(4) Besides free medical attendance, the State must pro- vide free hospitals for the sick, nurses for the poor, asylums for those who are incapacitated by infirmity from self-support. The care and treatment of the feeble-minded, the insane, the deaf, the blind, the crippled, should always be in the hands of experts; and, so far as possible, work that they can do must be provided. With the enforcement of the measures we have enumerated, the need of such institutions will become much less; but at present they are inadequate in number and equipment, too often managed by incompetent officials, and not always free from scandal. [Footnote: Cf. C. R, Henderson, Social Spirit in America, chap. XV.]
(5) Most important of all, perhaps, is the work that must be done to save the babies. Approximately a third of the babies born in this country die before they are four years old; half or two thirds of these could be saved. Wonderful results in baby saving have followed strict control of the milk supply and the banishing of the fly. Besides this, mothers must in some way be given instruction in the very difficult and complicated art of rearing infants; for many of the deaths are due to simple ignorance.[Footnote: For methods and results in baby-saving, consult the Secretary of the National Association for the Study and Prevention of Infant Mortality, 1211 Cathedral Street, Baltimore, Maryland. Also Outlook, vol. 101, p. 190. J. S. Gibbon, Infant Welfare Centers.] Poverty, the necessity of self- support on the part of mothers, also plays a large part; we shall consider in chapter xxx the possibility of state care of mothers during the infancy of their children. II. Poverty and inadequate living conditions? If human illness can be in large measure averted by state action, poverty can be practically abolished. The poor we have always had with us, indeed; but we need not forever have them. There is no excuse for our tolerance of the suffering and degradation of the submerged classes; the causes of this wretchedness are in the main removable. The initial cost will be great, but in the long run the saving to the community will be enormous. Individual effort can only achieve a superficial and temporary relief; and even the two or three hundred charity organization societies in the country are impotent, for lack of funds and of power, to stem the forces that make for poverty. To dole out charity to this family and to that is unhappily necessary in our present crude social situation; but it is not a solution. It not only runs the continual risk of encouraging shiftlessness and dependence, but it does not go to the root of the matter. There will always be inequalities in wealth and room for personal gifts from the more to the less fortunate; but the State must not be content with such patching and palliating, but must strike at the roots of the evil. We will consider the chief causes of poverty and their cure.
(1) The cause that bulks largest is the inadequate wages of a considerable portion of the lowest class. It is obviously impossible to support the average family of five in decency, not to say in health, efficiency, or comfort, with an income of, say, less than a thousand dollars a year, as prices go at time of writing (1914). Yet great numbers of families at present have to exist somehow upon less, even much less. Five million adult male workers in this country receive less than six hundred dollars a year for their work.[Footnote: Cf. Professor Fairchild's comments in Forum, vol. 52, p. 49 (July, 1914).] Even when mothers work who ought to be at home tending the children, even when children work who ought to be in school, the total income is often miserably inadequate. Yet there is ample wealth in the country, if it were better distributed, to pay a living wage to every laborer. By some one of the means which we shall presently discuss, the State must see that all laborers are well enough paid to enable them, while they work, to support in comfort a moderate family.
(2) Involuntary unemployment is the next source of poverty. This is due to many causes: the periodic depressions and failures of industries; the introduction of new machinery, throwing out whole classes of laborers; the enormous influx of immigrants and consequent congestion in the cities of unskilled labor; lack of education, or natural stupidity, which render some men too incompetent to retain positions. Ignorance can be overcome by proper compulsory education laws; all but the actually feeble-minded (who must be cared for in institutions) can, by skillful attention, be taught proficiency in some trade. And with a more widespread education the work that requires no skill can be left to the hopelessly stupid. The congestion of labor in the cities [Footnote: In February, 1914, there were reported to be 350,000 men out of work in New York City (Outlook, March 14, 1914).] can be largely remedied by free state employment bureaus which shall serve as distributing agencies; there is almost always work enough and to spare in some parts of the country, and usually not far away. But more than this is necessary; the State must see that work is offered every man who is able to work. All sorts of public works need unskilled laborers in every city of the country; there is digging to be done, shoveling and sweeping and carting. There are roads to be built, rivers to be dredged, parks to be graded, buildings to be erected, a thousand things to be done. It will be quite feasible, when wages are generally adequate, for the cities, by general agreement, to offer work to all applicants at a wage so low as not to attract men away from other employments, and yet to enable them to support their families decently. The low wages given will save the city much money directly, as well as saving it the care of the indigent. But it will be a feasible plan only when the city's jobs cease to be used as a means of vote-buying by politicians and are offered where they are needed. [Footnote: 1 See W.H. Beveridge, Unemployment. J.A. Hobson, The Problem of the Unemployed. Alden and Hayward, The Unemployable and the Unemployed. C. S. Loch, Methods of Social Advance, chap. IX. Quarterly Journal of Economics, vol. 8, pp. 168, 453, 499. Review of Reviews, vol. 9, pp. 29, 179. Charities Review, vol. 3, pp. 221, 323. Independent, vol. 77, p.363. National Municipal Review, vol. 3, p.366. The unemployment which is the result of laziness must be cured by compulsory work as in farmcolonies, which have been successful in Europe. Cf. Edmond Kelly, The Elimination of the Tramp.]
(3) The third important cause of poverty is sickness and the death of wage earners. Here the way is clear. When the State has taken the measures we have enumerated for the public health, when it provides competent doctors and nurses, and bears the cost of illness, we shall have only the loss of wages during the illness or after the death of wage earners to consider. And here some form of universal insurance will probably be the solution; this is preferable to state care of dependents, as it carries no taint of charity. This solves every problem but the delicate one, which must be entrusted to expert diagnosticians, of determining to work is caused by physical weakness or mere laziness.
(4) The fourth great cause of poverty, drink, can and must be abolished in the near future, by the means already considered.
(5) There remain three personal causes which need be the only permanently troublesome factors- -laziness, self-indulgence, and the incontinence which results in over- large families. The laziness which prefers chronic inactivity to work is not normal to human nature, and will be largely banished by education, the improvement of health, and the improvement of the conditions and hours of labor. The obstinate cases of unwillingness to work must be cured by compulsory labor in farm colonies or on public works; most such cases respond to intelligent treatment and cease to be troublesome when some physical or moral twist has been remedied. The waste of income in self-indulgence of one form or other is more difficult to deal with; but the law can justly forbid the wage-earner from squandering upon himself money needed by wife and children, and direct that a due proportion of his wages be paid directly to the wife. If neither father nor mother will use their money for the proper welfare of the children, the State must take the children from them though that step should only be a last and desperate resort. Finally, there is the tendency, unfortunately most prevalent among the lowest classes, to have more children than can be decently cared for. To some extent this evil can be remedied by the dissemination of information concerning proper methods of preventing conception [Footnote: There is, however, a danger in the general dissemination of such information- the danger of increasing prostitution by lessening one of the chief deterrents there from.]; to some extent by moral training to self-control and a sense of responsibility. Or the State may undertake the countenance large families; if this is done (see chapter xxx), steps must of course be taken to prevent the marrying of the unfit-or, at least, their breeding. With our rapidly decreasing birth rate, and the spread of education, which will do away with "lower" classes and fit every one in some decent degree to be a parent, this will probably be the ultimate solution. With the disappearance of poverty, the miserable living conditions of so large a proportion of our population will automatically improve. But much should be done directly by the State to prevent such housing conditions as make for physical or moral degeneration. We are far behind Europe in housing-legislation, and conditions in most of our cities are going from bad to worse. There is, however, no need whatever of unsanitary housing; it is merely the selfishness of owners and the apathy of the public that permits its existence. The crowding-which in New York City runs up to some thirteen hundred per acre-can be stopped by simple legislation. The lack of proper light or ventilation, of proper water supply, plumbing, or sewerage, of proper removal of ashes, garbage, or rubbish, is inexcusable. The results of living in the dark, foul-aired, unsanitary tenements of our slums are: a great increase in sickness and premature death; a stunting of growth, physical and mental, and an increase in numbers of backward and delinquent children; the spread of vicious and criminal habits through the lack of privacy and contagion of close contact with the vicious.
We are breeding in our slums a degenerate race,-boys who grow up used to vice, and girls that drift naturally into prostitution; we are allowing disease to spread from them, through the children that go to the public schools, the shop-girls we buy from in the stores, the servants that enter our houses, the men we rub elbows with on the street or in the street-cars. Very salutary are the laws that require the name of the owner to be placed on all buildings; shame before the public may wring improvements from many a landlord who now takes profits from tenements unfit for habitation. But it ought not to be left to the conscience of the individual owner; the State must exercise its primary right to forbid the crowding of tenants into houses which do not afford sanitary quarters and permit a decent degree of privacy.
III. COMMERCIALIZED VICE?
The duty of the State in regard to the vice caterers is obvious; the commercializing of vice must be strictly prohibited by law and enforced by whatever means experience proves most effective. We must learn to include in this class of enemies of society the manufacturers and sellers of alcoholic liquors, as well as of the less generally used arcotics; but this matter has been already discussed in connection ]with our study of the individual's duty in relation to alcohol. Of the proprietors of gambling dens, indecent "shows," etc, we need not further speak, concentrating our attention instead upon the worst species of vice catering, the commercializing of prostitution. The extent to which the sale of woman's virtue prevails in our cities is scarcely believable. The recent commission of which Mr. Rockefeller was chairman actually counted 14,926 professional prostitutes in Manhattan alone, in 1912; while personal visitation established the existence of over sixteen hundred houses where the gratification of lust could be bought. Not all, certainly, were counted; and this list is, of course, entirely exclusive of the great number of girls occasionally and secretly selling themselves to friends, acquaintances, and employers. Many hundreds of men and women, keepers of houses, procurers, and the like, live on the proceeds of this great underground industry; and to some extent-though to what extent it is, of course, impossible to ascertain the forcible retention of young girls is exist in most of the world's cities. What is being done to abolish this ghastliest of evils? In most great cities, scarcely anything, for two reasons: the one being that so many men, perhaps the majority, secretly wish to retain an opportunity for purchasing sex gratification, the other that the police generally find the protection of illegal vice an easy source of revenue. If the police are honest, they break up a disorderly house-and let the inmates carry the lure of their trade elsewhere. The magistrates fine them, or give them sentences just long enough to bring them needed rest and nutrition, and send them back to their business. Or they drive them out of town-to swell the numbers in the next town. Attempts at legalization and localization are frank admissions of inability or lack of desire to fight the evil; their effect is to make the way of temptation easier for the youth. Compulsory medical inspection gives a promise of immunity from disease which is largely illusory, and entices men who are now restrained by prudential motives. There are, however, many promising lines of attack: