Vol. XIV.

No. 7

HE sanitary awakening in the United States is notable. Its growth may be appreciated when we look back to the conventions called by those interested in these affairs just before and after the civil war. These conventions were held in New York, Philadelphia, Baltimore, and Richmond, and the discussions therein related almost exclusively to maritime quarantine. The great need was of uniformity in the administration of quarantine at the several ports. That uniformity was finally established through the National Quarantine Act of February 15, 1893. No longer is there heard the complaint that one port is lax in its quarantine administration with the evident purpose of attracting to itself commerce, seeking to avoid the more honestly administered quarantine restraints at neighboring or rival ports. This evil, so exasperating and dangerous in the past, has been so thoroughly done away with that it is almost forgotten.

Out of these quarantine conventions there developed the American Public

Health Association, composed of sanitarians in both official aud private life, who as the published transactions will show, have devoted themselves to the subjects of sanitation and hygiene. A leading cry of these sanitarians is the necessity of arousing popular sentiment and diffusing in popular form knowledge concerning the allimportant subjects of municipal sanitation and hygiene.

Popular sentiment has been aroused, and a brief review of the field will show that it is stirred at the present time to a degree hitherto unknown.

This is seen partly in the activities of the state boards of health. All the states have now boards of health, or health departments, which each year are increasing in importance and in direct influence upon their own people. The legislatures have widened the legal functions of these state boards, and are yearly becoming more liberal in their appropriations. True, in some states the appropriations are absolutely niggardly, and it is the duty of the

people appreciating the sanitary movement to demand of their legislators more liberal support of the state, health organization. The brief circulars, leaflets or pamphlets, issued by the state boards of health, for distribution throughout the length and breadth of the state, giving plain directions with regard to the communicable diseases pointing out the dangers and methods of meeting the same, are eloquent witnesses and contributors to the awakening of the public health sentiment.

As to the municipalities, one needs to but read the daily papers to be impressed with their increasing activities in the destruction of insanitary dwellings, tenement house reform, pure water supply, pure milk supply, pure food, compulsory notification of communicable disease and the restraints thrown about the latter to prevent extension thereof.

Throughout the length and breadth of the land, in nearly every state and in many of the cities and towns, there exist auxiliary sanitary associations, which are of great benefit in creating public sentiment and upholding the efforts of the authorities.

I need mention only, for illustrations, the great number of societies for the suppression of the great white plague, tuberculosis. Among other organizations for the suppression of this disease, there may be mentioned as of particular interest the American Federation of Labor. In a well-prepared pamphlet they have set forth the dangers and the care that must be exercised by the individual afflicted with this disease to prevent its conveyance to others, and as this association has a membership of about two million and extends to every part of the Union its influence in the suppression of this disease must be great.

The sanitary movements of the present time are answering the question: "Am I my brother's keeper?" and the answer is, "Yes!" There is more than a sentimental or religious reason in this answer; there is a practical and self-protecting reason, why every portion of the community should be interested in the sanitary welfare of every other portion-why the more prosperous should interest themselves in preventing the less prosperous from living under unhygienic conditions in insanitary dwellings or with indifference to the natural laws of health.

There is no part of any community which is not affected by the sanitary condition of

every other part. The millionaire, residing in his mansion in the suburbs, the Godgiven light falling in the windows on every side of his house, with fresh air in abundance, with a filtered water supply or drinking water imported from some spring of famous purity, and with plumbing and house drainage of the most modern and perfect type, may fancy that he has nothing to fear from the over-crowded rooms of an insanitary tenement house located in some interior court or alley of the slum district of the city, but the connection between these two dwellings is in many ways more direct than he may imagine. It needs but a little sociologic study to appreciate how readily the germ of a disease nurtured in the most poverty-stricken portion of a city may find its way to the residence of the wealthy.

I had this fact impressed upon me during a period of governmental service in a certain city where at the time of this incident the smallpox was prevailing. In one of its finest mansions there dwelt a beautiful child, the sole heir of its cultivated and wealthy parents, almost worshipped by them and guarded in every way possible with exceptional jealousy and care. The parents were unwilling to incur even the minimum risk of vaccination and established instead a system of prevention of contact with the outer world, involving a confinement of the child to the house until the disease should have disappeared from the city. But the faithful nurse must needs have rest and recreation, and during one of these periods made visits to her colored friends in their poor habitation, and brought back to the child the dread disease against which these unusual precautions had been taken, and which terminated its life.

The prosperous, intelligent, and ruling members of any community who are indifferent to the sanitary welfare of the ignorant, or the poor, or even the vicious, are thereby endangering themselves. The disease germ is too often considered a myth or something far away from the healthy and prosperous. It is invisible to the naked eye, but so is the air we breathe invisible. It is an entity; it has real existence. Though unseen by normal vision, it may be seen at any time through the microscope. now in such common use, the spectacles of science. You have but to put on your spectacles to see the germ. And

where will you hunt for it? You will not hunt where the sunlight from Heaven pours in, nor where the fresh pure air from ne mountains, seas, or plains permeates the habitation; you will not hunt for it in houses where there is pure water and sanitary plumbing, or in localities where there is good drainage, sewerage, and paving. These are not the natural haunts of the germ. You will hunt for him successfully where these conditions do not exist in your bad tenements, dark and unventilated rooms, in the hidden dirt and foul collections of untidy places; the parasite of rodents and insects, breeding along with these on unkempt premises. You will find it clinging to old carpets, furniture, wall paper, and bedding in these miserable habitations, or floating with the dust in the air, and clinging, also, to the persons of the inhabitants of such places.

Now, the disease germ is a social climber. Its existence is not stationary. It goes calling, with the old clothes and person of the inhabitants of the foul den, who surely will visit friends less degraded, and these have friends of higher degree. So that, slowly or rapidly as the case may be, the germ struggles upwards and is carried to the top. This shows the necessity of the absolute elimination of the slums in every city.

As I have previously declared, there is no adequate reason why slums should exist anywhere, and by slums I mean places where, through bad drainage, imperfect sewerage, inadequate air space, lack of pure water, and lack of sunlight, human beings are subject to disease and crime inducing conditions.

The existence of slums in a city is that city's fault, not its misfortune. Human beings are subject to disease, and as this means simply municipal cleanliness and decency, there can be no good reason why it should not be brought about. The chief pride of a city should not be in its boulevards and handsome buildings. These can wait. But the chief pride should be that nowhere within its boundaries can be found slum conditions as just described. The removal of such conditions can not wait.

Not only thus will disease be suppressed, but there will be encouraged the development of individual health and power. It would mean a greater average of mental aptitude for work in the higher fields of human activity, in all the arts and sciences. Under

more perfect sanitary environments we live longer, we live better; our energies, physical and mental, are stronger, and better fit us for entering upon a higher plane of living. There is better opportunity for greater culture and refinement, greater familiarity with the higher laws of life, greater ability to comprehend our spiritual being and wrest from the unknown those higher principles of existence towards which we are now groping with unexplained instinct.

Man, after the fall, was at first chiefly animal; next he gained mentality; and now he is reaching forward to what for a better term we may call spirituality, and which is so often expressed in the term, "uplifting of the human race," by those who plead for human advancement.

Thus it will be seen that the principles of preventive medicine apply universally. All are interested in them, from the highest to the lowest, no matter what their calling.

Physicians are the natural agents of preventive medicine, but there are other natural agents. There are the engineers, expert in sanitary works; lawyers, who have sanitary wisdom; philanthropists, sometimes misguided in their efforts, but helpful. Then there is the clergy and the religious denominations. These have great opportunities, but too often miss the mark.

The clergy and their various denominational societies could be much more effective than they are in bringing about improved conditions. Their opportunities are exceptional, but their operations, while helpful to a degree and worthy of commendation, too often fall short and fail to grapple with the real needs. Their benefits are but temporary, and too often by their palliative character result in a neglect of more radical and basic treatment. I refer particularly to the work that is done under the name of charity.

Charity, as it is ordinarily understood, is insufficient and temporizes with the real difficulty. The charity enjoined by Scripture, it seems to me, is charity of the mind, and disposition rather than physical charities. "Charity covereth a multitude of sins," but it does not cover a multitude of dirt. Much of the physical charity of today is but the individual or corporate atonement for the shortcomings of the community. The best physical charity is the establishment and enforcement of proper sanitary laws. The charity