SOME UNSOLVED PROBLEMS IN TENEMENT-HOUSE

LIFE.*

By S. A. KNOPF, M. D.

Mr. Chairman, Ladies and Gentlemen:

A new era has dawned on our beloved city and on our tenementhouse population. Greater New York, for the first time in its history, has a single Tenement-house Commissioner. Mr. Robert W. de Forest, who has done so much for the improvement of the condition of the tenement dwellers by his previous work, has, with a rare self-abnegation, accepted the position tendered him by His Honor the Mayor. Let us rejoice at this appointment of ideal excellence, and let us also be grateful that Mr. de Forest has for his lieutenant our esteemed friend and indefatigable worker in tenement-house reform, Mr. Lawrence Veiller.

Thanks to the labors of the Tenement-house Commission, which was appointed by our honored President when still Governor of New York, and thanks to our present tenement-house laws which this Commission has promulgated, Mr. de Forest and his staff will be able to see to it that our tenement-house dwellers shall have safe and sanitary habitations. Rooms without light and air will be a thing of the past; houses with insufficient and dilapidated fireescapes will no longer be tolerated. A pure atmosphere in every respect will prevail in these homes for toilers. But there still remain a few problems of the tenement-house question unsolved. They are such that the Commissioner cannot reach them, and are, in reality, beyond his province. They must be solved by private enterprise and by personal work, such as you, charity workers and friendly visitors of the poor, are doing daily. You must, however, also be helped in these labors of love by large and generous philanthropy on the part of the well-to-do.

These unsolved problems are, first, ignorance concerning personal hygiene, food and cooking; second, alcoholism; third, tuberculosis; fourth, the inability of laborers to get along with their earnings.

In a short address like this I can, of course, not go into the details of personal hygiene, and can only point out to you some of

* Address delivered by invitation before the Second Public Conference of the Friendly Visitors of the Brooklyn Bureau of Charities, at the Church of the Messiah, Brooklyn, N. Y., Jan. 13, 1902.

the essentials which the majority of the tenement-house dwellers do not know, or think they need not know, nor practice. There is, first, the question of baths. Many people, having no bathrooms, think they do not need to take baths; particularly are they opposed to taking cold douches, which are so essential to good health. Let me give you a few details of the procedures to accustom people to the use of cold water when they are afraid of it. Tell them to be rubbed off, or to rub themselves off, for a few days with pure alcohol all over the body. For the next few days to take half alcohol and half water, instead of pure alcohol; and lastly, to use cold water alone. After having become thoroughly accustomed to the friction by hand with cold water, let them gradually commence with a sponge bath, later the ablution, and lastly the douche. By this education of the skin and the nervous system there is nothing to be feared from the shock which cold water may produce. It is well to tell people not to take their douches in cold, chilly rooms, and always to follow the cold douche either by exercise or a return to the warm bed, if the douche is taken in the morning.

When ordering baths to the tenement-house population it is not unusual to be told that there is no bathroom. You must then assure these people that by buying an English bath-tub, about a foot deep and three feet in diameter, one can, with the help of a few pitchersful of water poured over the shoulders of the individual, improvise a very effective douche. By the use of a watering pot, with sprinkler, an almost perfect needle-bath can be improvised. Besides these daily douches one should recommend a weekly warm bath with soap, to be taken either in a public bath house, in their own bathrooms, or with the aid of a tub. These warm baths should be followed by a cold douche or a rapid cold sponging off. The use of water, cold and warm, in this way, will not only strengthen and improve the general condition of the tenement dweller, but will also prevent him from becoming susceptible to the various infectious and debilitating diseases.

Concerning dress, there is one habit which I have found prevalent among our tenement-house population and also among some more well-to-do people; that is the habit of sleeping with underwear which is never taken off until the end of the week, and sometimes not even then. Now, there is nothing more unhygienic and nothing more productive of skin diseases, so frequent among the poor, than just such habits. The healthiest way is, of course, to sleep in a muslin night-shirt, which should be well aired during

the daytime. Some people, however, claim to be cold unless they wear undergarments at night. To these one must recommend to have two sets of underwear, one to wear at night and the other during the daytime.

Another defect in personal hygiene is the common use of one towel for the whole family. This habit is particularly to be regretted, since it is known to all medical men of experience that a number of diseases have been transmitted through the medium of a towel. One cannot insist too much upon this point, and recommend that every member of the family should have his own towel and tooth-brush.

Of dress in general I have little to say, except to urge upon you women, who work among your sisters of the tenement, to teach by example and practice that a short skirt is more convenient than a long one; that a comfortable waist to which the skirts are attached is more hygienic than that little instrument of torture called the corset and half a dozen skirts tied tightly around the waist.

The children of the poor who are not kept clean and not taught cleanly habits at home must be educated to the love of cleanliness in schools, public kindergartens, settlements, etc. Whether you can induce the men not to impoverish the atmosphere of their little homes by the use of tobacco indoors will largely depend upon your tact, as well as upon the individual you have to deal with. Men are sometimes selfish and think that in their own homes they can do as they please, and chew and smoke to their hearts' content, without regard to the health of their wives and children.

In the equipment of the rooms of the tenement dwellers there is, of course, a great diversity. I have seen the most tidy, cleanly and hygienic arrangements in the dwellings of the poor, but on the other hand, misery and indifference have often created conditions in such rooms that made them scarcely resemble habitations of human beings. You have seen them as well as I. One is sometimes amazed at the accumulation of dirt and filth, and is often tempted to call in the Health Department to disinfect and fumigate at once. The first thing these people must be taught is love of fresh air, and that it is as essential to air the bed clothes as their own persons. If carpets are nailed down on the floor tell them to take them up and clean the floor with a moist rag. Urge them never to use carpets again, but to content themselves with rugs if they wish to have something on the floor. These people must be impressed with the idea that all accumulation of dirt and filth breeds disease.

Before leaving the subject of the interior arrangement of the tenement home, permit me to draw your attention to another feature; namely, the habit of several people sleeping in one bed. I have known of instances where four or five persons have slept in one so-called large bed. Leaving aside all moral considerations, this is unhygienic from every point of view. One should encourage these people to use single beds or cots, and if possible to give every member of the family his own bed.

The question of food is most serious among the tenement dwellers, yet it would be wrong to say that want of money is always the cause of mal-nutrition among this class of people. Permit me to say here what I have said on a previous occasion, that I know there is more waste in the households among some of the poor families than in the well-to-do. This waste is due to the ignorance of the poor woman who does not know how to cook and economize. To make a good, plain, healthy and tasteful meal with relatively little expense is an art which must be taught to the young woman leaving the factory or the position in the store to enter upon the duties of a housewife. Here is a field for noble-minded and experienced women who have made the art of cooking a study. By imparting their experience to their less fortunate sisters they will make a new household lastingly happy. I am convinced that badly cooked food, unappetizingly served, is in many cases an inducement for the laboring man to leave his home and seek compensation in drink. If, instead of a plate of good, warm soup, well-steamed vegetables, and appetizingly prepared meat, some cold product from the delicatessen store is placed before him after a day of hard labor, it is natural that he should feel the need of stimulation, which he seeks in the saloon.

The subject of alcoholism is most important. Fanatical reform movements will never be able to combat this evil. Education and example will certainly accomplish more. From early childhood the dangers of intemperance and its fearful consequences should be taught. In schools and at home the drunkard should be pictured as the most unhappy of mortals. While the very moderate use of feeble alcoholic drinks, such as light beers, may be considered as harmless to adults when taken with their meals, alcohol should never be given to children, even in the smallest quantities.

In families in which there is a fear of hereditary transmission of the desire for strong drink, even the mildest alcoholic drinks should be avoided. It would also be best if all people so predisposed, or who may have acquired only the occasional desire for

drink, would never smoke, for experience has taught that attacks of dipsomania (periodical sprees) are often caused by an excessive use of tobacco. The young man starting out in life should take with him the moral training which will enable him to be a gentleman, and be considered a polite gentleman, though he absolutely refuse to ever enter a liquor saloon in order to treat or be treated to drink. It is this treating habit, alas! so prevalent in our American society, which has ruined many a young man and made him a moral and physical wreck. The creation of tea and coffee houses, where warm, non-alcoholic drinks, including bouillon, are sold in winter, and cool ones in summer, is to be encouraged. It would be of additional advantage if some of these houses would also offer healthful amusements for young and old. Temperance societies, which, through intelligent propaganda, help to combat the fearful evil of alcoholism, should receive encouragement from everybody. Do what you can, ladies, in working against this curse of our country, in this and similar ways.

Alcoholism leads us to tuberculosis, for I do not believe that there is a more potent factor in the production of consumption than alcoholism. The children of alcoholics are very often doomed to tuberculosis, and if they have inherited in addition the love for strong liquor their lives are doomed. In one of the French sanatoria for tuberculous and scrofulous children, where it was my privilege to work for some time as assistant physician, the statistics showed that of the little inmates about 25 per cent. had alcoholic parents. Other recently published French statistics show that where the annual consumpti n of alcohol per head is six pints, only 30 to 40 in 10,000 inhabitants die from tuberculosis, but in localities where the people consume 25 pints per head per year, more than 90 out of every 10.000 inhabitants die from this disease. The excessive use of alcohol undermines the constitution and thus prepares the field for the invasion of the tubercle bacilli. The drunkard, when married, will spend more money for liquor than he will give to his family for food. Thus wife and children will be underfed and become subject to that disease which singles out the weaklings, the debilitated, and the badly nourished.

Consumption is a communicable, preventable, and curable affliction. There has been of late much discussion because of the declaration of the Treasury Department that tuberculosis is a “dangerous, contagious" disease. As a consequence of this decision all visitors and immigrants, rich and poor, afflicted with tuberculosis, must be excluded from this country. Prominent physicians, such