Chapter 1

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[Transcriber's Note: The Table of Contents and the list of illustrations were added by the transcriber. Hyphenation standardized within articles. Quotation marks added to standardize usage. Updated spelling on possible typos: ninteenth, beafsteak, and embarassed. Replaced canon (with tilde) with canyon. Preserved other original punctuation and spelling. Passages in italics indicated by underscore _.]

McCLURE'S MAGAZINE

VOL. XXXI JULY, 1908 No. 3

_Copyright, 1908, by The S. S. McClure Co. All rights reserved_

TABLE OF CONTENTS

ILLUSTRATIONS 241 GUARDIANS OF THE PUBLIC HEALTH. By Samuel Hopkins Adams. 241 Our Health Boards and Their Powers 242 Our Absurd Vital Statistics 244 The Criminal Negligence of Physicians 246 "Business Interests" and Yellow Fever 246 Newspapers, Politicians, and the Bubonic Plague 248 Fighting Prejudice and the Death Rate in Charleston 250 Killing Off the City Negro 251 Private Interests in Public Murder 251 A LITTLE VICTORY FOR THE GENERAL. By Josephine Daskam Bacon. 253 AMERICAN IMPRESSIONS. By Ellen Terry. 263 THE HERITAGE OF HAM. By Lieutenant Hugh M. Kelly, U. S. A. 277 THE SINGER'S HEART. By Harris Merton Lyon. 291 THE REPUDIATION OF JOHNSON'S POLICY. By Carl Schurz. 297 The Fourteenth Amendment 298 A Campaign to Destroy a President 298 Killing of Negroes at Memphis and New Orleans 300 Johnson "Swings Around the Circle" 301 New Congress Overwhelmingly Anti-Johnson 304 The Movement Toward Negro Suffrage 304 Reconstruction Under Military Control 305 The Public Fear of Johnson 306 The Fatal Bungling of Reconstruction 307 THE THIRTEENTH MOVE. By Alberta Bancroft. 308 GIFFORD PINCHOT, FORESTER. By Will C. Barnes. 319 CHIEF KITSAP, FINANCIER. By Joseph Blethen. 328 THE WAYFARERS. By Mary Stewart Cutting. 337 THE CATHEDRAL. By Florence Wilkinson. 357 THE NEW GOSPEL IN CRIMINOLOGY. By Judge McKenzie Cleland. 358

Illustrations

DR. CHARLES HARRINGTON, SECRETARY OF THE MASS STATE BOARD OF HEALTH DR. THOMAS DARLINGTON, COMMISSIONER OF HEALTH FOR NEW YORK CITY DR. CHARLES V. CHAPIN, SUPERINTENDENT OF HEALTH IN PROVIDENCE, RI DR. JOHN N. HURTY, SECRETARY OF THE BOARD OF HEALTH IN INDIANA DR. GEORGE W. GOLER, HEALTH OFFICER OF ROCHESTER, NEW YORK DR. J. MERCIER GREEN, HEALTH OFFICER OF CHARLESTON, SOUTH CAROLINA THE SCAVENGERS OF CHARLESTON, SOUTH CAROLINA CAROLINE WALKED AHEAD, HER CHIN WELL UP, HER NOSE SNIFFING PLEASURABLY THE UNACCUSTOMED ASPHALT YOUNG GIRLS ... CANTERED BY; THEIR LINEN HABITS ROSE AND FELL DECOROUSLY, THEIR HAIR WAS SMOOTH THE STANDING CROWD CRANED THEIR NECKS, AS DELIA SAT UP STRAIGHT AND HELD OUT HER ARMS 'I'VE GOT TWO O' MY OWN' 'WHO--WHO--WHAT IS THE MEANING OF THIS?' HE WHISPERED HOARSELY HENRY IRVING AS CARDINAL WOLSEY IN "HENRY VIII." ELLEN TERRY ELLEN TERRY WITH HER FOX-TERRIERS, DUMMY AND FUSSIE MISS ROSA CORDER SIR HENRY IRVING MISS ELLEN TERRY AUGUSTIN DALY AND HIS COMPANY OF PLAYERS AUGUSTIN DALY JOHN DREW AS PETRUCHIO IN "THE TAMING OF THE SHREW" ADA REHAN AS KATHARINE IN "THE TAMING OF THE SHREW" HELENA MODJESKA MARY ANDERSON JOSEPH JEFFERSON AS RIP VAN WINKLE ALL DAY LONG OLD SERGEANT WILSON SAT IN THE CORNER OF THE SQUAD ROOM, CLASPING AND UNCLASPING HIS STRAINING HANDS CABLE THE PRESIDENT! WHAT A JOKE! THE CIRCLE CLOSED IN AS THE SEA SURGES UP UPON THE LAND HARRY BARNES, OLD ACTOR HE GRINNED AND WINKED AND FRISKED AND CAPERED 'OH, YOU DIVVIL, YOU! YOU OLD, BLATHERSKITING DIVVIL' HE SAT STARING INTO THE BLANKNESS OF THE LITTLE ROOM JOHN POTTER STOCKTON, THE DEMOCRATIC SENATOR FROM NEW JERSEY SENATOR CARL SCHURZ SENATOR PRESTON KING SENATOR JAMES LANE SENATOR ZACHARIAH CHANDLER 'I'VE BEEN FOLLOWING YOU EVER SINCE YOU LEFT YOUR OFFICE,' HE SAID 'IT'S A DESPICABLE LETTER,' SHE TOLD HERSELF 'HOW DO YOU SUPPOSE I FEEL, BEING IN THIS POSITION--TO YOU?' GIFFORD PINCHOT A SECTION OF THE BIG HORN NATIONAL FOREST, WYOMING, SHOWING THE FOREST SERVICE METHODS OF LUMBERING SECTION OF A REDWOOD FOREST IN CALIFORNIA, SHOWING WASTEFUL AND DESTRUCTIVE METHODS OF LUMBERING THE EFFECT OF EROSION ON A HILLSIDE FROM WHICH THE FOREST COVER HAS BEEN REMOVED THE SAME HILLSIDE AFTER TWO YEARS OF CAREFUL AND SYSTEMATIC GRAZING HERD OF SHEEP GRAZING UPON A NATIONAL FOREST KITSAP, THE CLERK, DONNED THE TRIBAL FINERY OF HIS ANCESTORS ON ALL SIDES THE HOP-PICKERS WERE MAKING MERRY PICKING PROGRESSED TO AN END, AND THE INDIANS HELD THEIR LAST FEAST AND DEPARTED STOOD THERE LEANING AGAINST 'DADDY'S' SIDE IT WAS SWEET TO BE CHAFFED, TO BE HEEDLESSLY YOUNG ONCE MORE SHE CREPT OUT UPON THE LANDING OF THE STAIRS, AND SAT THERE DESOLATELY ON THE TOP STEP SHE TOOK THE PISTOL FROM HIS RELAXED HOLD THE TWO WOMEN SITTING ON THE BENCH, WRAPPED AROUND BY THE LONELINESS AND THE INTENSE STILLNESS OF THE ONCOMING NIGHT 'THEY'LL GET FULL OF EARTH AGAIN,' SHE PROTESTED LOIS STOLE INTO THE ROOM

John Chinaman is the logician of hygiene. To his family doctor he says: "I pay you to keep me well. Earn your money." Let him or his fall sick, and the physician's recompense stops until health returns to that household. Being fair-minded as well as logical, the Oriental obeys his physical guardian's directions. Now, it may be possible to criticize certain Chinese medical methods, such as burning parallel holes in a man's back to cure him of appendicitis, or banging for six hours a day on a brass tom-tom to eliminate the devil of headache; but the underlying principle of "No health, no pay" is worthy of consideration.

This principle it is which, theoretically, we have adopted in the matter of the public health. To our city, State, or national doctors we pay a certain stipend (when we pay them at all) on the tacit understanding that they are to keep us free from illness. With the cure of disease they have no concern. The minute you fall ill, Mr. Taxpayer, you pass into the hands of your private physician. No longer are you an item of interest to your health officer, except as you may communicate your disease to your fellow citizens. If he looks after you at all, it is not that you may become well, but that others may not become ill through you. Being less logical in our conduct than the Chinese, we, as a people, pay little or no heed to the instructions of the public doctors whom we employ. We grind down their appropriations; we flout the wise and by no means over-rigorous regulations which they succeed in getting established, usually against the stupid opposition of unprogressive legislatures; we permit--nay, we influence our private physicians to disobey the laws in our interest, preferring to imperil our neighbors rather than submit to the inconvenience necessary to prevent the spread of disease; and we doggedly, despite counsel and warning, continue to poison ourselves perseveringly with bad air, bad water, and bad food, the three B's that account for 90 per cent. of our unnecessary deaths. Then, if we are beset by some well-deserved epidemic, we resentfully demand to know why such things are allowed to occur. For it usually happens that the virtuous public which fell asleep with a germ in its mouth, wakes up with a stone in its hand to throw at the health officer. Considering what we, as a people, do and fail to do, we get, on the whole, better public health service than we deserve, and worse than we can afford.

_Our Health Boards and Their Powers_

As a nation, we have no comprehensive health organization. The crying need for one I shall point out in a future article. Our only Federal guardianship is vested in the United States Public Health and Marine Hospital Service, which, by some mystery of governmental construction, got itself placed in the Treasury Department, where it certainly does not belong. It is, with the exception of a few ancient political appointees now relegated to unimportant posts, a highly trained and efficient body of hygienists and medical men, the best of whom have also qualified as diplomats in trying crises. Any germ-beleaguered city may call upon this Service for aid. It is a sort of flying squadron of sanitative defence. When yellow fever broke out in New Orleans, it was the M. H. S. men who, working quietly and inconspicuously with the local volunteers, mapped out the campaign which rid the city of the scourge. In the San Francisco panic eight years ago, when bubonic plague beset the city, it was the Marine Hospital Service which restored confidence: and a Service man has been there ever since as the city's chief adviser. The Federal "surgeons," as they are called, may be in St. Louis helping to check smallpox, or in Seattle, blocking the spread of a plague epidemic, or in Mobile, Alabama, fighting to prevent the establishment of an unnecessary and injurious quarantine against the city by outsiders, because of a few cases of yellow jack; and all the while the Service is studying and planning a mighty "Kriegspiel" against the endemic diseases in their respective strongholds--malaria, typhoid, tuberculosis, and the other needless destroyers of life which we have always with us. In the Marine Hospital Service is the germ of a mighty force for national betterment.

Of the State boards, perhaps a fourth may be regarded as actively efficient. The rest are honorary and ornamental. Undoubtedly a majority would be ready and willing to perform the services for which they are not (as a rule) paid anything; but they lack any appropriation upon which to work. South Carolina, for example, has an excellent State board. Its president, Dr. Robert Wilson, is an able and public-spirited physician of the highest standing; an earnest student of conditions, and eager for the sanitary betterment of his State. But when he and his board undertook to get one thousand dollars from the legislature to demonstrate the feasibility of enforcing the pure food law and of turning away the decayed meat for which the State is a dumping-ground, they were blandly informed that there was no money available for that purpose. It was in South Carolina, by the way, that a medical politician who served on the public health committee of the legislature addressed this question to a body of physicians who had come there to appeal for certain sanitary reforms: "What do you want of laws to prevent folks being sick? Ain't that the way you make your livin'?" Which is, I fear, typical of the kind of physicians that go into politics and get into our legislatures, where, unhappily, they are usually assigned to the public health committees.

Under the State boards, in the well-organized States, are the county boards and officers, who report to the State boards and may call upon the latter for advice or help in time of epidemic or danger.

In certain circumstances the State officials may arbitrarily take charge. This is done in Indiana, in Maryland, in Pennsylvania, and in Massachusetts. The last State not only grants extraordinary powers to its health executive, Dr. Charles Harrington, but it appropriated last year for the work the considerable sum of $136,000. By the issuance alone of vaccine and antitoxin, the Board saved to the citizens of the State $210,000, or $74,000 more than the total appropriation for all the varied work of the institution. Some vague idea of the economy in lives which it achieves may be gained from the established fact that death results in only sixteen out of every thousand cases of diphtheria, when the antitoxin is given on or before the second day of the illness; 110, when given on the third day; and 210 when the inoculation is performed later. The old death rate from diphtheria, before antitoxin was discovered, ranged from 35 to 50 per cent. of those stricken.

Finally, there are the city bureaus, with powers vested, as a rule, in a medical man designated as "health officer," "agent," or "superintendent." What Massachusetts is to the State boards, New York City is to the local boards, but with even greater powers. Under the charter it has full power to make a sanitary code. Matters ranging from flat wheels on the Metropolitan Street Railway Company's antiquated cars, to soft coal smoke belched forth from factory chimneys, are subject to control by the New York City Department of Health. The Essex Street resident who keeps a pig in the cellar, and the Riverside Drive house-holder who pounds his piano at 1 A.M. to the detriment of his neighbor's slumber, are alike amenable to the metropolis' hired doctors.

The province of the city, State, and Federal health organization is broad. "Control over all matters affecting the public health" is a comprehensive term. "All the powers not already given to the school committees," observed a Massachusetts judge, "are now ceded to the Boards of Health." In theory, then, almost unlimited powers are vested in the authorities. But how carefully they must be exercised in order not to excite public jealousy and suspicion, every city health official well knows. More serious than interference and opposition, however, is the lack of any general equipment. At the very outset the loosely allied army of the public health finds itself lacking in the primal weapon of the campaign; comprehensive vital statistics.

_Our Absurd Vital Statistics_

Vital statistics in this country are an infant science. Yet they are the very basis and fundament of any attempt to better the general health. Knowledge of what is killing us before our time is the first step toward saving our lives. The Census Bureau does its best to acquire this essential information. For years Director North has been persistently hammering away at this point. But progress is slow. Only fifteen States, representing 48 per cent. of our population, are comprised in the "registration area"; that is, record all deaths, and forbid burial without a legal permit giving the cause of death and other details. Outside of this little group of States, the decedent may be tucked away informally underground and no one be the wiser for it. This is convenient for the enterprising murderers, and saves trouble for the undertakers. Indeed, so interested are the latter class, that in Iowa they secured the practical repeal of a law which would have brought that State within the area; and in Virginia this year they snowed under a similar bill in the legislature, by a flood of telegrams. Ohio, the third largest State in the Union, keeps no accurate count of the ravages of disease. Probably not more than 60 per cent. of its deaths are reported. Why? Inertia, apparently, on the part of the officials who should take the matter in charge. Governor Harris in his January message made a strong plea for registration, but without result. As for births, there is no such thing as general registration of them. So this matter is neglected, upon which depend such vital factors as school attendance, factory employment, marriage, military duty, and the very franchise which is the basis of citizenship. It is curious to note that Uruguay, in its official tables of comparative statistics, regrets its inability to draw satisfactory conclusions regarding the United States of America, because that nation has not yet attained to any scientific method of treating the subject. Patriotism may wince; but let us not haughtily demand any explanation from our sneering little neighbor. Explanations might be embarrassing. For the taunt is well founded.

Is it strange that, having no basis in national statistics, our local health figures "speak a varied language"? We have no standards even of death on which to base comparisons. But a dead man is a dead man, isn't he, whether in Maine or California? Not necessarily and unqualifiedly. In some Southern cities he may be a "dead colored man," hence thrown out of the figures on the "white death rate" which we are asked to regard as the true indication of health conditions. In New Orleans, until recently, he might be a "death in county hospital," and as such not counted--this to help produce a low death rate. In Salt Lake City he's a "dead stranger," and unpopular on account of raising the total figures for the city. They reckon their total rate there as 16.38, but their home rate or "real" rate as 10.88. That is to say, less than 11 out of every 1,000 _residents_ die in a year. If this be true, the Salt Lake citizens must send their moribund into hasty exile, or give them rough on rats, so that they may not "die in the house." As for the "strangers within our gates" who raise the rate over 50 per cent. by their pernicious activity in perishing, the implication is clear: either Salt Lake City is one of the deadliest places in the world to a stranger, or else the newcomers simply commit suicide in large batches out of a malevolent desire to vitiate the mortality figures. The whole thing is an absurdity; as absurd as the illiterate and fallacious three-page leaflet which constitutes this community's total attempt at an annual health report.

St. Joseph, Missouri, claimed, one year, a rate of 6.5 deaths out of every 1,000 inhabitants. Were this figure authentic, the thriving Missouri city, by the law of probability, should be full of centenarians. It isn't. I essayed to study the local reports, hoping to discover some explanation of the phenomenon, but was politely and regretfully informed that St. Joseph's health authorities issued no annual reports. The natural explanation of the impossibly low rate is that the city is juggling its returns. In the first place, that favorite method of securing a low per capita death rate--estimating a population greatly in advance of its actual numbers--is indicated; since the community has fewer lines of sewers and a smaller area of parks than other cities of the size it claims--two elements which, by the way, would in themselves tend to militate against a low mortality. Perhaps, too, the city has that ingenious way of eliminating one disturbing feature, the deaths under one week or ten days, by regarding them as "still-births." Chicago used to have this habit; also the trick of counting out non-residents, who were so thoughtless as to die in the city. At present, it is counting honestly, I believe. Buffalo used to pad for publication purposes. One year it vaunted itself as the healthiest large city in the country. The boast was made on the original assumption of a population nearly 25,000 in excess of the United States Census figures, to which 20,000 more was added arbitrarily, the given reason being a "general belief" that the city had grown to that extent.

Perhaps as complete returns as any are obtained in Maryland, where the health official, Dr. Price, culls the death notices from 60 papers, checks up the returns from the official registrars, and if any are missing, demands an explanation by mail. It behooves the registrar to present a good excuse. Otherwise he is haled to court and fined. The Board has thus far never failed to secure a conviction.

Now, if the most concrete and easily ascertainable fact in public health statistics, the total of deaths, is often qualified or perverted, it follows that dependent data, such as the assigned causes of death, as required by law, are still more unreliable; so I shall keep as far away from statistics as possible except where some specific condition can be shown by approved figures or by figures so inherently self-disproved that they carry their own refutation.

_The Criminal Negligence of Physicians_

This unreliability may be set down to the account of the medical profession. Realizing though they do the danger of concealment from the proper authorities, and in the face of the law which, as it gives them special privileges, requires of them a certain return, a considerable percentage of physicians falsify the returns to protect the sensibilities of their patrons. That they owe protection rather to the lives of the public, they never stop to think. Tuberculosis is the disease most misreported. In many communities it is regarded as a disgrace to die of consumption. So it is. But the stigma rests upon the community which permits the ravage of this preventable disease; not upon the victims of it, except as they contribute to the general lethargy. In order to save the feelings of the family, a death from consumption is reported as bronchitis or pneumonia. The man is buried quietly. The premises are not disinfected, as they should be, and perhaps some unknowing victim moves into that germ-reeking atmosphere, as into a pitfall. Let me give an instance. A clergyman in a New York city told me of a death from consumption in his parish. The family had moved away, and the following week a young married couple with a six-months-old baby moved in.

"What can I do about it?" asked the clergyman. "Mr. Blank's death was said to be from pneumonia; but that was only the final cause. He had been consumptive for a year."

"Warn the new tenants," I suggested, "and have them ask the Health Board to disinfect."

More than a year later I met the clergyman on a train and recalled the case to him. "Yes," he said, "those people thought it was too much trouble to disinfect, particularly since the reports did not give tuberculosis as the cause of death. Now their child is dying of tuberculosis of the intestines."

In this case, had the death been properly reported by the dead man's physician, as the law required, the City Board would have compelled disinfection of the house before the new tenants were allowed to move in. The physician who obligingly falsified that report is morally guilty of homicide through criminal negligence.