the city's helpless sick. Two years ago, Dr. Booth put an end to this system by burning the last consignment of furnishings (for reasons principally entomological); and announcing that he would admit to the hospital no more equipment, discarded as unfit by the police and fire forces. Now the plant has its own furnishings. The building is modern but of an obsolete and unsatisfactory type, and has not sufficient grounds for its convalescents. All the other hospitals in the city are private institutions. There is no co-ordination of hospital work among them, and their distribution is such that localities where there are the most ambulance calls are without easily available hospital plants.

To sum up, these are some few of Pittsburgh's immediate needs, if it is to fight its battle successfully for fewer deaths and a better living product:

Autonomy of the official health authorities (preferably a department of health, not a bureau) under the executive and administrative control of a physician or sanitarian.

A tuberculosis hospital for advanced cases which are now spreading infection throughout the city. More visiting nurses and more sanitary inspectors. Eventually a hospital for the incipient cases that can be saved.

Municipal collection and disposal of the rubbish which accumulates everywhere, seriously hampering efforts to make the city hygienically clean and which must now be removed at private expense.

A general hospital of sufficient size, proper equipment, and adequate surroundings.

Some reasonable division and co-ordination of effort on the part of the private hospitals.

Authority to condemn and destroy unsanitary buildings.

Authority to condemn and destroy, upon its entrance to the city, or upon discovery within the city limits, unclean, infected, or adulterated milk, and to refuse and revoke milk licenses. Establishment of a standard for milk.

Medical inspection of schools and school children.

Medical and sanitary inspection of hospitals, and of all public or semi-public chartered institutions.

These authorizations to be embodied in a city code. At present the health officials work almost wholly under the state law.

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What is Pittsburgh going to do about it? Though the foregoing rather general survey may suggest pessimistically "the little done, the undone vast," yet there is not lacking, in the view, definite promise as well as progress. Many and diverse agencies are helping the cause. The monthly reports of the bureau keep a public, which has for years been in a state of Egyptian darkness as to the how and wherefore of its mortality, fully informed. A Civic Improvement Commission has been appointed by Mayor Guthrie, one of the sub-committees of which will deal with needed hygienic reforms. The Chamber of Commerce has appointed a special committee to co-operate with the Health Bureau for the betterment of housing conditions, and another to aid in improving the milk supply. For the protection of the communities downstream, a sewage disposal plant has been voted; and badly needed it is, as is shown by the fact that, at the present writing, two thousand people are ill in the suburb of Bellevue, from drinking water polluted by Pittsburgh's sewage. The Allegheny County Medical Society has constituted a committee on public instruction in health matters; also a milk commission. The Tuberculosis Commission will soon be in the field with its broad campaign. Municipally there has been an important step forward in the establishment of a disinfection corps which sterilizes and makes safe, at the public expense if necessary, the premises from which a consumptive has been removed. Anti-tuberculosis education by the various corps of visiting nurses is extending into every corner of the city that harbors a dangerous consumptive. The state school commission has recommended medical inspection of schools. City ordinances providing for milk standards, and rubbish disposal, are in prospect. The Bureau of Health, only a short time ago a rusted and ineffectual machine fed by incompetents from other departments, has, under its new head, developed an _esprit de corps_, and is now welded into a compact, dependable organization. And this organization will constantly have a supply of better trained men to draw upon, since the University of Pittsburgh and the Carnegie Technical Schools have, at Dr. Edwards's suggestion, arranged for special courses in sanitary engineering and practical hygiene.

Yes; Pittsburgh is awake to the needs of the situation. But the true test is yet to come. Thus far it has been but the laying out of the lines of battle and a few preliminary, and, on the whole, victorious skirmishes. For when hygienic and sanitary reform impinges, in its advance, as it needs must, upon the private purse of some, the political purposes of others, and the industrial and commercial license of the whole, then will come the tug of war. Then, according as shortsighted selfishness shall prevail over, or succumb to, civic pride and patriotism, the victory will be to the germ or to the city.

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