XXIV. MAN'S IMPROVEMENT OF HIS ENVIRONMENT

Problems.—How may we improve our home conditions of living?

How may we help improve our conditions at school?

How does the city care for the improvement of our environment?

(a) In inspection of buildings, etc.

(b) In inspection of food supplies.

(c) In inspection of milk.

(d) In care of water supplies.

(e) In disposal of wastes.

(f) In care of public health.

Laboratory Suggestions

Home exercise.—How to ventilate my bedroom.

Demonstration.—Effect of use of duster and damp cloth upon bacteria in schoolroom.

Home exercise.—Luncheon dietaries.

Home exercise.—Sanitary map of my own block.

Demonstration.—The bacterial content of milk of various grades and from different sources.

Demonstration.—Bacterial content of distilled water, rain water, tap water, dilute sewage.

Laboratory exercise.—Study of board of health tables to plot curves of mortality from certain diseases during certain times of year.

The Purpose of this Chapter.—In the preceding chapters we have traced the lives of both plants and animals within their own environment. We have seen that man, as well as plants and other animals, needs a favorable environment in order to live in comfort and health. It will be the purpose of the following pages first to show how we as individuals may better our home environment, and secondly, to see how we may aid the civic authorities in the betterment of conditions in the city in which we live.

How I should ventilate my bedroom.

Home Conditions.—The Bedroom.—We spend about one third of our total time in our bedroom. This room, therefore, deserves more than passing attention. First of all, it should have good ventilation. Two windows make an ideal condition, especially if the windows receive some sun. Such a condition as this is manifestly impossible in a crowded city, where too often the apartment bedrooms open upon narrow and ill-ventilated courts. Until comparatively recent time, tenement houses were built so that the bedrooms had practically no light or air; now, thanks to good tenement-house laws, wide airshafts and larger windows are required by statute.

Care of the Bedroom.—Since sunlight cannot always be obtained for a bedroom, we must so care for and furnish the room that it will be difficult for germs to grow there. Bedroom furniture should be light and easy to clean, the bedstead of iron, the floors painted or of hardwood. No hangings should be allowed at the windows to collect dust, nor should carpets be allowed for the same reason. Rugs on the floor may easily be removed when cleaning is done. The furniture and woodwork should be wiped with a damp cloth every day. Why a damp cloth? In certain tenements in New York City, tuberculosis is believed to have been spread by people occupying rooms in which a previous tenant has had tuberculosis. A new tenant should insist on a thorough cleaning of the bedrooms and removal of old wall paper before occupancy.

Sunlight Important.—In choosing a house in the country we would take a location in which the sunlight was abundant. A shaded location might be too damp for health. Sunlight should enter at least some of the rooms. In choosing an apartment we should have this matter in mind, for, as we know, germs cannot long exist in sunlight.

This map shows how cases of tuberculosis are found recurring in the same locality and in the same houses year after year. Each black dot is one case of tuberculosis.

Heating.—Houses in the country are often heated by open fires, stoves or hot-air furnaces, all of which make use of heated currents of air to warm the rooms. But in the city apartments, usually pipes conduct steam or hot water from a central plant to our rooms. The difficulty with this system is that it does not give us fresh air, but warms over the stale air in a room. Steam causes our rooms to be too warm part of the time, and not warm enough part of the time. Thus we become overheated and then take cold by becoming chilled. Steam heat is thus responsible for much sickness.

Lighting.—Lighting our rooms is a matter of much importance. A student lamp, or shaded incandescent light, should be used for reading. Shades must be provided so that the eyes are protected from direct light. Gas is a dangerous servant, because it contains a very poisonous substance, carbon monoxide. "It is estimated that 14 per cent of the total product of the gas plant leaks into the streets and houses of the cities supplied." This forms an unseen menace to the health in cities. Gas pipes, and especially gas cocks, should be watched carefully for escaping gas. Rubber tubing should not be used to conduct gas to movable gas lamps, because it becomes worn and allows gas to escape.

During the summer all food should be protected from flies. Why?

Insects and Foods.—In the summer our houses should be provided with screens. All food should be carefully protected from flies. Dirty dishes, scraps of food, and such garbage should be quickly cleaned up and disposed of after a meal. Insect powder (pyrethrum) will help keep out "croton bugs" and other undesirable household pests, but cleanliness will do far more. Most kitchen pests, as the roach, simply stay with us because they find dirt and food abundant.

Use of Ice.—Food should be properly cared for at all times, but especially during the summer. Iceboxes are a necessity, especially where children live, in order to keep milk fresh. A dirty icebox is almost as bad as none at all, because food will decay or take on unpleasant odors from other foods.

The wrong and the right kind of garbage cans.

Disposal of Wastes.—In city houses the disposal of human wastes is provided for by a city system of sewers. The wastes from the kitchen, the garbage, should be disposed of each day. The garbage pail should be frequently sterilized by rinsing it with boiling water. Plenty of lye or soap should be used. Remember that flies frequent the uncovered garbage pail, and that they may next walk on your food. Collection and disposal of garbage is the work of the municipality.

School Surroundings.—How to Improve Them.—From five to six hours a day for forty weeks is spent by the average boy or girl in the schoolroom. It is part of our environment and should therefore be considered as worthy of our care. Not only should a schoolroom be attractive, but it should be clean and sanitary. City schools, because of their locations, of the sometimes poor janitorial service, and especially because of the selfishness and carelessness of children who use them, may be very dirty and unsanitary. Dirt and dust breed and carry bacteria. Plate cultures show greatly increased numbers of bacteria to be in the air when pupils are moving about, for then dust, bearing bacteria, is stirred up and circulated through the air. Sweeping and dusting with dry brooms or feather dusters only stirs up the dust, leaving it to settle in some other place with its load of bacteria. Professor Hodge tells of an experience in a school in Worcester, Mass. A health brigade was formed among the children, whose duty was to clean the rooms every morning by wiping all exposed surface with a damp cloth. In a school of 425 pupils not a single case of contagious diseases appeared during the entire year. Why not try this in your own school?

The culture (A) was exposed to the air of a dirty street in the crowded part of Manhattan. (B) was exposed to the air of a well-cleaned and watered street in the uptown residence portion. Which culture has the more colonies of bacteria? How do you account for this?

Unselfishness the Motto.—Pupils should be unselfish in the care of a school building. Papers and scraps dropped by some careless boy or girl make unpleasant the surroundings for hundreds of others. Chalk thrown by some mischievous boy and then tramped underfoot may irritate the lungs of a hundred innocent schoolmates. Colds or worse diseases may be spread through the filthy habits of some boys who spit in the halls or on the stairways.

Lunch Time and Lunches.—If you bring your own lunch to school, it should be clean, tasty, and well balanced as a ration. In most large schools well-managed lunch rooms are part of the school equipment, and balanced lunches can be obtained at low cost. Do not make a lunch entirely from cold food, if hot can be obtained. Do not eat only sweets. Ice cream is a good food, if taken with something else, but be sure of your ice cream. "Hokey pokey" cream, tested in a New York school laboratory, showed the presence of many more colonies of bacteria than good milk would show. Above all, be sure the food you buy is clean. Stands on the street, exposed to dust and germs, often sell food far from fit for human consumption.

A sensible lunch box, sanitary and compact.

If you eat your lunch on the street near your school, remember not to scatter refuse. Paper, bits of lunch, and the like scattered on the streets around your school show lack of school spirit and lack of civic pride. Let us learn above all other things to be good citizens.

Dust exhausts on grinding wheels protect lungs of the workmen.

Inspection of Factories, Public Buildings, etc.—It is the duty of a city to inspect the condition of all public buildings and especially of factories. Inspection should include, first, the supervision of the work undertaken. Certain trades where grit, dirt, or poison fumes are given off are dangerous to human health, hence care for the workers becomes a necessity. Factories should also be inspected as to cleanliness, the amount of air space per person employed, ventilation, toilet facilities, and proper fire protection. Tenement inspection should be thorough and should aim to provide safe and sanitary homes.

Inspection of Food Supplies.—In a city certain regulations for the care of public supplies are necessary. Foods, both fresh and preserved, must be inspected and rendered safe for the thousands of people who are to use them. All raw foods exposed on stands should be covered so as to prevent insects or dust laden with bacteria from coming in contact with them. Meats must be inspected for diseases, such as tuberculosis in beef, or trichinosis in pork. Cold storage plants must be inspected to prevent the keeping of food until it becomes unfit for use. Inspection of sanitary conditions of factories where products are canned, or bakeries where foods are prepared, must be part of the work of a city in caring for its citizens.

Care of Raw Foods.—Each one of us may coöperate with the city government by remembering that fruits and vegetables can be carriers of disease, especially if they are sold from exposed stalls or carts and handled by the passers-by. All vegetables, fruits, or raw foods should be carefully washed before using. Spoiled or overripe fruit, as well as meat which is decayed, is swarming with bacteria and should not be used.

An interesting exercise would be the inspection of conditions in your own home block. Make a map showing the houses on the block. Locate all stores, saloons, factories, etc. Notice any cases of contagious disease, marking this fact on the map. Mark all heaps of refuse in the street, all uncovered garbage pails, any street stands that sell uncovered fruit, and any stores with an excessive number of flies.

In addition to food inspection, two very important supplies must be rendered safe by a city for its citizens. These are milk and water.

Clean cows in clean barns with clean milkers and clean milk pails means clean milk in the city.

Care in Production of Milk.—Milk when drawn from a healthy cow should be free from bacteria. But immediately on reaching the air it may receive bacteria from the air, from the hands of the person who milks the cows, from the pail, or from the cow herself. Cows should, therefore, be milked in surroundings that are sanitary, the milkers should wear clean garments, put on over their ordinary clothes at milking time, while pails and all utensils used should be kept clean. Especially the surface exposed on the udder from which the milk is drawn should be cleansed before milking.

Most large cities now send inspectors to the farms from which milk is supplied. Farms that do not accept certain standards of cleanliness are not allowed to have their milk become part of the city supply.

Tuberculosis and Milk.—It is recognized that in some European countries from 30 to 40 per cent of all cattle have tuberculosis. Many dairy herds in this country are also infected. It is also known that the tubercle bacillus of cattle and man are much alike in form and action and that probably the germ from cattle would cause tuberculosis in man. Fortunately, the tuberculosis germ does not grow in milk, so that even if milk from tubercular cattle should get into our supply, it would be diluted with the milk of healthy cattle. In order to protect our milk supply from these germs it would be necessary to kill all tubercular cattle (almost an impossibility) or to pasteurize our milk so as to kill the germs in it.

Other Disease Germs in Milk.—We have already shown how typhoid may be spread through milk. Usually such outbreaks may be traced to a single case of typhoid, often a person who is a "typhoid carrier," i.e. one who may not suffer from the effects of the disease, but who carries the germs in his body, spreading them by contact. A recent epidemic of typhoid in New York City was traced to a single typhoid carrier on a farm far from the city. Sometimes the milk cans may be washed in contaminated water or the cows may even get the germs on their udders by wading in a polluted stream. Diphtheria, scarlet fever, and Asiatic cholera are also undoubtedly spread through milk supplies. Milk also plays a very important part in the high death rate from diarrhœal diseases among young children in warm weather. Why?

A diagram to show how typhoid may be spread in a city through an infected milk supply. The black spots in the blocks mean cases of typhoid. A, a farm where typhoid exists; the dashes in the streets represent the milk route. B is a second farm which sends part of its milk to A; the milk cans from B are washed at farm A and sent back to B. A few cases of typhoid appear along B's milk route. How do you account for that?

Grades of Milk in a City Supply.—Milk which comes to a city may be roughly placed in three different classes. The best milk, coming from farms where the highest sanitary standards exist, where the cows are all tubercular tested, where modern appliances for handling and cooling the milk exist, is known as certified or, in New York City, grade A milk. Most of the milk sold, however, is not so pure nor is so much care taken in handling it. Such milk, known in New York as grade B milk, is pasteurized before delivery, and is sold only in bottles. A still lower grade of milk (dipped milk) is sold direct from cans. It is evident that such milk, often exposed to dust and other dirt, is unfit for any purpose except for cooking. It should under no circumstances be used for children. A regulation recently made by the New York City Department of Health states that milk sold "loose" in restaurants, lunch-rooms, soda fountains, and hotels must be pasteurized.

Care of a City Milk Supply.—Besides caring for milk in its production on the farm, proper transportation facilities must be provided. Much of the milk used in New York City is forty-eight hours old before it reaches the consumer. During shipment it must be kept in refrigerator cars, and during transit to customers it should be iced. Why? All but the highest grade milk should be pasteurized. Why? Milk should be bottled by machinery if possible so as to insure no personal contact; it should be kept in clean, cool places; and no milk should be sold by dipping from cans. Why is this a method of dispensing impure milk?

Care of Milk in the Home.—Finally, milk at home should receive the best of care. It should be kept on ice and in covered bottles, because it readily takes up the odors of other foods. If we are not certain of its purity or keeping qualities, it should be pasteurized at home. Why?

New York City is spending $350,000,000 to have a pure and abundant water supply. This is the tunnel which will bring the water from the Catskill Mountains to New York City.

Water Supplies.—One of the greatest assets to the health of a large city is pure water. By pure water we mean water free from all organic impurities, including germs. Water from springs and deep driven wells is the safest water, that from large reservoirs next best, while water that has drainage in it, river water for example, is very unsafe.

The waters from deep wells or springs if properly protected will contain no bacteria. Water taken from protected streams into which no sewage flows will have but few bacteria, and these will be destroyed if exposed to the action of the sun and the constant aëration (mixing with oxygen) which the surface water receives in a large lake or reservoir. But water taken from a river into which the sewage of other towns and cities flows must be filtered before it is fit for use.

The city of Lowell in 1891 took its water without filtering, i.e. from the Merrimack River at the point shown on the map.

Typhoid fever broke out in North Chelmsford and about two weeks later cases began to appear in Lowell until a great epidemic occurred. Explain this outbreak. Each black dot is a case of typhoid.

Typhoid fever germs live in the food tube, hence the excreta of a typhoid patient will contain large numbers of germs. In a city with a system of sewage such germs might eventually pass from the sewers into a river. Many cities take their water supply directly from rivers, sometimes not far below another large town. Such cities must take many germs into their water supply. Many cities, as Cleveland and Buffalo, take their water from lakes into which their sewage flows. Others, as Albany, Pittsburgh, and Philadelphia, take their drinking water directly from rivers into which sewage from cities above them on the river has flowed. Filtering such water by means of passing the water through settling basins and sand filters removes about 98 per cent of the germs. The result of drinking unfiltered and filtered water in certain large cities is shown graphically at right. In cities which drain their sewage into rivers and lakes, the question of sewage disposal is a large one, and many cities now have means of disposing of their sewage in some manner as to render it harmless to their neighbors.

Filter beds at Albany, N. Y.

Cases of typhoid per 100,000 inhabitants before filtering water supply (solid) and after (shaded) in A, Watertown, N. Y.; B, Albany, N. Y.; C, Lawrence, Mass.; D, Cincinnati, Ohio. What is the effect of filtering the water supply?

Railroads are often responsible for carrying typhoid and spreading it. It is said that a recent outbreak of typhoid in Scranton, Pa., was due to the fact that the excreta from a typhoid patient traveling in a sleeping car was washed by rain into a reservoir near which the train was passing. Railroads are thus seen to be great open sewers. A sanitary car toilet is the only remedy.

This chart shows that during a cholera epidemic in 1892 there were hundreds of cases of cholera in Hamburg, which used unfiltered water from the Elbe, but in adjoining Altona, where filtered water was used, the cases were very few.

Stone filter beds in a sewage disposal plant.

Sewage Disposal.—Sewage disposal is an important sanitary problem for any city. Some cities, like New York, pour their sewage directly into rivers which flow into the ocean. Consequently much of the liquid which bathes the shores of Manhattan Island is dilute sewage. Other cities, like Buffalo or Cleveland, send their sewage into the lakes from which they obtain their supply of drinking water. Still other cities which are on rivers are forced to dispose of their sewage in various ways. Some have a system of filter beds in which the solid wastes are acted upon by the bacteria of decay, so that they can be collected and used as fertilizer. Others precipitate or condense the solid materials in the sewage and then dispose of it. Another method is to flow the sewage over large areas of land, later using this land for the cultivation of crops. This method is used by many small European cities.

Collecting ashes.

The Work of the Department of Street Cleaning.—In any city a menace to the health of its citizens exists in the refuse and garbage. The city streets, when dirty, contain countless millions of germs which have come from decaying material, or from people ill with disease. In most large cities a department of street cleaning not only cares for the removal of dust from the streets, but also has the removal of garbage, ashes, and other waste as a part of its work. The disposal of solid wastes is a tremendous task. In Manhattan the dry wastes are estimated to be 1,000,000 tons a year in addition to about 175,000 tons of garbage. Prior to 1895 in the city of New York garbage was not separated from ashes; now the law requires that garbage be placed in separate receptacles from ashes. Do you see why? The street-cleaning department should be aided by every citizen; rules for the separation of garbage, papers, and ashes should be kept. Garbage and ash cans should be covered. The practice of upsetting ash or garbage cans is one which no young citizen should allow in his neighborhood, for sanitary reasons. The best results in summer street cleaning are obtained by washing or flushing the streets, for thus the dirt containing germs is prevented from getting into the air. The garbage is removed in carts, and part of it is burned in huge furnaces. The animal and plant refuse is cooked in great tanks; from this material the fats are extracted, and the solid matter is sold for fertilizer. Ashes are used for filling marsh land. Thus the removal of waste matter may pay for itself in a large city.

The upper picture shows the stables where millions of flies were bred; the lower picture, the disinfection of manure so as to prevent the breeding of flies.

An Experiment in Civic Hygiene.—During the summer of 1913 an interesting experiment on the relation of flies and filth to disease was carried on in New York City by the Bureau of Public Health and Hygiene of the New York Association for improving the condition of the poor. Two adjoining blocks were chosen in a thickly populated part of the Bronx near a number of stables which were the sources of great numbers of flies. In one block all houses were screened, garbage pails were furnished with covers, refuse was removed and the surroundings made as sanitary as possible. In the adjoining block conditions were left unchanged. During the summer as flies began to breed in the manure heaps near the stables all manure was disinfected. Thus the breeding of flies was checked. The campaign of education was continued during the summer by means of moving pictures, nurses, boy scouts, and school children who became interested.

At the end of the summer it was found that there had been a considerable decrease in the number of cases of fly-carried diseases and a still greater decrease in the total days of sickness (especially of children) in the screened and sanitary block. The table and pictures speak for themselves. If such a small experiment shows results like this, then what might a general clean-up of a city show?

In the upper picture a little girl can be seen dumping garbage from the fire escape. She was a foreigner and knew no better. The picture below shows the result of such garbage disposal.

Public Hygiene.—Although it is absolutely necessary for each individual to obey the laws of health if he or she wishes to keep well, it has also become necessary, especially in large cities, to have general supervision over the health of people living in a community. This is done by means of a department or board of health. It is the function of this department to care for public health. In addition to such a body in cities, supervision over the health of its citizens is also exercised by state boards of health. But as yet the government of the United States has not established a Bureau of Health, important as such a bureau would be.

The Functions of a City Board of Health.—The administration of the Board of Health in New York City includes a number of divisions, each of which has a different work to do. Each is in itself important, and, working together, the entire machine provides ways and means for making the great city a safe and sanitary place in which to live. Let us take up the work of each division of the health board in order to find out how we may coöperate with them.

Comparison of cases of illness during the summer of 1913 in two city blocks, one clean and the other dirty. What are your conclusions?

The Division of Infectious Diseases.—Infectious diseases are chiefly spread through personal contact. It is the duty of a government to prevent a person having such a disease from spreading it broadcast among his neighbors. This can be done by quarantine or isolation of the person having the disease. So the board of health at once isolates any case of disease which may be communicated from one person to another. No one save the doctor or nurse should enter the room of the person quarantined. After the disease has run its course, the clothing, bedding, etc., in the sick room is fumigated. This is usually done by the board of health. Formaldehyde in the form of candles for burning or in a liquid form is a good disinfectant. In disinfecting the room should be tightly closed to prevent the escape of the gas used, as the object of the disinfection is to kill all the disease germs left in the room. In some cases of infectious disease, as scarlet fever, it is found best to isolate the patients in a hospital used for that purpose. Examples of the most infectious diseases are measles, scarlet fever, whooping cough, and diphtheria.

Immunity.—In the prevention of germ diseases we must fight the germ by attacking the parasites directly with poisons that will kill them (such poisons are called germicides or disinfectants), and we must strive to make the persons coming in contact with the disease unlikely to take it. This insusceptibility or immunity may be either natural or acquired. Natural immunity seems to be in the constitution of a person, and may be inherited. Immunity may be acquired by means of such treatment as the antitoxin treatment for diphtheria. This treatment, as the name denotes, is a method of neutralizing the poison (toxin) caused by the bacteria in the system. It was discovered a few years ago by a German, Von Behring, that the serum of the blood of an animal immune to diphtheria is capable of neutralizing the poison produced by the diphtheria-causing bacteria. Horses are rendered immune by giving them the diphtheria toxin in gradually increasing doses. The serum of the blood of these horses is then used to inoculate the patient suffering from or exposed to diphtheria, and thus the disease is checked or prevented altogether by the antitoxin injected into the blood. The laboratories of the board of health prepare this antitoxin and supply it fresh for public use.

Antitoxin for diphtheria prepared by the New York Board of Health.

It has been found from experience in hospitals that deaths from diphtheria are largely preventable by early use of antitoxin. When antitoxin was used on the first day of the disease no deaths took place. If not used until the second day, 5 deaths occurred in every hundred cases, on the third day 11 deaths, on the 4th day 19 deaths, and on the 5th day 20 deaths out of every hundred cases. It is therefore advisable, in a suspected case of diphtheria, to have antitoxin used at once to prevent serious results.

Vaccination.—Smallpox was once the most feared disease in this country; 95 per cent of all people suffered from it. As late as 1898, over 50,000 persons lost their lives annually in Russia from this disease. It is probably not caused by bacteria, but by a tiny animal parasite. Smallpox has been brought under absolute control by vaccination,—the inoculation of man with the substance (called virus) which causes cowpox in a cow. Cowpox is like a mild form of smallpox, and the introduction of this virus gives complete immunity to smallpox for several years after vaccination. This immunity is caused by the formation of a germicidal substance in the blood, due to the introduction of the virus. Another function of the board of health is the preparation and distribution of vaccine (material containing the virus of cowpox).

Rabies (Hydrophobia).—This disease, which is believed to be caused by a protozoan parasite, is communicated from one dog to another in the saliva by biting. In a similar manner it is transferred to man. The great French bacteriologist, Louis Pasteur, discovered a method of treating this disease so that when taken early at the time of the entry of the germ into the body of man, the disease can be prevented. In some large cities (among them New York) the board of health has established a laboratory where free treatment is given to all persons bitten by dogs suspected of having rabies.

Vaccination against Typhoid.—Typhoid fever has within the past five years received a new check from vaccination which has been introduced into our army and which is being used with good effect by the health departments of several large cities.

The following figures show the differences between number of cases and mortality in the army in 1898 during the war with Spain and in 1911 during the concentration of certain of our troops at San Antonio, Texas.

1898—2nd Division, 7th Army Corps, Jacksonville, Florida. June-October, 1898

Manœuver Division, San Antonio, Texas. March 10-July 11, 1911.

Comparison of cases of and death from typhoid in 1898 and 1911. What have we learned about combating typhoid since 1898?

During this period there were 49 cases of typhoid and 19 deaths in the near-by city of San Antonio. But in camp, where vaccination for typhoid was required, all were practically immune. In the army at large, since typhoid vaccination has been practiced, 1908-1909, the death rate from typhoid has dropped from 2.9 per 1000 to .03 per 1000, a wonderful record when we remember that during the Spanish-American War 86 per cent of the deaths in the army were from typhoid fever.

How the Board of Health fights Tuberculosis.—Tuberculosis, which a few years ago killed fully one seventh of the people who died from disease in this country, now kills less than one tenth. This decrease has been largely brought about because of the treatment of the disease. Since it has been proved that tuberculosis if taken early enough is curable, by quiet living, good food, and plenty of fresh air and light, we find that numerous sanitaria have come into existence which are supported by private or public means. At these sanitaria the patients live out of doors, especially sleep in the air, while they have plenty of nourishing food and little exercise. The department of health of New York City maintains a sanitarium at Otisville in the Catskill Mountains. Here people who are unable to provide means for getting away from the city are cared for at the city's expense and a large percentage of them are cured. In this way and by tenement house laws which require proper air shafts and window ventilation in dwellings, by laws against spitting in public places, and in other ways, the boards of health in our towns and cities are waging war on tuberculosis.

The best cures for tuberculosis are rest, plenty of fresh out-of-door air, and wholesome food.

A sanitarium for tuberculosis. Notice the outdoor sleeping rooms.

Ex-President Roosevelt said, in one of his latest messages to Congress:—

"There are about 3,000,000 people seriously ill in the United States, of whom 500,000 are consumptives. More than half of this illness is preventable. If we count the value of each life lost at only $1700 and reckon the average earning lost by illness at $700 a year for grown men, we find that the economic gain from mitigation of preventable disease in the United States would exceed $1,500,000,000 a year. This gain can be had through medical investigation and practice, school and factory hygiene, restriction of labor by women and children, the education of the people in both public and private hygiene, and through improving the efficiency of our health service, municipal, state, and national."

Work of the Division of School and Infant Hygiene.—Besides the work of the division of infectious disease, the division of sanitation, which regulates the general sanitary conditions of houses and their surroundings and the division of inspection, which looks after the purity and conditions of sale and delivery of milk and foods, there is another department which most vitally concerns school children. This is the division of school and infant hygiene. The work of this department is that of the care of the children of the city. During the year 1912, 279,776 visits were made to the homes of school children of the city of New York by inspectors and nurses. Besides this, thousands of children in school were cared for and aided by the city.

Adenoids.—Many children suffer needlessly from adenoids,—growths in the back of the nose or mouth which prevent sufficient oxygen being admitted to the lungs. A child suffering from these growths is known as a "mouth breather" because the mouth is opened in order to get more air. The result to the child may be a handicap of deafness, chronic running of the nose, nervousness, and lack of power to think. His body cells are starving for oxygen. A very simple operation removes this growth. Coöperation on the part of the children and parents with the doctors or nurses of the board of health will do much in removing this handicap from many young lives.

Eyestrain.—Another handicap to a boy or girl is eyestrain. Twenty-two per cent of the school children of Massachusetts were recently found to have defects in vision. Tests for defective eyesight may be made at school easily by competent doctors, and if the child or parent takes the advice given to correct this by procuring proper glasses, a handicap on future success will be removed.

Decayed Teeth.—Decayed teeth are another handicap, cared for by this division. Free dental clinics have been established in many cities, and if children will do their share, the chances of their success in later life will be greatly aided. Boys and girls, if handicapped with poor eyes or teeth, do not have a fair chance in life's competition. In a certain school in New York City there were 236 pupils marked "C" in their school work. These children were examined, and 126 were found to have bad teeth, 54 defective vision, and 56 other defects, as poor hearing, adenoids, enlarged tonsils, etc. Of these children 185 were treated for these various difficulties, and 51 did not take treatment. During the following year's work 176 of these pupils improved from "C" to "B" or "A", while 60 did not improve. If defects are such a handicap in school, then what would be the chances of success in life outside.

In conclusion: this department of school hygiene deserves the earnest aid of every young citizen, girl or boy. If each of us would honestly help by maintaining quarantine in the case of contagious disease, by observing the rules of the health department in fumigation, by acting upon advice given in case of eyestrain, bad teeth, or adenoids, and most of all by observing the rules of personal hygiene as laid down in this book, the city in which we live would, a generation hence, contain stronger, more prosperous, and more efficient citizens than it does to-day.

Reference Books

elementary

Hunter, Laboratory Problems in Civic Biology. American Book Company.

Davison, The Human Body and Health. American Book Company.

Gulick Hygiene Series, Town and City. Ginn and Company.

Hough and Sedgwick, The Human Mechanism, Part II. Ginn and Company.

Overton, General Hygiene. American Book Company.

Richards, Sanitation in Daily Life. Whitcomb and Barrows.

Richmond and Wallach, Good Citizenship. American Book Company.

Ritchie, Primer of Sanitation. World Book Company.

Sharpe, Laboratory Manual of Biology, pages 320-334. American Book Company.

advanced

Allen, Civics and Health. Ginn and Company.

Chapin, Municipal Sanitation in the United States. Snow and Farnham.

Chapin, Sources and Modes of Infection. Wiley and Sons.

Conn, Practical Dairy Bacteriology. Orange Judd Company.

Hough and Sedgwick, The Human Mechanism. Part II. Ginn and Company.

Hutchinson, Preventable Diseases. The Houghton, Mifflin Company.

Morse, The Collection and Disposal of Municipal Waste. Municipal Journal and Engineer.

Overlock, The Working People, Their Health and How to Protect It. Mass. Health Book Publishing Co.

Price, Handbook of Sanitation. Wiley and Sons.

Tolman, Hygiene for the Worker. American Book Company.

reports, etc.

American Health Magazine.

Annual Report of Department of Health, City of New York (and other cities).

Bulletins and Publications of Committee of One Hundred on National Health.

School Hygiene, American School Hygiene Association.

Grinnell, Our Army versus a Bacillus. National Geographic Magazine.