The old time city built a wall about it. That kept out invaders. The invaders of a modern city are infectious diseases. In the development of sanitary service and bureaus of health of wide powers and unquestioned integrity, the modern city is erecting its most effective wall. In Pittsburgh, the health authority is still a subordinate bureau without control over appointments under the civil service, and without that final authority which should go with its supreme responsibility toward the health of 500,000 people. Until the present incumbent was appointed, there had seldom or never been a physician at the head of this bureau. For five years there had not been so much as an annual report. Two-thirds of the appropriations to the Pittsburgh Health Bureau are to-day engrossed in a garbage removal contract; only one-third is free for general health purposes. With such an inadequate barricade, we can imagine that disease has sacked Pittsburgh throughout the years; and comparison of death rates with four cities of corresponding size,—Boston, Baltimore, Cleveland, St. Louis,—for five years, shows this to have been the case. In her average death rate per 100,000 for typhoid fever, for diarrhoea and for enteritis, Pittsburgh was first and highest. Pittsburgh was only fourth or next to the lowest in the list in pulmonary tuberculosis; but in pneumonia, in bronchitis and in other diseases of the respiratory system; and in violence other than suicide, Pittsburgh was highest. To retrieve the lost ground of years of neglect of health conditions has been a task upon which the present superintendent of the Pittsburgh Bureau of Health has entered, but it is a task in which the city must invest increasing resources. For such work it needs more than a health bureau. It needs a health department.
My point, then, is that democracy must overhaul the social machinery through which it operates if it would bring its community conditions up to standards comparable to those maintained by its banks, its insurance companies and its industrial corporations.
There are at least two tests to which the community can put such social machinery. The first is that of operating efficiency. In hospitals, in schools, in municipal departments, units of work and output can be worked out as definitely as are the tons of the steel workers, the voltage of the electricians, the dollars and cents of the banks. By vigorous systems of audit and intelligent systems of budget-making, understandable to the ordinary citizen, the community can see to it that the output of these social institutions is comparable with the investment it makes in them; that the taxpayer gets his money's worth. The Bureau of Municipal Research in New York embodies this idea in its program.
There is another, equally intensive test to which social institutions and sanitary conditions can be put. It is conceivable that the tax payer may get his money's worth from the municipal government, while the families of the wage earning population and householders may be suffering from another and irreparable form of taxation, which only increased municipal expenditure along certain lines could relieve. So it is that while I subscribe to the movement for stiffer standards of municipal accounting as a basis for effective government, for knowing the waste of a city's money, I subscribe further to the movement for such methods of social bookkeeping as will show us the larger waste of human life and private means; and will stand out not only for honesty and efficiency, but for the common well-being.
Let me illustrate by the case of typhoid fever which has been epidemic in Pittsburgh for twenty-five years. To eliminate typhoid Pittsburgh has erected a 5-1/2 million dollar filtration plant,[14] for the years of delay in the erection of which the city has suffered a terrible toll of deaths and misery. There were 5,421 cases of typhoid fever in Pittsburgh last year and 622 deaths. Computing death rate per 100,000 population for the larger cities having the highest rates in 1901, Pittsburgh was first with 124, New Haven second, Allegheny third; in 1902, Pittsburgh was first, Allegheny second, Washington third; in 1903, Pittsburgh first, Cleveland was second, Allegheny third; in 1904, Columbus was first, Pittsburgh second, Allegheny third; in 1905, Allegheny was first, Pittsburgh second and Columbus third; in 1906, Pittsburgh was first, and Allegheny second. But even these figures, startling as they are, fail to afford a grasp of the meaning of this typhoid scourge in the lives of the wage earners of Pittsburgh. The Pittsburgh Survey undertook to gauge this. In co-operation with Columbian Settlement, we collected data as to 1,029 cases in six wards reported in one year; 448 cases were found and studied. Of these 26 died. 187 wage earners lost 1,901 weeks' work. Other wage earners, not patients, lost 322 weeks,—a total loss in wages of $28,899. The cost of 90 patients treated in hospitals at public or private expense was $4,165; of 338 patients cared for at home, $21,000 in doctors' bills, nurses, ice, foods, medicines; of 26 funerals, $3,186; a total cost of $57,250 in less than half the cases of six wards in one year,—wards in which both income and sickness expense were at a minimum. But there were other even more serious drains which do not admit of tabulation. A girl of twenty-two, who worked on stogies, was left in a very nervous condition, not as strong as before, and consequently she could not attain her former speed. A blacksmith will probably never work at his trade with his former strength. A sixteen-year-old girl who developed tuberculosis was left in a weakened physical condition. A tailor who cannot work as long hours as before, was reduced $1 a week in wages. A boy of eight was very nervous; he would not sit still in school and was rapidly becoming a truant. A mother developed a case of pneumonia from over-exposure in caring for children who had the fever, and she has not been well since. So the story goes,—very real to the lives of the many who are so intimately concerned. The money losses can be replaced. My figures include no estimate of the value of human lives lost. And it is impossible to compute in terms of dollars and cents, what it means to a family to have the father's health so broken that he cannot work at his old job, but has to accept easier work at less pay. It is impossible to put in tabulated form the total value to a family of a mother's health, and strike a proper balance when typhoid has left her a physical or nervous wreck. It is impossible to estimate what is the cost to a boy or girl who is obliged to leave school in order to help support the family, because typhoid has incapacitated the natural bread-winners. Such facts as these show the drain that typhoid has been on the vital forces of the community. It is only one of such drains.
[14] In October there were but ninety-six cases of typhoid in Greater Pittsburgh, as against 503 for October, 1907.
Such facts as these bring home concretely to the average workingman his stake in good government.
It is not possible here to enter into a discussion, even briefly, of the democratic methods by which a community can improve the quality and lessen the cost of its food supplies as an integral part of the program for building up a vigorous working population. There is a direct bearing between these costs of living and the holding power of the wages paid in the Pittsburgh District.