Encouraged, the Bureau of Health sought from the Legislature the power to condemn unsanitary dwellings. At present, in order to destroy property prejudicial to the public health, the bureau must go to court and prove the conditions unsanitary,—a cumbrous, expensive, and uncertain process. It is not long since a presumably upright and intelligent occupant of the bench held that a house which leaked so badly that the floors were rotted and the plaster peeled from the walls could not, on that account, be adjudged unsanitary. The bill passed the Legislature, prescribing condemnatory powers, with a proviso for court review and damages to the owner if the condemnation should be found unjustified. Governor Stuart vetoed the bill on the ground that it was too sweeping. If the local undertakers haven't passed a vote of thanks to the governor, they have missed a gracious opportunity. What would have been the one most effectual check upon the city's mortality, the wiping out of those death-in-life conditions of housing which make for tuberculosis, the active contagions, and above all the undermined vitality represented in Pittsburgh statistics under every division from general debility to suicide,—that the gubernatorial veto has effectually blocked. So certain large and small owners of slum property have an extension of immunity for their rentals drawn, at the worst, from premises where they wouldn't house their pigs,—particularly if they designed to eat the pigs afterward.
Evil housing conditions are almost invariably reflected in the mortality figures of tuberculosis. Yet Pittsburgh's given death rate from tuberculosis is low; hardly half the normal rate for American cities, in general: so low, indeed, that I doubt whether any sanitarian would give implicit credence to it. Similarly, the death rate from pneumonia and bronchitis is suspiciously high. For example, in 1907 there were a quarter as many deaths attributed to bronchitis, as to consumption, an incredible assumption. Dr. Matson, who is in charge of the bureau's statistics, has decided, with a wisdom born of experience, to regard fatal cases of bronchitis as belonging, statistically, in the pneumonia column; so I shall lump the two diseases. In the first eight months of last year (which is as far as the monthly figures have been supplied to me) there were but 565 deaths set down to tuberculosis in all forms, whereas the pneumonia and bronchitis totals aggregated upwards of 1,100. This is a condition which, so far as I know, has never been paralleled in any American city. The inference is inevitable that deaths, which should properly be ascribed to the great white plague, are reported by physicians under other heads. This is due, usually, to the influence of the decedent's family, who fear to lose their places if it be known that there is "consumption in the house," or who will perhaps, forfeit the insurance money if the true cause of death appear on the records. Very wisely Dr. Edwards is proceeding, not upon local certificates, which may lie, but upon universally recognized facts, which cannot; and is planning an exhaustive tuberculosis campaign. In this campaign will be concentrated the local official health force, the Pittsburgh Tuberculosis League, and the local dispensary of the State Board of Health, all working in conjunction with a special Tuberculosis Commission now in process of organization by the city government.
At present the consumptive poor of Pittsburgh have a small, practically a negligible chance of life. The great, rich, busy city that slowly kills them, has no means to care for them while they are dying. There is no municipal tuberculosis hospital. To be sure, Marshalsea, outside the city, can care for some thirty victims; but they are taken there, usually, only when they are too weak to resist effectually. For Marshalsea is the Poor House. And there is inbred in the American an indestructible, illogical, pathetically self-respecting something which makes the term "Poor House" a poison to his soul. Live he might, within those walls. He prefers to stay outside and die. The late Dr. Charles Harrington of the Massachusetts department, wisest and most human of health officials, said to me once in one of his characteristic bursts of impatience with the stupidity of Things as they Are:
"If I had the choice to make between naming a refuge for the helpless sick 'Poor-house' or 'Sure-Death,' I'd choose 'Sure-Death' every time. You could get more people to go to it."
Marshalsea doesn't save many of the consumptives who come to its gates. Non-consumptives it does save, indirectly, since it removes from a susceptible environment, a certain number of spreaders of infection. Private effort does its altruistic but minute best in Pittsburgh; the Tuberculosis League has a hospital in which it can take care of fifty to sixty patients. And the State Board of Health relieves the situation a little by maintaining one of its admirable tuberculosis dispensaries in the city, with a staff of visiting nurses; and sends a few hopeful cases to its sanatoriums. Perhaps 100 victims of the plague can be cared for in proper institutions. There are to-day in the city probably 3,000 sufferers in a sufficiently advanced stage to be a peril to all with whom they come into contact. At a very moderate estimate three-fifths of this number are unable to afford proper home care, and of this three-fifths (all of whom will die, barring the few that can be accommodated in the hospitals) probably one-third,—again my estimate is conservative,—could be saved under proper conditions. That is, Pittsburgh of the mighty mills, Pittsburgh of the heaped-up millions, Pittsburgh of the rampant industrialism which has spread its influence to the far corners of the world, stands by helpless while six hundred lives are going out needlessly, not because they might not be saved, but because there is no place in which to save them. Nor is this the worst; since, in the slow process of dying, these victims will radiate the poison to hundreds, directly; indirectly to thousands, who are now well, strong, and unsuspecting the inevitable doom. What can the Health Bureau, the officially constituted army of defence, do to remedy this condition? Nothing. That is the answer which goes over the telephone wires, once, twice, half a dozen times a day, to people who ask for advice for helpless cases of consumption. I suppose that the sorriest duty of a health official, is to deny the application of some man upon whose life depends the support of other lives, for a fighting chance to get well and do his work in the world. Ask Dr. Edwards, oh comfortable resident Pittsburgher, how often he has had to do the very thing in the last year. It may give you new light on your civic responsibilities.
Not so often will that hopeless response be made in the future. The united forces, drawn together by the forming Tuberculosis Commission, will make it their first business to provide some refuge of increasing adequacy, for those who are now distributing the infection. Meantime, though there is little to be done for those already stricken, the city is being covered, district by district, by the visiting nurses of the league, of the State Dispensary and of the Health Bureau, soon to be re-enforced by five special nurses from the commission, and all training and instructing the consumptive in those measures of prevention which safeguard the people about him from contracting the disease.
One-third of all who die in Pittsburgh, die without having anything to say about it. That is, they die under five years of age. One-fourth of all who die, die without having anything to say about anything. That is, they die under one year of age. Most of these deaths are preventable, being the outcome of conditions which, humanly speaking, have no right to exist. Chief among the causes is bad milk. Pittsburgh uses 40,000 gallons of milk per day, coming from a wide radius in both Pennsylvania and Ohio. Before the present administration, this vitally important merchandise received rather less attention than the corner-stand vending of collar buttons. At the beginning of 1906 the Bureau of Health had one lone milk inspector. He collected samples, and, if one may judge by the brief records of analyses, he didn't imperil his own health by over-assiduity in the job. Dairy inspection was an unthought-of phase of activity. In August, 1906, two more inspectors were acquired and began, by prosecutions, to do some work in the matter of discouraging the use of formaldehyde. There was even some inspection of stores and adjacent dairies. Now the bureau has six men in the milk division, two of whom are dairy inspectors and one a veterinarian, and all of whom do conscientiously the work the city pays them to do. Two more have been arranged for, with which addition Dr. Edwards believes he will have a sufficient force to inaugurate a higher standard of supply. Unfortunately there is no official standard, though an ordinance is being prepared establishing bacterial and temperature requirements. Unfortunately, too, the law has been interpreted to mean that the Bureau of Health must issue licenses on demand; and that it cannot revoke these licenses. What has been done thus far is chiefly in the line of educating the dairymen and dealers. Dr. Edwards admits frankly that, while he regards pasteurization as a make-shift only, he believes that it will be necessary for a time to accept the deteriorated quality of milk consequent upon pasteurization, for the sake of destroying the pathogenic bacteria with which the supply swarms. Analyses made last summer showed an average of a million bacteria per cubic centimetre. The limit of reasonable safety is usually set at half that number.
As for conditions as they existed at that time in certain local dairies, I can do no better than quote from the report of Dr. Goler, the health officer of Rochester and an international authority on milk supply:
Go out to one of those dairies near the country club which supplies milk to some of the families living in the best localities and see the conditions under which milk is produced for the future citizens of the state and the nation. A dirty one-room house that once did duty as an out-house, supplied with water by a hose, a few old tubs in which cans, bottles and utensils are washed in cold water, and where all the waste flows into a vault beneath the foundation of the house. A damp, dark, old stable festooned with cobwebs, without drainage, where all the liquid refuse finds its way through cracks in the floor to the space beneath the structure, and where, on filthy floors, in some cases raised but one poor plank above the common floor of the stable, the swill-fed cows stand and give milk for some of the babies of Pittsburgh aristocracy, whose parents are willing to pay the munificent sum of eight cents a quart for the product.
Visit cow stable after cow stable within easy motor ride from Pittsburgh, and the conditions of filthiness prevailing in the stables are only exceeded by the depth of manure and mud in the barnyards.