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Title: Euthenics, the science of controllable environment - a plea for better living conditions as a first step toward - higher human efficiency
Author: Richards, Ellen H.
Language: English
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                               EUTHENICS

                      THE SCIENCE OF CONTROLLABLE
                              ENVIRONMENT

                           A PLEA FOR BETTER
                   LIVING CONDITIONS AS A FIRST STEP
                          TOWARD HIGHER HUMAN
                              EFFICIENCY

          The national annual unnecessary loss of capitalized
                 net earnings is about $1,000,000,000.

                     _Report on National Vitality_


                        _By_ ELLEN H. RICHARDS
      Author of Cost of Living Series, Art of Right Living, etc.


                            SECOND EDITION


                          WHITCOMB & BARROWS
                             BOSTON, 1912


                            COPYRIGHT 1910
                         BY ELLEN H. RICHARDS

                       THOMAS TODD CO., PRINTERS
                         14 BEACON ST., BOSTON



FOREWORD

     Never has society been so clear as to its several special
     ends, never has so little effort been due to chance or
     compulsion.

     _Ralph Barton Perry, The Moral Economy._


Not through chance, but through increase of scientific knowledge; not
through compulsion, but through democratic idealism consciously
working through common interests, will be brought about the creation
of right conditions, the control of environment.

The betterment of living conditions, through conscious endeavor, for
the purpose of securing efficient human beings, is what the author
means by EUTHENICS.[1]

    [1] Eutheneo, Εὐθηνέω (_eu_, well; _the_, root of _tithemi_,
    to cause). To be in a flourishing state, to abound in, to
    prosper.--_Demosthenes._ To be strong or
    vigorous.--_Herodotus._ To be vigorous in body.--_Aristotle._

    Euthenia, Εὐθηνία. Good state of the body: prosperity, good
    fortune, abundance.--_Herodotus._

“Human vitality depends upon two primary conditions--heredity and
hygiene--or conditions preceding birth and conditions during life.”[2]

    [2] Report on National Vitality, p. 49.

Eugenics deals with race improvement through heredity.

Euthenics deals with race improvement through environment.

Eugenics is hygiene for the future generations.

Euthenics is hygiene for the present generation.

Eugenics must await careful investigation.

Euthenics has immediate opportunity.

Euthenics precedes eugenics, developing better men now, and thus
inevitably creating a better race of men in the future. Euthenics is
the term proposed for the preliminary science on which Eugenics must
be based.

This new science seeks to emphasize the immediate duty of man to
better his conditions by availing himself of knowledge already at
hand. As far as in him lies he must make application of this knowledge
to secure his greatest efficiency under conditions which he can create
or under such existing conditions as he may not be able wholly to
control, but such as he may modify. The knowledge of the causes of
disease tends only to depress the average citizen rather than to
arouse him to combat it. Hope of success will urge him forward, and it
is the duty of lovers of mankind to show all possible ways of
attaining the goal. The tendency to hopelessness retards reformation
and regeneration, and the lack of belief in success holds back the
wheels of progress.

Euthenics is to be developed:

  1. Through sanitary science.
  2. Through education.
  3. Through relating science and education to life.

Students of sanitary science discover for us the laws which make for
health and the prevention of disease. The laboratory has been studying
conditions and causes, and now can show the way to many remedies.

A knowledge of these laws, of the means of conserving man’s resources
and vitality, which will result in the wealth of human energy, is more
and more brought within the reach of all by various educational
agencies.

The individual must estimate properly the value of this knowledge in
its application to daily life, in order to secure efficiency and the
greatest happiness for himself and for the community.

Right living conditions comprise pure food and a safe water supply, a
clean and disease-free atmosphere in which to live and work, proper
shelter, and the adjustment of work, rest, and amusement. The
attainment of these conditions calls for hearty coöperation between
individual and community--effort on the part of the individual because
the individual makes personality a power; effort on the part of the
community because the strength of combined endeavor is required to
meet all great problems.



EUTHENICS

BETTER ENVIRONMENT FOR THE HUMAN RACE



CONTENTS

                                                                   PAGE

I. The opportunity for betterment is real and practical,
   not merely academic                                               3

II. Individual effort is needed to improve individual
    conditions. Home and habits of living, eating, etc.
    Good habits pay in economy of time and force                    15

III. Community effort is needed to make better conditions
     for all, in streets and public places, for water and
     milk supply, hospitals, markets, housing problems, etc.
     Restraint for sake of neighbors                                39

IV. Interchangeableness of these two forms of progressive
    effort. First one, then the other ahead                         59

V. The child to be “raised” as he should be. Restraint for his
   good. Teaching good habits the chief duty of the family          73

VI. The child to be educated in the light of sanitary science.
    Office of the school. Domestic science for girls. Applied
    science. The duty of the higher education. Research needed      91

VII. Stimulative education for adults. Books, newspapers,
     lectures, working models, museums, exhibits, moving pictures  117

VIII. Both child and adult to be protected from their own
      ignorance. Educative value of law and of fines for
      disobedience. Compulsory sanitation by municipal, state,
      and federal regulations. Instructive inspection              131

IX. There is responsibility as well as opportunity. The
    housewife an important factor and an economic force in
    improving the national health and increasing the national
    wealth                                                         143



CHAPTER I

    _The opportunity for betterment is real and practical, not
    merely academic._


     Men ignore Nature’s laws in their personal lives. They crave
     a larger measure of goodness and happiness, and yet in their
     choice of dwelling places, in their building of houses to
     live in, in their selection of food and drink, in their
     clothing of their bodies, in their choice of occupations and
     amusements, in their methods and habits of work, they
     disregard natural laws and impose upon themselves conditions
     that make their ideals of goodness and happiness impossible
     of attainment.

    _Prof. George E. Dawson, The Control of Life through Environment._


     And is it, I ask, an unworthy ambition for man to set before
     himself to understand those eternal laws upon which his
     happiness, his prosperity, his very life depend? Is he to be
     blamed and anathematized for endeavoring to fulfill the
     divine injunction: “Fear God and keep His commandments, for
     that is the whole duty of man”? Before he can keep them,
     surely he must first ascertain what they are.

     _Adam Sedgwick. Address, Imperial College of Science and Technology,
     December 16, 1909. Nature, December 23, 1909, p. 228._


     In my judgment, the situation is hopeful. To realize that
     our problems are chiefly those of environment which we in
     increasing measure control, to realize that, no matter how
     bad the environment of this generation, the next is not
     injured provided that it be given favorable conditions, is
     surely to have an optimistic view.

     _Carl Kelsey, Influence of Heredity and Environment upon Race
     Improvement. Annals of American Academy of Political and Social
     Science, July, 1909._



CHAPTER I

     It is within the power of every living man to rid himself of
     every parasitic disease. _Pasteur._


Such facts as the following, showing the increase in health, or rather
the decrease in disease, go to prove what may be done.

Since 1882, tuberculosis has decreased forty-nine per cent; typhoid,
thirty-nine per cent. Statistics in regard to heart disease and other
troubles under personal control, however, show increase--kidney
disease, 131 per cent; heart disease, fifty-seven per cent; apoplexy,
eighty-four per cent. This means that infectious and contagious
diseases, of which the State has taken cognizance and to the
suppression of which it has applied known laws of science, have been
brought under control, and their existence today is due only to the
carelessness or the ignorance of individuals.

On the other hand, such results of improper personal living as do not
come under legal control--diseases of the heart, kidneys, and general
degeneration, matters of personal hygiene--have so enormously
increased as in themselves to show the attitude of mind of the great
mass of the people, “Let us eat and drink and be merry, what if we do
die tomorrow!”

Probably not more than twenty-five per cent in any community are doing
a full day’s work such as they would be capable of doing if they were
in perfect health. This adds to the length of the school course, to
the cost of production in all directions, to increased taxation, and
decreases interest in daily life.

The trouble is that the public does not _believe_ in this waste which
comes from being “just poorly” or “just so as to be about.” It has no
conception of the difference between working with a clear brain and a
steady hand, and working with a dull and nerveless tool. It must be
convinced of this in some way. General warnings have been ineffective,
and now the appeal is being made to the American people on the basis
of money loss. Thus it has been carefully estimated that the average
economic value of an inhabitant of the United States is $2,900. The
vital statistics of the United States for population give 85,500,000.
Eighty-five million five hundred thousand multiplied by $2,900 equals
$250,000,000,000 (minimum estimate), and this exceeds the value of
_all other wealth_. The actual economic saving possible annually in
this country by preventing needless deaths, needless illness, and
needless fatigue is certainly far greater than $1,500,000,000, and may
be three or four times as great.

Dr. George M. Gould estimated that sickness and death in the United
States cost $3,000,000,000 annually, of which at least one-third is
regarded as preventable.

From all sides comes testimony to the decrease in personal efficiency
of workers of all degrees. Medical science has prolonged life,
hospitals and visiting nurses have made sickness less distressful, but
have also in many cases prolonged the time and increased the cost.
Sanitary science aims to prevent the beginnings of sickness, and so to
eliminate much of the expense.

The discovery that the mosquito is the carrying agent for the yellow
fever germ has saved more lives annually than were lost in the Cuban
War. In the yellow fever epidemic of 1872, the loss to the country was
not less than $100,000,000 in gold.

“With our present population there are always about 3,000,000 persons
in the United States on the sick list.... By means of Farr’s table, we
may calculate that very close to a third, or 1,000,000 persons, are in
the working period of life. Assuming that average earnings in the
working period are $700, and that only three-fourths of the 1,000,000
potential workers would be occupied, we find over $500,000,000 as the
minimum loss of earnings.

“The cost of medical attendance, medicine and nursing, etc., is
conjectured by Dr. Biggs in New York to be from $1.50 each per day for
the consumptive poor to a greater amount for other diseases and
classes. Applying this to the 3,000,000 years of illness annually
experienced, we have $1,500,000,000 as the minimum annual cost of this
kind.

“The statistics of the Commissioner of Labor show that the expenditure
for illness and death amounts to twenty-seven dollars per family per
annum. This is for workingmen’s families only. But even this figure,
if applied to the 17,000,000 families of the United States, would make
the total bill caring for illness and death $460,000,000. The true
cost may well be more than twice this sum. Certainly the estimate is
more than safe, and is only one-third of the sum obtained by using Dr.
Biggs’s estimate. The sum of the costs of illness, including loss of
wages and cost of care, is thus $460,000,000 plus $500,000,000 equals
$960,000,000.... At least three-quarters of the costs are
preventable.”[3]

    [3] Report on National Vitality, p. 119.

The cost of certain preventable diseases a year is estimated by
various authorities as:

  Tuberculosis          $1,000,000,000
  Typhoid                  250,000,000
  Malaria                  100,000,000
  Other insect diseases    100,000,000

A hopeful sign of awakening is the endeavor by life insurance
companies to bring home to the people the possibilities of race
betterment. One company sends out among its policy holders trained
nurses, who give plain talks on health subjects and offer practical
suggestions as to hygienic living. This, to be sure, is on the
economic basis of money saving, but if that is the only thing that
will appeal to the people is it not wise to seize upon it as a lever
to lift the standard of well-being?

The possibility of saving the enormous sums that are lost by reason of
premature deaths was an alluring subject to the insurance men. It gave
to the world what, up to that time, it had lacked--a body of powerful
men who recognized that they had a financial interest in preventing
the needless death of men and women.

A table has been prepared showing that if insurance companies were to
expend $200,000 a year for the purely commercial object of reducing
their death losses, and should thereby decrease them only twelve
one-hundredths of one per cent, they would save enough to cover the
expense.

“If such a plan as this were placed on a purely scientific basis and
carried out by good business methods, and all the companies pulled
together for the common good, I should expect a decrease in death
claims of more than one per cent; and a decrease in the death claims
of one per cent would mean that the companies would save more than
eight times as much as they expended, or would make a net saving of
more than seven times the expense, which would be about a million and
a half dollars a year.”[4]

    [4] Hiram J. Messenger, Travelers Insurance Co., Hartford, Conn.

“While it would be impossible to state in general terms how rich a
return lies ready for public or private investments in good health,
these examples (life insurance) show that the rate of this return is
quite beyond the dreams of avarice. Were it possible for the public to
realize this fact, motives both of economy and of humanity would
dictate immediate and generous expenditure of public moneys for
improving the air we breathe, the water we drink, the food we eat, as
well as for eliminating the dangers of life and limb which now
surround us.”[5]

    [5] Report on National Vitality, p. 123.

Undoubtedly a moral force is to be strengthened by spreading the
biological lesson that man cannot live to himself alone, but that his
acts or failure to act affect a large number of his fellowmen. Also, a
stimulus to personal ambition is to be supplied in the suggestion of
better health and consequently more money to spend as a result.

Civic pride and private gain will be brought into the endeavor to show
man that to understand himself, to exercise the same control over his
activities that he uses over his machines, is to double his capacity,
not only for work, but for pleasure. This control is now possible
through the application of recently confirmed scientific knowledge as
to man’s environment.

It is the aim of this book to arouse the thinking portion of the
community to the opportunity of the present moment for inculcating
such standards of living as shall tend to the increase of health and
happiness.

To the women of America has come an opportunity to put their
education, their power of detailed work, and any initiative they may
possess at the service of the State.

Faith, Hope, and Courage may be taken as the three potent watchwords
of the New Crusade. There is a real contagion of ideas as well as of
disease germs.



CHAPTER II

    _Individual effort is needed to improve individual
    conditions. Home and habits of living. Good habits pay in
    economy of time and force._


     The hope is springing up in some minds that the entire
     problem of human regeneration will be much simplified when
     men shall have learned more fully the nature of their own
     lives, the nature of the physical world that environs them,
     and the interaction between this physical world and the
     spirit of man which is set to subdue it.

    _Prof. George E. Dawson, The Control of Life through Environment._


     We create the evil as well as the good. Nature is
     impersonal. To an increasing degree _man_ determines.

     _Carl Kelsey._


     The only certain remedy for any disease is man’s own vital
     power.

     Today only an exceptional man, almost a genius, learns to
     modify his habits and his life to his environment and to
     triumph over his surroundings, his appetites, and the absurd
     dictates of fashion.

     _Richard Cole Newton, M.D., How Shall the Destructive Tendencies
     of Modern Life Be Met and Overcome?_


     We have certain inherent capacities as to bodily strength,
     length of life, etc., but it lies largely with ourselves to
     adopt a mode of life which may make an actual difference in
     height, weight, and physical strength and intellectual
     capacity.

     _E. H. Richards, Sanitation in Daily Life._


     There are two recognized ways of improving the quality of
     human beings: one by giving them a better heredity--starting
     them in life with a stronger heart, better digestion,
     steadier nerves; the other by so combining the factors of
     daily life that even a weak heart may grow strong, a poor
     digestion may become good, and frayed nerves gain
     steadiness.

     _E. H. Richards, The Art of Right Living._



CHAPTER II

FAITH


The relation of environment to man’s efficiency is a vital
consideration: how far it is responsible for his character, his views,
and his health; what special elements in the environment are most
potent and what are the most readily controlled, provided sufficient
knowledge can be gained of the forces and conditions to be used.

To this end home life--in its relations to the child, the adult, and
the community--is considered in connection with the effect on the home
of the influences outside it, and the reaction of each on the other.
These relations and influences are partly physical and material,
partly ethical and psychical.

The right of the child is protection, and it is the responsibility of
the adult--parent, teacher, or state officer--to secure this
protection.

The knowledge that investigators are gaining in the laboratory and are
trying to give to the community must be accepted and applied by the
individual. How is the individual, discouraged by sickness and
hardship, to know that things are awry or that they can be set more
nearly straight? How can he know that he is responsible for his
limitations? Why should he suppose that he need not be eternally a
slave to environment? How can he realize that “health promotes
efficiency by producing more energy and leaving it all free for useful
purposes?” A few enlightened souls recognize the tendency of
environment to kick the man that is down; to be subservient to the man
of bodily and mental vigor, of keen understanding and human insight,
but the majority must be led to believe these scientific principles.

Again and again scientists and humanitarians must return to the
attack, for individual carelessness becomes community menace, and
“line upon line and precept upon precept” they must present their
knowledge in language that shall attract and hold the attention and
fancy. So the work and discoveries of Metchnikoff have gained
credence because the disciple who described them had the ability to
impress on his audience in a convincing fashion the one fact that made
a strong appeal--the possibility of long life. If those who are
zealous for any movement would study the psychology of advertising and
speak as forcefully as the legitimate advertiser, they would be more
persuasive and successful.

When an idea has won in a certain circle, it quickly spreads to the
other members, thence to active communities. So the universal law of
imitation may be the greatest help in the spread of ideas. The
individual eats a certain food because his neighbor does. Boston
determines to make an effort for a better city because Chicago has
felt the stirrings of civic pride.

A gifted individual with a deep sense of the need of his community
sees an ideal condition, which by his thought becomes a possibility.
These beliefs he shares with a few choice spirits till the circle has
widened. The new ideas come to the notice of the city or the town
officials, new means are adopted of educating the whole community,
and, if necessary, legal measures are passed. But the new means to
betterment must be applied by the individual. Beginning with the
exceptional individual and ending with the average individual, the
perfect circle is rounded out.

The leaders must show convincingly that the laws which they have
discovered may be applied to daily life, but the _individual himself_
must adopt them. When he has been saturated with knowledge, his
inertia will break down, his hopelessness give way to its very
antithesis, a strong hope for a better future. Every known method must
be used by the laboratory to develop this hope into a belief wide
enough to reach all members of every section of the community and deep
enough to become a vital working principle. Only through a belief
strong enough to ride over unbelief and inertia, a belief in the value
of science for personal life strong enough to make a wise choice
possible, can the will to obtain a better environment be developed.
The belief in better things must be thoroughly impressed on the
individual mind. Each individual must understand that it does affect
_him_, that it is _his_ concern, that _he_ must give heed to his
environment. Then he may have the will and make the effort to combat
dangers to body and mind.

Today, belief is much more difficult than ever before because the
dangers are unseen and insidious, and our enemies do not generally
make an appeal through the senses of sight and hearing. But the
dangers to modern life are no less than in the days of the pioneers,
when a stockade was built as a defense from the Indians. We have no
standards for safety. Our enemies are no longer Indians and wild
animals. Those were the days of big things. Today is the day of the
infinitely little. To see our cruelest enemies, we must use the
microscope. Of all our dangers, that of uncleanness leads--uncleanness
of food and water and air--uncleanness due to unsanitary production
and storage, to exposure to street dust, or to cooking and serving of
food in unclean vessels. Such conditions result not only in actual
disease, but in lowered vitality and lessened work power.

Lack of knowledge on the part of some, heedlessness on the part of
others who should be intelligent enough to interpret such conditions,
are responsible for their continuance. A few timely suggestions will
accomplish more in remedying many evils than any amount of attempted
legal enforcement. The very fact of a law makes many persons defy it.
They feel justified in showing their wit by outwitting the law’s
representatives. Many of our newer citizens have come to us from the
protection (?) of a personal authority that they can see and feel. In
this country of ours, we have taken away that binding regard for
authority, and we must as far as possible lead rather than compel.

It is, after all, what a man determines for himself and for his family
that affects both his views of life and his wish to secure for himself
and for them that which he believes to be best. It is not what some
other man believes for him that affects his life.

Evolution from within, not a dragging from outside, even if it is in
the right direction, is the method of human development.
Nevertheless, if the bale of hay is skillfully hung in front of the
donkey’s nose it will often serve to start the wheels on an easy road.

Evidence of the value of concerted effort by individuals and of the
power of suggestion was given by a woman’s club in a small town. The
members became aware of the dangers in exposed food, and on
investigation found their own market to be very low in standards of
cleanness. At a certain meeting they agreed to ask the proprietor why
he did not protect this and cover that article. Certain members were
told off for the duty and the days agreed upon. Mrs. A., making her
usual purchases, casually asked why such an article was not covered.
“I never thought about it,” was the answer. Mrs. B., the next day,
asked why such an article was left out for the flies. “I never thought
about the flies.” Mrs. C. asked the same question on the third day.
The proprietor said: “You’re the third woman who has asked me that. No
one ever suggested it before, but it would be a good idea.” Before the
end of two weeks the provisions and groceries were covered. The end
had been gained without resort to coercion.

We know that our capacity for mental and bodily work depends on our
supply of food. Proper food is necessary as a source of power for the
work of the body as well as to furnish material for growth and repair
of the losses of the body. Taking food is the most interesting of the
vital processes. It appeals to all the senses (except hearing).

Professor Dawson calls attention to the fact that the richest food
areas in the world have provided the most powerful stocks of men of
which we have any record, and it has been pointed out by many that
improper food is closely connected with mental and moral defects.
Strong men and women are not the product of improper food. Dr. Stanley
Hall says: “The necessity of judicious, wholesome food is
paramount.... You can educate a long time by externals and not
accomplish as much as good feeding will accomplish by itself. Children
must be supplied with plenty of nutritious food if they are to develop
healthily either in mind or body.”

Mr. Robert Hunter says: “All that we are, either as individuals or as
a complexly constituted society of men, is made possible by the food
supply.... Perhaps more than any other condition of life it lies at
the door of most of the social and mental inequalities among men.”

In these days of irresponsibility there is probably more harm done to
the health by ignoring physical law in the matter of eating than in
any other one thing.

It is in the study of food substances and their possibilities in
relation to better sanitary conditions that the widest field is open
to housekeepers, and the subject should be especially fascinating to
women of education and ability. All the skill and knowledge of the
best educated women should be enlisted in the cause of better food for
the people. Certainly no subject, except that of pure air, can have a
closer bearing on the health than right diet. Much sound teaching will
be needed before bad habits of eating and drinking will be conquered.

A strong, well man whose work is muscular and carried on in the open
air, as is that of the farmer and of the fisherman, will have the
power to assimilate almost anything, and can maintain abundant health
on the coarsest food poorly prepared, provided, only, that it is
abundant and composed of the chemical constituents that the body
requires.

Only a small proportion of our people, however, engage in work of this
sort. The majority are compelled by occupation, age, or health to
remain indoors. For them nutritious, readily digested food is a
requisite. The farmer or the fisherman can digest, even thrive upon,
food which would be deadly for a woman working in a factory.

In the fourth report of the Massachusetts State Board of Health
(1873), Dr. Derby, the secretary, holds that “we have good reason to
believe that the many forms of dyspepsia which are so commonly met
with among all classes in Massachusetts, in country quite as much as
in town, are but too often the danger signal that Nature gives us to
show that the food, either in its quality, or its preparation, or its
variety, is unsuited to maintain the vital processes. If this warning
is rejected, the result of malnutrition is frequently chronic disease
of the so-called major class.”

Sanitation in relation to food deals first with wholesome and clean
materials--meat from animals free from disease; fruit and vegetables
free from decay; milk, butter, etc., free from harmful bacteria. The
dangers are the transference to the human body of encysted organisms
like trichina; of the absorption of poisonous substances as toxins or
ptomaines; of the lodgment of germs of disease along with dust on
berries, rough peach skins, crushed-open fruits; of dirt clinging to
lettuce, celery, and such vegetables as are eaten raw.

For the next class of dangers we turn to the handling of foods with
unclean hands.

In countless ways disease is spread mysteriously, all due to unclean
habits. It is a safe precaution to patronize only those restaurants in
which the waiters are evidently trained to handle the food and vessels
with care. It will pay well to take care of one’s hands and learn
sanitary habits when one is young; then one will do right without
effort. Whatever change of ideas may come with increase of knowledge,
these habits will not need to be unlearned. Without knowing the
reasons for them, they have been proclaimed in civilized lands.

It should be the part of the physicians to take pains to advise, for
most of our people are accessible to ideas; yet from these can come no
improvement until the people are convinced that it is needed. Just as
soon as the individual fully realizes that he himself is to blame for
his suffering or his poverty in human energy, he will apply his
intelligence to the bettering of his condition. If he can, in a short
time, make as good a showing as public effort has made in the case of
water supplies, he will accomplish much for the race.

Of equal importance to food, in the proper care of the human machine,
comes the air we breathe.

Many of man’s present physical troubles are due to the roof over his
head confining the warmed, used-up air, which would escape freely if
there were an opening provided. The first law of sanitation requires
the quick removal of all wastes. Once-breathed air is as much a waste
as once-used water, and should be allowed to escape. Sewers are built
for draining away used water. Flues are just as important to serve as
sewers for used air. Air is lighter than water, and out-breathed air
being warmed is lighter than that at room temperature. It rises to the
ceiling, where it will escape if it is allowed to do so before it
cools sufficiently to fall.

The roof also keeps out sunlight, and some late investigations
indicate that glass cuts off some of the most vitally important light
rays. The “glame” of the Ralstonites--“air in motion with the sunlight
on it”--may have a scientific basis.

It will at once be retorted, “But we cannot heat all out-of-doors.”

A partial reply is: Do not try to make your house a tropical jungle.
Travelers assure us that such an atmosphere is not conducive to work
or to health.

All great nations have lived in a temperate climate, where physical
and mental activity was possible for many hours a day. Science is
more and more clearly giving reasons for the cooler temperature in
certain physiological laws. The habits of life in regard to air and
food are largely under individual, or at least under family control,
and should be studied as personal hygiene.

The lessons being so clearly taught in the treatment of tuberculosis
should be heeded in forming the general living habits of the people.

If loss of life can be lessened and working power increased by man’s
effort, why does he not make the effort? Why are men and women so
apathetic over the prevalence of disease? Why do they not devote their
energies to stamping it out? For no other reason than their disbelief
in the teachings of science, coupled with a lingering superstition
that, after all, it is fate, not will power, which rules the destinies
of mankind.

Perhaps it is too much to expect that a sturdy plant of belief should
have grown since the days of Edwin Chadwick and Benjamin Ward
Richardson (1830-50), less than a century ago, when there were
perhaps not a dozen men and women who believed that man had any
appreciable control over his own health.

This early school of sanitarians endeavored to “get behind fate, to
the causes of sickness.” The modern socionomist is, by a study of the
mental conditions of communities, endeavoring to get behind the causes
of poverty and consequent suffering to the reasons for _fatal
indifference to dirt_.

It is well recognized that in severe sicknesses of many kinds the will
to get well is more powerful than drugs, that something which we call
nerve force acting upon the physical machine sends a vital current
through the arteries, coerces the heart to renewed pumping action, and
life comes again to the blanched cheek and glazing eye. This more
often happens by a mental stimulus than by any medicine. In like
manner the improvement of the body’s shell, the home, like that of the
soul’s shell, the body, comes more often from an inward impulse than
from outward coercion.

Appeal to the loving but listless parent will reach the heart quickest
through love for the child. Therefore stress should be laid on the
child, its habits, its surroundings, its ideals. By ideals is meant
the very real stimulus to action coming from within. Action must come
through the material things which ideals control and through which
they express themselves.

Certain notions which have crept into popular currency need to be
corrected before the individual can free himself from bondage
sufficiently to attempt constructive advance and improvement.

Only a small percentage of adults obtain the full efficiency from the
human machine--the only means they have of living, working, enjoying.
They permit themselves to stand and walk badly, they breathe with only
a portion of their lungs, and so fail to furnish the blood stream with
oxygen. They dress unhygienically. They eat wrongly. They exercise
little. In short, they subject their bodies to abusive treatment which
would ruin any machine. Because retribution does not instantly follow
infraction of Nature’s laws, they become callous and unbelieving.
Economy and efficiency in human time and strength is one of the
lessons to be taught the young people, so that they may not waste
their patrimony.

The youth feels as rich in his fifty years to come as he does with a
legacy of $50,000 in the bank. The years, however, can yield only
small variations from the established rate of interest. The human
machine can manufacture only a limited amount of energy. It remains to
utilize that quantity to the best advantage. This can be done only by
having a purpose in life strong enough to resist alluring temptations
to fritter away both time and strength.

One of the world’s busy workers found that the distractions of urban
life were breaking in upon his working time and making inroads upon
his physical vitality. He recognized that work for the body and work
for the mind must be balanced, and he evolved an acrostic to be
followed as a rule of life, the fulfillment of which has meant
prolonged years of efficient work and has kept the freshness of middle
life with the advancing years. Taking the six days of the week as a
unit, the acrostic is as follows:

    _The Feast of Life_

  F   Food           One-tenth the time
  E   Exercise       One-tenth the time
  A   Amusement      One-tenth the time
  S   Sleep          Three-tenths the time
  T   Task           Four-tenths the time

The first and last are nearly fixed quantities, the other three may
vary within certain limits as to amount of time given and intensity of
effort. Amusement and exercise may be taken together; exercise and
sleep may be somewhat interchangeable.

The task, or daily work, is a necessity for mental and physical
health. It should be accepted as a part of human life and the will and
energy should be directed to doing it well. It may be a pure delight,
the most entertaining thing that happens; _it should be interesting_.
It is astonishing how interesting a dull piece of work may become if
one sets one’s self to doing it well. That which one subconsciously
knows one is doing badly is drudgery. The real pleasure in life comes
not from so-called amusements--things  done by other people to make
one laugh; to “take one’s mind off”--but from seeing the work of one’s
own hand and brain prosper. The work of creation, of transformation to
desirable result, is the purest joy the human mind can experience.
Fourteen hours a day is not too much for this kind of task. The
difficulty is to gain skill of hand and eye, or training of mind, to
this end. A fallacy, a canker at the heart of our social fabric today,
is that the daily task is something to be rid of.

The psychology of doing is clearly illustrated in the character of
Fool Billy, as drawn by the author of “Priscilla of the Good Intent.”

“Is there nought ye like better than idleness?” asked the blacksmith.
“Think now, Billy--just ponder over it.”

“Well, now,” answered the other, after a silence, “there’s
playing--what ye might call playing at a right good game. Could ye
think of some likely pastime, David?”

“Ay, could I; blowing bellows is the grandest frolic ever I came
across.” ...

“I doubt ’tis work, David.... I shouldn’t like to be trapped into
work. ’Twould scare me when I woke o’ nights and thought of it.”

“See ye then, Billy”--blowing the bellows gently--“is it work to make
yon sparks go, blue and green and red, as fast as ever ye like to
drive ’em?”

“Te-he, ’tis just a bit o’ sport--I hadn’t thought of it in that
light.” And soon he was blowing steadily.

Later, when David the smith was going to America and wished to leave
his forge with the half-witted Billy, he proposed the smith’s work as
play.

“Te-he,” laughed Billy, “am I to play wi’ all your fine tools, David?”

“Ay, just that. I’ve taught ye the way o’ them and Dan Foster’s lad
from Brow Farm shall come and blow the bellows for you.”

“Will that be work for Dan Foster’s lad, or play?”

“Hard work, Billy--grievous hard work, while you are just playing at
making horseshoes, fence railings, and what not.”

“And I’m to play at making horseshoes,” went on Fool Billy, “while Dan
Foster’s lad’s sweating hard at bellows-blowing.”



CHAPTER III

    _Community effort is needed to make better conditions for
    all, in streets and public places, for water and milk supply,
    hospitals, markets, housing problems, etc. Restraint for sake
    of neighbors._


     Quite slowly but surely, the idea is dawning on the social
     horizon that the persistence of conditions prejudicial to
     human prosperity is discreditable to a civilized community,
     and that economics if not ethics calls for their control.

     _Alice Ravenhill._


     It is the new view that disease must be understood and
     overcome; that hospitals, dispensaries, surgical and medical
     treatment, nursing and preventive measures must be developed
     and dovetailed into a general social scheme for the
     elimination of preventable diseases and a very substantial
     reduction in the prevalence of such diseases as cannot as
     yet be classed as preventable.

     _Edward Devine, Social Forces._


     Nature endows the vast majority of mankind with a birthright
     of normal physical efficiency. It is the duty of those who
     aspire to be known as social workers each to do his share in
     confirming his fellow beings in this possession.

     _Dr. H. M. Eichholz, Inspector of Schools. Paper before Conference
     of Women Workers, London, 1904._


     We know now that if we do the things we ought to do, we can
     prevent sickness. We have reached a point where it is
     recognized that it is the duty of the community or state to
     effectually protect itself against the ignorant, the
     selfish, the filthy, and the diseased. We believe now that
     we must have proper sewage disposal, pure water, decent
     tenements, clean streets, good-sized playgrounds,
     supervision of factories, protection of child labor, and
     pure food.

     _Eugene H. Porter, Report, 1909, New York State Department
     of Health._


     Next after himself, man owes it to his neighbor to be well,
     and to avoid disease in order that he may impose no burden
     upon that neighbor.

     _Dr. William T. Sedgwick, The Call to Public Health._



CHAPTER III

HOPE


The real significance of biological evolution has not been grasped by
the people in general. It is that man is a part of organic nature,
subject to laws of development and growth, laws which he cannot break
with impunity. It is his business to study the forces of Nature and to
conquer his environment by submitting to the inevitable. Only then
will man gain control of the conditions which affect his own
well-being.

Sickness, we know, is the result of breaking some law of universal
nature. What that law may be, investigators in scores of laboratories
are endeavoring to determine. In most diseases they have been
successful. Those remaining are being attacked on all sides, and it
may be confidently predicted that a few years will see success
assured.

Why, then, does sickness continue to be the greatest drain upon
individual and national resources? Because man, through ignorance or
unbelief, will not avail himself of this knowledge, or is behind the
times in his method. Where wisdom means effort and discomfort, many
feel it folly to be wise.

The individual may be wise as to his own needs, but powerless by
himself to secure the satisfaction of them. Certain concessions to
others’ needs are always made in family life. The community is only a
larger family group, and social consciousness must in time take into
account social welfare. Moreover, a neighbor may pollute the water
supply, foul the air, and adulterate the food. This is the penalty
paid for living in groups. Men band together, therefore, to protect a
common water supply, to suppress smoke, dust, and foul gases which
render the common air unfit to breathe. The State helps the group to
protect itself from bad food as it does from destruction of property.

The development of fire protection is a good example of community
effort. The isolated farmhouse may have buckets of water and blankets
in an accessible place with which to put out an incipient fire. Then
eight or ten families build close together. The danger of one becomes
the danger of all, and a fire brigade is organized that may protect
all. When hundreds of families crowd together in a small space the
danger becomes so much the greater that a paid department with
efficient apparatus is necessary. No one complains of the infraction
of individual rights. Each one is glad to pay his share of the
expense.

In securing protection from other dangers, the individual and the
family unit are fast relying on community regulations. In fact, in
many ways the individual, when he becomes one of a crowd, must go
whither the crowd goes and at the same rate of progress.

Failure to recognize that by coming into the community he has
forfeited his right to unrestrained individuality causes an irritation
as unreasonable as harmful.

A certain control of sanitary conditions must be delegated to the
community and its rules cheerfully followed. The legal aspects of
these rules will be considered in a later chapter. Here is to be
considered only the _mental attitude_ with which the members of the
community should come together to agree upon a common defense against
disease and dirt. The spirit of coöperation must prevail over a
tendency to antagonism when certain individual rights seem to be
involved.

Numbers of families living close together are served by the same
grocer or market man. These families may agree upon their requirements
as to quality and cleanliness and publish their rules. If they do not
take interest enough to protect themselves, the community must make
rules for them. If the local officials are not vigilant enough, the
State may step in and compel the observance of sanitary regulations.

The average citizen learns of the existence of a health regulation
when he is warned that he has broken it, or perhaps is fined. His
first attitude is rebellion at the invasion of his personal liberty.
The housewife usually takes the ground that the rule is absurd or
unnecessary.

When, in the interest of the community, any law is to be enforced, how
are the people to be led from this rebellious state of mind? Perhaps
first through authority. In America we have learned to use the phrase,
“Big Stick.” Authority is exactly that; it is coercion from without.
It has partial result in good; the law may be fulfilled because the
individual knows he must obey when within the jurisdiction of that
law; but if the result is simply obedience to authority and not to the
underlying principle, it will not be a force in his life or be
continued if by chance he can escape it. He will be a “tramp” in his
methods of obedience. This method can never be constructive; its value
lies in the possibility that by continuous usage or repetition the
procedure may become a habit, and from habit will come reason and
intelligence.

But the more direct and efficient way to help the individual to
realize his relation to communal right living is through education.
The former method--blind obedience--will foster the spirit of
antagonism and call the State’s protection “interference,” thus
weakening the efficiency of the State and of the individual, for the
State is the multiplication of its citizens; but through the latter
method the individual will carry out the law with intelligence and
interest. This will be constructive and it will be permanent, for
again, if the State is the sum of its citizens, the efficiency of the
State is the sum of the efficiency of the citizens.

Their interests are now identical, the man has become equal master
with the State; they are co-partners. His motive for right living is
greater than the letter of the law, for he is the living law, the
protest against wrong and the fulfillment of the right.

       *       *       *       *       *

The next generation must be born with healthy bodies, must be nurtured
in healthy physical and moral environments, and must be filled with
ambition to give birth to a still healthier, still nobler generation.
But, as has been said, “whatever improvements may sometime be
achieved, the benefits of their influence can be enjoyed only by
future, perhaps distantly future generations. We of the present have
to take our heredity as we find it. We cannot follow the advice of a
humorous philosopher to begin life by selecting our grandparents; but
through hygiene (sanitary science) we can make the most of our
endowment.”[6]

    [6] Report on National Vitality, p. 55.

There is a force in the development of public opinion somewhere
between individual action and national compulsion which may be termed
“semi-public” action. It is in a measure the same sort of influence
that in a later chapter is termed “stimulative education.” For
instance, a hospital for the treatment of some special ailment is
needed. Private enterprise furnishes the capital, proves the success
of the treatment, and then the community comes forward and supports
the institution. Such helps are accepted freely and are not considered
undemocratic.

The less spectacular but more effective office of prevention of the
need for charity, in the maintenance of cleanness in the markets,
streets, and shops, yes, even in the homes of the people, has been
neglected. Through lack of belief, and especially through inattention
to causes so common as to escape notice, many details of great
hygienic importance have been overlooked.

Some daring ones in commercial ventures are showing the possibilities
of a standard in cleanness, and model establishments, dairies,
bakeries, and restaurants should receive the hearty support of a
community. If they do not receive this support, it is more than
discouraging to the promoters, for _it costs to be clean_, a lesson
the community must learn. The saving of money and the consequent loss
of life through disease, or the spending of money and the saving of
life through prevention, are the alternatives.

Undoubtedly the old view of charity as tenderly caring for the
sick--because there must always be a certain amount of sickness in the
world--has held men back from attempting to make a world without
sickness. The charity worker of the past had no hope of really making
things better permanently.

The new view, based upon scientific investigation, is that it is not
charity that is needed to support invalids who once stricken must
fade away, but preventive action to give the patient hope and fresh
air. Most important of all, the experience already gained shows how
far from the truth was the old fatalistic notion of the necessary
continuance of disease.

While the support of many agencies--dispensaries, clinics, hospitals,
sanatoria, etc.--must for a time depend upon private philanthropy, the
expense is in the nature of an investment to bring in a high rate of
interest in the future welfare of the race. As soon as the belief in
the efficiency of these agents reaches the taxpayer he will willingly
furnish the funds for public agencies.

Today the child in the school is examined; then, if need be, is given
special consideration at the dispensary, then sent to school, where,
with fresh air, pure food, and hygienic surroundings, he will so
strengthen himself as to combat the ravages of disease.

The Association for the Improvement of the Condition of the Poor, New
York City, not only sends bread to fill the hungry stomach, but now
sends a wise and sympathetic worker to help women to understand food
and money values, which means a permanent help. And it no longer
simply says to the tired, worried woman who has had no education-stimulus
along the line of cleanness, “Be clean,” but sends in women to make
the house an example, an exhibit of clean conditions, if you will.
Example is stronger than precept.

In the rapid growth of cities, so often beyond anticipation,
preparation for development or plans for extension have seldom been
laid. Much suffering has been wrought to the families of men in our
crowded cities, for there is no greater evil than the congestion of
streets and buildings.

Many students of social conditions of today believe that the most
serious menace is the situation best described as housing--the site,
the crowding, the bad building, poor water supply and drainage, lack
of light and air and cleanliness. All believe that it is economically
a loss to the city in general, however profitable to a very few. To
rent such buildings is a far greater crime than cruelty to animals or
even the beating of women and children.

But groups of people the wide world over are keenly awake to this
state of affairs, and though the problem is tremendous they are trying
in numerous ways to solve it.

In some cities there are at present organizations urging “city
planning,” while in several foreign cities the municipality has
already made regulations. In some cities there are municipal model
tenements, but this is still a project of too small proportions to
affect the community.

Perhaps no modern movement that comprehends both the city planning and
the housing of the working people is more ideal than the “Garden
Cities” movement in England and the other countries following it.

If there is any spot on which the hand of the law should be laid, it
is the congested districts in cities and mill villages. The evil has
grown to such magnitude that the first steps will mean some drastic
measures.

The author has elsewhere called it the _Capitalists’ Opportunity_.
Instead of investing in an uncertain gold mine in some distant land,
let the millions, for no less sum will suffice, be invested in a plot
of land, whether an open field or a slum district depends on local
conditions, and thereon cause to be erected habitations decently
comfortable, wholly sanitary, and place over each group an inspector
as both agent and teacher who shall be a friend to the tenants, and to
whose office they may come freely with their needs. This plan has been
in part carried out in the Model Tenements in New York, but variations
and improvements are needed. There should be more light and air, more
grass and trees, even if the buildings are fifteen-story towers.

The old story has been so often reiterated, “But the tenants will not
use the devices,” that the capitalist has become callous to this
appeal. The missing link in the chain has been the instruction to go
with the construction.

All department stores, all venders of new mechanical appliances, have
come to recognize the value of demonstration, or instruction, in the
use of articles as an aid to purchase. The advocate of better
dwellings must take a leaf from the commercial book and _show how_. It
is in this that philanthropy has been weak in the past. It has assumed
a power to see, where there was only a fear of handling the strange
objects.

There is a virgin field for the capitalist who wishes to use some
millions for the prosperity of the country to build a short trolley
line to a district of sanitary houses with gardens, playgrounds,
entertainment halls, etc.; such a village to contain, not long blocks,
but both separate houses and tenements from two rooms up, possibly
several stories high, where the elders may have light and air without
the confusion of the street. Dust and noise will be eliminated. There
should be a central bakery and laundry, and, most important of all, an
office where both men and women skilled in sanitary and economic
practical affairs may be found ready to go to any home and advise on
any subject. There has never yet been such an enterprise with all the
elements worked out. Several, however, have shown the way, the Morris
houses in Brooklyn, for example.

It is easier to take a city block and construct fireproof, high
buildings than to solve transportation problems. We are losing our
fear of the high buildings as we see the great value of light and air.
There is chance for work in this direction, for in spite of rapid
transit some must live in the center of things.

Let a philanthropist or two, instead of building hospitals, set some
bright young architects and sanitarians to devising such suitable
housing conditions for city and suburbs as will obviate the necessity
for hospitals. Any lover of his kind, any one who longs for fame,
could find both it and the blessing of the homeless by this means, and
in the end get a fair return for his investment.

The Federal Department of Labor[7] has studied workingmen’s houses,
but _living in the house_ has not been worked up. The housewife has no
station to which she may carry her trials, like the experiment
stations which have been provided for the farmer. Here is another
opportunity for the capitalist to hasten the time when the State will
supply these. The way will very soon be laid out and the first steps
taken.

    [7] Bulletin No. 54.

For the immediate present some standard of healthful housing is
needed, and now that a similar type of house and of apartment house is
being built in all cities and towns from one ocean to the other, and
from Texas to Maine, such a standard is compatible with conditions.

A score card for houses to rent would save much wrangling. The agent
shows the card with this house’s rating, and the tenant learns that
some of his wishes are incompatible with the standard, and some would
mean a much higher rent than he is willing to pay. Professor J. R.
Commons, Department of Economics, University of Wisconsin, has devised
a score card to serve the house hunter and householder as a standard
of comparison. This should serve the house builder as well, indicating
what the demand will be forty or fifty years hence.

At present the rating stands somewhat as follows:

    Dwelling, 100 points

  Location, 18 points out of 100
  Congestion of buildings, 26 points
    Common entrance for two or more, discredit 2 points
    Basement, discredit 5 points
    Sunlight, credit 16 points of the 26
  Window openings, 11 points
  Air and ventilation, 13 points
  Structural condition, 6 points
  House appurtenances, 26 points
    Well outside, discredit 3 points

The final score card may vary somewhat.

For rent collectors there is also a score card.

    Occupants, 100 points

  Congestion of occupancy, 61 points cubic air space
  1,000 cu. ft. per person, no discredit
    600 cu. ft. per person discredits 20 points
  Condition of air and ventilation, 18 points
  Cleanliness, 21 points

A score card movement might be started as a hobby, and in the end lead
public opinion to judicial choice and action. No such movement,
however, is possible without leaders, and leaders of the right type.

The lesson for the community to be drawn from a study of crowd
psychology is that of leadership and loyal coöperation. The common man
is likely to be possessed of one idea at a time. If such an one
becomes a leader, there is danger that equally vital factors will be
overlooked. Safety is found in a combination of leaders to make an
all-round improvement.

Each individual is too busy in his own affairs to look after his own,
much less his neighbor’s, health and comfort, hence community life,
with its advantages, brings its own dangers. Children in school in
contact with other children; crowds in trains, in elevators, stores,
in lecture halls, contract habits as well as diseases. The need for
large quantities of supplies at one point brings long-distance
transportation and cold storage difficulties. The man who caters to
public need does not look far ahead to consequences, and if
unrestrained may prove more of a menace than a convenience.

The safe and reasonable way is to delegate to certain persons the
making and enforcement of regulations corresponding to the needs of
the times, and then to obey them, even at some personal inconvenience.

Each community should put into the hands of its health officers the
carrying out of the rules it has agreed to as an _insurance_ against
outbreaks of disease. Does a man let his fire insurance policy lapse
because the year has passed without a fire? Even if the regulation
seems superfluous to the particular individual or family, let it be
remembered that there are inflammable spots in every community.
Eternal vigilance is the price of safety in sanitary as well as in
military affairs. As in the army, the community must delegate scout
duty to certain chosen individuals and rely on their report for
safety.



CHAPTER IV

    _Interchangeableness of these two forms of progressive
    effort. First one, then the other ahead._


     Preventive medicine is the watchword of the hour, and
     enlistment in the cause can come only through education....

     He who understands the dangers is thrice armed, and is
     trained and entitled to enlist in the home guard to protect
     the health of his household and neighbors.

     _Dr. M. H. Rosenau, Harvard Medical School._


     The next generation of parents is being made strong or weak
     in home and school today by an environment furnished by
     parents and teachers. These latter cannot be too well
     instructed in physiology, hygiene, and biology.

     _Prof. John Tyler, The Responsibility of the Medical Profession
     for Public Education in Hygiene._


     The new view is a social view, which seeks in all movements,
     whether of research or of remedial action, for the common
     welfare.

     _Edward Devine, Social Forces._


     Democracy means that the best of all life is for all, and
     that if there are many incapable of entering into it, then
     they must be helped to become capable.

     _Ralph Barton Perry, The Moral Economy._


     If the child is not only in theory but in practice
     recognized as the main interest in society, the family and
     society will more and more assist the mother in his nurture.

     _W. I. Thomas, Women and Their Occupations._


     Health administration cannot rise far above the hygienic
     standards of those who provide the means for administering
     sanitary law. The tax-paying public must believe in the
     economy, utility, and necessity of efficient health
     administration.

     _Wm. H. Allen, Civics and Health._


     The connection between poverty and ill health is so direct,
     so immediate, and so important that the moment any
     individual or society turns its attention to the causes of
     poverty, that moment it finds itself in the thick of the
     public health movement.

     _Homer Folks, Journal Public Hygiene, November, 1909._



CHAPTER IV

FAITH AND HOPE


Progress is a series of zigzags: now the individual goes ahead of the
community; now the community outstrips the individual.

The community cannot rise much above the level of the individual home,
and the home rises only by the pull of the community regulations, or
by the initiative of a few especially farsighted individuals.

The steps need to be carefully measured, for if the family begins to
rely on the State for the backbone it should have, it will not stay
up, and its fall will be lower than the stage it rose from. “When man
reverts, he goes not to Nature, but to death.”

The example set by the city in maintaining clean streets and well-kept
parks reacts upon the home yards. The insistence by the police on city
regulations as to alleys and garbage educates the family as to the
general attention to be paid to such things.

The city authorities, on the other hand, are prodded to their work by
well-informed individuals who see the great gain to the community from
certain measures.

The centers of movement, civic and quasi-religious or philanthropic,
are usually the outgrowth of individual effort. The great movements
for betterment--water supply, street cleaning, tenement laws,
etc.--are carried out by community agreement with a common tax outlay.

The clean city means streets of clean houses. The clean house in the
midst of a dirty city may be the match to start a fire of cleansing.

Probably medical inspection in the public school is as good an example
as may be given of helpfulness to the community. No quicker means of
influencing both home and community life may be found, for in five
years it might revolutionize the whole.

School buildings should be so constructed and so managed that they
cannot themselves either produce or aggravate physical defects.
Departments of school hygiene should be organized, not only in every
city, but for every rural school under county and state
superintendents of instruction. The general question of physical
welfare of children involves too many considerations to be
satisfactorily treated by school physician and school nurse alone, or
by busy teachers and principals.

“New York City will spend in 1910 $6,500 for making over twenty rooms
in regular buildings, a first step in an entirely new plan of
ventilation, which will eventually give outdoor air to all children,
sick or well.”[8]

    [8] Bureau of Municipal Research.

Speaking generally, America is one of the last of the civilized
nations to deal with the subject of the medical inspection of school
children upon a comprehensive and national scheme. But once aroused to
the needs, it is safe to say that the nation will speedily educate
parents to correct such home conditions as reduce the child’s ability
to profit from schooling, and to persuade governments to see that safe
homes are provided. It will be easy to convince the taxpayer that it
is cheaper to provide such care than to neglect the future parent and
citizen, for it is easy to prove that medical inspection in our
schools returns large dividends on small investments. Dr. Luther
Gulick says that it seems probable, though only a guess, that the
total annual expenditure for medical inspection of schools in the
United States at the present time is perhaps $500,000. The money saved
by enabling thousands of children to do one year’s work in one year,
instead of in two or three years, would greatly exceed the total
expense of examining all children in all boroughs.[9]

    [9] Quoted in Report on National Vitality, p. 123.

The health of all our school children should be conserved by a system
of competent medical inspection which should secure the correction of
defects of eyes, ears, teeth, as well as defects due to infection or
malnutrition.

The statistics of medical inspection in public schools tell a pitiful
tale wherever it has been tried: thirty or forty per cent of the
children are found with defective or diseased eyes, ten to twenty per
cent with distorted spines, fifteen per cent with throat and nose
troubles, all of which directly affect their intellectual proficiency.

When these deficiencies are discovered and reported to the parents,
such is the apathy of disbelief that seventy-five per cent of the
cases usually go unattended; therefore the school nurse, who follows
the case home and explains the needs and sets forth the penalties, has
become a necessity.

The parent who permits his child to go to school physically unfitted
to profit from school opportunity is not only injuring his own child,
but is injuring his neighbor’s child, and is taxing that neighbor
without the latter’s consent.

It would seem as if such parents had forfeited their right to the sole
care of the children, and that government would be obliged, for its
own protection, to step in and do the work while it is needed. The
author has termed this _temporary paternalism_. The providing of penny
lunches during the morning recess, the service of the school nurse and
the home visitor to teach those parents who are willing to learn all
these schemes for the saving of the child, may be carried out in a
spirit of helpfulness with a support which may be withdrawn when no
longer needed.

Although all America has not become aroused to the undoubted fact of
tendencies toward physical deterioration, it is on the verge of an
awakening. The public school is the natural medium for the spread of
better ideals, and if the teachers of cooking and of hygiene would
coöperate and use all the material which sanitary science is heaping
on the table before them, we should soon see a betterment of the
physical status. Combined with medical inspection and sanitary
construction of schoolhouses, this would raise the general health of
the community thirty or forty per cent in five years and fifty to
seventy per cent in ten years.

There has been in some quarters much objection to public effort
towards remedying evils which would not have existed if each family
had lived up to its duties. The community is a larger family, with
greater resources, and can employ investigators to find the means for
greater security. That individual is very foolish who does not
recognize this interaction between community and individual, and who
objects to taking the benefits of the larger knowledge.

To take one of the latest examples of social problems: In every
thousand children in the public schools of any city, probably of the
town also, there are perhaps fifty who are ill-nourished (not
necessarily underfed), ill-clothed, unwashed, and deprived of good air
for sleeping. What is the duty of the public? This is one of the
burning questions of the moment. Send missionary teachers to the
homes, some say, but that is costly; the selection of the suitable
missionary is difficult, and the result may be slight. Others say,
give one good luncheon at the school, for which the children pay in
part or in whole, and make that an education which, by the aid of the
school nurse, will in time affect a change in habit. In short, the
problem is this: Shall the children suffer in childhood and become a
burden on society in adult years, or shall society protect itself from
future expense by community care now? “Because _finding_ diseases and
defects does not protect children unless discovery is followed by
_treatment_, fifty-eight cities take children to dispensaries or
instruct at schoolhouses; fifty-eight send nurses from house to house
to instruct parents and to persuade them to have their families cared
for; 101 send out cards of instruction to parents either by mail or
the children; while 157 cities have arranged special coöperation with
dispensaries, hospitals, and relief societies for giving the children
the shoes or clothing or medical and dental care which is found
necessary.”[10]

    [10] Bulletin, Bureau of Municipal Research.

Nearly all preventive measures adopted by society and ranked as
paternalism by timid philanthropists are or may be educative and
temporary at the same time. They may be dropped as soon as the end is
gained. The attention of parents must be called to neglected duties.
Compulsory attention to such duties as affect the wards of society,
the children, may be needed for a time. Just as the wise father,
taking the child for a walk, allows him to run free as soon as his
strength and courage permit, so the paternalism of society is relaxed
as soon as its _protégées_ show themselves both able and willing to
do the right thing without its aid or command.

Compulsory school attendance places responsibility for certain care,
vaccination, decent clothing, good food, decent shelter. The thousand
and one ways in which society is now protecting itself are all
educating the newcomers to American ideals. They are all intended to
make efficient, self-sustaining citizens who do not feel the pull of
the law or the bond of outside care. It is the last conflict between
the ideals of individualism and those of the community need,
subordinating the individual preference. Much wisdom and forbearance
will be needed to secure this community ideal, but in that way
evidently lies progress. It behooves the leaders of social effort to
make all their work educational, and thus remove the necessity for a
repetition in the future.

Just as the parent in the home establishes habits while the child’s
mind is plastic, so the community stands _in loco parentis_ to the
future citizen, and surrounds him with safeguards while needed.
Knowledge is needed, scientific investigation is fundamental, expert
wisdom is indispensable, costly though it is, being the product of
long research and rare brain power. This is at the service of the
nation for the good of all the people, and it is the surer the wider
the range of experience. For this reason chiefly, greater actual
knowledge and more complete harmonizing of conflicting interests is
necessary. Certain sanitary measures are carried out by the Federal
government as an education to communities, just as communities educate
individuals. Federal effort may be unwisely put forth in certain
cases, investigations of little consequence may be undertaken, but on
the whole a democracy must learn to manage its affairs by making
mistakes. The principle should not be discarded as a result of the
first mistake.

The immediate concern of this chapter is with the leaders of community
movements, the educated, sympathetic, farsighted sociologists,
sanitarians, and economists, whose concern is for the advancement of
mankind. These leaders must have courage and belief in the value of
their work, for no half-hearted means will carry the community
forward. Still more, they must have knowledge, a sure ground to stand
upon. To acquire this means both time and opportunity. To go into
betterment work without it is to set back the wheels of progress, not
to advance them.



CHAPTER V

    _The child to be “raised” as he should be. Restraint for his
    good. Teaching good habits the chief duty of the family._


     Our success or failure with the unending stream of babies
     (one every eight seconds) is the measure of our
     civilization: every institution stands or falls by its
     contribution to that result, by the improvement of the
     children born or by the improvement of the quality of births
     attained under its influence.

     _H. G. Wells, Mankind in the Making._


     Children are the most hopeful element of our population, and
     we should concentrate our efforts on them.

     _Dr. W. F. Porter, Harvard Medical School Lectures._


     We want the mothers to be the health officers of the home.

     _Charles W. Hewitt._


     When human beings and families rationally subordinate their
     own interests as perfectly to the welfare of future
     generations as do animals under the control of instinct, the
     world will have a more enduring type of family life than
     exists at present. This can only be accomplished by the
     development of controlling ideals which are supported not
     only by reason and intelligence but by ethical impulse and
     religious motive.

     The home should be considered the place where are to be
     developed and conveyed the precious qualities which are so
     vital to the continuity of the race and the progress of
     human society and civilization.

     Those factors which are of a more material or physical
     nature, such as shelter, food, dress, and personal health,
     are to be estimated in their relation to mind, character,
     and effective conduct.

     In the confusion of relative values human health as one of
     the essential means to many worthy ends is usually
     neglected. Man is the most highly developed of all species
     of animals. He is, to some degree at least, civilized, and
     yet human beings are of all animals the sickliest, and this
     in spite of the fact that human health is more important to
     man and to the world than the health of any other creature.
     And by health I do not mean simply existence, freedom from
     pain, or absence of disease, but rather organic power and
     efficiency, the maximum vital ability possible to the
     individual for the doing of all that seems most worth while
     in life.

     _Dr. Thomas D. Wood, Lake Placid Conference, 1902._



CHAPTER V

RESPONSIBILITY


The ideal of “home” is protection from dangers from _within_--bad
habits, bad food, bad air, dirt and abuse,--shelter, in fact, from all
stunting agencies, just as the gardener protects his tender plants
until they become strong enough to stand by themselves. The child’s
home environment is certainly a potent factor in his future
efficiency.

But more than physical protection is that education in all that goes
to make up profitable living, acquired by following the mother or
nurse in her daily round and in having legitimate questions answered.
Imitation is the first step in good habits, as in learning to walk or
to read. That which is set before the child should be worthy its
imitation, and be of value when fixed as a habit. Habits of health,
correct position, deep breathing, clean ways, distaste for dirt in
one’s person or in one’s vicinity, liking for fresh air, for simple
food, good habits of exercise, of reading, and the thousand and one
trifles that go to make up the efficient worker in adult years, all
belong to the well-ordered home, where, as one author puts it, the
child is the business of the day.

But the State cannot risk its property too far.

When mothers become so careless or ignorant that half their children
fail to reach their first birthday, and of those that live to be three
years old a majority are defrauded of their birthright of health, some
agency must step in.

If the State is to have good citizens it must provide for the teaching
of the essentials to a generation that will become the wiser mothers
and fathers of the next. Therefore, even if we regard this as only a
temporary expedient, we must begin to teach the children in our
schools, and begin at once, that which we see they are no longer
learning in the home. “The achievement at Huddersfield, England, is
especially noteworthy. The average annual number of deaths of infants
for ten years had been 310. By a systematic education of mothers the
number was in 1907 reduced to 212. The cost of saving these
ninety-eight lives was about $2,000.”[11]

    [11] Dr. Charles H. Chapin.

One university has established a course in the care of children, much
to the amusement of the press. The United States Commissioner of
Education has, however, been a responsible mover in the idea.

But real progress by means of family education means the stable family
and the permanent dwelling. Where is the family in the permanent
dwelling today? Among any class, except the agricultural, where is the
stable family?

Since industry has taken woman’s work from her, and she has to follow
it out into the world, the means of education for the child has gone
from the home. Its atmosphere is artificial, if the attempt is made.

To work exclusively on the family, for the sake of the child, is a
very slow process. As in all American life, the quicker method appeals
most strongly. The school is today the quickest means of reaching
both child and home; the present home through the child, and the
future homes through the children when they grow up.

And time presses! A whole generation has been lost because the machine
ran wild without guidance, and all attempt at improvement was met by
futile resistance.

It is very difficult to present the socionomist’s view of the child in
the home so that it may appeal to the two extremes of opinion. There
are those who still apply mediæval rules to twentieth century living;
those who believe, honestly, that the ideal life was found in the days
when the mother was the manufacturer in her own home and the children
were her helpers in all the varied processes. “There was never any
artificial teaching devised so good for children as the daily helping
in the household tasks.” The inference is made that therefore the same
restriction for the mother and the children leads to an ideal life
today. Such persons fail to realize that the twentieth century is
practically a new world. The old rules which related to material
things hardly hold more closely than they would on the planet Mars.
The fundamental moral principles of reverence, obedience, love, and
unselfish sacrifice must be worked in on a new background.

To keep the eighteenth century habit, so carefully taught the girl, of
courtesying as she stepped aside to allow the rider or the ox cart to
pass, in these days of the swift automobile, which would be out of
sight before the knee could bend, is no more ridiculous than to expect
the average young mother to follow the methods of her grandmother. Her
mother’s ways are now pronounced all wrong, not necessarily because
they were wrong then, but because conditions have changed, knowledge
has been gained, and it is clearly a waste of human life, of money, of
physical and mental power for people to be sick and die because the
caretaker does not use the knowledge in circulation.

If the young mother can learn how better to fulfill her duties by
going out of the house to lectures or classes, why not?

Tracts are not always successful as an incentive to conduct. It is
obviously impossible to pass a blue law compelling parents to conform
to--what ideal? The school is fast taking the place of the home, not
because it wishes to do so, but because the home does not fulfill its
function, and so far has not been made to, and the lack must be
supplied. The personal point of view, inculcated now by modern
conditions of strife for money, just as surely as it must have been by
barbarian struggle in pre-civilized days, must be supplanted by the
broad view of majority welfare. The extreme of the personal point of
view, expressed in such phrases as “The world owes me a living;” “My
child is mine to treat as I please;” “It is nobody’s business how I
spend my money;” “I have a right to all the pleasure I can get out of
life,” is well shown in Mr. H. G. Wells’s analogy[12]: “A cat’s
standpoint is probably strictly individualistic. She sees the whole
universe as a scheme of more or less useful, pleasurable, and
interesting things concentrated upon her sensitive and interesting
personality. With a sinuous determination she evades disagreeables
and pursues delights. Life is to her quite clearly and simply a
succession of pleasures, sensations, and interests, among which
interests there happen to be--kittens.”

    [12] Mankind in the Making.

This unsuspicious ignorance of the real nature of life is by no means
confined to animals and savages; it would seem to be the common view
of many young people today. At least they take as little care of the
homes to which they bring children, and they follow the cat’s example
in boxing the children’s ears and turning them out to fend for
themselves.

The last generation seemed to become disciples of Schopenhauer in his
passionate rebellion against the fate that deferred all the pleasure
of the present to the needs of the future generation. Evolution has
revealed the necessity for this subordination of the individual lot to
the destiny of the race, if progress is to be made. The man who
asserts himself as free from race trammels is snuffed out as a
factor--a blighted blossom fallen to earth and trodden under foot. To
the student of biological evolution, the individual is as a mere pin
point on the chart of community advance, for surely society grows
according to evolutionary law. “As certainly as Nature gives the poor
child its chance of a good life, so certainly do the circumstances of
slum environment rob it forthwith of its birthright--it is not
uncommon to find more than half the children of three years of age
hanging on to life with marks of disease and undergrowth firmly
implanted on their tender frames. Yet, practically, none of this is
inherited in the true sense; it is the victory of evil human devices
in their endeavor to cheat Nature of her own. If ever there was a
mission in the world worthy of the most strenuous service, it is to
wrest back this victory, be it out of pity for suffering children or
for the very welfare and existence of the nation.

“The schools have made their beginning; the _homes_ have not yet
started; they wait the impulse from without. It is for voluntary,
intelligent opinion to get to work on the home, and never to relax
until a race of parents has arisen which knows no other duty to the
state than to rear with heart and brain the children which have been
given to them. Then we shall hear no more about physical
degeneracy.”[13]

    [13] Dr. H. M. Eichholz, Inspector of Schools. Paper before
    Conference of Women Workers, London, 1904.

Hope for the future is to be found in the conclusions of the
immigration commission, that in one generation certain marked changes
in stature and in head measurements have taken place in the children
of immigrants of various nationalities, such changes as have hitherto
been considered as the result of centuries. The commissioners credit
the better environment and larger opportunities with these indications
of increasing intellectuality and mental force.

Most human efficiency is the result of habits rather than of innate
ability. These habits of mind, as well as of body, are developed by
the home life at an early age. The home is responsible for the
upbringing of healthy, intelligent children. Here is the place for
fostering the valuable and suppressing the harmful traits. The school
can never take the place of the home in this. With the large classes
of the public schools, the teacher should not be asked to undertake
this individual work. Moreover, correcting a child for personal habits
can hardly be effective before fifty or sixty pairs of critical eyes.

The office of the home must be to teach habits of right living and
daily action, and a joy and pride in life as well as responsibility
for life. It is not fair that the parents should sit back and shift to
the school the whole responsibility for the future citizen.

The little modifications can best be made in the home, permanent
foundations can be laid and braced with habits so good and strong that
nothing can shake them. Most powers are the result of habits. Let the
furrows be plowed deeply enough while the brain cells are plastic,
then human energies will result in efficiency and the line of least
resistance will be the right line. Everything, therefore, which
influences the child must be the best known to science. The houses of
the land must be regulated by the scientific laws of right living. To
the woman, the home worker, we say: “You must have the will power,
for the sake of your child, to bring to his service all that has been
discovered for the promotion of human efficiency, so that he may have
the habit, the _technique_.”

To pay a tax today for the benefit of one’s children is a principle of
insurance, of benefit association. This feeling of obligation means
present sacrifice of ease and inclination, and it has been
increasingly shirked, so that it is not surprising that a tax to
insure one against future loss by disease is an unwelcome proposition.

The whole question of the child in the home is one of ethics, as the
writers on social conditions have been trying to convince the world.
If the swarms of dwellers in the busy hives of industry have no sense
of their humanity, if they do not use the human power of looking
ahead, that power which differentiates man from animals, what better
are they than animals?

No one can be sorry that there are no children in thousands of homes
one knows. It is better that children should not have been born than
to come into an inheritance of suffering and mental and moral
dwarfing. Social uplift will not be possible while parents take the
view of cats, or even of a well-to-do mother who said, “I did not have
my baby to discipline her; I had her to play with.”

No state can thrive while its citizens waste their resources of
health, bodily energy, time, and brain power, any more than a nation
may prosper which wastes its natural resources.

America today is wasting its human possibilities even more prodigally
than its material wealth. The latter deficiency is being brought to a
halt. Shall the human side receive less attention? A sharply divided
line between home and school is no longer clearly drawn. Parents’
associations are being formed and are coöperating with the
school-teacher. To what end? To the better moral and intellectual
atmosphere of the home. Physical education has had its vogue, but too
much as an endeavor apart, not as a necessary element in the whole.

The pedagogical world is now becoming convinced that physical defects
are more often than not the basis of mental incompetence, and this
leads logically to the teaching of the laws of right living in a
practical way, not merely as lessons from books, but as daily
practice. This practice must eventually go into the home, where the
most of the child’s hours are spent. It is as useless to expect good
health from unsanitary houses as good English from two hours’ school
training diluted by twelve hours of slovenly language. Hence the
imperative need of such teaching and example as can be put into
practice; and since immediate house to house renovation and change of
view are impossible, the school must provide for teaching how to live
wisely and sanely, as well as for clear thinking and æsthetic
appreciation. Practical hygiene, food, cleanliness, sanitation, all
must eventually be exemplified by the schoolhouse and taught as a part
of a general education to all pupils, boys and girls.

If this sounds like socialism, let us not be afraid, but educate for
five or ten years all children, so that homes may be better managed,
and then it is to be hoped there will be no need for such school
training. To live economically in the broad sense of wise use of time,
money, and bodily strength is the great need of the twentieth century.
This is practical economics. This is something which cannot today,
except in rare instances, be learned at home, for conditions change so
rapidly that grown people may not keep up with them. Mothers’ ways are
superseded before the children are grown.

The school, if it is maintained as a progressive institution and a
defense against predatory ideas, is the people’s safeguard from being
crushed by the irresistible car of progress. I repeat, standards may
be set by the school which will reach and influence the community in a
few months. Such standards should be a means of safeguarding the
people, and this leads to the most important service which a teacher
of domestic economy can render to the people in giving them a sense of
control over their environment, than which nothing is so conducive to
stability of ideas.

To feel one’s self in command of a situation robs it of its terror. A
great danger in America today is the loss of this feeling of
self-confidence with which the pioneer was abundantly furnished. A
certain helpless dependence is creeping over the land because of the
peculiar development of resources, which must be replaced by a sense
of power over one’s environment.


     _Home Ideals_

     There is no noble life without a noble aim.

     The watchword of the future is the welfare and security of
     the child.

     Love of home and of what the home stands for converts the
     drudgery of daily routine into a high order of social
     service.

     The economy of right uses depends largely upon the
     home-maker, and brings the return in health, happiness, and
     efficiency.[14]

    [14] Motto, Mary Lowell Stone Home Economics Exhibit,
    Jamestown Exposition, 1907.



CHAPTER VI

    _The child to be educated in the light of sanitary science.
    Office of the school. Domestic science for girls. Applied
    science. The duty of the higher education. Research needed._


     No Christian and civilized community can afford to show a
     happy-go-lucky lack of concern for the youth of today; for,
     if so, the community will have to pay a terrible penalty of
     financial burden and social degradation in the tomorrow.

     _President Roosevelt, Message to Congress, December, 1904._


     The loss of faith brings us by a short cut straight to the
     loss of purpose in life--of any purpose, at least, beyond
     purely material ones. To those who need money the duty of
     getting it first and above anything else becomes the gospel
     of life. To those who feel the need of position, whether in
     society, business, or elsewhere, their gospel drives them to
     all means within the law to attain that. To those who have
     both money and position comes the only remaining purpose in
     life--that of using them for an existence of amusement and
     enjoyment. Is it too much to say that never before in our
     history have such aspirations so completely dominated and
     limited such large classes?

     What is the poor American to do in his present fever and
     with his present nerves, but with fivefold greater powers
     placed in his hands and fivefold greater attention and
     capacity demanded for their control? If sixty years ago the
     free forces and rushing advance of the republic urgently
     needed the regulation of a powerful and learned conservative
     body, who can overestimate the necessity for such service
     now?

     When you ask how it is to be rendered, one cannot be
     mistaken in turning first to those priceless qualities in
     any sound national life whose tendency to decay we noted at
     the outset. Give back to us our faith. Give back to us a
     serious and worthy purpose. Restore sane views of life, of
     our own relations to it, and of our relations to those who
     share it with us.

     _Whitelaw Reid, Phi Beta Kappa address, 1903._



CHAPTER VI

THE HOME AND THE SCHOOL


One must not displace the other, for one cannot replace the other, but
rather the home and the school must react on each other. The home is
the place in which to gain the experience, and the school the place in
which to acquire the knowledge that shall illuminate and crystallize
the experience. The child should go out to the school with enthusiasm,
and return to the home filled with a deeper interest and desire to
realize things.

In morals and manners the school can only give tendency or direction
to the child’s life. The school is not the best place to teach ethics.
In the family life the child himself finds his future revealed,
reflected by his relations to other members of the family. The spirit
of coöperation nurtured there will develop in the school through the
more various opportunities of relationship to others.

The earlier conditions cannot be restored, even the home training
cannot be brought back, except on the farm, and there, it is hoped, it
may be revived. The city or suburban children cannot have the
opportunity to pick up chips when too young to bring in wood; cannot
stand by and hold skeins of yarn, or go to the barn and help feed the
calves--all most interesting and provocative of endless questions.
They cannot go into the garden and pick berries or vegetables for
dinner, cannot learn how to avoid breaking the vines, or how to judge
the ripeness of the melons.

All that is probably not feasible for many, because it is not possible
to give children of this age responsibility without oversight, and
today’s elders are loath to give and are often incapable of giving
oversight.

But while these circumstances over which, apparently, we have no
control, preclude much of the valuable outdoor work, food has still to
be prepared, dishes need washing, and clothes must be mended, even if
towels and napkins are no longer hemmed by hand. Rooms are still
swept and dusted, beds are made, and chairs and tables put straight.
Has any better means of giving experience ever been devised than these
small, daily tasks which differentiate men from animals? The care of
the fixed habitation, the foresight needed to prepare the things for
the family life in the weeks and months to come, the coöperation of
all the members of the family toward one common end--all tend toward
high _human ideals_. If the wise mother only realized the value to the
child of helping in such portions as are not too heavy, of being a
part of the life, she would let nothing stand in the way of using this
natural means of development. But with foreign domestics whose idea is
to get the various duties over as soon as possible, and whose gift is
not that of teaching, how is the child to grow into the normal ways of
right daily living, unconsciously and effectively?

If the parents continue to throw all the work of education on the
school, then the school must take the best means of fulfilling the
task.

Not only has the home put the burden of education on the school, but
the school has drawn the child away from the home. The school of today
demands much more from him than the school of the early New England
days. It has taken the time that was formerly given to assisting in
the duties of the household; it has taken from the home the interest
and responsibility that were developed through the coöperation in the
family life. School has taken the place of home in the child’s
thoughts. In the morning the thought is of reaching school in time,
not of the home duties whose performance could lighten many a mother’s
burden.

The school, hurried with a curriculum that is wasteful of time and
energy, lacking correlation in the studies (except in a few schools
that are noted exceptions proving the rule), has little time to relate
its work to the home as the kindergarten does in its morning talk; so
there must come an intermediate step in order that the school may
emphasize the home life and industries, and that a generation may grow
up who shall have a knowledge of the daily needs of life.

The interest awakened in the school will surely react upon the home.
It is like an expedition going out to make discoveries and to bring
back knowledge to its own land. The directive work of the school will
thus become a practical realization in the home. Then the cycle will
be complete, for while the school has separated the child from his
natural environment for many hours and weeks, it is sending him back
better equipped through knowledge and experience to fulfill his place
there.

How shall the ends be gained artificially by devices of the school?
For gained they must be, if civilization is to be maintained.

To quote from Isabel Bevier:

“As the home is so inseparably connected with the house, and our
comfort and efficiency are so greatly influenced by the kind of houses
in which we live, much of interest and importance centers in the study
of the house.”

Moreover, with the house, its evolution, decoration, and care, may be
associated much that is interesting in history, art, and
architecture, as well as much that has a direct bearing on the daily
life of the individual.

The philosophers have struggled for centuries, each contributing
according to his experience and vision to determine what is the
purpose of life. America’s thought could be translated into the word
efficiency. Yes, we might almost say she worships efficiency. If,
then, efficiency is to be the goal, what are the means to develop it?
Efficiency depends chiefly upon good health, and to maintain this we
must first consider in the scheme of education the physical
aids--food, air, water, clothing and shelter, exercise and rest--and
with this goal in view must come also recreation, play or amusement,
and beauty to develop the mental and the spiritual. In relating our
scheme of work to this ideal we will consider first the shelter.

The children of ten or twelve years of age have passed the
“make-believe” stage of play; they want the “real,” but of their own
kind and age. After little children have made and played with toys and
foreshadowed the needs of the actual home, the time has come for the
youth to have his demands, which are not yet the demands of man and
manhood.

At the Tuberculosis Congress, held in Washington in 1908, a sanatorium
in England, which won a prize, presented among many good features a
system of graded work with graded tools, almost childlike implements
for the weak and unskilled, gradually advancing toward the normal as
the strength and health of the man grew. So it should be with the
material we should give to the children.

After the toy age a house about two-thirds the ordinary sized house
may be constructed. A room seven feet square is very livable for a
child. Three rooms is a very good working plant--the kitchen and the
bedroom, the dining and living room combined. Both boys and girls may
coöperate in planning, building, and furnishing this home.

The plan of a modern house may be drawn, basing it on the knowledge of
house architecture through history, of the modification necessary to
site through geography, and the knowledge that science has brought of
drainage, ventilation, and construction. The house could be built by
the manual training class, or if that is not feasible it may be built
by one of the firms making portable houses. At all events, it can be
painted by the children, and this will lead to lessons on color, the
use of paint and its composition.

While the “shelter” is being constructed the child must be considering
at the same time the principles of caring for the home, for this would
naturally influence the thought of furnishing. The simply furnished
home means less physical exertion, but not less beauty. The home
planned and executed on scientific principles of hygiene and
sanitation means a healthful home, a much cleaner home.

The shelter of the individual has been considered; now comes the
immediate protection of the child--its clothing. It would not be quite
practical in this little home to enter into the personal activities of
bathing and dressing. A very large doll, approximating the child, may
be used, one large enough so that it can wear boots, stockings, etc.,
that are usually bought for the real child. Here can be taught also
the lesson in wise spending.

The right care of the body must be included among the necessities of
education. The teaching of the principles of hygiene should be closely
related to the lives of the children. Correct habits, not rules, are
the proper prevention for all sorts of defects. To secure and maintain
a healthy body, habits of cleanliness and enthusiasm for health must
be inculcated. Such habits can be readily impressed on the body while
it is plastic--that is, while it is young; but they are acquired only
with difficulty and by much thought in after years. Hence there is the
greatest economy of time and energy in accustoming young people to
habits of daily living which will give them the best chance in after
life--the chance to be “healthy, happy, efficient human beings.” Most
of the teaching must be by indirect methods--illustrations--and so the
doll may be used again to demonstrate and relate facts about the daily
life.

An old Scotch writer once said, “He that would be good must be happy,
and he that would be happy must be healthy.” As has already been said,
the great increase of disease from causes under individual control,
such as that which is brought on by errors of diet, points to a need
for a more general education in this respect. The food problem is
fundamental to the welfare of the race. Society, to protect itself,
must take cognizance of the questions of food and nutrition. It is
necessary to give the child the right ideas on these subjects, for
only then will there be sufficient effort to get the right kind of
food and to have it clean. Right living goes further and demands the
right manner of serving and eating the food. The home table should be
the school of good manners and of good food habits of which the child
ought not to be deprived.

If all the foregoing principles have been developed, if the child has
been led to see the joy of living through these home activities, he
will consider the home the true shelter, the place where he can have
the happiest play, the easiest rest, where he can study most
earnestly, and express himself most honestly.

And the parents, the fathers and mothers of children of the city? How
far are we helping the city dwellers to take advantage of city life?
The principles back of housekeeping are the same, the end the
same--what are to be the means to stimulate the modern home-maker?
Show the possibilities within reach of them; send the children home
with ideas which the mother must consider.

Education in pursuing the so-called “humanities” has been holding up
to view a hypothetical man in a hypothetical environment.

The pursuit of gold has not been hindered thereby, and has gone on
without the restraints of education because of the complete detachment
of ideals inculcated from the actual daily life where money meant
personal pleasure and comfort for the time being.

The power over things gained by a few students was utilized by money
power to hasten all progress. Speed was the watchword. No one could
stop to see what injury he had caused. “Get there,” really seemed to
be the motto. In this scramble for power the “purpose” for which life
is lived has been lost sight of. No “worthy aim” has been impressed on
the mind of the child.

An awakening has come and the school is the leading factor in the
upward movement. Education is coming to have a new meaning, or better,
perhaps, is going back to the older meaning with new materials. No
knowledge or power the youth may acquire will avail in real struggle
for existence of the race without a definite aim to hold steady the
eye fixed on a certain goal. This is a law of man’s existence.

The change in point of view has been growing like a root underground.
It seems to have suddenly sent up shoots in every direction. In no
line of thought has this change come more generally than in relation
to the things youth should be taught. Himself and his relation to his
environment are now to the front. Instead of extolling man as the lord
of all created things, the youth is made to see that man unaided by
scientific knowledge is at the mercy of Nature’s forces; that man in
crowds is sure to succumb unless he makes a strong effort to keep
himself erect.

Hence the boys are given manual training--power over wood and stone,
steam and electricity; and are taught the principles of production of
food and metals. The girls are being taught to distinguish values in
textiles and food stuffs; to manage finances and to keep houses in a
sanitary manner.

It is the business of the higher education at once to apply the
knowledge of preventive measures to its own students and through them
to reach the people, but it has been very slow to take up the cause of
better environment.

In colleges there is still more emphasis laid on external works, such
as water supply, drainage, etc., than on the more intimate hourly
needs of fresh air and clean rooms. The halls, study rooms, and dining
rooms of colleges are notoriously ill ventilated and not over clean.

The senses are blunted at an age when they should be keenly
sensitive. It is only within ten years or so that very many of the
higher schools have made a point of indoor sanitation beyond plumbing
provisions. Outdoor sports have been relied upon to give sufficient
impetus to the health side of education.

A new element has come into the State universities through the Home
Economics courses, which have been steadily growing in favor during
the last two decades. Within that time several buildings have been
erected and equipped to teach the principles of sanitary and economic
living both in institution, school, and family life.

Probably no one movement has been so powerful as this in convincing
educators of the efficiency of trained women as factors in sanitary
progress. In no other direction is the outlook for social service
greater. The woman must, however, be more than a willing worker; she
must be educated in science as a foundation for sanitary work.

Within the next few years the demand for trained women is sure far to
exceed the supply, for the fundamental sciences are not to be acquired
in one or two years.

Young college women are even now realizing their mistake in neglecting
the sciences. They assumed that science was not of practical use. They
assumed that educational curricula were stable and would go on in the
same lines forever.

The high school is now fully awake to these vital factors. Some of the
best buildings in the United States are the high school buildings,
those of the West excelling those of the East. By 1911 nearly every
school will have a course in Sanitary Science. It may be under the
name of Home Economics, or of Camp Cookery, or of House Building, but
the idea of better physical environment has already taken root. In the
extension of school work by the employment of the school visitor to
supplement the work of the teacher in the grade schools, in Parents’
Associations, in Mothers’ Clubs, in social endeavors on every side,
there is coming the study of more special branches of sanitary
science, clean air, clean floors, clean clothes--where once cooking
lessons were the extent to which the workers could lead.

Evolution has at last been accepted as applying to man as well as to
animals. In his inaugural address, November, 1909, President H. J.
Waters, of Kansas Agricultural College, said: “... for every dollar
that goes into the fitting of a show herd of cattle or hogs, or into
experiments in feeding domestic animals, there should be a like sum
available for fundamental research in feeding men for the greatest
efficiency.... We have millions for research in the realm of domestic
animals and nothing for the application of science to the rearing of
children.”

Evidence is not wanting that all this is to be speedily changed. Man
has awakened to the fact that he is “the sickest beast alive” and that
he has himself to blame, and, moreover, that it is within his power to
change his condition and that speedily.

After all, human life and effort are governed largely by the conscious
or unconscious value put upon the varied elements that go to make up
the daily round.

It seems to be a universal law that effort must precede satisfaction,
from the infant feeding to the man building up a successful business.
The satisfaction grows in a measure as the effort was a prolonged or
sustained one.

Well-being is a product of effort and resulting satisfaction. The
child without interest in work or play does not develop; the man with
no stimulus walks through life as in a dream.

The first steps in “civilizing” (?) a nation or tribe are to suggest
_wants_--things to strive for. Struggle, with all its attendant evils,
seems the lever that moves the world. It is therefore in line that
health, and whatever favors it, is to be gained at the expense of
struggle. The one necessary element is that men should value it enough
to struggle for it.

Sanitary science above all others, when applied, benefits the whole
people, raises the level of productive life.

In the rapid development of our civilization, the laboratory, the
shop, the school can be the quickest mediums of suggesting wants.

In an earlier chapter, the indifference to clean conditions, the
ignorance of the means of obtaining pure food and clean air, were
dwelt upon, and still later the need of _will_ to choose the right
thing.

Now we should consider the means of stimulating that choice. So far it
has been chiefly exploitation for the personal gain of the
manufacturer, who has persuaded the people to buy his product
regardless of its economic or hygienic effect. Thrift has been
undermined most subtly.

“That’s the secret of the whole situation we’re talking about; it’s
easier to buy a new shirt than to take care of the one you’ve
got.”[15]

    [15] Meredith Nicholson, Lords of High Decision, p. 133.

All sense of values has been lost, so that with no sound basis choice
is apt to be unwise, unsatisfactory, and is gradually dropped, while
the individual drifts.

No more effective agent for the dissemination of knowledge was ever
devised than the American Public School. If only it would live up to
its opportunities, its teachers could bring to its millions of
receptive minds the best practice in daily living (never mind the
theory for the children), and through the children reach the home,
where the infants may be saved from the risks that the elders have
run.

To be effective, however, school conditions should be satisfactory,
and teachers should be familiar with the best ways of living, or at
least in active sympathy with the medical inspector and the school
nurse.

No more revolting revelations have ever been made than those usually
locked in the hearts of these faithful servants of the people. How
they can have courage to go on in face of parental and community
indifference is a marvel. We shall consider in the next chapter how
the average parent is to be aroused.

But the leaders in educational and scientific thought--what of them?
The school is the pride of the community and measures the progress of
the community toward ideals. Alas, how is pride laid low in most
public school buildings in the inability of most of the teachers to
see the relations between mental stupidity and bad air.

The awakening has begun, however, and thousands of teachers have
responded and are urging authorities to burn more coal, to employ more
help, to keep the house clean, to make it more beautiful, to make the
curriculum more helpful, to make provision for good food to be
purchased, and the hundred ways in which the school may be the most
powerful civilizing factor the nation has. _But civilization must not
spell disease and ruin._

The economic factor must not be lost sight of. To tell the boy and
girl that they are as good as any does not give them the right to the
most expensive food and clothing they see. How shall they choose
wisely in the multitude of new things? They wish the best, naturally,
and all America is honeycombed with the wrong idea that the best costs
the most. An Alaska Indian came into the store in Juneau one day to
buy some canned peas. The storekeeper said, “I am out of the brand you
want.” “No peas?” asked the Indian. “No, only some small cans of
French peas at forty cents a can. You don’t want those.” “Why not? Me
want the best.”

The schools of domestic economy, the classes in all grade schools,
will have to attack and conquer these prejudices as to values, or,
rather, will need to substitute right estimates of value before our
people will choose wisely in distributing their income, for that is
what right living means. The division of the income according to the
necessities of health and efficiency, not according to whim or selfish
desire, is sometimes estimated as

  20 to 25 per cent for rent
  25 to 30 per cent for food
  10 to 15 per cent for clothing

This leaves only forty-five or thirty per cent for other things, and
the pennies must be carefully counted to cover fuel, light,
amusements, education, books, insurance, or investments. Something
that the family would like must be left out--no matter what, providing
only it does not injure their efficiency as wage-earners, as
comfortable human beings.

The sensation of comfort or satisfaction is so completely a psychic
factor that the school training has a great chance to affect after
life. The child can acquire the habit of being more comfortable in
plain, washable, clean clothes, with clean hands, than in dirty,
ragged furbelows. This habit once thoroughly acquired is not likely to
be quickly lost. Provision for clean hands is a necessity in school,
and ways of making a small amount of soap and water serve may also be
taught. All the while, care is to be taken not to introduce
unnecessarily expensive materials or to inculcate over-refined
notions.

Sound instruction as to dangers of transference of saliva, of nose
discharge, etc., can be given without also giving the despair of
impossible achievement.

The teaching in the classes must have this practical bearing on daily
life. It is insisted on here because unclean hands are the chief
source of infectious disease.

Instead of blaming water supplies, dusty streets, or even contagion by
the breath, sanitarians are everywhere putting emphasis upon the
actual contact of moist mucus with milk and other food, in preparation
or in serving. It is not a supercilious notion to examine tumblers
for finger marks, or to object to the habit of wetting the finger with
saliva in turning leaves of books. These little unclean acts are the
unconscious habits that cling to a person in spite of education from
reading. The greatest service to be done today in improving the health
of the community is in the application of the principles which may be
summed up in the phrases--fresh air all the twenty-four hours, clean
hands the livelong day, the free use of the handkerchief to protect
from contamination of mouth and nose.

All these small personal habits should be taught in the earliest
months of life, _i. e._, in the home; but if the child reaches school
untaught, then in defense of the whole community the school must
insist upon teaching them.



CHAPTER VII

     _Stimulative education for adults. Books, newspapers,
     lectures, working models, museums, exhibits, moving
     pictures._


     The efficient sanitarian is not so great when he conquers a
     raging epidemic as when he prevents an epidemic that might
     have raged but for his preventive care, and for this result
     his most continuous and effectual work is to
     educate--educate--educate.

     _Wm. H. Brewer, New Haven Health Association, 1905._


     The essential fact in man’s history to my sense is the slow
     unfolding of a sense of community with his kind, of the
     possibilities of coöperation leading to scarce-dreamt-of
     collective powers, of a synthesis of the species, of the
     development of a common general idea, a common general
     purpose out of a present confusion.

     _H. G. Wells, First and Last Things._


     The great mass of the population is, indeed, at the present
     time like clay which has hitherto been a mere deadening
     influence underneath, but which this educational process,
     like some drying and heating influence upon that clay, is
     rendering resonant.

     _H. G. Wells, New Worlds for Old._



CHAPTER VII

     In a store an advertisement reads: “Any kind of tea you
     prefer; no charge whatever.”

     She: “The women look so tired when they come in, and in ten
     minutes they are so rested and refreshed.”

     He: “Ready to go home?”

     She: “Why, no--ready to do some more shopping.”

     _Spectator, The Outlook, December 18, 1909._


Something in motion and something to eat attract the crowd.

The social worker is just beginning to realize what the manufacturer
and the department storekeeper have long since found out.

Why is it not legitimate to “attract a crowd,” to do them a good
service in showing them how to save money as well as in impelling them
to spend it? It is wiser to _show how_ before explaining why.

The force of example, the power of suggestion, should be used fully
before coercion is applied. Exhibits and models come before law.

The psychology of influence is an interesting study (see
Münsterberg’s article, _McClure’s_, November, 1909). Its principles
have been grasped and used by those who exploit human feelings for
their own gain. The student of social conditions should make a wider
and better use of a real force.

Publicity is perhaps first. Exhibits showing existing conditions often
shock people into attention, for it is inattention more than anything
else that prevent betterment.

It is said that “a knowledge of danger is the surest means of guarding
against it,” but this knowledge must be translated into belief and the
danger be brought home to the individual as a member of the community.

Exhibits may often suggest for existing evils simple remedies never
thought of before. They should never suggest the one idea without the
other. Even though the remedy is not worked out, it should be called
for. America’s inventive power may well be turned on its own social
affairs as well as on adaptation of European machinery.

The man considered in these pages is the man in community environment,
and the discussion is as to what controls this community life. It will
be acknowledged by all thoughtful persons that the prime control lies
in the purpose for which the community exists. If for selfish gain,
then all is sacrificed to that end. Men and women become mere machines
and children are only in the way until they, too, may be put into the
service.

If it exists for mutual help and general advance in civilization, then
the leaders in the community take into account the elements that
contribute to the future as well as those for the immediate present.

In the confusion of ideas resulting from the rapid, almost cancerous
growth of the modern community, made possible by mechanical invention,
the people have lost the power of visualizing their conception of
right and wrong, a power which made the Puritan such a force in early
colonial times. Heaven and hell were very real to him and were
powerful factors in influencing his daily life. The average man today
has no such spur to good behavior. Perhaps the sword of Damocles must
be visualized by such exhibits as the going out of an electric light
every time a man dies, by the ghastly microbe in the moving picture,
by the highly colored print or by a vivid reproduction of crowded
quarters. The social worker has been doubtful of the real value of
such exhibits, but such reminders have their place in a community
accustomed to the advertising of less worthy subjects.

A decided recognition of the value of exhibits is found in the
advertisement of a company: “We design and equip Exhibits on
Tuberculosis, Milk, Civic Betterment, Dental Hygiene, Saner Fourth of
July. Have you our catalogue?” Much of our educational work for the
dissemination of useful knowledge would gain in power and directness
from an adaptation of the methods of the man skilled in promoting
commercial interests. He knows how to apply the right stimulus at the
right time in order to arouse the desired interest.

In many ways the adult is but the child of a larger growth, who needs
something concrete to make him understand. And so have grown up the
great industrial fairs and exhibitions. One comes away from these
wondering that so much, both good and bad, is being prepared for him,
and stimulated, usually, to work out certain suggestions and better
many of the present conditions. Both the manufacturer and the consumer
have been helped.

Wherever it is possible, a working model illustrating the chief
features to be explained should be installed. The expense of this kind
of exhibit has in the past been prohibitive, and moreover the use of
such “claptrap” has been frowned upon; but scientific knowledge is no
longer to be held within the aristocratic circle of the university. It
is to be brought within the reach of the man in the street, and to
make up for the wasted years of seclusion experts now vie with each
other in putting cause and effect not merely into words but into
pictures, and even into motion pictures. The fly as a carrier of
disease is now shown in all its busy and disgusting activity. The
lesson of awakened attention by such means is being learned, and soon
lessons in botany, in gardening, in housewifery, will be given through
the eye, to be the better followed by the hand.

Of all means, that product of man’s ingenuity, the moving picture, is
destined to play the greatest part in quick education. It is the
quintessence of democracy.

The extension movement in education is an evidence of a new social
ideal. It is a true expression of democracy that the university and
school can be utilized by the busy working people. Museums that at one
time were only for the educated who by previous training could
understand them now assume as a privilege the educating of all the
people. Schools of art and science, also, through lectures, bulletins,
guides, and special exhibits, extend a generous welcome to the public.

The citizens ought to be a gladder, sadder people, stirred and
delighted and grateful for much that the city affords; sad and shocked
by some of the forbidding, existing conditions. That is the power of
an exhibit, so to visualize a condition that the mind really
conceives it, never again to recover from the shock, to be unmindful
of such possibilities of degraded existence for human beings.

The influence of these great expositions is of a most subtle kind, not
often to be traced, but there is a noticeable change in the estimation
in which Home Economics is held dating from the time of the Mary
Lowell Stone Home Economics Exhibit held at the Exposition in St.
Louis in 1905. This illustrated the application of modern knowledge to
home life, chiefly in economic and æsthetic lines, all bearing upon
the health and efficiency of the people. The Chicago Exposition in
1893 had its Rumford Kitchen, an exhibit under the auspices of the
State of Massachusetts. This practical illustration of scientific
principles modified the ideas of the world as to the place and
importance of cookery in education. Indeed, there seemed a distinct
danger that other lines would be neglected, so that when the
Exposition at St. Louis was determined upon this legacy of fifteen
years before was drawn upon to show the wide scope of the subject as
it had been developed.

Boards of Health might pave the way for a better understanding of
their rules and regulations if they would have temporary exhibits in
public places of some of the conditions known to them but unsuspected
by the average citizen and taxpayer.

Traveling exhibits may show local and temporary conditions and may
call attention to needs demanding immediate remedy--with the remedy
suggested.

Permanent exhibits in museums should, on the other hand, teach a
deeper lesson. They should always be constructive and should be
replaced when the conditions have changed. The modern idea of a museum
is a series of adjustable exhibits with distinct suggestive purpose.
Such are found in the Town Room, 3 Joy Street, Boston, the Social
Museum, Harvard College, the American Museum of Safety, and the
Sanitary Science Section, American Museum of Natural History, New
York.

The distribution of the printed word has become so universal that it
would seem as if every family might be influenced by it; but the
scientific title, or the size of the book, or the scientific terms
seem forbidding, and so the whole question is thrust aside.

In the past, newspaper science was largely discounted as sensational
and only one-tenth fact. Scientific workers were largely to blame for
this. They could not take the time to explain the meaning of their
work, and the few things they were ready to say were worked over out
of all semblance to truth by the writer who must have a “story” and
who had not the training in “suspension of judgment” which the
scientific investigator knows to be necessary.

There is no concern of human life that cannot be made interesting, and
the magazine writers of today understand that art. Read the newspaper
and the world is yours. It is all things to all men. The popularizing
of knowledge is now proceeding on somewhat better lines.
Intermediaries between the laboratory and the people are springing up
to interpret the one to the other. This work is good or bad according
to the individual writer. Most of it is still too superficial. Here is
one of the most fertile fields for the educated woman, since the
evils of which we complain have to do so intimately with woman’s
province, the home and the school. There is hope that the trained,
scientific woman will take her place as interpreter. Her practical
sense will give her an advantage over the young man who has never
known other home than a boarding house.

But the expert knows that the man of “practical affairs” wants and
needs certain knowledge, and so seeks another way. Our Federal
government, through the departments of Agriculture and Education; the
State Boards of Health; the educational institutions, have with care
and accuracy formulated this knowledge and are sending to the people,
in the form of bulletins meeting their interest and requirements,
knowledge in concise and readable form, and so most valuable. More
than five hundred thousand copies of Miss Maria Parloa’s bulletin on
Preserving have been distributed by the Department of Agriculture.

These efforts by both men and women have meant independent scientific
research, which is often the only available knowledge for the
housekeeper. It is bringing to them in their “business” of life the
same help that the men on the farm and elsewhere are receiving in
theirs.

But the written word, however clearly put, can never reach the
untrained as can the voice and personality of an earnest speaker with
a compelling vitality. Lectures by those who have been engaged in
research themselves, so that they have absorbed the spirit of the
laboratory--not by those who have merely smelled the odors of the
waste jars--are ten times more valuable than even the most
attractively illustrated articles. It is well that the personality of
the human being is an asset, and that there is a stimulus in hearing
and seeing the person who has accomplished things. There is always a
power in the spoken word. The government, with its public lectures,
recognizes this as well as the private organization, and today
ignorance is necessarily due only to indifference.

Illustrated lectures followed by literature are of inestimable value
if rightly and not sensationally given. Even then, the seed must have
time to sprout.

Man has reached his present stage of civilization, however we regard
it, by an incessant warfare against adverse conditions. Enemies, man
and beast, surrounded him; mountains and rivers obstructed his
passage; fire and flood swept away his dwellings; but ever onward the
inward impulse has carried him.

It is interesting to see how the same vocabulary is transferred to the
warfare for social betterment, “campaign,” “warfare,” “battle,”
“fight,” “weapon,” “corps,” “army.” And the fight to be won can only
come through knowledge, its dissemination and then its application.

Publicity today means coöperation and democracy--all to help, all to
be helped.

All the foregoing methods should be used in these campaigns for
health, with the dictum, “Man, know thyself.”



CHAPTER VIII

    _Both child and adult to be protected from their own
    ignorance. Educative value of law and of fines for
    disobedience. Compulsory sanitation by municipal, state, and
    federal regulations. Instructive inspection._


     The strength of the State is the sum of all the effective
     people.

     _Dr. Edward Jarvis, Massachusetts State Board of Health, 1874._


     When the Americans took charge of Bilibid Prison in Manila
     the death rate was 238 per 1,000 per year: by improving
     sanitary conditions, this death rate was reduced to about 75
     per 1,000: here it remained stationary until it was
     discovered that a very high percentage of the prisoners were
     infected with hookworms and other intestinal parasites: then
     a systematic campaign was inaugurated to expel these worms,
     and when this was done the death rate fell to 13.5 per 1,000.

     _C. W. Stiles._


     So the duties and responsibilities of a Health Department
     are not only changed, but they are very greatly increased
     and are constantly increasing. And on broad lines to cause
     the citizen to do the things he can and ought to do, and
     then to do for him the things that he cannot do, but which
     should be done, is the duty of the State, and that, being
     interpreted, means the real prevention of disease.

     _Eugene H. Porter, Report, New York State Department of
     Health, 1909._


     The whole difference of modern scientific research from that
     of the Middle Ages, the secret of its immense successes,
     lies in its collective character, in the fact that every
     fruitful experiment is published, every new discovery of
     relationships explained. In a sense, scientific research is
     a triumph over natural instinct, over that mean instinct
     that makes men secretive.

     _H. G. Wells, New Worlds for Old._


     Public or governmental hygiene has been chiefly concerned
     with pure air and pure food, and with organisms producing
     epidemic diseases. Boards of health are a recent invention,
     and in this country they have as yet been only imperfectly
     developed. They can never become the power they should be
     until, first, public opinion better realizes their
     usefulness and the fact that their cost to the taxpayer is
     saved many times over by the prevention of death and
     disease; second, more and better health legislation is
     enacted--national, state, and municipal; and, third, special
     training is secured for what is really a new profession,
     that of a public health officer.

     _Report on National Vitality._



CHAPTER VIII

LEGISLATIVE COMPULSION


Government is delegated to persons specially set apart for the
oversight of the people’s welfare.

Personal conduct was free from such delegated power in the Anglo-Saxon
thought. The Englishman’s house was his castle inviolate. This was
especially true of the early American settlers. Laws interfering with
personal liberty, a man’s right to drink tea, to punish his own
children, to beat his own wife, to keep his own muck-heap, have been
deeply resented by the American citizen. Each step in the protection
of his neighbor has been taken only by a struggle extending the common
law of nuisance to a variety of conditions.

The protection of the man against himself, and of his wife and child
against his ignorance or greed, is one of the twentieth century tasks
yet hardly begun.

The control of man’s environment for his own good as a function of
government is a comparatively new idea in republican democracy. The
cry of paternalism is quickly raised, on the one hand, of socialism,
on the other. Each gain has been at the cost of a hard-fought battle.
But it is certain that the individual must delegate more or less of
his so-called rights for the sake of the race, and since the only
excuse for the existence of the individual is the race, he must so far
relinquish his authority.

It is a part of the urban trend that the will of the man, of the head
of the family, should be superseded by that of the community, city,
state, nation.

Even though all the agencies for the education of both young people
and adults that have been discussed in the preceding chapters were set
in motion at once, there would still remain many thousands in township
and city untouched by these forces, or so touched as to arouse
rebellion against such novel notions.

Only the child can be educated to acquire habits of right living so
perfectly that the suitable action takes place unconsciously. Twenty
years hence these trained children will be the chief citizens of the
republic, the leaders of public opinion. Today, however, less gentle
means, less gradual processes, must be used in order that these
children may have a chance to grow up.

In the social republic, the child as a future citizen is an asset of
the state, not the property of its parents. Hence its welfare is a
direct concern of the state. Preventive medicine is in this sense
truly State Medicine, and means protection of the people from their
own ignorance.

In the laws made with this end in view lies one of the greatest
educative agencies known. We have referred in the last chapter to the
need of drawing attention to defects and dangers in order that people
may know what the results of their careless ways may be. No surer way
has been found to fix attention than to attempt to enforce a law or
collect a fine for disobedience of it. A marked illustration of this
truth is given in the case of the ordinance against spitting in street
cars. In many cities a notice was posted in each car--usually with
little effect. In some a fine of five dollars was added, with little
more result. Boston was one of the first cities to pass an ordinance,
and it accompanied the law with a fine of one hundred dollars. This
compelled attention--a sum which represented to the workman more than
his yearly savings, more than any single expenditure. To the business
man, even, it was a sum not to be lightly dropped on a filthy car
floor. This mere statement of the value of cleanness made an almost
instantaneous change in the habits of thousands. Within two days the
car floors became practically free without a single fine being
collected within that time, as far as the author is aware.

The law imposing fines for neglect of removal of garbage or of
screening stables must be occasionally enforced in order to express
degree of disapproval. A petty fine is of little use.

Conditions of motion, of rapid intermingling of distant populations--a
thousand miles in a day is now possible--make national control a
necessity. It is proved that quick results may be gained in saving
lives and property by that prompt and thorough action which
well-equipped Federal forces alone possess. The stamping out of yellow
fever in Cuba, the redemption of Panama, the suppression of sporadic
outbreaks at New Orleans, the quick response to a discovery, as in the
cases of pellagra and the hookworm--all these show what a thoroughly
alive government may do.

It is no disgrace to an individual or a city to have the national
laboratory make discoveries, to have the national power put down
epidemics, as it does civil rebellion, for the good of the whole
nation. It is disgraceful, however, for the citizen to remain
indifferent or obstructive, to grumble over the cost. The indifference
of the people themselves is today almost the only stumbling block to
national prosperity.

The time lost to the average worker by inefficient labor is a drain on
the community largely avoidable, and is the cause of that other drain
on the moral as well as physical vitality--charity.

Preventive medicine is a science by itself, a combination of social
and scientific forces guided by research quickly applied, and it must
be accepted and upheld by those whom it benefits, namely, all the
citizens. The nation is in many cases the only power strong enough to
command confidence, and in the combination of government effort an
international science of human welfare is bound to be evolved.

It is a waste of effort for each state to prepare a fly pamphlet. The
correctness of a Government Bulletin would give an added value as well
as the rapidity of circulation. The bulletins of the Agricultural
Department are an example.

The Weather Service, with its quick notifications, shows what a health
service might do. A monthly or weekly _health chart_ would give the
best and worst spots.

Precautions really workable might be furnished the Associated Press.

In short, system and science might be put at the service of the local
health officer, of the traveler, and even of the housewife.

The Library of Congress now furnishes cards in duplicate to a large
number of centers, thus saving time to the investigator and giving
information often not otherwise obtainable.

The Farmers’ Bulletins of the Department of Agriculture are also most
valuable to the people who are in search of help. Such agencies might
be extended without fear of trespass on any existing agencies.

Just as the individual, if he is to do and be his best, accepts his
limitations, obeys Nature’s law, and thrives in body and estate in
consequence, and as the community banding together makes and carries
out with penalties for deviation certain regulations for mutual
benefit, so must the still larger groups--the state and the
nation--use their larger wisdom and wider knowledge for the benefit of
all. The individual should recognize the value to himself of this more
complete investigation, and instead of raising the cry of paternalism
and national interference, should welcome all aids to increased
efficiency.

State hygiene is necessary to supplement municipal hygiene. Often the
rural district has no other hygiene, and the city and the country are
interdependent, the city dependent upon the country for its water,
milk, and other supplies.

Almost all the states are alive to the importance of milk inspection.
As early as 1869 in Massachusetts, Dr. Bowditch called the Board of
Health “The State Medicine,” and quotes from Dr. Farr: “How out of the
_existing_ seed to raise races of men to divine perfection is the
final problem of public medicine.” That is the function of all boards
of health. If factories are incorporated under state laws, they must
also be governed by the state regulations for health.

Here in America we are always locking the stable door after the horse
has been stolen. Not until many “accidents” had occurred in the use of
antitoxins did Congress pass an act (1902) regulating the manufacture
and interstate sale of the viruses, serums, toxins, etc. The
supervision and control were vested in the Secretary of the Treasury
through the Public Health and Marine Hospital Service. Previous to
April 1, 1905, there was no official standard for measuring the
strength of diphtheria antitoxin. Previous to October 25, 1907, there
were as many units or standards for tetanus antitoxin as there were
producers. One was labeled “6,000,000 units per c.c.” and another
“0.75 unit per c.c.,” while, according to official standard, the first
had only 90 and the latter 770.

The point to be made is that however faulty an official or Federal
standard for sanitary devices may be, it is a standard, and so is of
service in protecting the people, especially those away from active
centers of research.



CHAPTER IX

    _There is responsibility as well as opportunity. The
    housewife an important factor and an economic force in
    improving the national health and increasing the national
    wealth._


     It would indeed seem that opposition to woman’s
     participation in the totality of life is a romantic
     subterfuge, resting not so much on belief in the disability
     of woman as on the disposition of man to appropriate
     conspicuous and pleasurable objects for his sole use and
     ornamentation. “A little thing, but all mine own,” was one
     of the remarks of Achilles to Agamemnon in their quarrel
     over the two maidens, and it contains the secret of man’s
     world-old disposition to overlook the _intrinsic_ worth of
     woman.

     _W. I. Thomas, Women and Their Occupations, American Magazine,
     October, 1909._


     The president of the British Medical Association about 1892
     said, “I wish to impress it upon you that the whole future
     progress of sanitary movement rests, for its permanent and
     executive support, upon the women of our land.”

     In a letter to Madame Bodichon, dated April 6, 1868, George
     Eliot writes: “What I should like to be sure of as a result
     of higher education for women--a result that will come to
     pass over my grave--is their recognition of the great amount
     of social _unproductive_ labor which needs to be done by
     women, and which is now either not done at all or done
     wretchedly.”

     _Quoted by Mrs. Nixon in a paper before the Conference of Women
     Workers in England, 1904._



CHAPTER IX

WOMAN’S RESPONSIBILITY


There are about 40,000,000 women and girls in the United States. About
14,000,000 live in the country and have a direct and compelling power
over the life of the community.

In rural agricultural districts the home-keeper is the provider. She
practically requisitions from farm and garden what she deems necessary
for the family table. To an extent she makes the clothing and sews the
house linen. She also exchanges her perquisites, egg money, perhaps,
for furniture and ornaments. The itinerant peddler brings the world’s
wares to her door; the mail-order houses do the rest.

“The ideal home is a social and coöperative society in which all of
its members unite their efforts for the common good. This ideal is
realized most nearly in the country home, where even the smallest
child has opportunity to be and generally is a contributor to the
family support. It has come to be a recognized fact that boys and
girls, healthy, industrious, frugal, capable, intelligent,
self-supporting, cheerful, and patriotic, abound in country homes, and
that the prevalence there of these high qualities is largely due to
the family life, which requires each individual from his earliest
years to bear his proportionate share in providing for the maintenance
of the home. By bringing within the reach of the country people
educational advantages suited to their needs, rural life becomes more
attractive, country homes are multiplied, and the valuable qualities
which these homes develop become the possession of a correspondingly
larger number of the citizenship of the state.”[16]

    [16] I. H. Hamilton, U. S. Dept. of Agriculture, Circular 85.

The government has recognized the need and the possibilities of
meeting it in the recognition it has given to Farmers’ Institutes for
women, in which, by lectures, demonstration, and short winter courses
at the colleges, the interest of the woman in her occupation is
aroused. She is not only given help in details of her daily work, but
she is shown how much the efficiency of the farm life depends upon her
capability and intelligence. She is encouraged in the using of all
mechanical and scientific appliances, is introduced to the means of
mental growth; but, best of all, she is given the stimulus of social
recognition. In the year 1908 there were held 832 such meetings in the
several states. In the year 1910 the number will be nearly or quite
doubled.

In no other form of society is the power of the woman for good or ill
so paramount as in rural life, in no other mode of living is the
family so much at her mercy.

In suburban and city life the family can in a measure escape from
insufficient care and uncomfortable conditions. That they do so
escape, any student of social tendencies will testify. The great
increase of restaurants, of clubs and hotels of all grades, shows one
phase of the unattractiveness of home life. The city woman is only
half a housekeeper; she has only one-eighth of a house as compared
with her rural sister. Her control is therefore curtailed until she
feels her helplessness in the hands of her landlord. She sighs and
turns to other interests. To her must be brought the knowledge of her
power as a social factor if she will but use the knowledge she can
easily gain.

The city woman has amused herself because she has seen nothing better
to do with her time. The utilization of her ability is all that is
needed to regenerate city life. Without it all efforts will prove
fruitless. Education of all women in the principles of sanitary
science is the key to race progress in the twentieth century.

As an economic factor, the influence of the housewife is of the
greatest moment. Production on the farm is only one phase. The city
and suburban dweller is a buyer, not a producer. In suburban and city
life the housekeeper has more temptations to buy needless articles,
food out of season, to go often to the shops, especially on bargain
days. She thinks her taste is educated, when it is only aroused to
notice what others like. She is led to strive after effects without
knowing how to attain them. It has been estimated by advertising
experts that ninety per cent of the purchases of the community are
determined by women, not always according to their judgment, but by a
suppression of it. Woman is made to think that she must buy certain
lines of goods. The power of suggestion has been referred to in a
preceding chapter.

When civilization, as it is called, persuaded woman to give up
manufacture and to become a buyer, the first step in the
disintegration of the home as a center of information, as well as of
industry, was taken. The housewife and mother were made to look to the
dealer, and thus to feel their helplessness. This sense of ignorance,
this subconscious loss of power over things, only increased the effect
of that fatalism which the control of machinery was leading man out
from under.

It is barely fifty years since woman began to ask questions and insist
upon knowing, to claim freedom of movement, a chance to breathe. The
time between has been a time of plowed fields, often muddy, usually
stony, but the furrows are turning green and the harvest will prove
the wisdom of the plowing.

Woman had to struggle for right to private judgment and public action.
Some pioneers had to enter the field of research, of investigation, in
order that they might call to those below that the way was open. This
vast company, which has been nearly untouched by the scientific
spirit, was warned off the field of investigation, and society is
paying the penalty of its own blindness.

In the very field where applied science can most serve human welfare,
scarecrows have been set up most prominently. Not until society avails
itself of those qualities of mind sorely needed in the field of
sanitary science, patient attention to detail, strong, practical sense
directed by a profound interest in the subject, will it begin to show
what height it is capable of scaling.

The intrusting of so many great fortunes to women shows an increasing
confidence in their judgment of social needs. It shows that woman’s
education has passed the selfish stage, that it has given a wider
vision of the whole horizon.

It may be said without fear of contradiction that the future
well-being of society is largely in the hands of woman. What will she
do with it? Responsibility is always sobering.

Let her once realize her position and woman will rise to the task.
Instances are not wanting of groups attacking scientific and
administrative problems in the true spirit, without sentimental
charity, to which in the past women have been prone.

If civic authorities felt that women’s leagues were informed bodies of
women whose suggestions they would make no error in adopting, more
legislation could be effected. Too often city councils are approached
by those who favor some whim or fad, and so ALL women’s demands are
classed together. Much harm has been done to the cause by indiscreet,
pushing women with only a glimmer of knowledge. The question is not
WOMAN, but ability and women. It is better, as a rule, to work out
ideas through existing organizations.

All the problems of environment which we have been considering would
be solved in half the time, yes, in one-quarter, if all housewives
would combine in carrying out the knowledge which some of them have
and which all may have.

Infant mortality is controllable through the training of the mother
and nurse. Unsanitary houses are the results of careless housekeeping,
usually a product of apathetic fatalism. Landlords assume that the
woman will submit. When she has a woman sanitary inspector to appeal
to, matters will take on a different aspect.

Unsanitary alleys exist because the abutters do not complain loudly
enough to the right authorities. Dirty markets have been so long
tolerated because women buyers carried the same fatalism to the
stalls--“what is, has to be.”

Society is only just beginning to realize that it has at its command
today for its own regeneration a great unused force in its army of
housewives, teachers, mothers, conscious of power but uncertain how to
use it. Perhaps the most progressive movement of the times is one led
by women who see clearly that cleanness is above charity, that moral
support must be given to those who know but do not dare to do right,
and that knowledge must be brought to the ignorant. Nothing can stop
this most notable progress but a relapse into apathy and fatalism of
the vast army of women now being enlisted to fight disease.

The opportunity has come, the responsibility is woman’s hereafter. No
one can take it from her; she has knowledge. The door has opened, she
has taken the weapons in hand, is learning to use them. Will she
falter on the eve of victory simply because it involves some sacrifice
of prejudice or tradition? Must she not boldly accept the twentieth
century challenge and fight her way to victory, even at some æsthetic
sacrifice? In another hundred years, then, Euthenics may give place to
Eugenics, and the better race of men become an actuality.

The keeping of the house, the laundry work, the cleaning, the cooking,
the daily oversight, must have for its conscious end the welfare of
the family. It cannot be done without labor, but the labor in this as
in any process may be lightened by thought and by machinery.

Knowledge of labor-saving appliances is today everywhere demanded of
the successful establishment EXCEPT of the family home. Is it not time
that it came in for its share? If the housewife would use wisely the
information at her hand today, it is safe to say that in six cases out
of ten she could cut in half the housekeeping budget and double the
comfort of living.

As conditions are, the twentieth century sees a strange
phenomenon--the most vital of all processes, the raising of children,
carried on under adverse conditions; human labor and life being held
of as little account as in the days of building the pyramids.

Women may be trained to become the economic leaders in the body
politic. It is doubtful if life will be anything but wasteful until
they are trained to realize their responsibility.

The housewife was told that she must stay at home and do her work.
This was preached _at_ her, written _at_ her, but no one of them all,
save, perhaps, the Englishmen Lecky and H. G. Wells, saw the problem
in its social significance, saw that the work of home-making in this
engineering age must be worked out on engineering principles, and with
the coöperation of both trained men and trained women. The mechanical
setting of life is become an important factor, and this new impulse
which is showing itself so clearly today for the modified construction
and operation of the family home is the final crown or seal of the
conquest of the last stronghold of conservatism, the home-keeper.

Tomorrow, if not today, the woman who is to be really mistress of her
house must be an engineer, so far as to be able to understand the use
of machines and to believe what she is told. Your ham-and-eggs woman
was of the old type, now gone by in the fight for the right to think.

The emergence from the primitive condition was slow because the few of
us who did show our heads were beaten down and told we did not know.
It has required many college women (from some 50,000 college women
graduates) to build and run houses and families successfully, here one
and there another, until the barrel of flour has been leavened.
Society _is_ being reorganized, not in sudden, explosive ways, but
underneath all the froth and foam the yeast has been working. The
world is going to the bad only if one believes that material progress
is bad. If we can see the new heaven and the new earth in it, then we
may have faith in the future.

The human elements of love and sacrifice, of foresight and of faith,
are going to persist, and any apparent upheaval is only because of
settling down into a more solid condition, a readjustment to
circumstances. As Caroline Hunt has said[17]: “We may disregard the
popular fear that the home will finally take upon itself the
characteristics of a public institution.... Human intelligence, which
suits means to ends, and which is ever coming to the aid of human
affection, will prevent that. So long as affection lasts it will seek
satisfactory expression in home life, and so long as intelligence
endures it will stand in the way of the extension of the borders of
the home beyond the possibilities of the mutual helpfulness to its
members.”

    [17] Home Problems from a New Standpoint, p. 140.

The persistent efforts of the farsighted to secure a place in
education for the subjects fundamental to the modern home are now
respectfully listened to.

It is, perhaps, not strange that the first successes in modern
housekeeping were gained in public institutions, for there accounts
were kept and saving told. When one hospital saved $12,000 in one year
by an expenditure of $2,000 for a trained woman, trustees began to
take notice. When large state institutions were reorganized and made
over from unsavory scandals into reputable and life-saving
establishments, even legislators took notice. The trained woman
superintendent proved not only more competent but less affected by
perquisites.

(I do not vouch for the universal maintenance of this high standard
when women managers have had longer experience; but so far conscience
and sterling integrity have been attributes of all my expert women,
even if they have now and then disappointed me in endurance or in
ability. Is not this a fact of great social significance?)

It is universally conceded today, only a few willfully blind or
croaking pessimists dissenting, that home-keeping under modern
conditions requires a knowledge of conditions and a power of control
of persons and machines obtained only through education or through
bitter experience, and that education is the less costly.

When social conditions become adjusted to the new order, it will be
seen how much gain in power the community has made, how much better
worth the people are. Have faith in the working out of the destiny of
the race; be ready to accept the unaccustomed, to use the radium of
social progress to cure the ulcers of the old friction. What if a few
mistakes are made? How else shall the truth be learned? Try all things
and hold fast that which is good.

The Home Economics Movement is an endeavor to hold the home and the
welfare of children from slipping over the cliff by a knowledge which
will bring courage to combat the destructive tendencies. Is not one of
the distinctive features of our age a forcible overcoming of the
natural trend of things? If a river is by natural law wearing away
its bank in a place we wish to keep, do we sit down and moan and say
it is sad, but we cannot help it? No, that attitude belonged to the
Middle Ages. We say, Hold fast, we cannot have that; and we cement the
sides and confine or turn the river.

The ancient cities whose ruins are now being explored in Asia seem to
have been abandoned because of failure of the water supply as the
earth became desiccated; so was the home of our own Zunis. Does such a
possibility stop us? No, we bring water from hundreds of miles. Will
man, who has gained such control over nature, sit down before his own
problems and say, “What am I going to do about it?”

What if the apparent motion is toward cells to sleep in, and clubs to
play bridge in, and amusements for evenings, and a strenuous business
life, run on piratical principles, into which the women are drawn as
decoy ducks? Because this _is_, is it going to be, as soon as a good
proportion of the thinking people stand face to face with the
problem? I believe it is possible to solve the problem, but only if
the aid of scientifically trained women is brought into service to
work in harmony with the engineer who has already accomplished so
much.

Household engineering is the great need for material welfare, and
social engineering for moral and ethical well-being. What else does
this persistent forcing of scientific training to the front mean? If
the State is to have good citizens, productive human beings, it must
provide for the teaching of the essentials to those who are to become
the parents of the next generation. No state can thrive while its
citizens waste their resources of health, bodily energy, time and
brain power, any more than a nation may prosper that wastes its
natural resources.

The teaching of domestic economy in the elementary school and home
economics in the higher is intended to give the people a sense of
_control_ over their _environment_ and to avert a panic as to the
future.

The economics of consumption, including as it does the ethics of
spending, must have a place in our higher education, preceded in
earlier grades by manual dexterity and scientific information, which
will lead to true economy in the use of time, energy, and money in the
home life of the land. Education is obliged to take cognizance of the
need, because the ideal American homestead, that place of busy
industry, with occupation for the dozen children, no longer exists.
Gone out of it are the industries, gone out of it are ten of the
children, gone out of it in large measure is that sense of moral and
religious responsibility which was the keystone of the whole.

The methods of work imposed by housing conditions are wasteful of
time, energy, and money, and the people are restive, they know not
why. As was said earlier, shelter was found by early students of
social conditions to be most in need of remedy, so we see that

“In the first place the state is beginning to offer positive aid to
secure a suitable home for each family. A communistic habitation
forces the members of a family to conform insensibly to communistic
modes of thought. Paul Goehre, in his keen observations printed in
‘Three Months in a German Workshop,’ interpreted this tendency in all
clearness. The architecture of a city tenement house is to blame for
the silent but certain transformation of the home into a sty. Instead
of accepting this condition as inevitable, like a law of nature, and
accepting its consequences, all experience demands of those who
believe in the monogamic family, that they make a united and
persistent fight on the evil which threatens the slowly acquired
qualities secured in the highest form of the family. It would be
unworthy of us to permit a great part of a modern population to
descend again to the animal level from which the race has ascended
only through æons of struggle and difficulty. When we remember that
very much, perhaps most of the progress has been dearly purchased at
the cost of women, by the appeal of her weakness and need and
motherhood, we must all the more firmly resolve not to yield the field
to a temporary effect of a needless result of neglect and avarice. As
the evil conditions are merely the work of unwise and untaught
communities, the cure will come from education of the same
communities in wisdom and science and duty. What man has marred, man
can make better.”[18]

    [18] C. R. Henderson, Proceedings Lake Placid Conference, 1902.

It is not impossible to furnish a decent habitation for every
productive laborer in all our great cities. Many really humane people
are overawed by the authority, the pompous and powerful assertions of
“successful” men of affairs; and they often sleep while such men are
forming secret conspiracies against national health and morality with
the aid of legal talent hired to kill. Only when the social mind and
conscience is educated and the entire community becomes intelligent
and alert can legislation be secured which places all competitors on a
level where humanity is possible.

Here, again, the monogamic family is the social interest at stake. It
is a conflict for altars and fires. We are told that all these results
are the effect of a natural, uniform tendency in the progress of the
business world, and that it is useless to combat it. Professor
Henderson reminds us that tendency to uniformity revealed by
statistics may be reversed when resolute men and women, possessed of
higher ideals, unite to resist it. Jacob A. Riis holds that these
evils are not by a decree of fate, but are the result of positive
wrong, and he dedicates his “Ten Years’ War” as follows--“to the
faint-hearted and those of little faith.”

In like manner we call today for more faith in a way out of the slough
of despond, more resolute endeavor to improve social and economic
conditions. We beg the leaders of public opinion to pause before they
condemn the efforts making to teach those means of social control
which may build yet again a home life that will prove the nursery of
good citizens and of efficient men and women with a sense of
responsibility to God and man for the use they make of their lives.



INSTRUCTIVE INSPECTION

     Mrs. Richards intended to embody the following material in
     Chapter VIII of the second edition. Because of her death it
     has seemed best to add it as an appendix.

     WHITCOMB AND BARROWS.



CHAPTER X

INSTRUCTIVE INSPECTION[19]

    [19] Read before the American Public Health Association at
    Richmond, Va., October, 1909.


The checking of wastes of all description is much in the air, but
there is less discussion about WASTE OF EFFORT than might be expected.
Yet effort means time, and saving of time saves lives as well as
money.

Nearly every investigation of sanitary evils leads back to the family
home (or the lack of one), and a great deal of the health authorities’
work is saving at the spigot while there is a hundred times the waste
at the bunghole. The medical inspection of the schools was found to
have little effect without the visiting school nurse, for the parents
did not know how to better conditions and in the majority of cases did
not believe in the need.

Such experience should give the health authorities a cue. Rules and
Regulations should be enforced, but enforced with instruction as to
the means of doing. The WHY is not so easily understood as the student
of sanitary science seems to think. Germs and microbes are empty air
to the street urchins until they have been shown on a screen in a
lecture hall or until cultures have been made in the sight of the
children in a schoolroom. One whole school district of intelligent
parents was converted, many years ago, by giving the children in one
class two Petri dishes each with sterile prepared gelatine, with
directions to open one in the sitting room while it was being swept,
and two hours after the room had been thoroughly dusted to open the
other in the same place for the same time. These “dust gardens,” as
the children called them, “took the place of the family album” for
callers, and spread knowledge.

Hundreds of similar experiences should convince any intelligent,
earnest Board of Health that a teacher by nature or training should be
in their employ, to be sent WITH POWER, like any other inspector,
wherever ignorance--usually diagnosed as stubbornness--is found.

The health officer whose mother was a good housekeeper, not afraid of
work, has no idea of the attitude of half the housewives of his
district. Having been made as a boy “to get the dustpan and brush and
sweep up his whittlings,” he does not realize that these houses in the
tenement district have no dustpans, and that no one would bend his
back to sweep up litter if there were. It is all swept into the alley
or the street. Cheap, long-handled dustpans would be valuable sanitary
implements. As has been elsewhere suggested, the garbage question in
the tenement house needs study and must be solved by a practical
housewife. There are such, and Boards of Health are wasting effort and
the town’s money until they avail themselves of this help in the
enforcement of their rules.

All Health Boards use the strong arm of the law, _i. e._, a police
inspector’s club, to drive the ignorant and careless householder to
keep his premises from becoming a nuisance. The newly-arrived,
prospective citizen, or more often citizeness, fails to understand
what it is all about--neither the words nor the pantomime convey an
idea, except that this country is topsy-turvy anyway, for everything
is different in this new land.

In the process of learning what not to do, the dwellers in the alleys
flee when the health officer appears, and oppose a stubborn
indifference to his threats. When his back is turned, matters go on as
before and nothing is gained, but an opportunity is lost. Law is a
potent educator when rightly applied, but it may work more harm than
good.

Rules of action clearly explained are soon accepted--like traffic
rules, notification of contagious diseases, disinfection, etc.

The placing on the force of each town of at least one specially
trained “Explainer” would result in cleaner back yards and less
illness and, better than all else, a more friendly feeling between the
officials and those they honestly wish to help; for I do not think
there is often justification for such remarks as were made to me by a
shrewd California countryman when I was showing him about in the
traveling exhibit, the sanitation car: “Oh, this is all to get a job.
It’s another form of graft--to get some money to spend.”

It is true that the value of many health measures does not appear on
the surface. Sometimes it is necessary to wait for vital statistics to
prove a gain.

It is beginning to be thrown in the faces of sanitary authorities that
the laboratory wisdom does not reach the street; that there is not
enough, or rapid enough, improvement in general conditions. Newspapers
are ready, for the most part, to disseminate information and
benevolent societies write tracts, but we must remember how little
WORDS mean--especially printed words--to those unaccustomed to
acquiring information that way.

The actual showing in an alley of the process of cleaning up; the
going into a house and opening the windows at the top and tacking on a
wire netting to keep out the flies; the actual cleaning of the garbage
pail, perhaps, or at least the standing by and seeing that it is
properly done--all such actual doing, even if it is done only in one
house on a street, will spread the information all over the
neighborhood.

One of the most helpful offices is to tell the woman where she can
get the special article needed, and what it will cost, and to show her
the thing itself, in a friendly spirit. Such visits would soon
revolutionize the sanitary condition of any community.

Villages need this help even more than cities, for there they have
fewer chances to know about inventions and perhaps are less
resourceful in making them.

There may be races, as there are individuals, whom persecution drives
to progress--who do find means to execute unjust commands--but the
people a health officer has to deal with can be better led by kindness
and will learn from teachers, if the teaching is in the form of
example or demonstration.

It is an incontrovertible fact that to hasten sanitary reform it is
only necessary to hold out the helping hand; to encourage the ignorant
citizen to ask for instruction and direction, instead of placing upon
him the task of making bricks without either clay or straw. There are
times and seasons and individuals at which and on whom the bludgeon
must be used--the greater good covering the lesser evil; but such
cases are less common than present practice would seem to indicate.

The tenement house mother who has only one pan for all her needs and
one broken pitcher for all fluids does not readily understand why she
must keep her milk bottle for milk only. Who is to tell her so that
she will understand?

The men may be shamed into cleaning up the back yards and alleys by
pictures of such conditions in contrast to what might result with a
little effort. [The famous Cash Register yards were started in this
way.] Neglected spots have been cleaned up all over the country by
similar influences. Why does not the health officer take a leaf from
this book of recorded good work and show conditions known to him? Is
he afraid of hard words from the owner? He will have the approval and
support of all good citizens.

Health Board regulations may be left at a house AFTER they have been
explained, and a firm insistence on obedience may then have an
effect.

Why should there not be a constant exhibit of the conditions found
within the boundaries of a district, with the changes for the better
indicated as soon as they occur?

The Health Board office is now in some out-of-the-way place, where few
people ever go and where those who do go are frequently not welcomed.
Has the Board ever asked itself why it is often so misunderstood, so
hampered in its work? What Board will be the first to take an office
on a busy street and put pictures and samples with clearly printed
legends in the windows--examples of the evasion of the plumbing laws
on a T-joint pipe; photographs of a dairy barn; photographs of a
street at daybreak, showing the few open windows, and the one or two,
if any, open at the top--these would serve as texts for the
newspapers’ sermons, sure to be preached, and back-alley conversations
thereon.

Why not? Rival water companies are allowed to show filters to prove
their claims.

The basis of all successful sanitary progress is an intelligent and
responsive public.

The problem is to visualize cause and effect to the ordinary
individual, too absorbed in his own affairs to study out the principle
for himself.

The success of the street cleaning brigade, tried for one season in
Boston; the improvement in the condition of parks wherever receptacles
for wastes have been placed; the tidy condition of corner lots where
civic improvement leagues have taken the matter up with the children,
all point to a means neglected by the officials, and hence to wasted
opportunity and delayed obedience to regulations.

For the position of instructive inspector, it goes without saying that
a trained woman will be worth more than a man, since most of the
regulations affect or would be controlled by women.

A gain in the speed of adoption of sanitary reforms would be
comparatively rapid under a thoroughly qualified woman as instructive
inspector, and that there will not be any great gain until such a
measure is adopted is the firm belief of the writer.

Mrs. von Wagner’s work in Yonkers, begun in 1897 under the Civic
League, is well known. After three years’ trial the Board of Health
established her in the position of Sanitary Inspector. Her work in the
tenement districts has been most successful. Several other cities have
followed the example of Yonkers, but the practice is by no means
general. Yet there is no doubt that it would add efficiency to any
Board of Health.

The most recent experiment was the employment, the past summer, of an
inspector provided by the Women’s Municipal League of Boston, to
inspect and devise means for bettering conditions in a district of
small shops where food is sold. The district had been found by the
Market Committee of this organization to be in need of such help. A
graduate of the School for Social Workers was chosen, who carried on
her campaign with the spirit of helpfulness fostered by her training.
She was given a badge by the Board of Health, who have been most
sympathetic and cordial in their support. The experiment has been
justified by the results and especially by the reception accorded the
inspector by the people of the district. It has proved that there is a
responsive desire to fulfill the law wherever its provisions are
understood.

Inspection cannot fulfill its purpose until it is instructive. Man and
the law will be in accord when the benefits of the law to man are
appreciated.

It is incumbent upon the sanitary authorities to see to it that their
efforts are not wasted on an inert, partially hostile clientele.



EUTHENICS, OR THE SCIENCE OF CONTROLLABLE ENVIRONMENT


Human efficiency and welfare due to

  Heredity (See Eugenics) and

  Environment
    1. Natural, cosmical--climate--
    2. Natural, modified by human effort
      Wet and dry soil
      Waterways and forests
      Food supplies
    3. Artificial
      Housing--clothing--sanitation

  EUTHENICS--Conscious acquisition and application of scientific knowledge

    I. Science in the laboratory
      Discovery of laws of science
      Knowledge of cause and effect

    II. Dissemination of scientific knowledge
      Education

    III. Application of science
      Habits of living
        Technique
      Stimulus to civic improvement
      Constructive legislation

I. Science acquired through laboratory and field research

    Universities
      Johns Hopkins, Clark, etc.

    Research institutes
      Rockefeller Institute
      Carnegie Institute
      Henry Phipps Institute
      Sage Foundation, etc.

  Sanitary Science = Application of acquired laws to

    1. National welfare
      Hook worm, Pellagra, Yellow fever, etc., in Panama,
        The Philippines, Cuba, Porto Rico, etc.

    2. Individual health of body and mind

The people are reached by

II. A. Dissemination of scientific knowledge through

         1. Schools
         2. Publicity
             a. Bulletins
                  Boards of Health
                  Department of Agriculture
             b. Lectures
                  Municipal
                  Endowed
             c. Magazines and newspapers
             d. Placards
             e. Commercial advertising
                  Inventions of manufacturers
                  Food fairs, electrical exhibitions, etc.
         3. Expositions for limited purposes
              Mary Lowell Stone Exhibit
              “Boston 1915”
         4. Health Campaigns
              Tuberculosis classes, etc.

     B. Legislation

         Restrictions

III. Application of science to living

     A. 1. Unconsciously acquired habits of the CHILD, through imitation
               in the home, the school, the street
        2. Conscious endeavor of
            a. the trained parents in the home
            b. the teacher in the school
            c. the policemen in the street

     B. Conscious personal effort of the ADULT to better conditions
            for himself and the community

       1. Pioneer leading public opinion by
         a. Personal example in right living
         b. Precept and persuasion

     C. Community progress

       1. Semi-public agencies for guarding itself and the individual
         a. Remedial measures
           Endowed hospitals, sanatoria, dispensaries, day camps and
             hospital schools
           Charity organizations--material relief
         b. Preventive measures
           Endowed schools (model and outdoor), extension movements,
             settlements, model tenements, model factories, garden cities

         Both are developed by social organizations, civic clubs,
           women’s clubs, museums, libraries, lectures, exhibits,
           statistical inquiries, etc.

       2. Private agencies leading to legislation
            Special hospitals and schools
            Health organizations--sanitary inspection at model
              dairies--private water supply
            Consumer’s league

       3. Legislation. Temporary paternalism (protection).
            Interpretation by individual becomes constructive.
            The people work out freedom under law

          a. City
               (1) Schools
                     Grade and trade and outdoor
               (2) Police
                     Building laws
               (3) Board of Health
                    (a) Shelter
                          Sanitary laws
                                               { Drainage
                            Air--light--refuse { Garbage
                                               { Ashes
                    (b) Food
                            Milk--water--foods { Food values
                                               { Adulterations
                    (c) Sanitary laws for public places
                            Buildings
                            Streets
                              Sewer
                              Ice on sidewalk
                              Spitting
               (4) Beauty
                     Height of buildings, bill boards, telegraph wires,
                       parks
               (5) Amusements
                     Playgrounds, municipal music, parks, aquarium
               (6) Other municipal activities
                     (a) Traffic regulation
                     (b) Medical inspection
                     (c) Public baths

          b. State
               Education
               Board of Health
               Factory legislation
               Water supply (advisory power)
               Interstate commerce
               Food (advisory)
               Park reservations
               Textile laws
               Forest
          c. Federal
               Sanitation
                 (a) Pure food laws
                 (b) Quarantine
                 (c) Immigration restriction
                 (d) Future needs
                       Textile laws, etc.





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