[PITTSBURGH'S FOREGONE ASSET, THE PUBLIC HEALTH]
A RUNNING SUMMARY OF THE PRESENT ADMINISTRATIVE SITUATION
SAMUEL HOPKINS ADAMS
Starting at the lowest level, let us formulate our initial axiom in terms of dollars. A sound man can do more work than a sick man. Therefore he can make more money. A sound city can do more work than a sick city. Therefore, in the long run, it can accumulate more wealth. Public health is a public asset. This is a truth which, in her single-minded purpose of commercial and industrial expansion, Pittsburgh long ago forgot, if, indeed, she ever stopped to realize it. Consequently, at a time when all the other great American cities have organized their forces thoroughly and are waging battle, with greater or less scientific skill, against that most potent of all destroyers, the germ, this mighty aggregation of half a million human beings has only just declared war, and has barely established its outposts. After two years of preparation to meet conditions which have been half a century in forming and solidifying, Pittsburgh's little regular army of defence now faces the most complicated problem of municipal betterment to be found in American hygiene.
A health bureau performs a defensive and protective function. Its intelligence department must keep it apprised of every manifestation on the part of the enemy; and it must rally to the threatened point to check the advance before it be too late, whether the emergency be a school epidemic of diphtheria, or a localized onset of typhoid. It must maintain a jealous watchfulness over the food and water supplies that are brought into the city, lest with them shall come the invading diseases. And its statistics of death and disability must point out for repair, the breaches made in its walls by the never-ceasing onslaught. Such a sanitary garrison has little rest, and no respites, for the besieging germ never sleeps.
The date of Pittsburgh's last annual health report is 1899. That fact is crammed with meaning. Strategically it means that for nearly a decade the sentries have all been asleep at their posts. Politically it has meant that those responsible for the administration of the city were too lethargic, too ignorant, or too indifferent to disturb that profound Rip Van Winkleism. Civically it means "Who cares!", and that companion gem, "What's the use?". Between public indifference, private selfishness, and political inertia, the germ has pretty well had its own sweet way with Pittsburgh, and the city's annual waste of life from absolutely preventable disease has been a thing to make humanity shudder, had it been expressed in the lurid terms of battle, holocaust, or flood, instead of the dumbly accepted figures of tuberculosis, typhoid, and infant mortality.
Presumably, before this article gets into print, the Pittsburgh health report for the year 1907 will have been issued. What laborious exhumation of dilapidated statistical skeletons that report represents, I have not space to explain here. The important and significant point is that the authorities are at last at work, and energetically, under the leadership of a skilled sanitarian, Dr. James F. Edwards, superintendent of the Bureau of Health. It would be pleasant to add that Dr. Edwards goes into action with his hands free; pleasant, but quite untrue. On the contrary, he is bound and hampered to an extent that would devitalize the efforts of any but the most patient of enthusiasts. His forces are not under his own control, since under the Pennsylvania system he is at the head, not of a department, but of a bureau of the Department of Public Safety, administered by a layman. The law gives him no power to choose or discharge his own subordinates within the limits of the civil service; all that he can do is to train and educate such of them as most need it, when they come to him. He has no specific supervision or control over public or charitable institutions, those prolific culture-beds of contagion. Even the Municipal Hospital for Contagious Diseases has been taken out of his hands and put under other management. He cannot condemn a building inimical to the public safety, nor can he revoke a milk license. He cannot abate a nuisance without going to court for it. And, lest the powers of his bureau should wax too great and impinge upon individual privilege, old laws have been raked up and carefully interpreted to restrict the scope of its work. Yet in spite of all this, wonderful to say, the efforts of the bureau seem to have made an initial impress already on the death rate, and, even more important, to have gathered to its support some tangible force of public opinion.
"Seem to have made," I say, because figures in this connection are largely a matter of conjecture. Basis for any detailed comparison between present and past, is lacking. What is certain, however, is that the sanitary forces are doing work which must inevitably have its effect in life-saving in the future; and the efficacy, if not the qualitative result, of that work is hopefully apparent. The first attack was made on a condition of affairs which would have disgraced a country village, the prevalence of unprotected outhouses, scattered over the length and breadth of the landscape; not only lurking in the slums, but peering from the proud eminence of hilltops down upon the homes of wealth and elegance below.
Through the agency of flies in summer and of wind or heavy rains in winter, these relics of communal barbarity spread filth and contagion through the city. How many of them existed at their maximum will never be known. There are still six thousand survivors, but the number is being reduced daily. Proceeding under an ordinance which declares them illegal, Dr. Edwards began his campaign modestly. Opposition he foresaw, but he waited to keep it, as far as might be, sporadic, and to prevent it from concentrating. In the year 1905 only forty-six of these nuisances had been abolished. In 1906, six hundred of them fell. Thereupon the sensitive nerve of property rights thrilled the alarm throughout the commercial body. Reform was threatening rental profits; was becoming "radical," and "destructive." People with pulls, real or imagined, rushed to councils with demands for the repeal of the ordinance. But here an unexpected ally appeared. Destruction of the old meant construction of the new and modern, with much accruing increment to the plumbing trade. Therefore these shrewd business sanitarians hastened before the committee with lawyers and arguments, and so effectually backed up the case of the Health Bureau, that the repeal project was killed then and there. In the enthusiasm of well-won victory plumbers' supplies soared heavenward, with the result of bringing the unfortunate property owners down upon the Bureau of Health in agonized droves, begging for protection from the masters of the situation. Thereupon the bureau quietly allowed an extension of time, until the enthusiastic plumbers, somewhat chastened, saw the point and came nearer to earth in their prices; after which the process continued, and has been continuing, with accelerated progress. For the issue had now been decided. The proprietors of noisome property had lost the first skirmish. In 1907, 7,755 notices were served on recalcitrants, and 3,590 privies were abolished. By the end of 1910, Dr. Edwards hopes to have relegated these nuisances to a purely historical status.