(50rncU Bnitijtaitg Slthrarg atltacEi. IStm ^ath ..l'n^.....\x..l-3wiA/... Cornell University Library RA 422.S72 1915 The new chivalry — health. 3 1924 012 503 847 Cornell University Library The original of tiiis book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924012503847 SAMUEL P. BROOKS. LL.D. president southern sociological congress Waco. Tex THE NEW CHIVALRY- HEALTH SOUTHERN SOCiaLOGICAL CONGRESS HOUSTON, TEXAS MAY 8-11, 1915 EDITED BY JAMES E. MCCULLOCH NASHVILLE, TENN. SOUTHERN SOCIOLOGICAL CONGRESS 1915 R 4^^543 COFYRIGEET, 1916, BY SOUTHERN SOCIOLOGICAL CONGRESS L.aiu«. ^.c^o^cjf c.^.^^.^- 'iiKxJi^!?:g^^"r"-«r-^- Press op Benson Printing Company Nashville, Tenn. MRS. ANNA RUSSELL COLE founder southern sociological congress Nashville, Tenn. INTRODUCTION At the meeting of the Executive Committee of the Southern Sociological Congress, held at Blue Ridge, N. C, in August, 1914, it was decided that the general theme for the program of the next Congress should be "The Conser- vation of Health." The Congress met in Houston, Tex., May 8-11, 1915. Seventy-one addresses were delivered on various aspects of the general theme. This entire volume, therefore, is devoted to "the conservation of health." The results of focalizing the attention of the Congress on one theme at a time were so satisfactory at Houston that the Congress adopted this policy for future conven- tions. The Congress also set for itself the definite and immediate task of conducting a crusade for health. This is to comprehend: First, a searching survey of facts and forces in our country bearing on health. Second, a clear translation and a full exposition of the abounding and astounding knowledge of disease conditions and health progress in the South and the nation. Third, a campaign o£ obligation and opportunity, civic, economic, and religious, for the conservation of health — physical, mental, and moral — ^to be continued throughout the year and to culminate in a great Health Congress in the spring of 1916. The work of the Congress will be done under the super- vision of six commissions: The Government and Health, the School and Health, the Medical Profession and Health, the Press and Health, Race Relations and Health, and the Church and Health. This volume will be used as a cam- paign handbook in a health crusade, Which is the supreme need of the hour in the Southern States. Nashville, Tenn., August 18, 1915. THE EDITOR. CONTENTS PAGE Portrait of Samuel P. Brooks, LL.Di, President of the Congress. Portrait of Mrs. Anna Russell Cole, Founder of the Congress. Introductory Note 3 I. Peeliminaky 9-26 A Creed and a Crusade ,. H The Battle Hymn (Sung at Houston to tune of "Tip- perary") 12 Address to the Churches 13 The President's Address 15 How Mexico and the United States Can Cooperate in the Prevention of Diseases 20 Prof Andres Osuna, Official Delegate of President Carranza, of Mexico II. The Cost of Preventable Disease 27-84 The Cost of Preventable Disease in the South 29 Oscar Dowling, M.D. The Financial Cost of Preventable Disease 41 Prof. A. Caswell Ellis, Ph.D. Distinct County Health Problems 46 William M. Brumby, M.D. The Price Paid by the South to Hookworm Disease 50 C. H. Brownlee, M.D. The Poor State and the Tuberculosis Problem 55 L. B. McBrayer, M.D. Why the Federal Government Should Establish Hos- pitals for Consumptives in the Southwest 60 Robert J. Newton Prevention of Tjrphoid Fever 65 R. H. Von Ezdorf, M.D. Prevention of Malaria 70 R. H. Von Ezdorf, M.D. A Neglected Problem in the^ Conservation of Health. ... "77 Prof. John M. Fletcher, Ph.D. III. Some Causes of III Health 85-149 The Causes of Society's Lack of Health 87 Hon. George Fames Barstow War as a Destroyer of Public Health 93 Arthur Deerin Call The Effects of Caffeine upon the Human Organism. . . 103 Harvey W. Wiley, M.D. The Relation of Alcoholism to Poverty and Crime 114 Edwin C. Dinwiddie 5 THE NEW CHIVALRY — HEALTH PAGE The Alcohol Question and Social Justice 124 Miss Cora Frances Stoddard Housing and Health 13V John Ihlder, Ph.D. IV. The Health of Mothers 151-164 The Conservation of the Health of Mothers, A Primary Responsibility of the State 153 Mrs. Minnie U. Rutherford Why the State and the Church Should Require Health Certificates before Marriage 159 Rabbi George Pox, Ph.D. V. The Health of Children 165-230 Prenatal Responsibility of Parents for Children 167 M. M. Carrick, M.D. The Influence of Prenatal Conditions on Infant Mortality 176 Prof. H. H. Hibbs, Jr., A.M. The Conservation of the Health of Children — ^A State Privilege and Asset 190 Mrs. C. A. Waterfield Safeguarding the Health of Boys 200 W. L. Clark The Treatment of Delinquent Boys 204 Prof. T. G. Kenney Treatment of the Delinquent Girl 209 Miss Ethel A. Claxton Health Teaching in Schools 216 Proif. F. B. Dresslar The Relation of the School to the Public Health 223 Prof. Robert Granville Caldwell, Ph.D. VI. Mental Hygiene 231-254 The Mental Laboratory in the Juvenile Court 233 Judge George F. Austin Mental Hygiene 244 Miss Laud Loeber, M.D; Mental Health Safeguarded by Physical Health 249 President Samuel P. Brooks, LL.D. VII. The Health of Criminals 255-296 Physical 111 Health as a Cause of Crime 257 Gilbert T. Stephenson Treatment or Punishment for the Prisoner 263 John S. Tilley The Old and New Attitude of the State toward Its Prisoners 274 J. H. Pratt, Ph.D., and W. S. Rankin, M.D. The Problem of Health in Connection with Prisons 290 Charles Richmond Henderson, Ph.D. CONTENTS 7 PAGE VIII. Means op Promoting Health 297-372 The Press and the Fight for National Health 299 George Waverly Briggs What Woman Suffrage Will Do toward the Conserva- tion of Public Health 307 Mrs. Helena HoUey, Ph.B. Onganized Play and Public Health 314 Rev. Henry A. Atkinson A Working Program for Rural Recreation 322 Warren Dunham Foster Public Amusements Safeguarded for Moral Health 327 Orrin G. Cocks Relation of Nutrition to Public Health 340 Miss Mary Gearing A Sociologist's Health Program for the Rural Com- munity 349 Prof. L. L. Bernard, Ph.D. The Value of State Laboratories of Hygiene 358 B. L. Arms, M.D. Insane Asylums as Destroyers and Restorers of Health. 364 Prof. C. S. Yoakum, Ph.D. IX. The Health of Negroes 373-446 Is the Negro Dying Out? Who Cares? 375 W. D. Weatherford, Ph.D. Causes of Unusual Mortality among Negroes 385 B. F. Riley, D.D. The Negro Woman and the Health Problem 392 C. V. Roman, A.M., M.D. City Housing of Negroes in Relation to Health 405 Prof. J. W. Gilbert The South and the Health of Negroes 412 Prof. Monroe N. Work Recreation as Related to the Health of Negroes in Rural Communities 421 J. A. Booker, D.D. Health Problems of the Negro Church 427 L. K. Williams, D.D. Health the Basis of Racial Prosperity 436 E. R. Wright, Ph.D. X, The Church and the Conservation of Health 447-521 Health — The New Attitude, the New Knowledge, the New Responsibility 449 Dean J. L. Kesler, D.D. Modem Miracles of the Church in Health Conservation. 460 Samuel Zane Batten, D.D. The Challenge to the Church to Keep Children Out of Heaven 476 Rev. C. A. Waterfield 5 THE NEW CHIVALRY — HEALTH PAGE The Primary Function of the Church — To Save Life 489 Prof. John C. Granbery, Ph.D. Physical Health Championed by the Church 494 Dean J. L. Kesler, D.D. The Program of the Church as the Conserver of Social Health 503 Prof. Henry Beach Carre, Ph.D. War on Disease — ^A Worthy Objective for a Religious Crusade 510 Charles S. Macfarland, Ph.D. XI. Organization 523 Constitution and By-Laws of the Congress 525 Officers and Committees 528 Houston Plan 536 The Social Program of the Congress 537 Resolutions on National Department of Health 538 Membership List ■ 539 Index to Speakers, Writers, and Officers 552 Index to Subjects 554 I. PRELIMINARY A Creed and a Crusade The Congress Battle Hymn (Sung at Houston to the tune of "Tipperary") The Address to the Churches The President's Address How Mexico and the United States Can Co-operate in the Prevention of Diseases A CREED AND A CRUSADE We Believe: 1. That God, our Father, is the Giver of All Life, 2. That health is life as it ought to be. 3. That health is the basis of prosperity and happi- ness, and therefore our first duty both individually and socially. 4. That fifty per cent of the deaths in our country are preventable, and that ninety per cent of com- municable diseases should be prevented. 5. That the essential and first work of the medical profession is the conservation, not the correction, of health; and that the physician should be paid for preventing disease, rather than for curing it. 6. That the Federal Government should establish a Co-ordinate Cabinet Department of Health. 7. That the death of children is a defeat of God's purpose, and their health — ^physical, mental, and moral — should be a primary function and responsi- bility of the Church. 8. That the school should conduct all its work on the basis of health first. 9. That the press can render at the present time no greater service to the nation than to champion the cause of public health. 10. That the time has come for a nation-wide crusade for health. And We Call On the people of the South to co-operate, through the agencies of home and school, medical profession and press, church and government, for the achieve- ment of health for the individual, for the community, and for the nation. CONGRESS BATTLE HYMN IT'S A HARD FIGHT TO SAVE THE CHILDREN (Sung at Houston to the tune of "Tipperary") Through our sunny Southern land there spreads encircling gloom, Leaving anxious sorrow in the heart of every home, For the silent fiend Disease is stalking o'er the land To smite the little children with his deadly poison hand. CHORUS It's a hard fight to save the children ; It's a hard fight, we know. It's a hard fight to save the children, But the fiend Disease must go. Come, men, for hearth and homeland, play up, do your share ! It's a hard, hard fight to save the children ; But the Old South's right there! Hail ye, doctor captains, on your far-tflung fever line; And ye preacher pickets, brave with love of life divine ; Rouse, ye sons of Lee and Lincoln, heed the will of God, Who never meant a darling child to sleep beneath the sod. Should this smiling playground of the nation's children dear Frown with tiny orphaned graves that make the mothers fear? Hark, men ! a million children's bitter wail of woe ; For this is God's clear chorus call : "The fiend Disease must go!" ADDRESS TO THE CHURCHES The Southern Sociological Congress, assembled in its fourth annual session at Houston, Tex., made up of dele- gates from every Southern State and of guests and workers from many Northern States, and from Canada, Mexico, and Guatemala, begs leave in the sympathy of a common impulse and obligation to send greetings both grateful and hopeful to all the Churches. The members of the Southern Sociological Congress are members of the Churches, and it is mainly through the Churches that they have received their social impulse and training. A hundred years before modern fraternal and humani- tarian organizations had recognized their obligation to pro- vide against physical ills the Churches had set what is, and will remain, the sublimest of all examples of brotherhood and social service in their missionary undertakings at home and abroad — undertakings in which sanitarium, hospital, orphanage, and other social institutions are and have been an integral element. Such a mission has the sanction and even the command of both the Old and the New Testament. The protection and recovery of human health filled a large place in the Mosaic legislation, and were a distinguishing phase of the work and teaching of Jesus. To the continuation of his own healing ministry Jesus committed his disciples and follow- ers; he even announced that the simplest service to the physical needs of others would be accounted as rendered to him : "Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me." In the assurance, therefore, of the cordial sympathy of all the Churches, the Southern Sociological Congress brings to their consideration the public health campaign upon which, for the year now beginning, its endeavors are to be concentrated. As the task of the Churches is larger than any program of social service, so the task of the Congress is larger than that of public health. The Congress will not 14 THE NEW CHIVALRY — HEALTH forget its wider obligations, nor would it have the Churches turn aside from theirs; yet it has determined for the time to focalize its energies in an active health crusade. Our purpose is: 1. To fight disease, to reduce the use of the drugs which destroy individual health, and to set up barriers against the plagues which spread through the social body, 2. To create a public conscience in regard to health where it does not exist, and to quicken and enlighten it where it does exist. 3. To rally everywhere moral purpose and intelligence to the support of local and national health agencies. 4. By means of a quick, decisive, and continuous cam- paign, to establish effectively and permanently in the public mind the sanctity and obligation of personal health, and, in the social structure, to promote and strengthen efficient agencies for healing and for preventing disease. We believe that the Churches will recognize such a cam- paign as an opportunity and that, in public utterances, in teaching services with constructive programs, and in coope- rating with local hygienic surveys, and in direct ministries of healing, they will bring to bear, with especial emphasis during the coming year, their unparalleled influence upon this sphere of human brotherhood in which they have already long operated. Signed by the Committee : Dean J. L. Kesler, Chairman; Rev. C. a. Waterfield, Secretary; Rabbi Henry Barnstein, Rev. Peter Gray Sears, Mrs. Anna Russell Cole, Dr. W. D. Weatherford, Dr. Samuel Z. Batten, Dr. Samuel P. Brooks, Dr. W. L. Poteat, Mr. J. E. McCulloch. THE PRESIDENT'S ADDRESS EX-GOV. WILLIAM HODGES MANN, RICHMOND, VA.* While the six great topics before this Congress are Public Health, Moral Health, Health of Children, Mental Health, Health and Race Relations, and the Church as the Conserver of Social Health, they are so subdivided and present themselves from so many standpoints and angles that to attempt to deal with them all in a paper of ordinary length would be both impossible and unprofitable. Indeed we have been dealing with these and kindred subjects during the life of our organization in such a manner that a public sentiment has been created and the time has now arrived when, if we wish to be practical, this sentiment must be crystallized into action. I am intensely desirous by some action or suggestion of mine to have a part, however humble, in the results which, I am sure, sooner or later will be accomplished by this organization of men and women whose interests and efforts are constrained by love for God and humanity. Conscious of my inability to deal with more than a single subject, and profoundly convinced that even within this limit I shall be groping and feeling my way as one in the dark looking for guidance and light, I am nevertheless impelled by the very great importance of the subject and the necessity of a start being made by some one to take up the subject of tuberculosis, from the standpoint of organized society, and to venture some crude and tentative suggestions as to how it shall be dealt with. The investigation I have been able to make has con- vinced me that in the States represented in this Congress there are certainly from one hundred thousand to one hundred and fifty thousand people suffering with tuber- culosis, consciously or unconsciously. I say "unconsciously" because the first symptoms impress the victim that he is a sufferer from cold, which he regards as of little importance, ♦Unavoidable • circumstances prevented Governor Mann from attending the Congress. His address was read by title. 16 THE NEW CHIVALRY — HEALTH and from which he expects to recover as a matter of course, even without the use of remedies. His symptoms, however, become more and more aggravated until, in order to get rid of the inconvenience (it can hardly be called suffering) , he commences to use simple remedies; or perhaps he consults a physician, who, being no more impressed than the patient, without examination prescribes a remedy for cold; and so the patient drifts through the stages of incipient and curable into confirmed tuberculosis. In the meantime he has kissed his wife and children, has used in common with them the glasses and china of the family, and has become without knowing it the disseminator of a dreadful disease. It may be, however, that he suspected the gravity of his symptoms; but as he was a working man and poor and all of his energies and resources were required to take care of himself and his family, he was unable to consult a physician, and so went from bad to worse, until he has become hope- lessly diseased, unable to work, and can only wait for death to end his sufferings. There are many other ways by which the disease may be contracted; but in whatever way it finds lodgment and proceeds to development, it is safe to say that of the deaths from all diseases one in every seven or eight is from tuber- culosis, and that a very large number of our people, say from eight to ten thousand to the million, are suffering from this disease, and that not more than one-half of this number, at a liberal estimate, are able to provide segre- gation and treatment for themselves and to take the precautions recognized as necessary to prevent the spread of the disease. To emphasize these facts suppose we take a State having two million inhabitants with twenty thousand consumptives and a revenue of from six to eight million. The Legisla- ture is composed of earnest, level-headed, patriotic men from all sections of the State. The lawmaking and appro- priating body finds itself confronted with many problems — the government must be effectively conducted, the children educated, and hospitals for the insane maintained. These are primary duties. Then it is infdrmed by its Board of THE PRESIDENT'S ADDRESS 17 Charity and Correction that there are thousands of defect- ives who increase so fast that already, I venture to say, they have become a menace in almost every State in the Union, The State is unable to segregate, unwilling to adopt cruel remedies, its taxes are already burdensome, and its revenues will not permit the adoption of those methods suggested alike by science and common sense. Being unable to adopt efficient measures, the Legislature practically does nothing with defectives ; and although convinced of the wisdom and necessity for action pursues the same course with tuber- culosis, except perhaps some inadequate provision is made which, while it may go to the limit of the States' resources, reaches very few of its citizens, and only serves to prove that vigorous and adequate action would at once lessen and eventually destroy the disease more fatal to human life than all the wars that were ever waged. Up to this time I have pointed out difficulties and made general suggestions, but have not specifically pointed out any steps within the power of the State which should be taken, and promptly taken, to meet an enemy constantly receiving reinforcements without the necessity of sending for them. If my information is correct, 6nly a few of the States represented in this Congress have Boards of Charities and Correction. They should be organized in every State and should be composed of the very best and wisest men in the State. They should be absolutely free from political influence, should have ample and varied powers, should be required to look out for and report to the State Medical Board all cases of tuberculosis and other contagious diseases in any jail, reformatory, almshouse, or other institutions visited and inspected by the said board and should be supported by liberal appropriations. In many, if not all, of the States there are Boards of Health, with local boards in every county and city which should be used as effective agencies for the prevention and cure of tuberculosis. The State boards should be composed of skilled physicians of high character and they should have large powers and financial support, and have control of all 18 THE NEW CHIVALRY — HEALTH the local boards. The State board should see to it that the chief health officer of every city and county should be competent, with the aid of the State board when required, to determine by examination the presence of tuberculosis in its incipient state, and should be required at stated times and places, and especially at public gatherings, to make examination of all persons applying or who he had reason to suspect had tuberculosis. And the iState whose economic prosperity is diminished by the disabling and destroying power of the disease should pay fair fees for these exami- nations. In addition, every public school teacher and county and city officer should be furnished with circulars compiled and printed by the State Boards of Health, stating in plain terms the symptoms of tuberculosis and the danger of delay in treating it, and one of these circulars should be sent by the teachers and officers above mentioned to every person suspected of having the disease. Whenever the examination of a health officer disclosed tuberculosis, the patient should be instructed, by printed and oral directions, what to do for his cure and to prevent a spread of the disease. Whenever possible he should be segregated and cared for by his city or county, and, if able, should be required to pay the actual cost of his treatment. I have pointed out what may be done in every State represented in this Congress under conditions that now exist; certainly this is true so far as my information goes. Now I venture to suggest a method by which segregation may be enforced and medical attention furnished. I fully appreciate the expense which must attend even the simplest effective arrangements for the comfort of tuberculosis patients. I cannot even suggest that any but skilled physi- cians shall be in charge, and skill makes demands and should receive reasonable compensation. Our troubles, however, may be solved by cooperation. Cities and counties must come together and by distributing the work lighten the burden, if it can be called a burden, to extend comfort and health to our suffering citizens. The object in view might be effected by the establish- ment of sanitariums in every congressional district, pro- THE PRESIDENT'S ADDRESS 19 viding separate accommodation for colored people. These sanitariums for purposes of health, and for economic reasons, should be located on large tracts of land, which should be convenient to transportation and be under the management of skilled farmers. Labor should be furnished by prisoners in the county and city jails of the district to be worked under guards, provided and paid by the State, and such of the patients as might be able should have the opportunity of doing such light work as would contribute to his happiness and recovery. It is believed that at least one-half of the patients going to these sanitariums would be able to pay actual cost of treatment. The expense of those unable to pay should be borne by the cities and counties from which they come. By thus collecting the patients into a congressional insti- tution, skilled physicians and nurses could be employed, fixed charges lessened, and scientific methods adopted and maintained. This plan for the segregation and care of consumptives would not be very expensive — indeed, if properly managed, it might be almost, if not quite, self-supporting. The city of Washington has for some years on a farm in Virginia taken care of its criminals and made a considerable yearly profit. It has so managed that very few guards are required, and while making an income from the work of its criminals the methods pursued have contributed to their physical and moral uplift. Similar experiments have been made in several States for the care of defectives. Farms have been purchased; but instead of using the labor of jail prisoners, the inmates, or such of them as have sufficient intelligence, are required to do the work. These experi- ments have proved successful. The inmates of institutions or farms have either entirely supported them or the expense of maintenance has been greatly reduced. In every case the farms have greatly increased in value. Later on, if the plan for the cure of persons suffering from tuberculosis shall prove successful, it may be extended and the example of other States followed for the segregation and support of defectives. 20 THE NEW CHIVALRY — HEALTH I have not gone into details, because the limits applicable to this paper will not permit me to do so; but I believe the plan feasible, and, if it is, a solution has been found for a problem which many good men have carried close to their hearts for years and may start a crusade which will result in freeing our people from a disease that destroys hope and aspirations and each year exacts a toll of hundreds of thou- sands, averaging, as before stated, one in every seven or eight deaths from every other disease. Let us consider and discuss this plan and if feasible, or if it can be made so, let us put behind it the united intellect, efforts, and influence of the Southern Sociological Congress, and by the appointment of legislative committees and otherwise endeavor to secure its adoption in every State in our jurisdiction. HOW MEXICO AND THE UNITED STATES CAN COOPERATE IN THE PREVENTION OE DISEASES PROF. ANDRES OSUNA, REPRESENTATIVE OP MEXICO, APPOINTED BY GEN. VENUSTIANO CAERANZA IN BEHALF OF THE CONSTITUTIONAL GOVERNMENT It is a very difficult problem for any one man to present an adequate study of this subject, and especially for one who has had no opportunity to undertake special investi- gations about it. But I will endeavor to offer a few sugges- tions that may induce others to pursue a thorough study of the problem so as to formulate a complete plan of cooperation between the neighboring nations of the United States and Mexico. The first point that I consider important is the culti- vation of the spirit of cooperation between the two repub- lics. This does not mean that there has been no cooperation in the past, for every one familiar with American history CO-OPERATION IN THE PREVENTION OP DISEASES 21 knows that Mexico has always tried to cooperate with the United States in everything that may bring better under- standing and that may promote common interests. Even the question of common health has been discussed and studied by representatives of both nations on different occasions. I believe that the cultivation of this spirit of cooperation is always a vital issue, and ought to be con- sidered in a congress like this, whose great ideals are the improvement of social, civic, and economic conditions. The Mexican people have always been ready to respond to any movement which means cooperation for mutual benefit. Even in international affairs it is the common belief of my people that the United States and 'Mexico ought to cooperate with the other American nations for our mutual protection and defense. The present gigantic war in Europe is a warning so that we may see that it is not out of the question to come to a practical understanding in regard to a modern Monroe doctrine by which all the American nations may consider as a common cause the preservation of the whole American continent and the protection of the territorial integrity, independence, and all other rights of each one of the American nations. There are many common interests and there are common ideals and institutions all through the continent, so that we may work together, not only to coordinate our common defense, but to promote the political, economical, and social conditions of all of them. This is important in a general way of the whole continent, but it is more so in dealing with two nations which lie side by side, and which are only divided by an imaginary line. There are many thousands of Mexican people living in the territory of the United States and there are American citizens living in Mexico, even in the present disturbed and unsettled conditions of that country. We have been learning more and more every day of how many things there are which affect both nations in common, and which demand harmonious action to promote the common welfare. But if in dealing with the subject of cooperation in diplomatic affairs there are problems difficult of solution, it is not so in dealing with the problem of public health, for we do not 22 THE NEW CHIVALRY — HEALTH consider that there are any obstacles which may not be removed in order to secure the protection of life on both sides of the Rio Grande. We are coming closer together every day, and a constant endeavor to cultivate better friendship and better understanding between ourselves will undoubtedly produce many practical means of cooperation in the prevention of diseases, which is the special topic of my address. We can secure a fundamental basis of cooperation by waging a vigorous campaign in behalf of public education in both countries, especially in the border States. It may seem strange that I should talk of cooperation with the United States in a campaign in behalf of education; for though everybody agrees that it is a very much needed thing in Mexico, the majority of the people think that the work is thoroughly done in the United States. But I think that there is still something to do in the way of education, in some of the Southern States of the American Union at least. I know that there are in the State of Texas alone more than fifty thousand Mexican children of school age who are not provided with the facilities of a common education. Even if some of these children belong to the refugees who have come from Mexico during the last four years, nearly the whole of that number belong to perma- nent residents of the United States. Therefore, I am justified in advocating a more vigorous campaign in behalf of the education of all children of school age on both sides of the international line. The best way to secure the cooperation of the people in a campaign for the prevention of disease is to spread the benefits of a common education so that everybody may understand at least the elementary laws of individual and public health. A man who has no conception of the mechanism of life and of the laws of growth and health cannot cooperate willingly and fully in the preservation of public health. A man who cannot even read the posters or pamphlets distributed with the object of directing the public mind in regard to the essentials of sanitation cannot be a positive factor in the great work of social improvement. It may seem out of the question to CO-OPERATION IN THE PREVENTION OP DISEASES 23 talk of cooperation in behalf of Mexico when the commoi; opinion is that very little has been done there in the line of education. Undoubtedly, much is there to be done in this important subject, but we have already begun the task. One of the Mexican border States succeeded in the first decade of this century in increasing the number of its public schools from 96 to 251; its army of teachers from 215 to 563 ; the enrollment of its schools was also increased from 11,372 to 28,533 (which is about 151%), and the expenditure of the different towns of the State for the support of the common schools was also increased from $103,000 to $386,000, which means no less than 274%. Is not that enough for the beginning of a campaign in behalf of education? There is a great deal to be done, to be sure; but I can assure you that the greatest ambition of the Mexican people is to see that within the next twenty years there should be not a single person in the whole country who cannot read and write and who has not enjoyed the benefits of a common school education. Therefore, we can talk on cooperation on this great and important subject. We are determined to undertake a great educational cam- paign through the country. We are looking for the good will and the cooperation of our distinguished neighbors of the North and of our neighbors of the South. We are seeking to establish the foundation of public health on a cultivated and educated community which may understand her local and general problems and may contribute to their proper solution. Mexico and the United States can cooperate in the prevention of diseases by working together in a common plan to undertake a real crusade in behalf of the conser- vation of health. This can be done in various ways, among which are the following: A systematic instruction in the public schools of both countries, especially in the schools of the border States. Such instruetion may consist not only in training given to children of the various grades, but also of special talks and lectures to all children, inducing them to avoid the spread of specific diseases. Parents' meetings could also be called 24 THE NEW CHIVALRY — HEALTH to discuss the same problems of the prevention of disease. Pictures and illustrations could be used very effectively on the walls of the schoolrooms so as to incite practical ideas of sanitation in private residences and in public places. In connection with this last topic special work could be done to secure the betterment of the home life with regard to sanitation. The school could be used also as a means to distribute appropriate popular literature and to induce the parents of the children to pay more attention to health aiid sanitation. The work could also be secured through the systematic preparation and distribution of popular literature. The boards of public health in nearly all of the States of the American Union are very active in preparing leaflets and pamphlets for free distribution. This work ought to be encouraged and new ones recommended so that special studies may be prepared in popular language for public distribution. A close cooperation could be secured in the border States in which these publications are to be pub- lished in Spanish for distribution among the Spanish- speaking residents. The boards of public health of the neighboring States on both sides of the international line could come to an understanding by which cooperation could be secured in this important part of the campaign. It may also be possible to make arrangements to deliver popular lectures for the Spanish-speaking' people in the United States and also in the northern part of Mexico. These lectures may be delivered by specialists and should be illustrated with charts, drawings, lantern slides, and in any other possible way so that they may appeal to the people, even if they are not accustomed to listening to lectures of this kind. It is even possible that the boards of public health on both sides of the international line may provide for a course of popular instruction by means of moving pictures. I do not see why we could not use the picture show to spread the knowledge of the laws of health, and to show the better way of living and the best methods Of preventing diseases. The subject is new so far as my knowledge goes ; but if worked systematically it may prove CO-OPEEATION IN THE PREVENTION OF DISEASES 25 a very effective means of popular education in behalf of public health. Finally, cooperation may be secured to establish similar summer courses for teachers on both sides of the inter- national line with the special object of giving instruction on individual and public health, taking up the various subjects which may help the teachers to impart a thorough training to their pupils with reference to the preservation and improvement of life. There may also be frequent joint meetings of the boards of health of the border States of both sides of the inter- national line for special study and consultation on common problems in regard to public health. These meetings will promote not only the special research and investigation of important subjects, but will also afford an opportunity for the officers of the boards to become personally acquainted with each other and to be better prepared to cooperate in ordinary work intrusted to them and on special cases of emergency. I would also suggest that these boards of health may take joint action to improve the sanitary conditions of some of the neighboring border towns and other places which may require improvement. Of course, some of this work has already been done, but that is not a sufficient reason why we should not encourage a more systematic cooperation in this important work. We would also recommend the continuance of the practice of common action in handling any plague that may appear at any place in the border States. I am sure that the Mexican officials will always be ready to do their part, and no one doubts that the members of the boards of health in the United States will continue to do theirs, so that the cases may be handled promptly and vigorously and in that way secure the immediate extermination of any contagious or infectious disease that may threaten the common well-being. It is possible that there is still room for better coopera- tion in the use of the products of original researches and investigations in case of new diseases or of new discovery applied to the old ones. Any discovery on this line should 26 THE NEW CHIVALRY — HEALTH be made public property, and both nations ought to see that the public enjoy its benefits on both sides of the interna- tional line. Cooperation is of material importance in this case, and I am sure that the Mexican people will always be ready to do their part. There could also be a certain amount of cooperation in securing the services of specialists to work for the benefit of sectional communities on both sides of the international line. There is no reason why, in dealing with the problems of public health which so directly affect the highest interests of humanity, two neighboring nations may not work together to eradicate common diseases and to protect human life in both countries. International committees could also be appointed to undertake such studies and to recommend common measures to be applied on both sides of the inter- national line. Finally, the friendly and generous attitude of the General Secretary and other officers of the Southern Sociological Congress are worthy of praise in their endeavor to bring together representatives of their Southern neighbors to take part in the sessions and deliberations of this important gathering of distinguished men of the country. I do not hesitate to express my personal conviction that this great organization may be made a permanent source of coopera- tion between the people of Mexico and the people of the United States in this important subject of public health, and in many others which directly bear on important social questions. II. THE COST OF PREVENTABLE DISEASE The Cost of Preventable Disease in the South The Financial Cost of Preventable Disease Distinct County Health Problems The Price Paid by the South to the Hookworm Disease The Poor State and the Tuberculosis Problem Why the Federal Government Should Establish Hos- pitals for Consumptives in the Southwest Prevention of Typhoid Fever Prevention of Malaria A Neglected Problem in the Conservation of Human Life THE COST OF PREVENTABLE DISEASE IN THE SOUTH OSCAR BOWLING, M.D., PRESIDENT LOUISIANA STATE BOARD OF HEALTH, NEW ORLEANS, LA. Disease, preventable disease, is the nation's greatest jiability, its greatest burden. Each family, each individual pays, directly or indirectly; it may be directly in dollars and cents, or it may be in that which is far more precious — ^health and comfort, perhaps in life itself. Six hundred thousand people, in this country, every twelve months die of preventable deaths — six hundred thousand who might have been saved. About one-third of these are our own; one-third of the money loss is our loss. We pride ourselves on our business sense, our modern methods, our efficiency. In the business of amassing for- tunes, it is conceded that we lead the world, but in the business of prevention of the disease-curse we are laggards. The discussion of this topic places one between the horns of what may be termed a sanitation dilemma. To present the situation intelligently, figures exact and comprehensive are needed, yet these are not at hand ; to convince the skep- tical, the ignorant, the thoughtless, clear and cogent argu- ment is imperative, but the fundamentals of this, statistics, are lacking. However, the obligation to speak the truth, as one knows it, obtains, and I consider it a very great priv- ilege to raise my voice in the promulgation of the doctrine of prevention. Our only resource in this argument is indirect proof — figures gathered by States farther along the highway of hygienic progress and whose citizens are more thrifty of real values and more economic-minded than we. These statistics, since people are the same in all ages and states, can be applied with reasonable assurance that the conclu- sions will be correct. A word as to why we must depend upon others for this help will be in order. In the South, until very recently, the 30 THE NEW CHIVALRY — HEALTH field of health activities lay fallow. An explanation would lead us far afield, but, briefly, lack of statistics in this section is historically consistent. Natural resources and climate predetermine the vocation, and that in turn prede- termines the form and spirit of the institutional life. Before the days of sixty-one there were few if any health boards or ofiicers, except in the coast cities, where it was often thought necessary to quarantine against yellow fever or cholera. Each plantation was in itself a community, sepa- rate and distinct; each planter, if he chose, was legislator, executive, judge, and perhaps a court of last appeal for those who lived under his guardianship. The regulations governing this unit could be as different from those of the adjoining plantations as the owner pleased to make them. Rules of sanitation and hygiene — health rules — if any, were simply those which appealed to the "master" as humane or economic. The standard of carelessness or cleanliness, of insanitary shiftlessness or sanitary excellence, was the standard of the individual. A sense of reciprocal obligation, of social oneness had not developed. At that time here, as elsewhere, the idea of community responsibility did not exist even in the subconscious mind of the average man or woman. In the bitter and turbulent days of readjustment, and for many years after, thought and legislation were centered in an effort to keep intact inherited social ideals and a standard of racial segregation and purity. Lack of knowledge of the causation and mode of trans- mission of disease was equally a potent factor in the slow evolution of a health conscience and the notion of health rights. Preventive medicine is one of the most recent, possibly the most beneficent, of all the achievements of science. Back a quarter of a century it seemed to spring full-grown from the brain of the scientist, but in truth it was the "long result of time." From age to age knowledge of the physical man and his environment had grown by degrees until many relations of these two factors were clear. Forty years ago the physician and the layman alike were ignorant of many simple facts of hygiene which to-day COST OP PREVENTABLE DISEASE IN THE SOUTH 31 every school child knows, or should know. Thirty years ago we were groping in the mists of uncertainty as to prevention of malaria, yellow fever, diphtheria, and plague, just as we are now in reference to pellagra and cancer. With no science of sanitation, no science of prevention, no idea of the community value of birth, mortality, and morbidity statistics, there could be no effort at their collec- tion, even if the governmental machinery for this purpose had been available. The traditional attitude toward sickness is everywhere apparent. "Bad colds" are accepted as inevitable, likewise "spring fever;" adults must have "spells" every now and then, while children must — if they can — ^live through a series of illnesses. No matter what doctors preach, "a man will die when his time comes." There are many otherwise intelligent people who have in this fatalistic sickness creed a steadfast faith. The more thoughtful ask in all seriousness, "Are any diseases really preventable?" The scientist, with his micro- scope and his records of experiments, gives an unhesitating reply, "Six, at least." The bite of the infected flea gives bubonic plague; the tiny organism which is the causative agent of typhoid fever is known ; its habitat and its action on the human body have been demonstrated. But there are two parties to the contract of elimination of communicable diseases — ^the medical officer and the public. The scientist and the medical executive are positive, the public is negative. The health officer says there are means, but the public, unconvinced, balks at the expense involved. The result is logical. Government records of 1913 give the number of cases of some reportable diseases in several States of the registration area. I have selected four South- ern States (Alabama, Maryland, South Carolina, Virginia) , in two of which the number of deaths is not given, and in one the record shows that not all cases of tuberculosis were reported. The numbers are: typhoid fever (in the four) cases, 11,124; deaths, in two, 871; tuberculosis, 9,284; deaths, in two, 3,131 ; smallpox cases, 3,237. 32 THE NEW CHIVALRY — HEALTH Dr. L. I. Dublin in a recent article gives as a minimal estimate the death rate (1914 in Continental United States) from typhoid fever as 20 per 100,000, with the number of cases 198,000 and deaths 19,807. The February (1915) report of one Southern State shows 445 cases of malaria (Virginia Public Health Report, April 2, 1915) . Dr. Wilbur gives as an estimate of deaths from tuberculosis in one year in the United States 191,000 ; in one city of our own section in January, 1915, there were from tuberculosis 106 deaths, in February 107, in March 93. I have quoted advisedly statistics relating to only three diseases: typhoid fever, tuberculosis, and smallpox. Two of these, typhoid and tuberculosis, among the clearly pre- ventable maladies, are our greatest foes. A recent govern- ment report says, "Typhoid fever continues to be prevalent almost to the extent that it may be termed a national dis- ease," while in the same issue the report states : "Tubercu- losis exacts the greatest toll in human lives." I have included smallpox because it is a disgrace to any community to have even a slight epidemic of this disease. In my own State this winter we have had a large number of cases of a mild type, the result of carelessness pure and simple. We have in the South, because of the negro, a more complex problem in the control of communicable diseases than exists elsewhere; and while I do not wish to weary you with figures, I think this point too important to be omitted. The first pamphlet on negroes in our statistical history was published March 20 by Mr. William J. Harris, Director of the Census. One of the tables shows that deaths among them from malaria, tuberculosis of the lungs, other forms of tuberculosis, pneumonia, and whooping coUgh are relatively greater among whites. In thirty-one cities of the South the lowest death rate per 1,000 given is 21.5 (San Antonio), highest 39.3 (Charleston), the average being 27.9. This is clearly not alone a question of concern to the negro ; it is of equal moment to the white man, and especially in portions of the South where negroes are in the excess in population. COST OF PREVENTABLE DISEASE IN THE SOUTH 33 These facts, few but convincing, imply that if the disease enemies to human happiness can be routed we are indeed careless. That some can be controlled, even eradicated, is a matter of record. In England in the eighteenth century smallpox was more prevalent than tuberculosis is to-day. Rigid enforcement of the vaccination law there and in several continental countries has almost eliminated this loathsome scourge. In the German Empire, where for a century sanitary reforms have been in progress, the typhoid rate between 1901 and 1905 was 7.6. By contrast in this country, for the same period, it was four times as great, being 32.2. In Pennsyl- vania, where the health budget item is over two million dollars, there was a decrease, during the year 1911 as com- pared with 1910, in the total number of communicable dis- eases of 19.016 ; typhoid decreased in number of cases 2,032, while the death rate per 100,000 declined from 24.6 to 21.9 in 1911. In tuberculosis, again, figures from across the water are pertinent and encouraging. For a number of years in London, the Island, and in Wales, parliamentary commis- sions have been investigating insanitary working conditions. Reforms in London in housing have been made. As a result the consumption rate in these places has been falling faster than in the cities of the United States, with possibly one exception, and London has a lower death rate than Chicago or Los Angeles. Doctor Evans says: "A study of the figures of this country and abroad and a knowledge of the work show that the diminution in the disease is proportionate to the effort made to control it." In England the figures per 10,000 inhabitants are as follows: In 1891, the rate was 15.99; in 1901, 12.64; in 1909, 10.93. One encouraging feature showing in Mr. Harris's recent report is decrease in the death rate of the negroes in the decade between 1900 and 1910, this decrease being 3.9 per 1,000. In American cities the typhoid death rate, which is typical of sanitary progress or negligence, has declined 3 34 THE NEW CHIVALRY — HEALTH from 51 per 100,000 population, during the decade ending with 1892, and 25 in the ten years ending with 1912. The tuberculosis death rate also has decreased from 318 per 100,000 to 182, while the smallpox rate has fallen to about one-tenth (0.3) of what it was between 1900 and 1905. The statistics above represent conditions in States and cities of the registration area. If your State or mine is not on the honor roll, we do not know the specific number of cases of any communicable disease for any one year ; but we do know that if Alabama, with a population of 2,500,000 (about) , has 1,303 cases of typhoid with 565 deaths, propor- tionately, according to population, we have the same number; if Maryland has a fatality rate of 34 per 100 of tuberculosis, we may be sure that in nearly every State in the South the rate will be relatively the same. If the negro death rate in Atlanta is 25.4, Charleston 39.3, SaVannah 34.1, Memphis 28.3, and Lynchburg 24.3, the rate in your city will not be far above or below, unless conditions are strikingly dissimilar. Any estimates concerning the cost of these preventable diseases based on figures given above will be approximately correct for our own localities. According to the figures of the latest report of Minne- sota, during the past six years tuberculosis and typhoid alone cost the State the enormous sum of $88,524,000. Typhoid was placed at $21,958,000. These figures were reproduced by the Journal of the American Medical Association, with the comment: "In making this estimate the following economic values were used in computing the financial loss from deaths : professional, business men and farmers, $500 ; skilled laborers, $300; unskilled laborers and domestics, $200; married women, $200; children under 15 years of age, $100. In the opinion of the Journal these valuations are conservative and represent the minimum rather than the maximum loss." In one city of the South in 1914 there were 1,087 deaths from tuberculosis in all forms. If only one-fourth of these were wage-earners, according to the Minnesota estimate, COST OP PREVENTABLE DISEASE IN THE SOUTH 35 the loss to the community in dollars and cents which would have been earned, was $81,300. In the same city in 1914 there were 78 deaths from typhoid fever; for every death the conceded estimate of additional cases is 10; therefore, in that community there were 780 cases besides the 78 deaths. Further, 31 deaths additional may be counted — within three years — caused by after effects of this disease. The loss from the death of these wage-earners comes up to thousands. In Virginia, where since 1908-09 definite work in the control of typhoid fever has been in progress, it is estimated by the commissioner that the average cost of each case of typhoid illness (including loss of wages for 8 weeks) is $150. At this figure in five years the total loss in Virginia on this account is $3,280,950. The proportion of deaths from this disease may be had for your own city or State by taking the figures 20 per 100,000 (Dr. L. I. Dublin, Statis- tician of the Metropolitan Life Insurance Co., in a paper before the American Public Health Association, Jackson- ville) and the cost by using the Minnesota average wage Value, which for the six classes averages $250. Investigations in Louisiana by the Department of Agri- culture in 1914 furnish a concrete example of the loss in one community from malaria. An intensive study was made of one plantation where malaria is prevalent. A typical spot was selected, where the ground was rich and productive and other diseases not endemic — little, if any, pellagra, hook- worm disease, or typhoid. This plantation comprises 3,500 acres — 1,191 cultivated, 1,700 swamp, and 600 pasture. Two hundred ninety-nine persons made up the 74 negro families of the plantation. Of these, in one season, 48 families were treated for malaria. The total loss of family time by all workers was equal to that of 625.5 adults' full working days. It was estimated after careful inquiry that the loss of time in cases which were of a mild type, treated at home, equaled the loss of 250.75 adults' full working days. The loss occasioned by adults attending the sick equaled 235.5 adults' working days. The total time lost of 36 THE NEW CHIVALRY — HEALTH the 74 families equaled 1,111.75 days of an adult. Now to apply : These 74 families cultivated 1,191 acres — 743 cotton, 448 corn. The normal yield for this class of land under all conditions would be 793.25 bales of cotton and 17,635 bushels of corn. The actual yield was 305.93 bales and 13,600 bushels. (The cotton yield was slightly affected by the boll-weevil.) This may be considered a clear case of at least twenty- five per cent loss in productivity due to a preventable disease. Additional to the loss incident to the death of the wage- earner and in productivity because of illness, there is the loss in the expense incurred. Do you know a family that has been free from sickness for an entire year? One, perhaps; not more. What of yourself, of your own family? Have you had a severe headache three times in twelve months? What did it cost? Fifteen cents for a bottle of aperient water, ten cents for aspirin tablets — ^that is 25 cents; 75 cents for the year. Did anyone have an attack of sore throat? Would $1 cover the medicines purchased? Or was it malaria or an enteric disturbance? Did $2 pay for the ordinary remedies ? If you add to this one visit of the phy- sician during twelve months, the total for the lightest pos- sible attack of ordinary illness for your family amounts to $5.75. Let us use that as an average. In thirteen Southern States (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia) there are approxi- mately (27,000,000 adding 7% increase in 1910) about 5,000,000 families. At the above figure ($5.75 for medicine and one visit of a physician for each family in one year) the total would be $28,750,000. Suppose this were spent in sanitation and proper instruction in the principles of hygiene? Would it pay? In the report of the Hookworm Commission, it is stated that in the four counties in Virginia where 15% of the total population was infected with this disease the cost of treat- ment is annually $17,750. How much of this illness is preventable? If we could trace to its source each attack, we would find headaches and COST OF PREVENTABLE DISEASE IN THE SOUTH 37 other common ills the direct results of transgressions of simple rules of hygiene; colds, sore throats, diphtheria, and other infections to the carelessness of the individual, the laxity of the health officer, or the apathy or ignorance of the community. There are yet other phases of the sickness problem the cost of which cannot be measured. Those who are ill must be cared for. At what expense? The labor of some person — generally the one whose time and labor are worth most to the family. Does this extra effort have a money value? Always, more or less. If the father of the family loses sleep, he is less efficient ; he, too, may become ill. If the mother is nurse, she is less fitted for her duties as a home- maker, and if she loses in vital force the children and her husband suffer with her in the consequences. The history of many who are the care of the State shows clearly that their misfortunes began in the lengthened term of illness of some member of the family. In New York recently there was published a pitiful story. A painter, the bread winner of the family, was stricken with tuberculosis. He could find no institution which his slender means could afford. He died, though he might have been saved. His wife con- tracted the disease and before her death she and her three children became paupers, charges of the town. Within a year from the death of the father the children were inmates of orphan asylums. The expense to the county (including maintenance of the children) was $7,725. Do you know of a similar incident in your community? And still another aspect is worthy of consideration. To refer again to the Virginia investigations, it is estimated that the loss in public funds for education, owing to the longer time it takes children affected with hookworm to reach the full standard, in that State equaled $27,459,000 annually. If this estimate is five times too great and if in each State there are relatively as large a number infected, the loss in this alone is a fourth of a billion of dollars. The cost of preventable diseases is indeed hydra-headed. Even enumeration of its many phases leads to discussion of almost every feature of social order. One of these is the 38 THE NEW CHIVALRY — HEALTH national sin of self-drugging. Dr. Osier says that men just naturally want .to swallow medicine; if not prescribed, they will take it on their own account. Patent medicine adver- tisements are proof of the statement. Investigations in this line show startling results. In 1905 Mr. Adams estimated that the American people spent $75,000,000 a year on patent nostrums. Great Britain requires every proprietary medi- cine to carry a stamp, and from the revenues derived the sum of $15,000,000 was found to be the amount spent annually by the British public on these so-called remedies. (Harper's Weekly, January 2, 1915). From evidence in our office concerning the sale of a few of these nostrums, we in the South must pay for concoctions of burnt sugar, cheap alcohol, cheap drugs, and water more than one-third of the $75,000,000 spent in the United States. For pains and aches the average man and woman buys whatever remedy ( ?) is advertised in the county paper. For malarial and other fevers, often for the manifestations of incipient tubercu- losis (not diagnosed or understood), the patent) medicine seems a God-send to the poor. One of the most important items of cost of preventable diseases cannot be estimated. There are no data as to impaired vitality from illness and the train of economic evils which follow in its wake. Neither is there sufficient infor- mation to estimate how many inmates of hospitals for the insane, prisons, and reformatories are such because of physical defects due to attacks which might have been pre- vented through intelligent supervision of public health. A review, even as brief as this, of our toleration of preventable suffering with its economic results brings out forcibly the need for complete and accurate figures of births, deaths, and sickness in each community and State. If your daily or weekly paper published a financial state- ment from day to day, or week to week, of the cost of preventable attacks of illness, public opinion would demand prompt remedial measures. If in your city you had a proved record of a servant girl, a "carrier" of typhoid, who was the cause of five cases of the disease in as many families, would COST OP PREVENTABLE DISEASE IN THE SOUTH 39 you not feel a responsibility to have something done to protect your family? If you knew positively that a child with a running ear carries the diphtheria infection to school, would you not be willing to pay an additional fraction of a mill taxes for medical supervision of the school children? Health officers and physicians know that of these incidents ; often they can trace the cause of a death to community or individual ignorance or carelessness, but unless there is the authority of an acknowledged bureau of record back of their conviction they are powerless. I have traveled the whole State of Louisiana, I know from personal observation the sanitary environment of every town in the State, I know from inspection the general condition of food supply places in every city and town situated on a railroad; but when from Dakota, Nebraska, Iowa, Canada, or Holland home- seekers write for specific information regarding health conditions, my observations, or those of any other indi- vidual, without statistics, count for little. For our own awakening and for the industrial development of our States we need to put into operation whatever is necessary for the collection of statistics. Without these we know that the foe is within the gate ; we know that with intelligent expenditure of a reasonable sum we can protect ourselves from suffering, impaired vitality, and economic loss. Further, with the experience of others as a basis, we know that protection is, for the community and the individual citizen, a wise and economic policy. Sickness is waste ; it is a debit item. The business man of to-day is an economist; he has little patience with foolish extravagance or with slipshod management which implies loss. Health has a money value; it implies a stable earning capacity and something more. The normal man is a more intelligent worker, he is more inventive, he has more foresight, he is better poised, he is a better citizen than the one who is only half well. I am sure you are convinced of the truth of these state- ments, that you realize the need for concerted civic action, and that you are impatient of delay. 40 THE NEW CHIVALRY — HEALTH What, then, are practicable and feasible measures? Briefly, to realize that health is purchasable — which means adequate funds wisely and intelligently expended; which, again, implies trained health officers with trained assistants and sufficient funds to do whatever is necessary and not what is expedient. Back of this is the demand of a com- munity enlightened as to health — not alone as to its preser- vation but, further than that, its promotion. Conservation of resources appeals as sensible and practical and intelligent; development of the resources conserved is of even greater import. Material wealth is generally thought of as the basis of a nation's greatness, but forests and mines, waving fields of grain, and bank accounts, though tangible, are not so important to the nation's welfare and progress as the lives and physical vigor of the men and women who make up its citizenship. Ultimate values are spiritual. The happiness, prosperity, and permanence of a nation or a section depend on achievements in the science of human rather than material development; in the transmuting of material resources and moral ideals into the hearts and minds of strong, purposeful, well-poised men and women. These human qualities flourish only in the soil of physical vigor. The South is rich beyond belief in climatic and material advantages ; rich in its heritage of a history of effort unique among the peoples of the world ; rich in millions of citizens who have a vision of what may be accomplished. To recog- nize the fundament — physical soundness — ^for progress and permanence is an obligation, and to work to this end the duty of each and all. THE FINANCIAL COST OF PREVENTABLE DISEASE PROF. A. CASWELL ELLIS, PH.D., DIRECTOR OF EXTENSION, UNI- VERSITY OP TEXAS, AUSTIN, TEX. I HESITATE to give the true figures with regard to the cost of needless disease lest you should think that my imagination has run away with me or that I am aspiring to a position among those superlative liars known as statis- ticians. Seriously these losses are so stupendous that one finds it difl[icult to take them in. There are three million people sick in the United States every day in the year. As the productive capacity of these three million people is temporarily destroyed and as the energy of many others is consumed in doctoring and nursing the sick, we can see what an enormous sum this sickness must cost. Irving Fischer conservatively estimates the annual losses in the United States from preventable disease alone at over one billion, five hundred million dollars. If Texas has her proportionate share of this sickness, then the expense to this State of preventable diseases is sixty million dollars per year. Omitting any consideration of the human suffering and sorrow, needless disease causes each year a financial waste of over twenty times the cost of all the State's higher educational institutions. It is over four times the cost of the entire State government, it swallows up practi- cally one-third of a four-million-bale cotton crop valued at ten cents per pound. Let us look now at the figures for a few of our common preventable diseases to see just what they are costing us, and to learn how easily these diseases have elsewhere been reduced or abolished. Consumption alone formerly cost the United States over $1,000,000,000 per year. Three times as many people in proportion to population have this disease in America as do in England, Wales, Scotland, Sweden, Norway, or Switz- erland. Since the discovery of the germ by Dr. Koch and of the improved methods of prevention and cure, it has been shown that where this knowledge is applied 79 per cent of 42 THE NEW CHIVALRY — HEALTH the loss from tuberculosis can be prevented. Of course, the greatest saving comes from the prevention of the spread of the disease through modern sanitation, but even in the treatment of those already afflicted the saving is large. Of the patients treated in the great Bourgemont Sanitarium in Belgium in 1903-04, 76 per cent had returned to their regular occupations and were still continuing their improve- ment four years after leaving the hospital. Germany has reduced the death rate from consumption over 57 per cent in the nation and 42 per cent in the army by applying modern science. Frederick L. Hoffman, the insurance statistician, states that the death rate from this disease in American cities has been reduced from 318 per 100,000 in the decade 1872-1882, to 182 per 100,000 in the decade 1902-1912. Hoffman estimated that 200,000 lives had been saved in the United States during the decade ending 1910 by the scientific methods applied in combating tuberculosis. Placing the value of each life at $1,700, the conservative figure usually used, this represents a saving of $340,000,000 to the country. Typhoid fever costs the country $350,000,000 a year. The city of Pittsburg alone has been shown by careful inves- tigation to have lost $3,142,000 from typhoid in one year. The discovery that typhoid is produced by a special germ, which is usually got from the water or milk supply or from flies, has made it possible to control this expensive disease. As soon as all citizens have good sanitary training this $350,000,000 expense for typhus can be eliminated. It has been shown that in the numerous cities in which the water supply alone has been made sanitary typhoid has been reduced on the average 71 per cent. This disease is esti- mated to be 85 per cent preventable by modern sanitation. The new typhoid vaccine now affords practically perfect immunity and will soon eradicate this dreadful and ex- pensive disease. In 1911, the first year of the use of vaccine in the army, 65 per cent of the typhoid fever disappeared ; in 1912, 68 per cent of the small remaining fraction disap^ peared, and in 1913 there were only two cases reported in the FINANCIAL COST OF PREVENTABLE DISEASE 43 entire army of 80,000 troops. One of these was contracted before the man was immunized. The other was reported in China and the case is in doubt. In a similar manner the diphtheria antitoxin treatment discovered by Dr. Bohrens has reduced the death rate from diphtheria from 55 per cent to 19 per cent. Where treat- ment is given promptly the loss is less than one per cent. This disease has also been shown to be 70 per cent prevent- able by the use of modern scientific methods of sanitation. Four other diseases that have caused the South enormous financial losses — smallpox, yellow fever, malaria, and hook- worm — can now be practically exterminated as soon as the public is informed about the scientific discoveries that have made the conquest of these diseases practicable. Smallpox was the first of these conquered. Before Dr. Jenner's dis- covery one-tenth of all the people of England died of small- pox, and practically everybody caught the disease when it got started in any district. The epidemic of 1871-72 in Philadelphia cost $22,000,000. How completely modern science prevents this enormous loss is shown by our experi- ence in Havana. Between 1870 and 1899 12,722 people died in Havana of smallpox. During the next nine years, in which modern scientific methods were applied, only two died from this disease. Our experience in Havana and Panama likewise demonstrates the enormous financial value of Dr. Finley's and Dr. Reed's discoveries with regard to yellow fever and the mosquito. In Havana between 1870 and 1899 there were 21,448 deaths from yellow fever. In the next nine years of enlightened sanitation and treatment there were only thirty-six deaths. General Wood states that the /discoveries of these men save each year more lives than were lost in the Cuban war, and save the commerciial world each year more than the cost of the entire war. Something of the saving of the Southern States can be seen when we recall that the epidemic of 1878 cost 15,954 lives and over $180,000,000. On the subject of malaria we can only say that 12,000 people die of this disease each year in the United States. 44 THE NEW CHIVALRY — HEALTH There are 3,000,000 cases of sickness from malaria each year, causing a loss estimated by Dr. W. A. Evans at $160,000,000, and practically all are preventable as is shown by our experience in Panama. The death rate in Panama among a certain class of laborers largely from malaria was seventy per thousand in 1906, whereas now, since modern science has been applied, this rate is less than four per thousand. A regiment of 800 once lost two-thirds of its strength in Panama in a fortnight from the terrible tropical diseases which prevailed before modern sanitation was practiced there. Dr. Evans states that with our present knowledge of the method of transmission of malaria it is possible by a concerted intelligent campaign to abolish this disease from the United States within five years. The losses from hookworm disease each year are not yet all known, but enough is known to see that this disease has cost the United States hundreds of millions of dollars. South Carolina alone is estimated to have lost $30,000,000 per year from the lowered vitality of her working people caused by this disease, which our army surgeons in Porto Eico, and later others in the South, have shown is easily cured and also easily prevented. This costly disease should also soon be practically exterminated. That the incredible waste through disease and death is not necessary is shown again by the fact that cities like The Hague and Frankfort-on-the-Main, which enforce intelli- gent sanitary laws, have a death rate of 16 as compared with the death rate of 37 in Moscow and 40 in Dublin, where less educated citizens have made less intelligent laws. The death rate in the United States in 1912 was 13.9 per 1,000, while in illiterate British India it was 32 per 1,000. That the deaths in India were entirely preventable is shown by the fact that of the deaths in 1911 354,000 were from cholera, 58,000 from smallpox, and 733,000 from plague, three diseases that modern sanitation and medical science have made almost unknown among educated nations. Over 4,200,000 deaths in India that year were from fevers, prac- tically all of which are preventable. From 1901 to 1910 FINANCIAL COST OP PREVENTABLE DISEASE 45 India lost 10,166,028 people from cholera, plague, and small- pox, and 47,208,157 from fevers and dysentery. These figures give us some idea of what we would be losing but for the results of modern sanitation and medical education. The plague during the fourteenth century, before modern sanitation was known, took off one-fourth the entire popu- lation of Europe. Oxford lost two-thirds of her academic population from it in 1352. In 1570 300,000 died from it in Moscow. In 1665 it was brought to London, and though two-thirds of the population at that time of 450,000 fled, it still killed 69,000. In India from 1897 to 1907 there were 3,865,903 cases. Yet, while this disease has in recent years been carried to Glasgow and to several cities in Australia, South Africa, and America, in every case it has been quickly wiped out by the intelligent methods of controlling it, developed by modern science since the discovery of the plague bacillus in 1894, and the later discovery of the means by which it is transmitted. The total effect of modern science in preventing disease and death is well shown also by the decrease in the death rates in the same cities as modern sanitation has advanced. From 1881 to 1885 the death rate in Berlin was 26.5 per thousand of population. This had fallen to 14.7 in 1910. The death rate in London during the same period fell from 20.9 to 12.7; in Paris from 24.4 to 16.7; in Vienna from 28.2 to 15.8 ; in New York from 27.5 to 16 ; in Chicago from 21.5 to 15.1. This would mean that in a city like New York each year over 50,000 people, valued at $1,700 each, who would have died in 1885 are now saved. The average length of human life has been doubled in the past 350 years. At present it is lengthening in Europe at the rate of 17 years per century, in Massachusetts 14 years per century, and in Prussia 27 years. Dr. Fisher states that by the adoption of hygienic reforms already proven entirely practicable, human life in America could be lengthened by over one- third — ^that is, by fifteen years. That the enormous losses from preventable disease may be stopped has not only been shown in other States and 46 THE NEW CHIVALRY — HEALTH countries, but here in Texas many families and districts have profited by making use of the knowledge of sanitation and preventive medicine carried to them by the Extension Department of the University and by the State Health Department. One country family told me a few days ago that they had not had a doctor in the house since March, 1914, when at my advice they screened their house, whereas for twenty-one years before not a month had passed without illness and doctor's bills, which amounted each year to from fifty to two hundred dollars. In a similar manner we could banish more than one-half the sickness from the farm homes of the South, if the means were given us to carry convin- cingly to these people a few simple facts about sanitation that can be learned in half an hour. By merely screening the dwelling house from flies and mosquitoes, providing a sanitary toilet, and properly locating the well, it would be possible to practically abolish malaria, typhoid fever, hook- worm, and the dysenteries from every farm in Texas. An extension fund of $100,000 a year devoted to this purpose would accomplish this much in five years' time, and save Texas each year fifty times the cost of this work. How long, O how long yet is it gping to take our people of the South to learn the frightful cost of alleged economy in education ! We are not too poor to carry out a vigorous campaign against disease. We are too poor not to do it. Refusing to spend money on health education is not economy, but stupidity. DISTINCT COUNTY HEALTH PROBLEMS WILLIAM M. BRUMBY, M.D., WACO, TEX., ASSISTANT MEDICAL DIRECTOR AMICABLE LIFE INSURANCE COMPANY, EX-PRESI- DENT OP THE TEXAS STATE BOARD OF HEALTH In our efforts toward "health conservation" we urge the return to the simple life, and "back to the farm" is often given as a remedy for the evils of the strenuous city life. DISTINCT COUNTY HEALTH PROBLEMS 47 Once accustomed to the comforts and advantages of the latter, luxuries practically beyond the reach of rural com- munities, the advice to change to adverse conditions is seldom needed. An overconfidence in the natural advan- tages of sunshine, pure air, and supposed freedom from some disease peculiar to city life gives the suburbanite too frequently a false idea of security, and little effort is made to maintain nature's pristine advantages. My experience as Assistant Medical Director of the Amicable Life Insurance Company has been that the cautious selection of country applicants for insurance is justified because of the preponderance of typhoid, malaria, hookworm, and pellagra in the country, as well as the remoteness from hospitals, good surgeons, and other special- ists in emergencies. The majority of more capable men, as their experience broadens, are drawn to the more lucrative fields of medicine and surgery in the larger centers. Fourteen per cent of our losses in younger insured lives comes from typhoid fever, and it is outranked by only one other disease — ^tuberculosis. While marked improvement in health conditions has been made in recent years our experience is still appalling. I will enumerate a few of the diseases and distinct health problems incident to country life and calling for special effort at the hands of the county authorities. Shallow wells, surface water, unprotected springs, and running streams contaminated with the near-by city sewage make typhoid fever largely a disease of rural life. Clear running streams, with a deceptive nidus of infection, insidi- ously offer to the unsuspecting boy a "swimming hole," and the disease follows in a new community where flies and shallow wells pass it on to more remote points. Malaria, a disease strictly of country life, is conveyed by the anopheles mosquito, whose breeding places will be quickly deserted if exposed to direct sunshine by clearing away the underbrush. The usual drainage necessary to improving the farm has incidentally assisted in removing the mosquito habitat. Screening the home against mos- quitoes completes the protection. 48 THE NEW CHIVALRY — HEALTH Pellagra is certainly a disease of rural communities regardless of its having been recently attributed to a badly balanced diet. The latter, to the writer's mind, is a con- tributing factor, but not the cause of infection. In any event some effort in prevention is needed for a disease which is so rapidly filling our insane asylums. This dreadful modern disease, practically unknown in our States six years ago, claims to-day ten thousand victims suffering in the State of Texas alone. The solution of this problem would give to the scientists immortal fame and the gratitude of humanity. Hookworm, a disease wholly dependent on unsanitary toilets and ignorance of personal hygiene, impossible of propagation in a city with a proper sewer system, falls to the lot of the county authorities if its prevention and control are ever to be practiced. Tuberculosis, the poor man's disease, and by no means limited to the city, falls before the blade of the grim reaper more quickly in the country, because of a want of proper medical service and poor general health conditions, with ignorance of prophylaxis. An unusually high infant mortality is the shame of the South. Negroes, Mexicans, and the poorer classes of whites, living under bad sanitary conditions and lacking a liberal and wholesome diet, suffer the most. Statistics show that there is a relatively much larger percentage of children in the country than in our cities. In the country marriage at younger ages naturally precludes the standard of education and intelligence found in the same class in the cities, thus explaining the proportionate higher mortality from pre- ventable diseases so destructive to infancy and childhood. School inspection and school hygiene in the country, as with the city, demonstrate a benefit to pupils formerly thought impossible by the average parent. County schools in the South have notoriously bad toilet facilities and other ganitary conveniences. In consequence typhoid fever, hook- worm disease, intestinal worms, and summer diarrhea are far more common among these school children than among their more fortunate city cousins. DISTINCT COUNTY HEALTH PROBLEMS 49 Home ownership, with its usual beneficent influences, improved housing conditions, better hygienic and sanitary environments, better medical attention, shows marked improvement in the general death rate over that of the tenant, the case of the latter being almost hopeless because of the lack of appreciation of these special advantages by both tenant and landlord. A special effort should be made to organize clubs or have regular neighborhood meetings, encourage sociability, procure relaxation from routine work, excite a spirit of civic pride, and stimulate interest in cooperative sanitary measures. Lack of this community spirit and a monotonous, lonely life are largely responsible for a lowered mental activity and a tendency to nervous maladies. It even accounts for the fact that insanity is more common in country women than in those of the cities. And, indeed, it leads directly to the lamentable indifference that tol- erates a low standard of health conditions, illiteracy, and social degeneracy. In our capacity for usefulness we all appreciate the value of personal acquaintance and intimate contact. So the county health oflScer, instead of mailing literature, should himself visit each community at frequent intervals and thus endeavor to interest his people in sanitary measures. THE APPARENT LOGICAL SOLUTION OF THESE PROBLEMS 1. The organization of a National Department of Health. 2. Subdivision of State and county into health districts. 3. Careful tabulation of statistics covering death and sickness. 4. Scientific investigation and research work. 5. Awakening of the authorities to a proper realization of responsibility. 6. Recognition of the economic value of improved health conditions — "A purchasable commodity." 7. Educational propaganda for the people, including rural recreation programs and entertainments. 8. A well-paid, whole-time county health officer, held personally responsible, but with supreme authority. 4 THE PRICE PAID BY THE SOUTH TO THE HOOK- WORM DISEASE C. H. BROWNLEE, M.D., AUSTIN, TEX. In the fall of 1909 it was announced that Mr. John D. Rockefeller had given a million dollars to be used in an effort to control the hookworm disease. In January, 1910, a commission composed of doctors, educators, and business men of national reputation was formed and the following officers were elected: Mr. F. T. Gates, of New York City, Chairman; Dr. Wickliffe Rose, Administrative Secretary; and Dr. C. W. Stiles, Scientific Secretary. The work of this Commission has involved three definite tasks: (1) To determine the geographical distribution of the infection and to make a reliable estimate of the degree of infection for each infected area; (2) to cure the present sufferers; and (3) to remove the source of infection by putting a stop to soil pollution. The State was taken as the unit of organization and of work, for it was fundamental, in the interest of economy and efficiency, that the work be done as far as possible through existing agencies. This would insure the perma- nency of the work from the beginning for the reason that each State had its own institutions which were rooted in the life and traditions of the people. Each State had its own system of public health, its own system of organized medi- cine, its own organized public press, and its own system of public schools. These four fundamentals and a host of other agencies were ready for use in educating the people. Recog- nizing that outside agencies can be helpful only in so far as they aid the States in organizing and bringing into activity their own forces, the Commission has cooperated in organ- izing the work in those States in which widespread infection had been demonstrated, at the invitation of State Boards of Health. In a State thus inviting cooperation a State Director of Sanitation was appointed by the State public health authori- PRICE PAID BY SOUTH TO HOOKWORM DISEASE 51 ties and the Rockefeller Sanitary Commission. His work of organizing and directing the whole work for the eradication of the hookworm disease in his State is done under the general supervision of the State Health Department. Under the direct supervision of each State Director is a force of field directors of sanitation. These inspectors con- stitute an ambulant service and devote their whole time to work in the field. They determine the geographical distri- bution and degree of infection, the sanitary conditions responsible for the presence and prevalence of the disease. They enlist the cooperation of the physicians in curing the sufferers, provide for the treatment of the indigent, inspect schools, instruct the teachers, enlist the press, and, by lectures, demonstrations, and personal conferences, teach the people the importance of getting all infected persons cured and how to prevent the spread of the disease by putting a stop to soil pollution. The most effective teaching, whether of physicians, of editors, of school officials and teachers, or of the people, is by actual demonstration. The chief agency in this demon- stration teaching has been the county dispensary for the free examination and free treatment of the people. Every case of hookworm treated and cured is a walking, talking, living advocate of better sanitary conditions in his locality. EXTENT AND EFFECT In the United States the disease is found throughout the States south of the Potomac and Ohio Rivers ; in Arkansas, Missouri, Oklahoma, and Texas, and also in California. Its prevalence and severity vary widely within a State and even in a county, in some localities less than one per cent of the people being infected, and in others more than 90 per cent. Generally speaking, the heaviest infection is found on the light, sandy soil of the coastal plains; the lightest infection on the stiff, clay soil of the Piedmont region, and an intermediate infection among the foothills and mountains. It is peculiarly a disease of the agricultural districts, which goes far to explain the long puzzling lack of 52 THE NEW CHIVALRY — HEALTH physical and intellectual vigor to be noted among large classes of people in what ought to be one of the healthiest and most prosperous sections of the country. During the five years 1910 to 1914 examination of more than 496,000 school children in 488 counties of the eleven Southern States has shown 40 per cent of them infected. Of more than 892,000 persons of all ages taken at random in this same territory, 34 per cent were found to be suffering from this disease, and in a vast majority of cases were completely cured. For generations the hookworm disease has been insidi- ously spreading unrecognized and unchecked over those countries of the globe that have a mild climate. Its victims, numbering many millions, have through centuries been hosts to the small blood-sucking intestinal parasites which cause the disease. Their strength has been sapped, their vitality lowered, their physical and intellectual growth stunted. They have been a fertile field for the germs of other diseases. They have been mastered in war, commerce, and industry by the more hearty people in the colder latitudes tothenorth. The social and economic importance of the disease is there- fore almost beyond comprehension. The infection is in most instances so insidiously acquired by the unsuspecting victim that he and the members of his family, who are prob- ably likewise infected, do not know just when the effects of the disease began to manifest themselves. In the course of a few summers a once healthy family has become pale and puny; a once industrious family has become languid and backward in its work; a once prosperous family has fallen into debt; a once proud family, owning valuable property, has been reduced by an easily curable and easily preventable disease to tenancy and to poverty. The children, once bright and well advanced in their school classes, begin to lose their zeal and their mental alertness when gradually robbed of their vitality. They fall behind in the struggle with their healthier classmates, and finally, discouraged and perhaps abused, give up school work in despair. School and college records show that infected students, even though not apparently ill, average lower in their PRICE PAID BY SOUTH TO HOOKWORM DISEASE 53 studies than those found free from infection. In one woman's college the average standing of fifty-six girls found infected was 77.75%, whereas fifty-six girls taken at random from those in the institution found free from infec- tion averaged 89.28%. Similarly, in an academy a group of twenty-five infected men and boys averaged 64%, and a non-infected group beside them averaged 86%. Teachers in all parts of the South report marked improvement in zeal and intelligence, as well as in weight and physical appearance, of children immediately on being freed from the parasites. In fifty-one counties of East Texas we have examined 36,760 school children and have found 13,005, or 35.3%, of them infected with hookworm. Hundreds of thousands of dollars of the State school appropriation are wasted each year in trying to teach children whose minds are not alert, attentive, or receptive. Nor is the loss wholly represented by the money thus wasted ; thousands of fertile and tillable acres are only half worked or not worked at all, because of the wide prevalence of the hookworm disease in the rural districts. Aside from the humanitarian aspect, the economic importance of this dis- ease is tremendous. Let us say that in fifty counties of East Texas there are 50,000 school children, and 25% of these are hookwoinn sufferers, hence cannot attend school, or if they do they are not capable of grasping their full quota of instruction. A yearly school tax of $6.80 is voted for each child of the school age, or $1,700,000. Therefore, twenty- five per cent of this amount, or $425,000, is the annual loss in school appropriations for fifty counties because of the hookworm disease. Apply the same principle to adults, the producers and the breadwinners. Place the average wage of the farm or mill hand at $1.50 per day ; 10,000 adults in each county earning $1.50 per day, but 5% of these are infected with hookworm and their earning capacity is cut down 5%, aggregating a loss to each county in production of $273,750, or $13,687,500 is lost annually by fifty counties. In 1898 when the United States troops landed in Porto Rico that island was practically unknown to the American 54 THE NEW CHIVALRY — HEALTH public; every phase of development and progress was retarded; 80% of the entire population were unable to read and write; there was but one building in the island erected for school purposes; the total school enrollment was only 26.000; the death rate was 24.02 per thousand population. The presence of 190,000 cases of hookworm disease in Porto Rico was the cause of a vast majority of this impoverished condition. During the last fifteen years 190,000 cases of hookworm disease have been treated and approximately 60,000 cases cured. As a result of treating these hookworm cases and improving the general sanitary conditions in the last fifteen years, illiteracy has been reduced to 66% ; 264 modern schoolhouses have been built ; the school enrollment has increased from 26,000 to 161,785; the death rate has been reduced from 24.02 to 22.36 per thousand. Diversified agriculture has been instituted, and as a result the export value of oranges, grape fruit, pineapples, and other fruits has increased from $100,801 in 1901 to $3,120,919 in 1912. During 1912 and 1913 the export value of sugar increased 26% over the previous year; in 1900 the coffee plantations were almost abandoned because about 90% of the coffee pickers had hookworm disease. Governor Colton's report on Porto Rico closes as follows : "The point is not far dis- tant, after reaching which, internal enterprise, stimulated by improved health conditions and of the influence of public schools, will become a potent factor in developing the people of Porto Rico, as a whole, into a sound body politic." The same idea is applicable to the Southern States where the hookworm disease is so prevalent, if the work for the eradication of this disease, which has been so energetically started, can be systematically carried out. However, we must never lose sight of the fact that the eradication of a single disease is of lesser importance than the final success of a campaign whose aim is to educate the laity up to the point where they demand ideal sanitary surroundings. THE POOR STATE AND THE TUBERCULOSIS PROBLEM L. B. McBRAYER, M.D., SANATORIUM, N. C. "Poor" is a comparative term. Fifty years ago Pennsyl- vania's income and assets were much less than those of any Southern State to-day, but in comparison we still look upon the Southern States as poor. There are no poor States in the South or elsewhere in this blessed Union of ours. When one of our poorest States, so-called, can spend six million dollars a year on primary education and nine million dollars in two years on building good roads, as North Carolina has done and is doing, and be richer for the expenditure, it is evident that any State has sufficient wealth to do anjrthing her people want done. We will readily admit, however, that there is no other one thing that will go so far toward producing poverty either in the State or in the home as tuberculosis. In the fight against tuberculosis environment, as in everything else, plays a very important part in our plans and procedure. What would be proper and necessary in a great city would be entirely unnecessary in rural communities. The New York Association for Improving the Condition of the Poor is a splendid organization with large amounts of money at its command. In studying the causes of poverty in New York City they early reached the conclusions that, with 8,601 deaths from tuberculosis annually and with 53,883 cases on hand all the time, tuberculosis was respon- sible for a large per cent of the poverty. This same conclu- sion has been reached by investigators in every land and clime, whether the population be rural or urban. Can you conceive of anything that brings poverty more rapidly to the home than to have the man who was working at a moderate or good salary, supporting his family, edu- cating his children, saving a little each year, stricken with tuberculosis? He lingers for one, two, maybe four or five years, unable to work, a care to the wife, and if any of the 56 THE NEW CHIVALRY — HEALTH children are large enough to help, they must stay at home from the school provided by the State to help nurse and care for the sick father ; when the funds are all exhausted, the mortgage is foreclosed, the home goes, and finally death ensues. And then — perhaps the worst of it all — ^he has infected four out of five of his family and the vicious circle is started again. In the warfare against tuberculosis we use the same ammunition, personal and community hygiene, rest, fresh air, sunshine, good food, and education in every land, whether in the crowded tenements of New York City or on the broad plains of Texas. But our maneuvers, our military tactics must be suited to the exigencies of the times, the place, and the occasion. In other words, as in times past, the Southern States must work out their own salvation. North Carolina is an average Southern State, about as poor and about as rich as the others, and I will give you our plan of campaign which would be suitable for any of the other Southern States, with a few minor changes perhaps here and there as needed. ONE POWER IN COMMAND OP ALL THE FORCES We are of the opinion that the whole tuberculosis cam- paign should be directed by one general. It seems useless, a needless multiplication of salaried ofl!icials, office employees, etc., and a needless duplication of work to have, say, a State Board of Health, a State Anti-Tuberculosis Society, a State Tuberculosis Commission, and perhaps a State Sanatorium, each in a general way trying to cover the same ground. A better plan it seems is to have all tuberculosis work in the State under the State Board of Health, where it cer- tainly belongs, the Executive Secretary of the State Board of Health to form a Bureau of Tuberculosis and the chief of this bureau to have complete control and direction of the whole tuberculosis campaign under the State Board of Health and its Executive Secretary. He is Superintendent of the State Sanatorium, Director of the Bureau of Tuber- culosis, Executive Secretary of the State Red Cross Seal THE POOR STATE AND THE TUBERCULOSIS PROBLEM 57 Commission, Executive Secretary of the State Anti-Tuber- culoais Association, editor of the State tuberculosis bulletin if there be one, etc. Then all the work will be correlated, there will be no duplication of work, the army can be mobil- ized at strategic points at will, and the entire command can move forward in one unbroken phalanx in a fight to the finish with this terrible destroyer of human life. THE STATE SANATORIUM The most important single thing in this fight is the State Sanatorium. Its function is educational and curative. The educational function of the sanatorium was placed first advisedly, because this is the larger share of its function. It must be educational to the remotest bounds of the State. It must be educational to every one who comes within its influence, from the superintendent to the casual reader of the daily or weekly newspaper. The superintendent studies his subject first-hand, he is then much more able to direct his sociological work free from error. The patients are put on the road to recovery, but not cured, for it takes years to cure tuberculosis, and while this is being done they are taught the personal hygiene necessary to prevent the spread of tuberculosis and the personal discipline necessary to get well of the disease. When this is done, which requires from three to six months, they are sent home to continue the cure, to preach fresh air and sunshine to every one who comes within the sound of their voice, to preach their new religion by example as well as by precept, by building them a sleeping porch, breathing God's pure fresh air, and leading the simple life and not infecting others. The sanatorium must instruct the physicians in the State in the diagnosis and in the treat- ment of tuberculosis — and perhaps there is no more crying need to-day in the fight against tuberculosis than the early, diagnosis of the disease. The sanatorium must help train health officers. The North Carolina State Board of Health has established a training school for health officers, and as a part of the course they must take a three months' course or longer at the sanatorium, learning thoroughly both the 58 THE NEW CHIVALRY — HEALTH medical and sociological sides of the disease. The sana- torium in its training school for nurses should prepare the much-needed public health nurse, giving postgraduate instruction to graduates of other training schools desiring to take up public health nursing, as well as training nurses from the beginning in their own graduate school. The State should require not only the registration of deaths, but she should require the registration of every case of tuberculosis in the State, for we must locate the enemy before we can make a successful attack. These should be reported to the same general, and when so reported they are furnished printed information how to live, how not to infect others, furnished sputum cups at actual wholesale cost with plain printed instructions how to use them and why. The other members of the family are likewise given instructions how not to contract the disease, and in twenty-one different communities a public health nurse is sent to help in this instruction personally, which number we hope to increase as the days go by. We could go on for an hour mentioning other activities that would emanate from the sanatorium, but time forbids. PUBLICITY If publicity can amass large fortunes by creating a demand for absolutely worthless, not only worthless but harmful, things known as patent medicines, surely it can be turned to good account in the campaign against tuberculosis. Use publicity in every known way. The people are paying more attention to the printed page to-day than at any period of our civilization. Use the bulletins of the State Board of Health, special bulletins, leaflets, posters, newspapers, lec- tures, stereopticon exhibits, moving pictures, the schools, the churches, the fraternal orders, the woman's clubs — any- thing and everything and everybody that will give publicity to the methods of combating this terrible disease and checking its rapid spread. COOPERATION The army of occupation is securely intrenched; the attacking army must secure volunteers from every available THE POOR STATE AND THE TUBEECULOSIS PROBLEM 59 source. The State should provide the sanatorium, provide for the overhead expenses, provide for the extension work, the keeping of the records, supply the publicity department, and make secure the director — ^the general. The fight is long and hard, the task is great, the cost enormous — ^too great for the Southern States to bear with the present attitude of our people, caring more for property than for human life, giving more thought to preventing disease among cows and hogs and trees than among her citizens; giving heed lest her farmers be sold a fertilizer or some garden seed that are fraudulent, and allowing the fakers to sell to her people all kinds of patent medicines that are not only frauds, but bring destruction both of mind and body. North Carolina would hold up her hands in holy horror and swear she would be bankrupt were she asked to spend as much money on preventing and curing tuberculosis among her people as the State of Pennsylvania is spending in her successful attempt to eradicate tuberculosis from her cows. And yet I believe North Carolina is leading the South- ern States in this particular. So we must secure all the allies possible. After the State has provided the things above mentioned, which is the very least she can afford to do, then the patient, or his family, his friends, his church, his secret order, his county, his town or corporation, or philanthropist — one or all of these must provide the remainder of the expense of maintenance at the sanatorium, which in our State amounts to $1 per day. And I might say that all the agencies mentioned are to-day cooperating with the State in the maintenance of the patients at its sanatorium. In the equipment of the sana- torium we are having the cooperation of corporations, philanthropists, the woman's clubs, and individuals. In our extension work we must secure the cooperation of the newspaper men — ^they always stand ready to give of their space, time, and intelligence to the furtherance of any good cause ; the preachers — ^they can do valiant service and they do, but they should lead their churches into fields of greater usefulness, for Jesus, when he was in the flesh and 60 THE NEW CHIVALRY — HEALTH, dwelt among men, first healed the body, afterwards he healed the soul; the teachers — overworked and underpaid, they can always be depended upon to do their full duty as they are given light to see that duty ; the club women — ^be it said to their credit, they are at this time more interested in the living present than in the dead past, they have joined the allied forces against the common enemy, and they are a mighty power. Last, but not least, I would mention the medical profession — ^the doctors can be depended upon on all occasions; they do more real charity than any other class of men in the world, excepting none ; they are the only class of men that have ever been expected to devote their time and talents to the furtherance of those things which are dia- metrically opposed to their own pecuniary interests. They are the captains of the hosts in this fight against tubercu- losis ; they have never been known to falter or to waver. With these agencies and many others that will readily occur to you, working in harmony and to the one end, wisely directed from one source, we can and we will conquer this most relentless and destructive foe of our people. WHY THE FEDERAL GOVERNMENT SHOULD ESTAB- LISH HOSPITALS FOR CONSUMPTIVES IN THE SOUTHWEST EGBERT J. NEWTON, SECRETARY SOUTHWESTERN CONFERENCE ON TUBERCULOSIS, AUSTIN, TEX. I HAVE been asked to answer the question, "Why should the Federal Government establish hospitals for consumptives in the Southwest?" I might reply in seven words, "Because no other agency will do so." To those of you who come from the Old South or from the North and East, the question and answer will not be sufficient; I shall give some facts which will surely interest GOVERNMENT HOSPITALS FOR CONSUMPTIVES 61 you and will help arouse your sympathy and support in a movement which means much to the Southwest. For over one hundred years consumptives have been coming to the West and Southwest, seeking health and a longer lease of life. The movement still continues, and according to the Public Health Service, which made a study of tuberculosis in this section, the number of consumptives coming to the Southwest is increasing. How many have come in years gone by, how many are now coming each year, no one knows, but estimates have been made. The National Association for the Study and Prevention of Tuberculosis believes that 10,000 consumptives, hope- lessly diseased, come West annually to die, and that 10% of the 6,000,000 people in this territory have tuberculosis themselves or have come to the West because some member of their family has had it. The Public Health Service says there is not the slightest reason to doubt either of these statements. The Public Health Service estimated that there are 30,000 consumptives in West Texas, 27,000 in New Mexico. The National Association for the Study and Prevention of Tuberculosis estimated |;hat 50 to 60% of those who come West are too poor to secure the proper necessaries, and therefore starve or accept meager charity. There is nothing I could say that will give you an ade- quate idea of the extent and the seriousness of this problem. The condition confronting the indigent "lunger" is described in a resolution adopted by the Southwestern Conference on Tuberculosis at Waco in 1912 : "Whereas the Southwestern States have climatic and other natural advantages which have attracted people from other States for years past, especially the sick ; and as many of th^se people come into the Southwest with insufficient funds to maintain themselves until well, as a result of which they have become public charges or suffer great privation, which counteracts all possible benefit of climate; and whereas the number of such indigent persons, who are careless in their habits of living and spread their disease, 62 THE NEW CHIVALRY — HEALTH is not decreasing, it seems proper for us to issue a warning to the public, and especially to that portion of it afflicted with tuberculosis and to all physicians, churches, lodges, labor unions, and charitable organizations; therefore be it "Resolved, 1. That the newspapers of the country be asked to give publicity to the following facts : " (a) There are no free hospitals in the Southwest for pther than citizens of Southwestern States. " (b) No assistance can be given strangers by charitable associations because the public does not contribute funds for that purpose. " (c) Owing to the large immigration of healthy people there is small chance for employment for sick persons. The number of factories is limited, cheap labor is performed by Mexicans and negroes, ranch and farm work is strenuous, and invalids are not employed by landowners. "(d) Invalids cannot hope to secure assistance from private individuals, because the demands for aid from strangers has exhausted the patience of the people. " (e) That invalids coming to the Southwest should have funds sufficient to carry them for one year, as they cannot hope for restoration to health and strength under that period of time. "(f) That each community should provide proper hos- pitals, dispensaries, visiting nurses, etc., and care for their own people. "Resolved, 2. That the railroad corporations of the United States be hereby requested not to sell half -rate or charity tickets to the Southwest, unless responsible parties guarantee that the prospective passenger will not become a public charge after reaching his or her destination. "Resolved, 3. That the Committee of Ninety-Nine of the Conference is hereby requested to give full publicity to these and other facts tending to discourage the further immigra- tion of indigent consumptives to the Southwest, and to use a part of such funds as they may collect for this purpose." The condition became so serious that we of the South- west were compelled to take some action, and Governor GOVERNMENT HOSPITALS FOR CONSUMPTIVES 63 O. B. Colquitt, of Texas, called a Southwestern Conference on Tuberculosis to meet at Waco in 1912 to consider the problem. After discussion the Conference adopted the following resolution: "Whereas for many years consumptives have been coming to the Southwestern States because of the superior advantages of climate for the treatment of this disease ; and whereas the majority of such persons are financially unable to maintain themselves for a period of time sufficient to restore them to health and to become self-supporting; and whereas there are not a sufficient number of State, county, and city hospitals in the Southwest to maintain the large number of persons from other States who apply for free treatment, and the public charitable organizations of the Southwest cannot care for all such applicants ; and whereas the States, counties, and cities from which these people come and where they contracted their disease have not aided and will not aid them ; and whereas the people of the Southwest are becoming infected with tuberculosis, spread by the care- less and ignorant consumptive strangers, notwithstanding the fact that natural conditions are unfavorable to the development of tuberculosis ; therefore be it "Resolved, That we, the delegates to the Southwestern Conference on Tuberculosis, appointed by the Governors of Arizona, California, Colorado, Kansas, Nevada, New Mexico, Oklahoma, Texas, and Utah, representing the people of these States, hereby declare that the care of consumptives in the Southwest is an interstate problem and that it is the duty of the Federal Government to take action to provide hospital care for citizens suffering from consumption who have left their native States and are residing in the Southwest seeking health and who are unable to pay for hospital care ; and we call attention to the fact that precedent has been established for such action by the establishment and operation of the Fort Bayard Hospital for soldiers and ex-soldiers and the Fort Stanton Hospital for marines, sailors, and steamboat 64 THE NEW CHIVALRY — HEALTH A Committee of Ninety-Nine was organized, consisting of eleven members from nine States appointed by the Governors of the States and including the Governor, United States Senators, Congressmen, and prominent citizens. The Public Health Service was asked to study the situ- ation, and their reports are now being published in the weekly bulletins of the Service and reprints will be pub- lished later. A bill was prepared and introduced in Congress, and at the hearing before the Committee on Interstate Commerce of the House a memorial was presented giving the facts, presenting arguments, and submitting the indorsements of thirty-six Governors, of many State boards of health, city officials, commercial organizations, etc. The hearings of the committee were printed with a summary of the memo- rial. The Secretary of the Treasury has taken a stand against the bill which blocked its chances for success at the last session. Efforts will be renewed when Congress convenes to have the bill passed. The passage of the bill was asked as a measure of pro- tection to the people of the Southwest. Congress has no constitutional right, we are told, to relieve individuals, but can take any action to prevent the spread of disease. We have always believed that the presence of large numbers of advanced and careless consumptives was a menace to the health of our people. According to the report of the Public Health Service, they are not dangerous to us. We enjoy a "climatic immunity" and few native-born Westerners and few of the healthy people who settle in the Southwest con- tract the disease. This is the greatest endorsement ever given to climatic treatment of tuberculosis and will doubt- less increase our problem. Reverting to the question, "Why should the Federal Government provide hospitals for consumptives in the South- west?" I shall sum up briefly: (1) Because hospital segregation limits the spread of tuberculosis. PREVENTION OF TYPHOID FEVER 65 (2) Because there are large numbers of American citi- zens in want suffering for the sins of our civilization who are not proper charges upon the charity of the Southwest. (3) Because the Southwest cannot, even if willing to do so, finance the care of this army of sick. (4) Because home States, counties, and cities will do nothing for their expatriates, although responsible for their diseased condition. (5) Because the National Government is the only agency rich enough to meet the problem, and it is the duty of all the people to share the burden. PKEVENTION OF TYPHOID FEVER SURGEON R. H. VON EZDORF, U. S. PUBLIC HEALTH SERVICE A DISCUSSION of the prevention of any infectious disease must take into account the cause and method of spread. All present-day hygiene and sanitation is based on this principle. Typhoid fever is an infectious disease which in our South has a greater percentage mortality rate to deaths from all causes than in any other section of our country. METHODS OF SPREAD The most common and usual ways in which this infection spreads are well known to us. The typhoid germ originates from some previous case in man and is distributed in the excreta of man. Not only every active case of typhoid fever is a prolific source of typhoid germ, but it is estimated that 3% of those who have recovered from the disease con- tinue to discharge the typhoid germs in their excreta for varying periods of time, sometimes extending over a period of years. These are the typhoid carriers. 5 66 THE NEW CHIVALRY — HEALTH Every case of typhoid fever means that some of these germs of typhoid, coming from the excreta of some other case of typhoid fever, or "carrier," have been swallowed. It is true that every person who swallows germs of typhoid does not develop typhoid fever, fortunately for us, but about 10% of them do. This means that for every case of typhoid fever 10 persons have ingested some of the typhoid infected excreta of some person. This state of affairs, of course, is not recognized as such, as the germs are widely spread and are taken into the body through the mouth in a very dilute form. The most common sources to which we are exposed in the consumption of this dilute human excrement are : (a) Water. While in the North the public water supplies, as a rule, form a more important factor in the spread of this disease, in the South other factors, in addition to water — namely, those attendant upon insanitary disposal of human excrement so common in the rural districts — are of increas- ing importance in the spread of the disease. Contaminated, or polluted, water has long been recog- nized as the source of typhoid and other intestinal diseases, such as dysentery and infantile diarrheas. Springs, surface wells, and streams furnish the most common sources of water supply. Under the system, or rather custom, prevailing these sources are commonly exposed to pollution from sewage, or human excrement. Water is probably the most important single factor in the spread of typhoid fever. (b) Food, milk, uncooked veffetables, and shell fish (such as oysters) are more likely to carry infection than other or cooked foods. Of these, milk is the most important. Com- munities are daily adopting more rigid regulations for assuring a clean' milk supply. Regulations are made for controlling the sources of supply, handling and distribution of milk. Contamination of milk owing to unclean habits of per- sons suffering from typhoid, or carriers of typhoid, contami- nation from unclean containers, or adulteration with sewage PREVENTION OF TYPHOID FEVER 67 polluted water, exposure to flies, have all contributed at times to the development of epidemics. The handling of food by persons of unclean habits, such as cooks who may be carriers, and the exposure of food to flies which carry filth on their feet, have been responsible for many cases of typhoid fever. Contact with active cases of typhoid forms is still another source. The devious routes by which the typhoid germs travel are innumerable. The fact remains, however, that it origi- nates in the discharges of man. PREVENTION The solution then for the prevention of spread can be expressed in the few words, "proper disposal of human excreta." Simple as this may seem, the problem of formulating simple measures has baffled many and is yet being studied. Large cities having good sewerage systems, water sup- plies, and regulations for reporting typhoid fever, and the control of food supplies, particularly milk, are not so much concerned. The large majority of the people in the South living in unsewered towns and in the rural districts are, or should be, most vitally interested. There are innumerable instances where the adoption of sanitary methods for the disposal of human discharges has produced untold benefit and reduced the incidence of disease. The general health of such communities was also much improved. The simple measure of constructing and install- ing a sanitary privy for every home will prevent and reduce the number of cases and deaths from typhoid at least 75%, in addition to preventing hookworm, dysentery, and other intestinal diseases amounting in all to three times as many cases as typhoid. EDUCATION The people must be educated to the necessity of making proper sanitary provisions for disposing of their excreta in order that excreta may not become part of their daily 68 THE NEW CHIVALRY — HEALTH ration in their food and drink, which is, more or less, the case at present. We see, therefore, that good health revolves about the habit of cleanliness. On account of ignorance we are paying dearly in sick- ness and lives. It would cost much less to protect ourselves against this daily exposure to filth. Let us see what it is costing the nation. It is estimated that 400,000 to 500,000 cases of typhoid fever occur annually in the United States. Of this number, from 8% to 10% result in death. Then three times as much other sickness is attributable to the same insanitary conditions. This means that another 1,200,000 persons suffer an illness. The annual cost to our country may thus be estimated. The cost for the care and treatment of a case of typhoid will easily reach $100, and that of other illnesses of intes- tinal disorders at least $10. A funeral on an average will cost $50, and the value of a person to a State is estimated at from $1,000 to $2,000. We have then an account, at the lowest estimation, as follows : 400,000 cases of typhoid at $100 $40,000,000 40,000 funerals at $50 2,000,000 40,000 lives at $1,000 40,000,000 1,200,000 cases of other illnesses at $10 12,000,000 An annual loss conservatively estimated to be $94,000,000 Education of the people is to be accomplished through literature, lectures, and especially demonstrations. The campaign against hookworm has done much toward this, still there is a lamentable lack of adoption of preventive measures. The cure of the hookworm disease has undoubtedly been accomplished to a great extent, but the direct results for better sanitation are still woefully lacking. It is curious how people think of this matter. I recall an instance which is illustrative. On a tour in Alabama a lecture was given by Dr. C. W. Stiles on the subject of hookworm, and its cure PREVENTION OF TYPHOID FEVER 69 and prevention were set forth. After the lecture one of the men who had been present said to me: "I am sure that I have hookworms and I will see a doctor about it and get cured." On inquiry I learned that he was operating a hotel and that he had a wife and eight children and that some of these were also suffering from the same disease. I asked him if he did not think that a sanitary privy would do more good than simply looking after his cure, so that after he and his family were cured they would not contract the infection again. He answered : "I did not think about that, but I can see that is the thing to do." The prevention idea had not appealed to him at first thought, and it is this thought that must be continually drilled into the minds of people. VACCINATION AS A PREVENTIVE Typhoid vaccine, which is a suspension of dead typhoid germs, when injected into persons will give a measure of protection by forming or exciting an immunity. This form of immunity will last two or three years, or even more. It is of value in protecting persons, especially those who are directly exposed to infection, such as nurses and members of the family; in protecting persons who are likely to be exposed to insanitary conditions as is the case in the travel- ing public, or men in the military service. This measure does not make for a permanent improvement, but gives only individual protection against typhoid. The idea should not appeal to us as a general measure. SANITATION IS THE ONLY PREVENTIVE Typhoid is preventable. When we succeed in having sanitary measures for the proper disposal of human excreta generally adopted, we prevent not only this disease, but many others. As long as the present conditions prevail, we shall continue to record the enormous toll we are paying in sickness and deaths. The conservation of natural resources has received the attention of Congress. The conservation of health is the greatest of all natural resources. It requires the combined efforts of National, State, and local health organizations. PREVENTION OF MALARIA SURGEON R. H. VON EZDORP, U. S. PUBLIC HEALTH SERVICE In the South we hear the expression, "Everybody has malaria." Let us first see to what extent malaria prevails. During the past two years the United States Public Health Service has been making investigations regarding the prevalence, geographic distribution, and the conditions contributing to the spread of malaria. Postal cards were mailed to physi- cians asking for certain information. Only a brief summary of the tabulated reports received will here be given. In 1913 the reports for Alabama for six months (May to November) gave a total of 12,080 cases of malaria; for Arkansas, three months (August to October) , 18,528 cases ; for South Carolina, four months (August to November), 12,000; for Florida, four months (August to November), 9,190 ; and for Georgia, three months (August to October) , 9,825 — a grand total of 61,623 cases compiled from replies of one-sixth of all the postal cards mailed. In addition, the reports collected by the State Board of Health for the one State of Mississippi totaled 61,811 cases for the year (January to December) 1913. For the year 1914, the postal card replies gave for Alabama 9,865 cases Arkansas 23,941 cases Florida 4,491 cases Kentucky (for 6 months — July-Dec.) . 6,648 cases Louisiana (for 8 months — May-Dec.) . 13,016 cases North Carolina 8,357 cases South Carolina 8,113 cases Tennessee 6,454 cases A total of 81,075 cases reported upon 13.25% of all postal cards mailed and received by physicians during the year. To these may be added 7,008 cases reported in Vir- ginia for the six months, July to December, 1914, and 116,788 cases reported to the State Board of Health of PREVENTION OP MALARU 71 Mississippi. The reports of Mississippi are the most com- plete and give a ratio of one case of malaria for every fifteen inhabitants in the State, or a rate of over 6%. Mortality tables are incomplete. The reported deaths from malaria in Alabama for the years of 1913 and 1914 amounted to 2% of the total registered deaths from all causes, and those of Mississippi for the year 1913 5.93% of the total registered deaths from all causes. The reports therefore indicate that from 3% to 4% of the entire popu- lation of over 20,000,000 people living in the South suffer an attack of malarial fever each year. CAUSE OP MALARIA Malaria is caused by a minute animal parasite which lives in the blood of men. These parasites grow and multiply in the red blood cells, and when they reach large numbers the collective toxins liberated at the time they mature giye rise to the symptoms which characterize the disease. METHOD OP SPREAD Only since 1898 have we known the various phases of life of this parasite. This knowledge has served us for the formulation of proper methods of prevention. Malaria is transmitted from person to person only through the agency of mosquitoes belonging to the subfamily of Anopheles. A number of surveys were made in the Southern States by the United States Public Health Service, and where malaria prevailed there also the Anopheles mosquitoes capable of transmitting malaria were found. These surveys have demonstrated that many conditions contributing to the propagation of Anopheles mosquitoes could be readily con- trolled and could be profitably eliminated. MALARIA CARRIERS Man is the host for the malarial parasite from which Anopheles mosquitoes obtain their infection and thus carry and transmit it from person to person. It has been found that a number of persons who have suffered an attack of 72 THE NEW CHIVALRY — HEALTH malarial fever and who have not received sufficient and prolonged treatment frequently continue to harbor the parasite of malaria in their blood while appearing to be well. The ages of persons in whom parasites were found in a recent investigation ranged between nine months and eighty- five years. ECONOMIC When one travels over the country it is not uncommon to hear a newcomer to the South ask some questions regard- ing malaria. Many farmers in the North, desirous of coming South, are deterred from making a change in resi- dence on account of malaria. So also large corporations desirous of investing large sums of money in developing industries have learned that where malaria prevails labor is uncertain and inefficient. It is known that in some instances mills are operating at a loss on account of the effects of this disease upon the laborers. During my tours of investigation inquiries were made regarding sickness and deficiency of productive capacity of laborers employed in sawmills, on cotton plantations, etc., on account of malaria. It is estimated that the average loss of time per man on account of sickness from this disease is, in many places, at least two weeks in the season, June 1st to November 1st, or about one-eleventh of the time during this period. Employers of labor also increase their forces from 25% to 50% during this season, on account of lowered productive capacity of the employees from the effects of malaria. No one figures on the invalidism caused by malaria, its cost in loss of time and attendant expense incident to sickness. Let us for a moment consider this side of it. A case of illness from malaria will easily cost to the family or indi- vidual for drugs and medical attendance on an average of $5 each. The total minimum loss on account of sickness to the people in eleven Southern States alone (Texas PREVENTION OP MALARIA 73 not included), having an aggregate population of over 20,000,000, amounted to $4,000,000 for the past year. If we would estimate one death for about every 300 cases of malaria, the number of deaths numbered at least 2,500. The average cost of funerals may be estimated at $50, and the value of a person to a State at $1,000. We could then add 2,500 funerals at $50 each $ 125,000.00 2,500 lives at $1,000 each 2,500,000.00 This gives a total of $2,625,000.00 We can certainly estimate that one-fifth of the popu- lation — namely, 4,000,000 — ^live in fairly high malarious sections in the eleven States. The percentage of carriers ranged from 1.8% to 40.9%, the average being 14.92%. In only one community (of 515 population) was an exami- nation made of all persons, which gave 2.91% carriers, so that if we take this percentage for the average alone, we would have for one-fifth of the population no less than 116,400 persons who are carriers of the parasites in these Southern States. These persons, while apparently well, still may be considered invalided and their affection must neces- sarily be a burden and expense to themselves and their families. It must be evident from this that malaria is not only an important public health problem, but also an economic problem. PREVENTION Knowing these things, can the disease be prevented? Malaria is a preventable disease, and the united effort of the people would and could make it as rare as it is in many sections of our country, as in the North Central States, where, in former years, it was quite common. Yellow fever is transmitted by mosquitoes, but does not prevail in the South until some case enters, and the special mosquito, the .^des (Stegomyia) calopus, becomes infected from a case, when it, in turn, after a certain period elapses 74 THE NEW CHIVALRY — HEALTH for the development of the parasite in its body, can transmit the disease. When yellow fever is present, efforts are immediately made to control or eradicate the disease. The fight is made mainly on the mosquito which spreads the disease. But with malaria considerable apathy exists in the adoption of like preventive measures against this disease. It does not seem reasonable that the people should be so indifferent. To prevent disease costs money. When the people spend money, they feel that they must get some return for it immediately. That is the reason that we find the campaign for tick eradication so popular. It costs fifty cents per head to get rid of the ticks, and increases the value of the animal seven dollars. The same individual who spends money for eradicating ticks from his cattle will spend nothing for preventing malaria in order to protect himself or his family, because he cannot see an immediate profit. He can't see seven dollars or more entering his coffers. As long as he is well, he is indifferent as to what happens to his neighbor; and when he or one of his own family is attacked, he is concerned only in the immediate relief from active symptoms of the disease and does not think beyond this. Thus malaria has become so common that 600,000 to 800,000 persons in the South suffer the disease each year. It remains for us to demonstrate to the people that malaria is preventable and that freedom of malaria will increase the value of their lives — ^not in traffic as in cattle, but ultimately in health, happiness, and productive capacity, so that their increased earning power will count in dollars and cents, to say nothing of the increase in the value of their lands in consequence. MEASURES OP PREVENTION It is recognized that no progress in prevention has been made or can be made until the public is ready and desires to be free of disease. Education, therefore, is essential. It is evident that the public is not aware of the trans- mission of malaria by mosquitoes only. The old ideas that PREVENTION OP MALARIA 75 air, water, and food may cause malaria still prevail. Unfor- tunately there are physicians who have considerable influ- ence in their communities who still hold to the same theories. Successful measures must be based upon the facts, first, that malaria is transmitted from person to person only through the bite of a special mosquito ; and, secondly, that the mosquito is not bom with the malaria germ, but obtains its infection from man, who is the host of the animal parasite which causes malaria. There have been published by the United States Public Health Service articles for popular instruction, one of these especially for use in the public schools. The officers of the United States Public Health Service who are engaged in making malarial investigations have also given a number of lectures, illustrated with lantern slides, explaining the life cycle of the malarial parasite, through man and the mosquito, the life and habits of Anopheles mosquitoes, and the various measures applicable in the pre- vention of spread of malaria, based upon the etiological factors concerned. Some monthly bulletins published by State boards of health also deal especially with this subject. Only a brief outline of the measures applicable in the prevention of malaria is possible in the time allotted. These may be classed under two heads : 1. Mosquitoes. Measures directed against them: (a) By destruction, (b) by preventing their access to man. 2. Man. By treatment to (a) free him from parasites, (b) immunize to parasites. Mosquitoes. — Let it be understood, first, that the meas- ures directed against mosquitoes do not mean all mosquitoes, but only against the special mosquitoes concerned in the transmission of malaria; and, secondly, that the complete extermination of Anopheles mosquitoes is not necessary, but that a reduction of these mosquitoes below the point or to the minimum is only contemplated and sufficient for all practical purposes. The measures for destruction of mosquitoes are directed chiefly against the source — namely, their breeding places. These measures therefore include: 76 THE NEW CHIVALRY — HEALTH (1) Drainage, by ditching, tiling, training of streams. (2) Filling in of low places. (3) Oiling and use of larva- cides. (4) Stocking bodies of water with the natural enemies, such as fish. To prevent the access of mosquitoes to man, the measures employed are screening of living quarters, use of mosquito, netting over beds, and the use of fans and volatile substances. Man. — Since the parasite of malaria exists only in man, its destruction by treatment of man is important. Quinine is the specific remedy to be employed in the treatment. Every case of malaria after being relieved of the active symptoms should continue a course of treatment over a period of three to four months so that he does not become a carrier and thereby a source of infection for mos- quitoes. The amount, form of administration, and time of administration of quinine in the treatment are all impor- tant. Carriers of the parasite should also be given a course of treatment covering a period from three to four months. Immunizing a man is dependent upon the administra- tion of quinine and is termed quinine prophylaxis. Let it be understood that the object of administrating quinine to the healthy individual is for the purpose of inhibiting the development of multiplication of the parasites in the blood in the event such individual is bitten by an infective mosquito. In carrying out a campaign in any locality, the local conditions should be studied and a combination of the vari- ous methods mentioned should be employed and advised for immediate success. Instances can be cited where the adop- tion of one or more of these measures have been successful. For example : A family of nine members living in Arkansas suffered attacks of malaria, and for each of three consecu* tive years the medical services of a physician cost $175 per year. After destroying mosquito breeding places on the farm in and around the home and screening the house at a cost of $40 the medical attendance was $15 and $20 for each year (four years) thereafter. At Roanoke Rapids, malaria prevailed to a great extent in 1913. An examination of 400 apparently well school A NEGLECTED PROBLEM 77 children and some adults showed 55 persons, or 13.75% of all examined, to have the parasite of malaria in their blood. The mill owners contributed a fund, which totaled $3,600, and under the direction of Dr. T. W. M. Long a campaign of drainage, oiling, and education during 1914 was carried out with the result that Anopheles mosquitoes in that community were practically eliminated. Of the cases of malaria occurring during the year, 95% were relapses. An examination of the blood of 780 persons, secured October, 1914, the year after the first index was made, showed 35 persons to be carriers, equal to 4.48% of all persons examined, 67.4% reduction in the incidence. We found then in 1913 1 out of 7 and in 1914 1 out of 23 persons to harbor parasites. The mill owners are so well pleased with the results of their first year's efforts that the work will be continued, and a fund of $1,500 has been raised, which will amply cover expenses for its continuance. There is no reason why the South cannot become as healthful as any other region in the United States. The elimi- nation of malaria means much to the health of its people and to the development of its industries and resources. The sooner this is done, the sooner will the Southland come into its own and lead in all fields of endeavor. A NEGLECTED PROBLEM IN THE CONSERVATION OF HUMAN LIFE PROP. JOHN M. FLETCHER, PH.D., NEW ORLEANS, LA. "Come, I will show thee an affliction unnumbered among the world's sorrows, Yet real and wearisome and constant, embittering the cup of life." The problem which I beg to discuss is that of the speech defective, particularly as it concerns the children of the 78 THE NEW CHIVALRY — HEALTH country. There are tens of thousands of victims of this affliction throughout America who are without remedy and without hope. The United States alone among the civilized nations has neglected them. We have not even attempted to protect them from the shameful quackery that preys upon them. We not only lack a social conscience on the subject, but have not yet developed a truly scientific opinion. So far as I know, this is the first occasion on which this question has been admitted to a place by the side of what we generally consider the larger social problems. I desire to submit three reasons why the present attitude of neglect is not to our credit and should not be allowed to continue : In the first place the speech defectives outnumbered the blind, the deaf, the insane, or the feeble-minded. The gov- ernment report for 1909 shows forty-one State institutions for the blind, with property worth over twelve millions of dollars ; for the deaf we have fifty-seven State institutions, with property worth over sixteen millions of dollars ; for the feeble-minded we have twenty-six State institutions, with property valued at over thirteen millions of dollars. For the insane there is, of course, vastly more than for any one of the above groups. Of the insane, there are thought to be about three hundred thousand in the United States. There are about the same number of feeble-minded. What about the speech defectives? The best estimate we have is that given by Conradi.* On the basis of a study of about ninety thousand children in a number of large cities in the United States, and by use of military statistics for the adult popu- lation, he concludes that there are about a half million speech defectives in this country. He uses the 1902 statistics, and also counts only the children who are enrolled in school. When we remember that not all children are enrolled in school, and that speech defectives as a rule drop out as quickly as possible, it becomes obvious that his figures are below the actual present number. And yet not enough has ♦Edward Conradi, "Psychology and Pathology of Speech Develop- ment in the Child." Ped. Sem., XI, 1904, 327-380. A NEGLECTED PKOBLEM 79 been done for this much larger class of defectives to merit mention in any government report. The second reason why we should cease to neglect this problem is that the greatest single cause of stuttering (the worst form of functional speech defects) is imitation. Social contact, therefore, multiplies the affliction. Hence every stuttering child in the schoolroom or community becomes a menace to his associates. Blindness, deafness, dumbness, f eeble-mindedness, and insanity are not thus contagious. If therefore we have done so much for the latter group of defectives, should we continue to do nothing at all for the speech defectives? The third reason to be mentioned is prognosis. The blind, the deaf, the dumb, the feeble-minded, and most of the insane are incurable. Compare with these the stutterers according to the experience of Professors Gutzmann, of the University of Berlin. Of about a thousand cases. Dr. A. Gutzmann reports eighty-seven per cent cured, ten per cent improved, and three per cent failures. Of six hundred cases, Dr. H. Gutzmann reports eighty-nine per cent cured, nine per cent improved, and two per cent failures. It is generally held that stuttering, with very few exceptions, is curable. It is possible to save most of them and restore them to society whole and happy. Of what other class of defectives can this be said? When once restored they can compete on equal terms with others ; for neither physically nor mentally is the stutterer necessarily subnormal. Among the men of genius Lombroso mentions the following stutterers: Aristotle, u^sop, Demosthenes, Alcibiades, Cato of Utica, Virgil, Mangoni, Erasmus, Charles Lamb, Turenne, Erasmus Dar- win, Charles Darwin, Moses Mendelssohn, Charles V., Romiti, Cardan, Tartaglia. Bluemel adds the names of Boissy d'Anglas, Camille Desmoulins, David (artist), and Charles Kingsley. Civilization demands that we isolate and treat according to their needs all members of society who are hampered by disease, either physical or mental, in the fulfillment of their normal function in society. In all human progress social 80 THE NEW CHIVALRY — HEALTH consciousness must precede a social conscience, and a social conscience is a necessary antecedent of reform. In this field of human welfare we have not even advanced to the first stage of intelligent awareness or appreciation of the exist- ence of a need. After this plea for your consideration of the subject let us look for a moment at what would have more logically come at the beginning — namely, the definition of the type of defect which we are to consider. There are three distinct forms of speech defect — namely, aphasia, which is due to organic disease of the brain ; stammering, which is mispro- nunciation, and is due either to anatomical malformation or lack of physiological development; and finally stuttering, which is a temporarily appearing inability to begin the pronunciation of a word.* Aphasia is a form of dementia, and can be handled properly only under hospital conditions. It admits of accurate diagnosis, and the medical profession is in position to do all that can be done in such cases. The most common form of stammering is the baby talk charac- teristic of certain ages of most children. I use in speaking of this condition the German rather than the English or American terminology, which uses stuttering and stam- mering synonymously. Another typical form of stammering is lisping, which may persist to adulthood. The stammerer, unlike the stutterer, can always utter his words, however badly he may pronounce them. The baby talk of children is not considered to be pathological unless it is prolonged beyond the sixth or seventh year. It should be corrected, however, as early as possible. Most children are taught to stammer by their parents, who seem to think that it is a form of speech that is peculiarly appropriate to children. In cases of physical malformation of the speech organs it is frequently possible to perform slight operations to the relief of the individual. If the defect is due to lack of physiological development, there is need of a speech specialist. If the *E. Meumann, "Vorlesungen zur Einfuhrung in die experimentelle Padagogik," II Aufl., Leipzig, 1911, 1, 667-568. A NEGLECTED PROBLEM 81 subject is of normal mind, expert training will soon remove the defect. Stuttering is to be distinguished from the two foregoing types of speech defects by its intermittent character, and also by the fact that it is not necessarily associated with or caused by any organic disease or lesion. It is found to be conditioned rather by certain states of mind, such as emo- tions, feelings, attitudes, ideas. This makes of it a defect that must be handled educationally rather than medically. Stuttering is therefore a problem for the psychologist rather than for the physician. This fundamental fact must be realized and acted upon before the first step in solid progress can be expected. This, I feel sure, is the error that has held the world back in this matter for so many centuries. The malady of stuttering is an old one; it is mentioned in the Egyptian hieroglyphics, and has undoubtedly been known since the beginning of the science of medicine. And yet, while that science has been mastering the treatment of one disease after another, and has been discovering diseases formerly not known to exist, in this old malady very little has been done for the relief of sufferers. There are many repu- table physicians who attempt to treat stutterers by giving them nerve medicine. The stutterers themselves or else their parents seek the physician for relief because they know of no one else to whom they can go. Prompted by the desire to help, the physician resorts to the remedies which he has been trained to use. He notices the symptoms of nervous- ness and, contrary to his principles of therapeutics, applies his remedies to the symptoms and lets the cause remain. The nervousness is the result generally of the familiar word- fear (logophobia) of the stutterer and his painful antici- pation of stuttering. The writer has numerous records of cases whose pulse went to 102 when they were expecting to have to speak soon. The nervousness will also of course serve to exaggerate the stuttering, and thus play the role of both cause and effect. A nervous temperament is also naturally a fertile ground for the rise of stuttering. It remains to be said, however, with full appreciation of all 82 THE NEW CHIVALRY — HEALTH the physiological conditions of a predisposing nature, that no "cures" by medicine are on record and no such treatments are attempted. If the physician is able to offer no sort of remedy to the parents, he frequently tells them that their child will finally "grow out" of the affliction. As a matter of fact there is no such thing as "growing out" of stuttering. The child may in after years get the mastery of- his speech difficulty, but his recovery is not a mere incident of growth ; it is the result of strenuous effort. But too many, alas, are never successful in this struggle. The statement that the child will grow out of the difficulty is a mere evasion, but the physician will have to continue to resort to it until the question is taken up with the earnestness and scientific scrutiny that it deserves. The history of medical opinion concerning the nature of stuttering has gone through three distinct phases. The first theory held that the seat of the malady lay in the peripheral organs, especially the tongue. The story of Demosthenes and his pebble is familiar. A less humane remedy of this sort is attributed to a German surgeon, Dieffenbach,* who cut out wedge-shaped plugs from the back of the tongue. Whatever good results may have accrued from such an ope^ ration were doubtless due to the distraction of the victim's attention from his speech affiiction to a more severe physical one. After a few fatalities this remedy was abandoned. Other remedies of the same character, though not quite so severe, have been tried at different times. The tongue has been pierced with needles ; cauteries and blisters have been applied to it, and drugs like croton oil have been used.* The first theory ultimately gave way ,to the notion that the seat of the malady was not in the periphery but in the nervous system, which by reason of heredity or other causes is permanently impaired, so that the stutterer is to be regarded as a nervously afflicted person. It may be said *J. F. Dieffenbach, "Die Heilung des Stottems durch eine neue chirurgische Operation." Berlin, 1841, 35 pp. *G. Hudson-Makuen, "A Brief History of the Treatment of Stam- mering." Philadelphia Medical Journal, XIII, 1909-10, 191-197. A NEGLECTED PROBLEM 83 that this theory is generally held by the authorities who approach the question from the medical point of view. The third step in the diagnosis has not only abandoned the notion of peripheral causes, but it considers that the neuropathic systems found associated with stuttering are not necessarily causal, but in most instances sequential. This theory grants that a neuropathic diathesis may afford a favorable background for the rise of the affliction, but at the same time it does not forget that many thousands of persons show neuropathic diathesis and yet do not stutter. The cause has been traced to mental states, to memory com- plexes, to emotions and feelings of various sorts, and to habits and associations involved in the activities of the cortical centers. This is an affliction that is peculiar to childhood, although when firmly fixed it will cast its shadow 'of gloom even down to old age. It is during the plastic years of life that it gets its firm hold, and it is there that the great problem should be attacked. To say that we are at the very beginning of this neglected problem of human suffering is not to overstep the bounds of conservatism. We have years of experience behind us in the care of other types of afflicted mortals, so that there are many well-estab- lished principles concerning methods of treatment, types of institutions, and the like. But in this nothing of the kind has ever been attempted. There are a few competent physi- cians in this country who will take cases of this kind as a pure side line in their regular practice. Outside of these there are many institutions that make great claims and in certain cases give fraudulent guarantees of cure. It is just as much the duty of the government to prosecute these frauds as it is to prosecute those who sell bad drugs. Some of these institutions are not intentionally criminal, but the writer does not know of one that is in the least degree scien- tific, in spite of their many claims to the contrary. This whole situation must be changed. This great army of hampered, suffering human beings cannot be relieved by the side-line practice of busy physicians, nor should it be victim- ized by the unscrupulous and ignorant. What should be 84 THE NEW CHIVALRY — HEALTH done first? These are some of the many things that should be done now: 1. A commission, backed by the Children's Bureau of Washington, or the C?hild Welfare Department of the Rus- sell Sage Foundation, or some other similar organization, should be formed for the systematic study of the situation and the needs in this field. No intelligent action can be taken without this survey. 2. This study should look toward the establishment of a large central institution fully equipped and endowed where individual cases can be received and studied, just as we do in every other class of human affliction. This institution should have as its aim the enlightenment and guidance of the entire country in this field of human rescue. 3. One of the chief functions of such a central institution should be the training of teachers to be used by the State and municipal school systems of the entire country. No city should be without such teachers. The Gutzmanns have sent out more than a thousand such teachers from the Uni- versity of Berlin. Probably not a city in Europe is without such a teacher. 4. Meanwhile the State and city boards of education should be asked to compile statistics regarding the number of children in school who are thus hampered. Not until this is done can the magnitude of the task be appreciated, nor can adequate measures be provided. III. SOME CAUSES OF ILL HEALTH The Causes of Society's Lack of Health War As a Destroyer of Public Health The Effects of Caffeine Upon the Human Organism The Relation of Alcoholism to Poverty and Crime The Alcohol Question and Social Justice Housing and Health THE CAUSES OF SOCIETY'S LACK OF HEALTH HON. GEOEGE EAMES BARSTOW, BARSTOW, TEX. To enumerate all of such causes within the brief time allotted to me would be quite impossible. My purpose will therefore be to point out some of the reasons therefor, con- noting those having especial influence on the lack of health among the people of our Southern States. For many years past I have had occasion to give con- siderable study to* the question of reclaiming the swamp lands of the United States. There are 80,000,000 acres of such lands, about 60,000,000 acres of which lie within the borders of our Southern States. Their economic value to. the South if reclaimed is of the highest importance, as they would readily support 1,500,000 families, or 7,500,000 people, with an annual product of $3,000,000,000. But, more than all, if these lands were reclaimed the health condi- tions of the Southern States would be enormously enhanced with the concomitant economic value. These swamp lands are the natural breeding places of millions of mosquitoes, which ply their avocation with relentless persistence and with enormous destructiveness upon the health of humans. Some years since a young lady friend was visiting my daughter in the summer time. One evening on the veranda the young lady was adorned in evening dress, and the mos- quitoes were annoying her. I remarked: "The Bible tells us that there should be no backbiters." "Yes," she replied, "but that principle is not contained in the mosquitoes' bible." Some years since Dr. Ayers, of New York, a specialist on the mosquito, declared through the public print that there were 250,000 deaths per annum in the United States caused by mosquito bites. A terrible toll on humanity because of its neglect in making all possible protection anent this pest ! One of the worst scourges of disease in the Southern States is malaria., Dr. Von Ezdorf, of the United States Public Health Service, tells us that "malaria is contracted only through the bite of a special mosquito," and that "man 88 THE NEW CHIVALRY — HEALTH infects the mosquito and the mosquito infects man." He proceeds to explain that these conditions absolutely exclude air, water, and food as being methods by which malaria may be contracted. The mosquito is not born with the malaria germ, but in order to get them must first bite a person who has them in his blood. Malaria is a disease due to a germ which lives in the red cells in the blood of man. If therefore we desire to prevent malaria we must break the chain at some point; and that must be accomplished by eradicating the cause of the trouble — i. e., the enormous breeding places of the mosquito. One of the most important and masterful bills before Congress at the present time is the Newlands River Regu- lation Bill, which provides for the controlling of the waters of our rivers at their source ; hence among other important matters to be accomplished by the bill will be the estoppel of the overflowing of these enormous areas of lowlands, and thus by one gigantic effort cut off the great breeding places of the mosquito and conserve the public welfare. Josh Billings said: "In killing a mosquito you are liable to hit the place where he recently was." But if the Newlands bill is brought to its full fruition Uncle Sam will have succeeded most admirably in hitting the mosquito himself. Among the important lessons demonstrated by the military occu- pation of Vera Cruz has been a pronounced vindication of the war anent malaria and yellow fever which was so effi- ciently enforced on the Isthmus by Surgeon General Gorgas. Malaria was almost universally prevalent at Vera Cruz among the Mexicans. But few cases developed among our soldiers, due to the aggressive steps taken by our officers in command there to do away with the mosquito pest. In recent years scientists have unfolded to us the undoubted fact that the house fly is a vital cause contributing to the lack of the people's health. That the common weal is to be advanced by every man, woman, and child, "swatting" the house fly and thus removing this deadly enemy is now an axiom. No community, whether town or city, is immune from this obligation. Included in this duty to society is the THE CAUSES OP SOCIETY'S LACK OP HEALTH 89 requirement that we should demand of others and practice religiously ourselves the vital principle of cleanliness. That is not next to godliness, but a component part thereof ! The nesting place of the fly is in places of dirt and filth. Every city, town, and household in its own protection and that of others is bound to exercise drastic measures to eradicate the house fly. This pest constantly carries from its swarming places foul substances and deposits them on our food and drinks, causing sorrow and trouble in thousands of homes in our land. The question of cleanliness is of acute importance throughout all our communities, the lack of which in some of our Southern cities in years past has caused great human destruction. We have a most emphatic illustration of the great value of cleanliness as discovered by the serious appli- cation of sanitation in the armies of the world. The chief diseases of the army camps are those which, like typhoid fever, are caused by pollution of food and water. In the Crimean War of 1853 twenty-three per cent of the British soldiers died of disease; in the Franco-Prussian war of 1870-71 fourteen per cent of the French soldiers; while in the Russian-Japanese war only two and one-half per cent died from disease, showing a most marked improvement owing to proper sanitation. Among other causes of society's lack of health invading our Southern States are to be found pellagra and trachoma. Referring to the United States Public Health Reports for October, 1914, we are informed that pellagra is not a com- municable (neither infectious nor contagious) disease, but that it is of dietary origin ; that it is dependent on some yet undetermined fault in a diet; and that no pellagra develops in those who consume a mixed, well-balanced, and varied diet. Trachoma is an important infectious disease of the eyes, and careful surveys of this disease have been made in many of the States by the United States Public Health Service. In the rural sections of Tennessee 16,950 persons, largely school children, were examined and twenty per cent found to be suffering from this disease; while in Georgia, 90 THE NEW CHIVALRY — HEALTH out of 78,055 persons, mostly school children, the result was a case rate of only eight-tenths per thousand persons examined. As we all know, great importance attaches in the plant world to most careful maturing of tender vines, bulbs, and plants in order to secure the most successful issue. Even so with the human family. On high authority we are told that tenp of thousands of children suffer from injuries of multi- form character that may result from eyestrain. Scientists discover lines of treatment that should be carefully followed by parents from infancy, so as to avoid a race of imperfect men and women. Dr. Ernest Clark, the London specialist, urges that "no child having the hereditary tendency to short- sightedness should be allowed to learn to write or draw until reaching the age of at least seven years," and that insomnia is a prominent symptom of eyestrain. This leads to depression, which in turn may lead to the alcohol or mor- phine habit. Dr. Gould goes farther; not limiting the view of functional disorders, he names curvature of the spine among common conditions due to eyestrain. He says : "As to the millions of common school children, their ocular ills, their eyestrain and its effect upon general health, their standing in classes, the reasons of dullards and truants and even juvenile criminals — of all this big book of human ills and wrongs, we are now at the opening page." Dr. S. Josephine Barker, director of Child's Hygiene in the New York schools, says that "among the children of the metrop- olis there are sixty thousand cases of defected and un- treated eyesight." Too much cannot be said as to society's lack of health in its failure to use pure water and plenty thereof. In a recent article on "Guarding the Health of Armies," by C E. A. Winslow, he says : "The water supply of the army is safe- guarded with the greatest care. When the troops are in the field, all water for their use is purified either by heat, filtra- tion, or chemical disinfectants, and the most stringent regu- lations forbid drinking from roadside wells and streams. The Japanese use a field filter in which the water is strained THE CAUSES OP SOCIETY'S LACK OP HEALTH 91 and at the same time disinfected by chemicals. In the French army the water supply of the troops is sterilized by the use of ultraviolet light. The most common procedure for purifying water in the field is perhaps sterilization by heat, or distillation." The use of liquor as a beverage and the use of habit- forming drugs are among the very worst evils invading our nation in the destruction of the health of society. If ever a contention was completely exonerated at the bar of public opinion, the same is found in the action concerning the use of liquor by those great nations of the world now engaged in a clash at arms. From the outset most of these nations have prohibited the use of liquor in their armies and navies. More recently the English government has seriously con- sidered making Great Britain prohibition territory during the war period. The vicious use of drugs, such as opium, cocaine, and chloral, is increasing at an alarming pace in the United States, and has already become a national evil and most prejudicial to the common weal. At the present time there exists no adequate or efficient control of this deadly enemy to society's health. What is needed is to give broad, publicity to this matter, and early and wise action should follow by Federal, State, and municipal governments. That the intemperate search for greed and pleasure is constantly weakening the physical stamina of Americans is well recognized by all students of sociology. These trenchant lusts lead to ease and softness, and by dwarfing the mind and soul in due course bring deterioration to health. "Fear the Lord, and depart from evil. It shall be health to thy navel, and marrow to thy bones." In his "Social Sanity" Hugo Munsterberg says : "The more such longings are satisfied, the more they must grow and become a craze which sharpens the feeling of dissatisfaction. This desire for superficial joys, for sensual amusements, and cheap display is nothing but a suggested habit which imitation creates in a period of waste." Worry is a vital cause for society's lack of health. Such a mental condition acts as a sure perversion to all true 92 THE NEW CHIVALRY — HEALTH accomplishment in mental and spiritual life, and is a sure precursor to disease. That multitudes of people are dwarfed and shriveled by such a condition is verily regrettable. Many conscientious but foolish people are worrying them- selves into failure and an early grave, and should be taught the physiological effects of ideas. Our mental machinery is the force by and through which we must wage our battles in this world, and as the machinery is kept in good condition may we hope for achievements of excelsior order. Much has been accomplished by our Federal, State, and municipal governments in the way of safeguarding the public health. But there is room for important advance in this respect. The word "quarantine" is derived from the French word "quarantaine," meaning "forty days." Passen- gers on vessels arriving at Venice from Levant were formerly required to remain forty days in the House of St. Lazarus, or the Lazaretta. This general regulation was afterwards adopted by other Southern European ports, extending to travelers from all parts whence contagion might be carried. Quarantine acts were passed by our colonial legislatures, and later on by the States. The first national quarantine act was passed February 23, 1799, and required Federal officers to aid in the execution of State or municipal quarantine regulations. In 1878 national quaran- tines were established. In 1883 authority was conferred upon the President for establishing quarantine. Many of our Presidents, including Adams, Jefferson, Monroe, Arthur, ^nd Roosevelt, made recommendations regarding public health. The National Board of Health was established and approved March 3 and June 2, 1879, and substantial serv- ice has been rendered to our nation thereby. The ideals of any community, State, or nation are the barometer that discovers the true complexion thereof. This is obvious of all groups, whether in religion, the sciences, commerce, industry, or social sanction. The lofty and car- dinal ideals of any community or group are love, justice, and truth. The product of love is sacrifice, of justice is content- ment, of truth is right living. If these principles are WAR AS A DESTROYteR OP PUBLIC HEALTH 93 controlling, they will assuredly be compelling, the issue of which will produce in our common country the highest level of health in body, mind, and soul. "And now man hath no fate except past deeds, No hell but what he makes, no heaven too high For those to reach whose passions sleep subdued." WAR AS A DESTROYER OF PUBLIC HEALTH ARTHUR DEERIN CALL, EXECUTIVE DIRECTOR OF AMERICAN PEACE SOCIETY, WASHINGTON, D. C. Intelligence, staggered by the facts of war, seeks in vain at this time for adequate expression. Robbery, arson, rape, murder, disease, all on a gigantic scale, are happening with sickening iteration before us. "Inter arma silent leges," indeed! When Napoleon said, "A soldier like me does not care a tinker's damn for the lives of a million men," he voiced the inmost fact of all war. "Without war," said von Moltke, "the world would degenerate and disappear in a morass of materialism." We have been told that "nations can exist only upon physical force," that "without war there can be no patriotism," that "peace is a dream and not even a beautiful dream." But, measured by the acid tests of science, the world is beginning to believe with Novicow, Haeckel, Reclus, Jordan, and others that war tends to eliminate the biologically fit and seriously to retard the progress of the race. If, as with the savages, the victors could kill all the defeated and marry their women, and in the process were not themselves seriously reduced in numbers, there might be a biological advantage from war. But these things are no longer possible. Marriages between belligerents are rare. When 3,900,000 of the flower of Europe were killed because of Napoleon, it was a serious blow to the European stock. 94 THE NEW CHIVALRY — HEALTH It ought not to be necessary to elaborate the self-evident truth that taking recruits from society during their most procreative period is a step toward race suicide. It is a matter of common knowledge that even wholesome athletics tend to wither under military regime. It was Voltaire who said, "Pestilence and famine always follow in the wake of war." War always has been, and is, destructive of public health. EFFECTS OF CERTAIN PAST WARS In time of war the death rate of the civil population has always increased, especially among the women and children. In the war of Austria and Prussia against Denmark, which lasted for only about six months in 1864, the deaths in Den- mark jumped from 1.84% in 1862 and 1.83% in 1863 to 2.33% in 1864, after which the rate gradually decreased. The increase in the death rate among the women was espe- cially notable. During the war of Austria against Prussia in 1866 there was a devastating outbreak of cholera. During the Franco-Prussian war the death rate rose in 1870 from 1,200 to 3,174 in the city of Metz alone, the majority of these deaths being of the women. The increase in mortality in the city of Paris during the siege increased from 17,547 to 44,074. Prior to the nineteenth century statistics are of little value. It is, however, probably true that in 1648 the German population had been reduced from 16,000,000 to 6,000,000; that in some districts only one-tenth of the population remained. It has been shown that in the Austro-Prussian war of 1866 the proportion of deaths among the civil popula- tion increased in Germany from 2.92% to 3.22% and in Austria from 3.05% to 4.08%. The number of deaths among the Austrian women increased about a hundred thousand during the year 1866. In all the nineteenth century the death rate in France was never so high as in the year 1871. Indeed, as a result of the Franco-Prussian war deaths among the women in 1871 greatly increased in France, Switzerland, Belgium, Holland, England, Wales, and probably Germany. WAR AS A DESTROYER OP PUBLIC HEALTH 95 Krehbiel, adapting from Bodart, Myrdez, and others, concludes that the average number of men killed in battle has ranged from 2.2% to 2.5% of the number engaged, the number wounded ranging from 8% to 10%, the ratio of the killed and wounded standing at 1-4, while of the number wounded 10% are fatally so. About 1% of the whole num- ber engaged die from wounds, although military hygiene seems to have diminished this percentage perceptibly in later wars. In the Crimean war deaths from disease reached as high as 16% in the armies of the allies, four dying of disease to every one that died in battle. The deaths from disease in the Franco-Prussian war, not including the wounded, was 1.8% of the whole. The total loss from land engagements, including the killed, wounded, prisoners, deserters, and the rest, amounts to nearly 2'5% of the whole force engaged. In naval battles the rate is higher. During the Crimean war the French engaged 309,268 soldiers, of whom 20,240 died of wounds and 75,375 of disease. The English engaged 97,864, 4,602 of whom died of wounds, 17,580 of disease, while over 12,000 were "invalided" and nearly 6,000 "disabled" and sent home. Sardinia engaged 21,000 soldiers, of whom 28 died of wounds and 3,196 of disease. In other words, the allies engaged 428,132, 24,870 of whom died of wounds and 96,121 of disease. In the Franco-German war Germany engaged 913,967 men, over 17,000 of whom died in battle, nearly 11,000 of whom died of wounds, and over 12,000 of whom died of disease. Among the diseased, one-half died of abdominal typhus, one-sixth died of dysentery. There has been many an outbreak of smallpox among the prisoners of war which has spread to the civil population. Major A. M. Tulloch in a paper read before the Statistical Society of London in 1841 compared the mortality at Gibraltar, Malta, and the Ionian Islands with the naval forces of that vicinity for the years 1830-37. Striking what he calls "the "mean average" of the number of men in the naval force to be 55,709, he reported the number treated to be 72,671, which represents 1,304 for every thousand sailors. Out of this 96 THE NEW CHIVALRY — HEALTH number, 60,256 were diseases, or 1,082 out of every thou- sand. Out of every thousand 11.1% died, and 25.7% out of every thousand were "invalided." In the military force, out of 62,300 men there were treated 67,799, or 1,088 out of every thousand. Of this number, 61,094 were diseases representing 1,118 out of every thousand; 20.4% out of every thousand died and 0.5% out of every thousand were "invalided." Diseases of the lungs were the most prominent in the navy and fevers were most prominent in the military force. Because there were only 1,082 diseases for every one thousand in the navy. Major Tulloch closes his report with the remarkable paragraph : "The evidence adduced in these reports also warrants the pleasing conviction that the profession to which Britain owes so much of her greatness and prosperity is decidedly healthy." Dr. John Davy, F.R.S., wrote in 1862 a book entitled "Some of the More Important Diseases of the Army," etc., in which he states that from 45% to 84% of mortality in the army is due to fevers. He found dysentery, especially abroad, to be the most harmful of the diseases. Dr. George Ballingall, of Great Britain, wrote in 1818 : "When the destructive diseases of tropical climates once gain a footing in a regiment or an army, the devastation they occasion is melancholy to contemplate." Figures taken from the "Medical and Surgical History of the Civil War," compiled in accordance with the Acts of Congress, 1870, inform us that during the war the total number of dead among the Northern armies as a result of the war was 304,369, of whom 33,380 were colored troops. Of the number dead, 44,238 were killed in battle, 49,205 died of wounds and injuries, 527 from suicide, homicide, and execution, 186,216 from disease, while 24,184 died from unknown causes. In fine, 201,769 soldiers of the Northern armies died from disease. There were at least 5,424,547 cases of disease. I say "at least," for the tables are not complete and never can be. The number of wounds and accidents among the Northern soldiers was 400,933. Only one out of three deaths during the Civil War was due directly WAR AS A DESTROYER OP PUBLIC HEALTH 97 to violence. In the Spanish-American war the percentage of deaths from disease was even higher. It should be added that in the Civil War 284,545 were discharged from the Northern armies for disability. The United States Sanitary Commission reported that recruits in the Civil War were chieifly affected by catarrh, bronchitis, pneumonia, measles, mumps, diarrhea, and dysentery. For the first two years of the war 262,807 cases of malarial fever were reported, 213,260 cases of camp fever, 725,675 cases of diarrhea and dysentery, and 63,265 cases of venereal diseases. In short, the causes of death among the diseased in the Northern armies in the order of their significance were: diarrhea and dysentery, camp fevers, pneumonia, smallpox, varioloid, measles, consumption, inter- mittent fevers. The Confederates lost in our Civil War considerably over 300,000 lives. Mr. Noah Buxton, M.P., representing the English Balkan War Fund at the seat of hostilities in 1913, says : "And here, at closest quarters, by the insistent compact of sight and smell and hearing and touch, we realized this image smashed ; its capacity for work, thought, fatherhood, happi- ness, destroyed by resultant ill health; not one alone, such as would in peace time, in case of misfortune, move a whole nation to sympathy, but by scores and hundreds and tens of thousands." Every war presents a ghastly chapter of horrors. The International Commission which inquired into the late Balkan wars notes the number of deaths of girls and young children by fright. It calls attention to the almost universal mal- treatment of women and girls by soldiers, Serbian, Greek, Bulgarian. It notes also that the life of the soldier boys in barracks with many idle hours in town and city streets was both demoralizing and harmful. The long list of atrocities enumerated by this Commission can have had, and continues to have, but one effect upon health among the nations. In all past wars the killing of the bravest, the devastating scourge of diseases often spreading to the civil populations, 98 THE NEW CHIVALRY — HEALTH the unnatural life incident to soldiering, most of the features of the whole foul business have tainted immeasurably the blood and health of the world. PRESENT WAR Can this be true of the present war in Europe? Let us briefly examine some facts already impressively coming into view. This is the first war in which England has had an organ- ized sanitary service. In the Napoleonic wars 3% of the deaths were due to violence and 97% to disease. In the South African war there were 58,000 cases of typhoid fever, whereas in the present war England had, up to March 13, only 625 cases of typhoid fever with 49 deaths abroad, and 262 cases of typhoid with 47 deaths at home. This seems to demonstrate the importance of vaccination against typhoid and of organizing a sanitary service for the army. In this war the more frequent injuries, so far as we have been able to get them from medical reports, result from rifle bullets, shrapnel, and shell splinters. Tetanus is as serious a complication in case of the wounded as heretofore. Under date of February 19, London reported an increase in those blinded by war, due, it is implied, to the nature of modern explosives. Under date of March 12, London reported outbreaks of cerebro-spinal fever among the civil and military population, due largely to overcrowded condi- tions incident to war. London felt at that time the scarcity of doctors due to war service, and a week later urged that the scarcity was becoming serious. There is already percep- tible an appreciable increase in England's civil death rate, and the problem of the birth rate is receiving anxious atten- tion by all of the nations at war. The reports from England agree with those from France that there is universal and unprecedented sepsis among the wounded. This unfortunate condition is attributed to the trenches and to explosions in the highly cultivated soil, the wounded often remaining a long time in filthy mud and water three or more feet deep. The distance of the dressing WAR AS A DESTROYER OF PUBLIC HEALTH 99 stations from the scene of action, the inability to remove the wounded except at night, aggravate the problem greatly. Sir Rickman Godlee, of London, in a recent address before the Royal Institution said : "The only way to stop sepsis in war is to stop war altogether." Berlin has reported the percentage of severely wounded to be less than in former wars. The percentage of those slightly wounded is not materially increased. In the Ger- man-South African war the number of wounded returned to service was 46%, in the Russo-Japanese war the number of wounded returning to service was 60%, whereas in the Franco-Prussian war the number of German wounded returned to service was only 17.6%. The German surgeons are of the opinion that their efforts are returning an increased number of wounded to the service. They do com- plain, however, that the German soldiers are being stricken with typhus contracted from the Russian prisoners. On March 9 it was reported from Berlin that there are twenty- two universities in the German Empire. Enrolled in these universities last summer were 48,500 men and 4,000 women. From this number now in military service there are 36,000 men and 300 women. From the technical high schools seventy-five to eighty per cent of the students are in service. It has already been found necessary to organize in Germany an association for the care of cripples. Early in the year it was also found necessary to organize in Paris a national school for mutilated soldiers. It is not necessary to recount the distress in Belgium. The civic population in Austria is on the verge of starvation. There is a pitiful scarcity of grain and milk in the southern European countries engaged in the struggle. Virulent diseases are spreading rapidly in the armies. Typhoid, smallpox, and cholera are rife in the Russian and Serbian prisoners' camps in Austria. Some of the soldiers have lain in snow a week at a time, insufficiently clothed and underfed. Soldiers are returning from the front by thousands with bodies more or less permanently injured by diseases of the lungs and air passages. 100 THE NEW CHIVALRY — HEALTH Of six American doctors and twelve nurses, comprising two units sent to Serbia by the American Red Cross Associ- ation since the European war began, all but four on April 11 had contracted typhus, and two have died. Dr. M. P. Lane, of New Orleans, returning recently as a convalescent from that stricken country reports: "It is impossible to convey in words the condition of Serbia. When we arrived we found the country in the grip of an epidemic of recur- rent fever, with a high percentage of fatality. Following the recurrent fever came the scourge of typhus, brought into Serbia evidently by Austrian prisoners. In an almost incredibly short length of time the disease was spread through the entire country. Deaths were so numerous that it was hard to find means to dispose of them. In one day during the second week in February there were 450 deaths reported from typhus in the city of Nish alone. The death rate is rapidly increasing." ^ SOME CONCLUSIONS The improved medical and surgical methods due to the advance in modern sciences are more than counterbalanced in the present war by the unparalleled numbers engaged, the trench tactics, and the new machines of destruction. The deadly explosive employed by the French, tri-nitro-tolulol, instantly kills and transfixes men by the mere power of its detonation. The net waste and suffering in the present war probably exceed those of any other known to history. "Accompanying it all," says the editor of the Journal of the American Medical Association under date of March 6, "is an undeniable mental depression under conditions in which, despite the most commendable courage and endurance, the guarded traditions of success in surgery are overthrown and the highest scientific skill is hampered by the impos- sibility of exhibition." Under date of March 13, the same editor says: "Even with all the encouraging reports, the feeling is brought poignantly home that organization for the killing and maiming of men has far outdistanced that for caring for them after the maiming process has finished its work." WAK AS A DESTROYER OF PUBLIC HEALTH 101 Government authorities are still far more interested in the killing and maiming side of war than in that of preser- vation. The concurrent testimony of all observers is that the greatest danger to soldiers to-day, as always, is its diseases, due to exposure, fatigue, privation, and the unnatural life. The governments heretofore have been loath to state the facts. In the present war there seems to be apparent already a similar aversion to reporting the health conditions among the contending armies. It will be years before we shall know statistically the effects among the civil popu- lations of the belligerents, and upon the neutral peoples. We do know, however, that the effects have already reached to every nation, and that the costs are without precedent. AVhile direct losses of the Franco-Prussian war affected only one per cent of the German population, the indirect losses, while incalculable, were essentially larger. Men taken out of productive pursuits, the reduction in the number of mar- riages, the decrease in the birth rate, the increased general mortality, the epidemics in civil population, the increased emigration following war, these are factors needing to be considered, for these factors have heretofore depopulated whole cities, and they may again. There will necessarily be a falling off in the average of human achievement as a result of this war. The propa- gation by the unfit will become a more serious problem. It is true that a certain percentage of defectives from the military point of view may be fit for propagation, that the Mendelian law operates for the removal of certain taints in the progeny of the unfit, that those fit for war would in many instances have become the fathers of defective chil- dren, and that many defectives do not marry at all. Prof. Hugo Ribbert may be justified in believing that a majority of completely efficient men now in the armies will return and furnish vigor for the next generation. This, however, partakes more of prophecy than of science. It seems to be incontestably probable, however, that intermarriage between the unfit will increase as the result of this war, while marriages among the fit will be materially less. 102 THE NEW CHIVALRY — HEALTH Before this war Europe was spending two billion dollars every year for war and preparation for war. The peoples were paying interest on a century of borrowed money, all representing pure war debt. They are now spending this sum every week. This must mean of course wasted capital, higher prices, less consumption, less production, more unem- ployed, more women washing, and more babies dying. If before this war, as Jordan tells us, Europe had doubled her taxes and halved her producing power, borrowing from the pawnbrokers to make up the difference, what must be the outcome simply in terms of public health as a result of this debacle? The vast slaughter in the opposing armies abroad is not only an indictment of civilization but of Christianity and every other religion. But more discouraging than this, more deeply horrible, is the vision of the countless women, children, babes, aged, and diseased — innocent ones — ^pur- sued by scourge, famine, and death throughout the devas- tated reaches of Europe. The crush of helpless millions goes on in Galicia, Serbia, Belgium, Poland, East Prussia, England, Switzerland, France, Russia, Turkey. Emily Hobhouse has told us of the children she saw dying by the thousands in the South African war. When the history of this present war has been written, similar horrors will be none the less numerous and none the less repulsive. As in all wars, so in this, the brunt will fall most heavily upon the noncombatants. But a few days ago at a school entertainment in a West Virginia town six brothers, three on a side, paired off with knives as the deciding factors in a dispute which had arisen. The two oldest promptly hacked each other to death, and I am told that the next two have since died. The youngest pair is expected to recover. This example of primitive blood feud shows that the old blood law is not entirely passed away in our civil popula- tion. The principle is indeed still alive in certain other sections of the world, in Southern Europe, in certain islands of the sea. But, after all, the feudist is outlawed in modern THE EFFECTS OP CAFFEINE 103 civilization. He is looked upon as a menace and a curse. Such forms of family reprisal are treated as crimes. Men are expected now to settle their hatreds and animosities in accordance with the principles of law and order. The private blood feud is legislated against and eliminated as much as is possible. If for no other reason than human health, it is the hope of every right-thinking person that the ancient blood law may be made to cease between the nations. THE EFFECTS OF CAFFEINE UPON THE HUMAN ORGANISM HARVEY W. WILEY, M.D., WASHINGTON, D. C. The drinking of beverages containing caffeine evidently is a late acquisition of humanity. It is not my purpose to enter here into any historical sketch of the history of the drinking of tea and coffee. So far as Western nations are concerned, at least, this practice dates back only a few hundred years. It is evident from this fact that the human race got along very well from the time of its inception until a very short time ago without these beverages. There is a charm in tea and coffee as beverages which is extremely appealing to the human taste. There are very ;few people who dislike the taste and odor which together form the flavor of well-made tea or coffee. It is true, there are certain idiosyncratics who are injured by even small 'quantities of these beverages, so that it becomes impossible for them to indulge therein. There is also a smaller number who rebel at the flavor of these bodies. Wherever the human family has had access to beverages of this class and has had the means of securing them, they have obtained a wide vogue. Some countries prefer tea, and others coffee. Among the tea-drinking nations the Russians and the English take the lead. Among the coffee-drinking nations 104 THE NEW CHIVALRY — HEALTH the United States stands at the head. In round numbers the people of the United States consume ten pounds of coffee per year and only about one pound of tea. Experts differ greatly respecting the comparative effects of tea and coffee containing equal quantities of the drug that is common to both — namely, caffeine. Both of these beverages contain considerable quantities of tannin, while coffee contains very considerable quantities of fixed and essential oils. The evil effects of coffee-drinking have been ascribed by some people to the effect of these oils. The evidence, however, that has come to my notice does not seem to be convincing in this respect. All pharmacological experts agree that caffeine has a specific effect upon the nerve centers. They also agree very well in regard to the character of this effect. It is apparently a stimulant which, in a moderate quantity, acts in the way of increasing the quantity and precision of mental and physical work. Just how this is brought about may not be so clear. It is certain that common experience recognizes that one of the most pronounced effects of tea and coffee is a tendency to wake- fulness. As wakefulness is necessary to efficient mental work, the probability is that the increased efficiency, if there be any, is due solely to this effect. If we engage in mental work of a kind that appeals to us and interests us, we do not usually require any stimulus to keep us awake. On the contrary, if we engage in mental work which is more or less of routine, such as proof-reading or any work of that description, we are apt to be overcome with drowsi- ness, especially in the evening after a full dinner. That coffee and tea render such work more effective is hardly to be denied. Every physician is acquainted with many instances of very harmful effects which come from drinking tea and coffee. These harmful effects are either due to an anaphy- lactic condition which renders the system more sensitive to these toxic substances, or they are due to the consumption of a large amount thereof. Probably they may be due to the two causes combined. At any rate, the evil effects of THE EFFECTS OF CAFFEINE 105 coffee-drinking and tea-drinking are recognized by the medical profession and by pharmacologists. The further fact is well recognized by experts of this class that when caffeine is administered as a pure drug the general effects produced are entirely similar to those which are noticed in the over-consumption of tea and coffee. It is fair to infer, therefore, that at least the principal effects which are noticed are not so much due to a mass action of all the constituents of coffee and tea, but are particularly to be attributed to the influence of the caffeine therein, ip'or this reason attempts have been made, by preparing a coffee from which the principal part of the caffeine has been extracted, to produce coffee, especially, which will retain much of its flavor and character as a beverage — that is, its taste and aroma — and yet be free of the side effects of over-stimulation, producing insomnia. In so far as accounts are available it appears that a coffee of this kind appeals to the taste of the consumer without threat- ening his nervous system. The case of tea is quite different, as it would be difficult to extract the caffeine from tea leaves without so altering their appearance as to render their marketing difficult, if not impossible. While tea contains greater quantities of caffeine than coffee, and while the method of brewing tea is more variable than that of coffee, we may assume, for the sake of this paper at least, that what is known as an ordi- nary cup of tea and an ordinary cup of coffee will have practically the same content of caffeine. People who drink tea and coffee in excess may become immune to their nerve-exciting influence and sleep fairly well, while at the same time they may develop phases of dyspepsia which demand careful medical control. These stomach troubles have been attributed generally on the one hand to the tannin, and on the other to the fixed volatile oils which these beverages contain. It is not likely that such dyspeptic effects can be laid altogether to caffeine. On the other hand, it must not be forgotten that caffeine has a strong resemblance to the purin bodies which are thought 106 THE NEW CHIVALRY — HEALTH to be the source of uric acid. Theoretically caffeine, being a compound known as trimethyl xanthin, a purin body, might be expected to increase the quantities of uric acid in the body. In so far as I have been able to discover there is no scientific report indicating this to be a fact. Until caffeine is connected directly by experiment or observation with an increase of uric acid, this objection will not lie against it. It is, however, a diuretic. Recognizing that tea and coffee must be judiciously and temperately used in order to avoid detectable evil effects, we are justified in concluding that the addition of caffeine to beverages where it does not naturally belong is not calcu- lated to safeguard the public health. In speaking of this part of the subject I do not in any way refer to the use of caffeine as a medicine. Caffeine and its compounds are very extensively employed as remedial agents, especially in the treatment of headache in so far as its pain and discom- fort are concerned. It is not claimed, I believe, that the use of caffeine in such cases strikes at the root of the matter and tends to eradicate the cause to which headaches are due. A large class of so-called soft drinks in this country contain caffeine as an essential ingredient. The caffeine therein is undoubtedly one of the chief causes of the continued popu- larity of these beverages, although I am not blind to the fact that judicious, systematic advertising has been the chief cause at least of the inception and first use of this class of beverages by so many thousands of people through- out the country. Even skillful advertising would not be able to maintain the popularity of a beverage which did not have something more than an advertisement in its appeal to human patronage. The stimulating effects of caffeine in a free state I think may be reasonably considered as greater than in the com- bined state in which it exists in tea and coffee. I am aware of the fact that there is no direct pharmacological proof of this condition. If, for instance, pure caffeine were admin- istered by a pharmacologist in a certain quantity and com- pared with the effects of the same amount of caffeine in tea THE EFFECTS OF CAFFEINE 107 and coffee administered therein, the comparative results might solve this question. But here we have a complication. Tea and coffee contain a great many other materials besides caffeine, and hence the influence of these constituents could not be eliminated from the comparative results. Theoreti- cally it is found that the purer and more concentrated a drug is, the greater is its pharmacological effect, and on this general consensus of opinion I base my own view that caffeine as a drug administered in our foods is more likely to cause distressing results than when administered in a natural compound. Many eminent pharmacologists and physicians have testified to the harmful effects of caffeine in soft drinks. Many others equally eminent and expert have testified that moderate quantities of caffeine in soft drinks may be consumed without injury. Dr. John A. Witherspoon, of Nashville, Tenn., former President of the American Medical Association, testified as follows: "My experience with coca-cola shows that con- tinued users of it are seriously impaired in digestion. . . . I have treated probably thirty or forty patients afflicted with the coca-cola habit during the last four or five years. I have had three cases in the hospital that I have treated to break off the habit. As they gave up the habit their health improved. I have thought that the habitual use of coca-cola impaired their digestion. I regard coca-cola as habit-forming; one glass creates a demand for another because it stimulates the user and makes him feel better; then, when its effect wears off, the reaction is one of depres- sion, and he gets very nervous and seemingly cannot do without it very well." Dr. T. J. Searcy, Superintendent of the Alabama Insane Hospital, at Tuscaloosa, Ala., testified: "In my opinion caffeine is, in a sense, a habit-forming drug. It acts upon the nervous system and renders a man so he feels, or is able to feel, more comfortable. When he does not have it, he feels worse, and he knows he can get some more and relieve it, making him feel better. The habit consists in the fact that the user knows he can take more to relieve him." 108 THE NEW CHIVALRY — HEALTH Dr. Louis Leroy, a practicing physician of Memphis, Tenn., testified : "I have had experience with coca-cola and have consumed some of it myself. My first experience with it was ten or fifteen years ago. It was summer time and I drank half a dozen or so bottles of coca-cola a day, but soon I found that I would have to leave it alone, because I got so nervous that my hand trembled and I could not do fine work. I attributed the nervousness to the coca-cola I was drinking. When I quit using coca-cola I straightened out in a day or two. I have had occasion to treat patients who were users of coca-cola and found, as a rule, they were nervous and irascible. When they gave up coca-cola their nervous condition generally improved. I cannot take coca-cola at night; it keeps me awake." Dr. William F. Boos, graduate of Harvard University and of Heidelberg, testified: "The effect of caffeine on human beings is very similar to its effect upon frogs. There is a slowing of the heart, a more pronounced systolic action. The caffeine also acts on the spinal cord of the human being, producing an increased irritability, an increased reflex irritability, so that little insults, as we call them, occurring ordinarily, become magnified. It also has an effect upon the centers of the brain, stimulating those centers to increased activity, the effect of which is deleterious to health, as the stimulation is carried out at the expense of the organism. The effect of caffeine on the consumer is at times to produce sugar in the urine or the viscera, which is decidedly deleteri- ous to the organs. It also taxes or increases the tax that is made on the system to eliminate that poison from the system. It is decidedly deleterious, and weakens the resistance of the organs toward disease. The effects are worse upon very nervous people, and as for children, they should never be given drugs of any kind." The late Dr. J. H. Musser, twelve years Professor of Clinical Medicine in the University of Pennsylvania, testi- fied: "I consider caffeine a habit-forming drug. This opinion is based upon the fact that once taken, or taken for a period of time, there is a desire or craving of the system THE EFFECTS OF CAFFEINE 109 to repeat the dose. Caffeine is not a food, because it does not build up the tissues, it does not give energy, and does not aid in the repair of the organism. I have been called on to treat persons afflicted with caffeine-poisoning. When the caffeine was withdrawn from them their health improved. In my opinion the consumption of coca-cola, assuming that it contains the ingredients shown by Mr. Fuller's analysis, would seriously affect the health of a normal individual, and, if continued, would produce various symptoms of chronic caffeine-poisoning. In a person in depleted health or one suffering from nervous debility it would increase the irritability or excitability of the indi- vidual. Caffeine is an artificial stimulant, and the effect of artificial stimulation is harmful to human health." Dr. Oliver T. Osborne, Professor of Materia Medica and Pharmacology in Yale Medical School, testified: "I am acquainted with caffeine. It is a drug of poisonous ten- dencies. Its continued or repeated use in the quantities shown by Mr. Fuller's analysis to be contained in coca-cola would be harmful to human health. Its harmful results would be much more marked in a nervous person or a child than in a robust adult. The child's digestion would be impaired; his nervous excitability would be increased; his nutrition and growth would be impaired ; his mentality inter- fered with ; he might and often does become a neurasthenic. A simple dose of a mixture such as coca-cola will produce deleterious effects in a child or nervous person. I have seen such effects, not with coca-cola, but with caffeine admin- istered in another form. I have had to treat a good many persons who were suffering with caffeine-poisoning. I con- sider caffeine a poisonous and habit-forming drug." Dr. Solomon S. Cohen, Professor of Clinical Medicine at the Jefferson Medical College, Philadelphia, testified : "The harmful effects of caffeine may be summed up in this way : It is an excitant leading to overaction. This overaction is followed by fatigue and possibly by exhaustion, which leaves a person in a condition of irritability and weakness; that is to say, his energy has been used up in a bad way; the 110 THE NEW CHIVALRY — HEALTH machine has been driven too hard and too long, and is left in a wabbly condition, partially worn out, and liable to go off when it ought to be quiet. On a person accustomed to taking tea and coffee the use of coca-cola in addition thereto would produce harmful results. I have observed cases of caffeine- poisoning from tea, coffee, and guarana, but not from the alkaloid given in solution or swallowed as a powder. I consider caffeine a habit-forming drug." On the other hand, an abstract of the testimony favorable to caffeine, given by eminent experts, is given below: The late Dr. John W. Mallet, Professor of Chemistry in the University of Virginia, testified : "Caffeine is a stimu- lant, but not a poison, using the word 'poison' in the ordi- narily accepted scientific sense. The word does not admit of an exact definition, because even by scientific men it is used with a certain amount of variation, but I understand, as the generally accepted meaning of the word among scientific men, it is any substance which, when taken into the body in stated amounts, and usually in relatively small amounts, acting chemically, is capable of producing on ordinary persons, or an average person, death or grave injury to health." Dr. Robert L. Emerson, now Assistant Chief of the Bureau of Chemistry, Department of Agriculture, testified : "Caffeine acts as a stimulant. Whether that effect is injuri- ous to the body depends upon the degree of stimulation. I have made experiments tending to show the effect of caffeine when taken into the system of both men and ani- mals. I have studied the effects of caffeine, taking coca- cola syrup, on the nutrition process of the body by experi- mentation with two men, one of them weighing about 180 pounds, 23 years old, and another about 105 pounds, about 15 years old. The conclusions from these experiments can be summed up briefly by saying that the administration of caffeine even in large doses, as these were, is without any effect upon the amount of urine or upon the amount of nitro- gen, which is taken to a certain extent as an indication of the intake and outtake of the body; nor does it show any THE EFFECTS OF CAFFEINE 111 very great variation in the purin nitrogen beyond that accounted for by taking of that kind of nitrogen ; nor does it have any effect upon the amount of uric acid. The experi- ments conducted on these two men did not disclose the effect of the drug on the brain, because I did not examine that, and prove nothing as to the consumption of brain or nerve tissue or as to the heart." Dr. H. C. Wood, Jr., professor in the Medical Chirur- gical College of Philadelphia, testified: "I came to the conclusion that caffeine increased the working capacity of the muscle with probably a less expenditure of energy, because when the experiment was continued over a long period of time, and the muscles became exhausted, I found the total amount of work that the muscle was capable of accomplishing was greater under caffeine than under nor- mal conditions. I performed a number of experiments on different individuals, myself included among them, concern- ing the action of the drug on the circulating system. I found that under the influence of caffeine there was a slowing of the heart, with generally no great alteration in the blood pressure (that in the force of the circulation) , but in one person who never used any form of a caffeine bev- erage I found an increase in the blood pressure — ^that is, in the increase of force of circulation, with a slowing of the pulse. That would indicate that the muscles were working more economically, because the slower the heart works the more advantageous the work. It can accomplish the same amount of work with a less expenditure of energy by con- tracting slowly than by contracting rapidly, and the effect of the blood pressure is not lowered, so there is no weak- ening of the heart's force." Dr. R. W. Wilcox, practicing physician in New York City, testified : "I think the average healthy adult can take, with benefit to himself, as a minimum four to six grains of caffeine a day. I have myself taken, as near as I can ascer- tain, six grains of caffeine a day for the last thirty years. I took forty-two grains of caffeine alkaloid within an hour. It flushed my face considerably, I did not go to sleep until 112 THE NEW CHIVALRY — HEALTH three o'clock the next morning, and it had a diuretic effect. Caffeine, taken in the form of beverages, is not a habit- forming substance in the sense that it is used requiring more to satisfy the real or fanciful longings for the sub- stance. I have had occasion in my practice to prohibit patients using caffeine-containing beverages on account of the condition of the patient, but found no difficulty in inducing them to discontinue its use. Caffeine in the form of beverages in moderate quantities will produce exaltation, but the depression will not be below the level from which you started." Dr. Thos. E. Satterthwaite, practicing physician in New York City, testified : "I think a moderate amount of caffeine to be taken in beverages to be five or six grains per day. The effect of such an amount would not be harmful, but would be agreeable and quite stimulating. I have known of no permanent ill effect from the taking of caffeine in any kind of dose. I personally use caffeine in coffee and tea. This use of caffeine has never affected my health. I think there are occasionally times when a cup of coffee if taken stronger than usual will increase nervousness a little, but it has never had anything but a temporary effect on me." The above gives a fair presentation of the subject from two points of view by experts of acknowledged eminence in their various professions. What are we to do in the case of such conflicting opinions? One thing we should not do, that is to question the motives of the experts. There are two sides to every question. It is the business of the expert to develop that side of the question in which his client is par- ticularly interested. We may therefore conclude that the views of scientific experts concerning the effect of moderate quantities of caffeine upon the human system are widely variant. This is not a matter of surprise when we bear in mind that it is not the drug which is to be standardized, but the person who takes the drug. The same drug will appar- ently injure one person seriously and will have no detectable injurious effect upon another person. In view of these facts the path of wisdom is plainly marked. We should take that THE EFFECTS OF CAFFEINE 113 course which will avoid all possible injury. In the matter of the use of a caffeinated beverage, especially by children and those who are peculiarly susceptible to its influence, the safe road is one of total abstention. We may admit without question that the bad effects produced by caffeine are certainly much less to be feared than those that follow in the wake of the use of many other drugs. Alcohol, cocaine, morphine, acetanilid, chloral hydrate, cannabis, and similar drugs produce effects which are terrible in the extreme upon their unfortunate victims. They not only destroy health, but moral responsibility and physical vigor. Caffeine contents itself with its deleterious effects upon health, and it is not likely to impair the moral, and not to a very great extent the physical, efficiency of its victims. It is only in cases of great quantities and of long use that complete physical breakdown and mental ineffici- ency occur. The part of wisdom, however, is to avoid all contin- gencies of all kinds, and my plea in this connection is, first, that we should safeguard our children at all hazards against forming the caffeine habit, at least until they are grown and can use their own judgment. We should advise the users of tea and coffee and of caffeinated beverages in general to be extremely temperate in their use. In so far as possible the use of caffeine should be restricted to the beverages in which it naturally occurs, thus avoiding the added danger of synthetic products in which caffeine is one of the constitu- ents. Guided by this principle, the evils which now threaten us, and especially the children of the country, through the use of caffeine in any form will be effectually prevented. 114 THE NEW CHIVALRY — HEALTH THE RELATION OF ALCOHOLISM TO POVERTY AND CRIME EDWIN C. DINWIDDIE, SUPERINTENDENT OP THE NATIONAL TEMPERANCE BUREAU, WASHINGTON, D. C. The best estimate that can be made of the total amount of the annual expenditure for intoxicating liquors by the people of the United States is two and one-half billion dollars. The sum is so vast that we can grasp it only by comparisons. It is generally estimated that the cost of the Panama Canal, doubtless the greatest engineering achieve- ment in history, wiU be approximately four hundred millions of dollars. The American people are, therefore, spending each year for drink over six times the cost of the Panama Canal. Secretary Bryan states that he made the endeavor to secure an accurate estimate of the total amount spent on education in this country and the figure given him was seven hundred and fifty millions of dollars, this sum includ- ing all the cost of the educational work in our country among our over ninety millions of people, from the kinder- garten to the university. Is it not depressing to think that we spend much more than three times as much for drink as we spend for education? Our Federal Government in its Legislative, Judicial, and Executive Departments is run at an expense of a little less than a billion and a quarter of dollars. This includes the salaries of all our officials from the President of the United States down to the charwoman who scrubs the floors of our public buildings. To use Mr. Bryan's own language: "It includes the salaries and expenses of our Ambassadors and Ministers through whom- we maintain diplomatic relations with the entire world; it covers the cost of our consular service, which looks after our commerce in foreign lands. It includes the expense of the Treasury, which handles our money, collects our taxes, and supervises the banking RELATION OP ALCOHOLISM TO CRIME 115 system of the nation. It covers the expenses of the Army and the expenses of the Navy. It provides means for enforcing the laws of the United States. It includes the operations of the Post Office Department, which carries mail to every village, hamlet, and city, with its fifty-six thousand postmasters, its nineteen thousand railway clerks, and its seventy-five thousand mail carriers in the cities and in the country. It covers the expenses of the Interior Department, with its multiplied agencies for dealing with pensions, with the public lands of the country, with irriga- tion, and with Indian affairs. It covers the expenses of the Agricultural Department, with its experimental work and its search throughout the world for that which can be profit- ably grown in this country. It supplies the needs of the rapidly increasing Department of Commerce and the vitally important work of the Department of Labor. It supplies the funds needed by the Interstate Commerce Commission for the regulation of railroads and by the new Federal Trade Commission for the prevention of monopoly. All of these governmental agencies employed in administering the Fed- eral Government of this great nation are operated at an expense of less than a billion and a quarter of dollars." No statement is necessary anywhere in the Southland to emphasize the importance of the cotton crop, and yet we, the people of the United States, consume each year in alco- holic liquors the value of five average annual cotton crops, which at the prices current December 1, 1914, amounted to five hundred and twenty millions of dollars. Last year's wheat crop was valued at eight hundred and seventy-eight millions of dollars. The drink bill of the United States is, therefore, over two and three-fourths times the value of the entire wheat crop of the nation. The corn crop was valued at one billion seven hundred millions of dollars, so it is seen that in one year we consume in intoxicating liquors almost the entire value of all the wheat and all the corn grown in the United States last year. When we think of what these immense sums of money would purchase in the way of food and clothing and farms 116 THE NEW CHIVALRY — HEALTH and town homes with all their comforts and necessities, together with the increased demand for labor and material which the diversion of this fund into legitimate channels of trade would create and then realize that in addition to the direct cost of the liquors consumed the taxpayers, the philanthropists, and the sufferers through strong drink of the country must make up an almost equal sum to pay the cost of maintaining the paupers, the criminals, the insane, the feeble-minded, the physically and mentally diseased, and the innumerable wastes which flow as certainly from the consumption of alcohol as the rising follows the setting sun, we begin to have some idea of the magnitude of the alcoholic problem. According to the report of the Treasury Department, there are in this country 7,581 national banks, with a capital stock of $1,065,951,505, and surplus and undivided profits $726,935,755, making a combined capital and surplus of slightly less than $1,800,000,000. The annual drink bill of the United States would purchase all the national banks with their capital and all their assets and have seven hun- dred millions of dollars over for investment in other enter- prises. The annual drink bill of the United States would build three hundred thousand miles of standard macadam road sixteen feet wide and seven inches deep in the United States each year. Built twelve miles apart, it would pay for the construction of one hundred magnificent highways clear across the continent from the east to the west, and if we should devote a second year's drink bill to the construction of good roads, we could build them north and south twelve miles apart between the oceans, so that every inhabitant would be within six miles of a good road which would connect him through such a system with every other part of the United States. The most conservative estimate gives the traffic in intoxi- cating liquors as responsible for twenty-five per cent of the poverty and thirty-seven per cent of the pauperism of the country. These two items are used to differentiate the relief RELATION OF ALCOHOLISM TO CRIME 117 of distress in the one case by organized charitable associ- ations and the other in public almshouses respectively. The following figures taken from the Federal Census of 1910 afford a comparison between nine prohibition States and nine licensed States (counting the District of Columbia as a State) . The license States and districts are those in which less than twenty-five per cent of the population is living in prohibition territory. The figures speak for themselves. The ratio of population is as two plus to three, so that if the licensed States had only their proportionate number of paupers according to the population instead of having 28,050 they would have approximately 10,240. Instead of having 120.5 paupers to each one hundred thousand of the popula- tion, to keep the proportion with the prohibition States just referred to, the licensed States should have approximately 68.5. The Committee of Fifty, according to statistics which they, gathered in 1899 and reported in a volume entitled "Economic Aspects of the Liquor Problem," show that, within a small fraction, forty-six cents out of every dollar spent for the relief of destitute and neglected children went to take care of the results of alcoholic liquor drinking. The Chicago Juvenile Protective Association dealt with 1,379 adult delinquencies toward children during the first six months of the year 1912 and ascertained that seventy- five per cent of this number had drunkenness as the chief cause. The Charity Organization Society of New York and the New York Association for Improving the Conditions of the Poor maintain what is termed a "Joint Application Bureau" through which both societies look after homeless men and women. Mr. Charles K. Blatchly is the Superintendent of the Bureau's office at 105 East Twenty-Second Street, New York City. Their records during two periods of eight months each, running through portions of the years 1909 to 1912, pertaining to 18,606 destitute persons, show that sixty per cent of these cases were caused directly by intemper- ance. If the facts could be known, I do not doubt that fully 118 THE NEW CHIVALRY — HEALTH half the poverty and pauperism of the country is attributa- ble directly and indirectly to the use of intoxicating liquors. If we are satisfied to take the lowest estimate of the most conservative statisticians and figure about one-third of the pauperism of the country due to alcoholism, there is in that estimate a challenge to the God-fearing, humanity-loving people of the Southland to redouble their efforts to find and apply at the earliest possible date the remedy for this national scourge. When we consider alcoholism in its relation to crime, we find a still greater divergence in the estimates of those who have undertaken to give us the figures. The most conservative estimate is that fifty per cent of the crime of the country (exclusive of drunkenness itself) is attributable directly or indirectly to alcoholic liquor drinking. We have the testimony of rulers of nations, governors of States, judges on the bench, police court magistrates, wardens and chaplains of penitentiaries, and others qualified to speak which runs the percentage of crime coming under their notice as high as ninety per cent. In his speech several years ago before the naval cadets at Murwick, Germany, Kaiser Wilhelm II. made the following statement : "During my reign I have observed that of the great number of crimes appealed to me for decision, nine-tenths were due to alcohol." 0. L. Kipplinger, chaplain of the Northern Indiana Peni- tentiary, at Michigan City, recently said in a lecture at Elkhart, Ind., that "ninety-six per cent of the men in that prison for murder traced their crimes to liquor." He also made the appalling statement that "83.73 per cent of all the men passed through the Northern Indiana Penitentiary in the last eight or nine years have been moderate or exces- sive users of alcoholic liquor and traced their crimes directly or indirectly to it. Out of 1,150 prisoners, 963 were either drunk or drinking when their crimes were committed, or their drinking had lowered their moral standards." Judge Kobert Carey, of Jersey City, in an address in Philadelphia two years ago, stated : "In my experience on RELATION OP ALCOHOLISM TO CRIME 119 the bench I have judged over 15,000 criminal cases, which have included every imaginable type of crime, and seventy- five per cent of them came into the court because of the saloon." P. P. Garven, prosecutor of the pleas in Hudson County, N. J., which includes the cities of Jersey City, Hoboken, and Bayonne, stated that ninety per cent of the cases which he had prosecuted were caused by the saloon. Ex-Governor B. B. Comer, of Alabama, stated while Governor of that State : "Before I entered upon my official duties as Governor, while I was a strong temperance man, yet I was in no sense of the word a prohibitionist, believing that a State law was of doubtful utility. But after a year as Chief Executive I am an intense prohibitionist, having been made so by the mothers, wives, and children who have come to my office for the purpose of securing pardon or stay of execution for their sons, husbands, and fathers, in many instances for murders committed in nearly all cases while under the influence of whisky." Similar testimony could be adduced from other governors and judges over all the country, but it would simply be cumulative in its character. I content myself therefore by calling attention to the state- ment of John A. Kingsbury, Commissioner of Charities of New York, who says that "liquor is responsible for eighty- eight per cent of the inmates of the prisons of this country." The report of a special commission which conducted investi- gations at the municipal lodging house in New York City, upon which Mr. Kingsbury based his statement, used the following language : "Eighty-eight per cent of the inmates of the prisons of this country became prisoners as a result of the use of liquors. Over twenty per cent of the crimes committed by the inmates of our city prisons were com- mitted in liquor saloons. This is a terrible arraignment of the saloon as the cause of vagrancy and crime." Mr. A. D. Cutler, a member of the Board of Police Com- missioners in San Francisco during the three years follow- ing the earthquake and fire, made the following statement a few years ago : "It was my custom to examine the records 120 THE NEW CHIVALEY — HEALTH of the city prisons frequently, showing all the crimes and other particulars attending the arrests that numbered about two hundred daily, and my conclusion was that fully ninety per cent were due directly or indirectly to the use of liquors. Again, all saloons in San Francisco were closed for thirty days following the great Are in April, 1906, the result being that there was so little police duty necessary, in spite of the great confusion growing out of the fire, that one-half of the police force were given vacations for periods of from ten to thirty days. When the saloons were again opened, the officers on vacations were recalled, as it was deemed neces- sary to place the entire force on duty because of the increased crime and disorder." A little less than a year ago investigation was made con- cerning the inmates of the Ohio State Penitentiary at Columbus, and out of 1,640 convicts 1,458 admitted that drink caused their downfall. Within the last year most remarkable petitions were prepared by the inmates of two well-known penitentiaries in two of our largest States. Out of a total of 1,478 prisoners in the Eastern Pennsylvania Penitentiary 1,008 signed a petition for state-wide prohi- bition, the claim being made that the liquor traffic is prob- ably responsible for seventy per cent of the crime which brought the men there. A petition to the State Legislature of Illinois was prepared by twelve or thirteen hundred of the inmates at the penitentiary at Joliet and the statement was likewise made in that petition that they believed "if the sale of intoxicating liquors were prohibited by the enact- ment of laws by that honorable body the effect would be to reduce crime at least seventy per cent." Every student of economic and social conditions is aware of the irregularity and the unsatisfactoriness of our methods of keeping statistical information in this country and knows with what thoroughness and reliability such figures are kept in most European nations. The National Temperance Qvarterly of London, of which Mr. John T. Rae is the man- aging editor, a most conservative and reliable periodical, is authority for the statement that "since 1887 it has been the RELATION OP ALCOHOLISM TO CRIME 121 practice in Sweden to make careful inquiry and report as to how many prisoners were intoxicated at the moment of commission of crime and how many were addicted to drink before the crime. Between 1887 and 1905, of the men pris- oners, 71.9 per cent were either intoxicated when the crime was committed or were habitual drinkers." The influence of alcohol was proved as follows: In 86.5 per cent of the cases of breaches of regulations and public order, in 85.2 per cent of assassinations, murders, and other acts of violence; in 82.3 per cent of cases of robbery with violence; in 71.2 per cent of breaches of military law; in 68.3 per cent of thefts and larcenies ; and in 66.9 per cent of sexual crimes. Swindling, on the other hand, showed 38.8 per cent, perjury 34.6 per cent, and libel 33 per cent of the cases committed under the influence of alcohol." Even before the war in Europe, the Russian Govern- ment was making inquiries with a view of discontinuing its vodka monopoly. Undoubtedly the war hastened the decision for its prohibition, and practically universal testi- mony is borne of the beneficient results which have come to the Russian people by the adoption of that policy in the diminution of crime, the lessening of the drunkenness, the increased prosperity and happiness of the people. Dr. Sleyster, of Wisconsin, who has served both as a prison physician and as superintendent of a criminal insane hospital, has given some interesting evidence which he secured from a careful study into the lives and habits of 502 criminals out of 1,800 which he investigated. This means that in only about one-third of the cases was he able to corroborate the prisoners' statements from outside sources or has considered his information sufficiently relia- ble to accept for statistical purposes. "'Of this number, 217 (or 36.8 per cent) were the sons of drunken fathers; 239 (or 40.4 per cent) were addicted to the use of alcohol before reaching the age of 15 ; 311 (or 52.5 per cent) habit- ually drank to excess; only 57 (or 9.6 per cent) were abstainers ; and 384 (or 64,9 per cent) spent their evenings in saloons, at cheap shows, or on the streets." 122 THE NEW CHIVALRY — HEALTH Dr. iSleyster also makes public a separate study which he made of 269 murderers. "Of these, alcohol was used to excess by 41.5 per cent, while but 12.6 per cent were abstainers. Nearly half were under the influence of alco- hol when the crime was committed, and 27.9 per cent had a history of previous arrests for drunkenness." I close the testimony against the saloon as a breeding place of crime and the harbor of criminals by quoting from an interview of the presiding judge of one of the Chicago city courts which appeared in the Inter-Ocean of that city : "You may ransack the pigeonholes all over the city and county, and look over such annual reports as are made up, but they will not tell half the truth. Not only are the saloons of Chicago responsible for the cost of the police force, the fifteen justice courts, the county jails, a great portion of the Joliet State prison, the long murder trials, the coroner's office, the morgue, the poorhouse, the madhouse — go any- where you please, and you will find almost invariably that whisky is the root of the evil. The gambling houses of the city and the bad houses of the city are the direct outgrowth of the boon companions of drink. I know whereof I speak. This saloon, that saloon, the other saloon — saloons, saloons, SALOONS figured constantly and universally in the anarch- ist trials. Conspirators met in saloons, dynamite was dis- cussed in saloons; bombs were distributed over saloons; armed revolutionists were drilled above, under, or in the rear of saloons; and time and time again, witnesses say, 'We went to such and such a saloon for wine and beer.' There is not a country under the sun in which lurks so much treason, revolution, and murder as in the saloons of the United States, and notably in the larger cities." If we add to our indictment of alcohol as a prolific cause of pauperism and crime its record as a producer of disease, of family discord, of physical and mental deficiency, as the despoiler of childhood, as the destroyer of wealth, as the corrupter of morals, as the enemy of honest politics, as the vehicle for corrupt practices in the public life, we certainly present a case which the honest seeker after truth cannot RELATION OF ALCOHOLISM TO CRIME 123 ignore and dare not minimize. No one who has studied our present-day social conditions would hazard the statement that the stopping of liquor-drinking or the prohibition of the manufacture and sale of intoxicating liquors would remedy all our other evils. But I do not fear to assert that the other proposed sociological reforms will prove illusive and ineffective while the liquor problem remains unsolved; that all of them are rendered more difficult of solution by the evils of alcoholism and the presence of the liquor traffic — its producing cause — in society. The South in my opinion has a duty to perform and a responsibility to face in this reform, not only for her own benefit but for the nation as well. She has the purest Americanism in the whole country; she is still outside the doftiination of the great centers of population ; she is herself almost free from the licensed saloon and bids fair to see every one of the distinctively Southern States in the prohi- bition column within the next five years. Her leaders of thought and action, especially her preachers and teachers and doctors, should lead out in a great educational cam- paign concerning the evil effects of liquor-drinking with a view of ushering in an era of total abstinence on the part of her people which will render easier the adoption of prohibitory legislation and also its enforcement when adopted. The spread of the knowledge of the scientific truths concerning alcohol is a prime necessity at this stage of our national fight and it will tremendously buttress the prohibitory laws which fortunately obtain in so many of the Southern States. Alcoholism is a standing menace to the peace and health and prosperity of the people and the stability of our institutions. Let this Congress sound the tocsin of war and call to the colors every true friend of humanity and every lover of our country for a nation-wide campaign of extermination! 124 THE NEW CHIVALRY — HEALTH THE ALCOHOL QUESTION AND SOCIAL JUSTICE MISS CORA FRANCES STODDARD, SECRETARY THE SCIENTIFIC TEMPERANCE FEDERATION, BOSTON, MASS. This Congress is a council of war. It is a war for men and women and little children, for homes, for humanity. The disciples vf the infinitely small are in it, fighting the plagues of infectious diseases. The lovers of children are in it, fighting for a sound parenthood, a healthy home, a proper mental, moral, and industrial training. The con- servators of the race are in it, fighting for such care of the unfit as shall protect them against themselves and protect generations yet unborn against their weakness. The apostles of a new social order are in it, demanding that men and women shall have a fair chance to live and work and enjoy the fruits of their labor under healthful and just conditions. Inefficiency, disease, misery, delinquency, crime, vice, degeneracy — ^these are the strongholds to which we lay siege on this better battlefield for human progress, and "in this war there is no discharge." One very soon learns as we fight away along our par- ticular lines of trenches that they are not mutually exclusive. The corps which attacks preventable disease finds itself compelled to cope also with bad housing and city sanitation. If you fight for the health of the child, you presently find that infant and child mortality has dug itself into trenches of heredity, untrained parenthood, badly or ignorantly kept homes, low wages of parents. If you are wrestling with the question of mental hygiene, you at once run up against false standards of living and amusements, immorality and drugs. If you attack any question of human welfare, sooner or later you are bound to find woven into the very woof and warp of the question the dark threads of alcohol. Judge Popert, of Hamburg, well put the matter when he said : "If the alcohol question were solved, there would still remain other social questions to be solved; but as things stand THE ALCOHOL QUESTION AND SOCUL JUSTICE 125 to-day, no other question of social welfare can be taken up with any prospect of securing effective results until the alcohol question is solved." Equally emphatic was the Swedish Professor Thyren speaking before the parliament of Sweden: "Whether it shall be possible to do away wholly with alcohol, I cannot say, but I do say that it is necessary, if the race is to be kept from sinking, and if our social problems are to find anything like a fundamental solution." In this day one need not speak at length of the more obvious results of alcoholism. We well know that competent observers and investigators estimate that from fifty to ninety per cent of the crime with which our courts have to deal is directly or indirectly due to alcohol. We know that a certain amount of poverty is definitely due to the same cause. We know that there are misery, disease, and death in the trail of this jolly comrade of an hour which, by its false sense of exhilaration, may betray the user into all that is worst for himself and for society. I desire rather to speak of the social injustice which alcohol is doing in our midst through the subtlety of both its direct and its indi- rect influence which constitute it the great enemy of phys- ical and moral health, not only of individuals, but of society as a whole and of the nation. If our modem demands for social justice mean anything at all, they mean that there shall be a fair chance for all. They mean that the child shall not be unnecessarily handi- capped in life's race, that the unfortunate shall not be made more unfortunate, that the poor shall not be thrust deeper into poverty, that the strong shall not be made weak, that the weak shall not be made either weaker or a source of continued weakness to society, that the human race shall have a chance to free itself from deteriorating and disinte- grating forces. But what chance have we of carrying out this program in the presence of alcohol? A quarter of a century or more ago the scientists of the world began to turn to their laboratories to search out the true ways of this old companion of human sociability. With 126 THE NEW CHIVALRY — HEALTH the scalpel of truth they have laid alcohol before our eyes, stripping it of its glamour and revealing it as it is. They have shown us by actual demonstration that, far below the point of intoxication, alcohol impairs working ability, that it dulls the power of perception, decreases ability to give attention, impairs memory, tends to confuse the power of judgment, weakens self-control and self-restraint, lengthens the time required for choice or decision, or temporarily quickens muscular activity at the expense of accuracy. They have shown, for instance, that there is a physical explana- tion for crime committed under the influence of alcohol. A temporary quickening of muscular activity gives a sensation of increased strength; the paralyzing action of alcohol impairs judgment and self-restraint. The result is that when the drinker is irritated by a word, a gesture, the reaction may immediately take the form of an unconsidered blow with whatever weapon may be at hand. If the normal course of reaction were not affected by the alcohol con- sumed, he would consider the most practical form of defense, or else the imaginary character of the insult would be recognized. Science has shown that these effects of alcohol combine to make the drinker more liable to accidents, because it impairs his judgment of distances and thus of certain kinds of danger, because it dulls his senses and alertness in per- ceiving danger and his ability to decide quickly and accu- rately how to avoid it. He tends to become less efficient as a worker and thus eventually less capable of earning and providing adequate support for the healthful maintenance of his family, more capable of offenses against public order and welfare. On the health side, the same patient scientific research has shown that alcohol diminishes resistance to infectious disease. We have heard much said at this Congress about the germs which cause these diseases. But we must have not only the seed but the soil. If the body's resistance is good, we do not contract the disease. Science by the most painstaking methods has shown that alcohol by weakening THE ALCOHOL QUESTION AND SOCUL JUSTICE 127 or narcotizing the natural bodily defenses prepares the soil on which the disease germs may develop and flourish exceedingly; that, for instance, "drink," by itself or added to the trio, "dark, dirt, and damp," increases liability to tuberculosis and interferes with recovery, that it is the right- hand man of pneumonia. Science has shown that there are certain direct forms of organic or functional disease due to alcohol, especially those so-called "degenerative diseases" affecting the heart, liver, kidneys, and diseases of middle life. Between 1889 and 1911 the death rate in the registra- tion States from degenerative diseases increased 104 per cent. Alcohol is conceded to be an important factor in causing them, and it is therefore noteworthy that while the diseases were increasiilg 104 per cent the per capita con- sumption of alcohol increased 128 per cent. Drink is not to be debited with all this increase, of course, but that it has greatly contributed to it there can be no reasonable doubt. Science has shown, too, that alcohol causes or precipi- tates mental unsoundness. Just here, then, we come upon the fundamental facts of the whole alcohol problem. Every one of them has a direct bearing upon social welfare and human progress because they are the explanation of and reason for the more obvious ills that we are wont to charge up to drink. Given, then, the drink and the drinker, what are the possible outcomes from the standpoint of social justice? We know, in the first place, that alcohol increases the national death rate. Even the most conservative estimate makes alcohol a factor in the death of one adult in every thirteen who dies, and in the death of one man in every seven and one-half men who die. This is bad enough, but even then it does not include such deaths as result, for example, from the railroad accident caused by a drinking engineer. But even from this conservative point of view, alcoholism must be regarded as one of the serious prevent- able diseases. I use that term "preventable diseases" advisedly. Alco- holism and all the diseases to which it contributes are abso- 128 THE NEW CHIVALRY — HEALTH lutely preventable as far as the alcoholic factor is concerned. No man need have any alcohol-caused disease. He may and does contract smallpox or typhoid involuntarily, but he can absolutely avoid disease due to drink. Again, we know that on the average the drinkers' lives will be shortened. The well-known English statistics showed that in general the lives of insured moderate drinkers are about eleven per cent shorter than those of insured abstainers. Australian sick benefit societies showed that the rate of sickness, duration of sickness, and death rate were nearly twice as high in the non-abstaining socie- ties as in the organizations insuring abstainers only. Recent American statistics show that men who have been at times free drinkers, but whose habits were considered satisfactory when insured, die on the average about four years earlier than the insured men in general. "This means, of course, that many men will lose more years than this — ^for instance, that while at the age of thirty-five the expectation of life is thirty-two years, in the first year after that age instead of, say, nine persons dying, there would probably be twelve deaths. That is, three men would each lose thirty-two years of life; in the next year, probably four men would each lose thirty-one years of life." (Hunt). All such premature losses of life mean that society loses its men before they have made adequate return for the expense of rearing them to the age of self -maintenance ; it means in a certain proportion of cases that the drinker is taken from his family in the prime of life at the very age when he is most needed; it may thus mean poverty for the wife and children, a forcing of the wife into Industry at the expense of the physical and moral health of the children. It may mean that the child himself has to enter the treadmill of industry. The same point may be reached in another way. Here is a drinking father who lives, but his health or efficiency is gradually impaired by alcohol, earning capacity lessened. Add to this the waste of money on drink or the loss of THE ALCOHOL QUESTION AND SOCIAL JUSTICE 129 time through drunkenness and once more poverty appears in the home, and again we find the child drawn into misery. Here, then, is one of the vicious cycles of social injustice which tends to physical and moral deterioration. What- ever launches the child too early into industry starts this cycle going. Here is what we have in this case: Drink, poverty, child labor, the child's opportunity for industrial training or health and efficiency impaired; and as a result, low wages when he reaches maturity, low wages in turn bringing poverty, and this poverty again may lead to drink, and the cycle of the next generation repeat the story, but on a lower plane. Now the child first caught in this cycle was not to blame. He was the victim of an injustice which perhaps cannot be remedied at one stroke. But at least the cycle could be broken at the point where alcohol appears in it. Experience has shown that when drink is eliminated from a family or community these cycles of child misery where drink is involved are largely broken up. The alcoholic factor can be eliminated, and the child given that much more chance for development into a normal, healthful, rational life. Incidentally he himself is then eliminated from those with whom and for whom agencies for social welfare must wrestle. The child birthright is to be well born, well cared for, and well trained. Wealth and position he may acquire for himself, but these three essentials are his due. I know there is a diversity of opinion among students of heredity as to whether alcohol directly causes degeneracy in various kinds of offspring. But experiments on lower forms of life, simple cells, plant and animal life, and some anatomical and family observations seem to demonstrate that under certain conditions alcohol can so impair the life cells as to cause a deterioration of offspring manifesting itself in various ways. At all events, everybody agrees that at least alcoholism and degeneracy go hand in hand, even though the full extent of the relations of cause and effect are not yet wholly established in all respects. 9 130 THE NEW CHIVALRY — HEALTH But from a practical point of view the alcoholic problem is a highly serious one for race soundness in any case — whether we believe that alcohol is capable of producing inferior stock, or whether we believe that alcoholism is itself an expression of inferiority, or whether both points of view are correct. If alcohol causes deterioration, under right conditions it may be responsible for starting a train of degenerate tendencies developing slowly from generation to generation, the full effects of which may not be apparent for several generations. Indeed, it seems a fair question whether the families in which some of these defects appear, and frequently mixed up with alcoholism, may not have the roots of this degeneracy far back in some drinking ancestry too remote to be traceable at present. On the other hand, given a person of degenerate tendencies, there is no doubt that alcoholism is easily acquired to the detri- ment of even such chance as the unfortunate may have to be at least a reasonably self-supporting member of society. Dr. Milton J. Rosenau, in "Preventive Medicine," speaking of alcohol and insanity, refers to their inter- relation as showing the "great necessity of throwing special safeguards about unstable persons in whom intemperance may lead to such disastrous results." Alcoholism in the defective, by the very social environment which it engenders as it affects the choice of a mate, if in no other way, prac- tically precludes any possible chance (if such exists) of breeding out the defect, and means almost inevitably a brood of defective children. Remember this : The whole story is not told by statistics. Many a case of insanity, for example, precipitated by alcohol, never gets into those records of 15, 20, or 25 or more per cent of admissions to insane hospitals due to alcohol. A year or two ago a young girl in one of our large cities was brought for consultation to the psychopathic authorities. She was showing tendencies of mental unbal- ance. Her case was carefully studied. The home, though humble, was comfortable, the mother intelligent. Treat- THE ALCOHOL QUESTION AND SOCIAL JUSTICE 131 ment did not produce satisfactory results. Not until several visits had been made to the home by a trained worker from the social service department did the fact come out that the father was at times a hard drinker, came home cross, ugly, and abusive, and so terrified this daughter that her nervous system became unstrung and her mind was threatening to give way. She was promptly removed from home and placed with relatives, and only then did she begin to improve. Had the case gone on, and the girl been sent at last to an insane hospital, alco- holism, of course, would never have appeared as a contrib- uting cause, and yet it unquestionably would have been responsible for pushing over into instability a nervous and mental organization that otherwise might have retained its poise. Alcohol is thus unjust to the defective and unstable and to those physically below par because it preys upon weak- ness; it is unjust to society because it adds to the incompe- tency, derangement, and disease which the sound members of the social organism must care for. In the long run, alcohol probably strikes its most vital blows at the physical and moral health of the child. How many times drink brings the white hearse to the door in the United States in the course of a year no one knows. There are no statistics telling us how many child lives it is respon- sible for wiping out, but Laitinen's statistics were at least suggestive. In about 5,000 families, containing over 19,000 children, he found that the heavy drinking parents lost thirty-two per cent of their children, the moderate drinkers twenty-three per cent, and the abstainers thirteen per cent. These percentages do not vary greatly from other estimates in England and the United States based upon smaller groups of parents. The loss of life before birth was about six times as great in the heavy drinking as in the abstaining fam- ilies. Had the two groups of drinking parents lost only the thirteen per cent which dies in the abstainers' families, 2,156 of their children would have died. Actually, 4,563 died, an excess of 2,407 — ^that is, on the basis of the deaths 132 THE NEW CHIVALRY — HEALTH in the abstainers' families, child mortality might apparently have been reduced about one-half had all the parents been abstainers. Not many children die, presumably, because they use alcoholic drinks themselves, though not infrequently we hear of cases in which uninformed parents, especially among the foreign-bom, permit or encourage such use. But death strikes the child largely through the parent. It may be as the result of vitality impaired by parental drinking habits. It may come through syphilis, frequently con- tracted by the parent when under the influence of alcohol. Unhygienic home surroundings and lack of proper care are unquestionably the great causes of a high child death rate, and these, in turn, may be the result of a parent's drink habit. The Johnstown investigations in 1913 showed that the smaller the father's income, the greater the proportion of babies who died in their first year of life. More babies were lost by the mother who had to piece out the family income by engaging in wage-earning work, partly because of ignorance and lack of care, partly because of unhygienic surroundings. The average father to-day has none too much money with which to rear his family, even if wisely expended. In one Pennsylvania mining town, a company which employed 2,200 men found that these employees and their families were spending on the average about $200 each for drink. Nearly ten per cent of the men were off each month after each of the two pay days. They were not earning when idle in drunkenness. Put together the money spent for drink, the loss by this idleness and drink-reduced earning capacity, and it is evident that this total loss will make a very mate- rial difference in the income and environment into which the children are born and in which they are reared. The child death rate is known to be higher when homes are overcrowded, the physique below normal. Yet figures collected in Washington and New York showed that, even with the admittedly incomplete data obtained, enough was THE ALCOHOL QUESTION AND SOCUL JUSTICE 133 spent on an average to have provided a roomier home in each class of income, with all the hygienic and moral gain which this implies. We miss an important point in the child mortality cycle if we ignore the factor of drink in producing conditions of vitality and environment fatal to life or, at least, to the sturdy, vigorous life to which the child is entitled as a part of his birthright. The third part of the child's birthright is that he shall be well trained. Moral health is often closely knit up with physical causes. A former judge of the Washington juvenile court stated last week, according to the public press, that eighty-five per cent of all the cases brought before him could be traced directly to the use of intoxicating liquor — largely, of course, by the parents, though he said that the use of alcohol by the children themselves was not unknown. The Chicago Juvenile Protective Association found two or three years ago that seventy-five per cent of the cases of delinquency toward children with which it had to deal were attributable to intemperance. A study of one thousand neglected children appearing before the juvenile court in St. Louis revealed the fact that forty-two per cent were brought because of drunken homes, twenty-three per cent because parents were intemperate. "While nearly one-fourth of the children were the direct victims of their parents' intemperance, the great majority of the fathers and about one-half of the mothers were intem- perate." "Undoubtedly," said Dr. George B. Mangold, "intemperance contributed largely to incompetency and to broken homes. Drunkenness easily degenerates into brutal- ity and breaks up the home, or it makes its victims unsteady and useless and promotes incompetency." The New York Society for the Prevention of Cruelty to Children reported in 1912 : "Reference to records of the society would establish beyond all controversy the fact that to the immoderate use of intoxicants by parents is largely due the great neglect, the suffering, and grosser forms of cruelty imposed upon childhood." 134 THE NEW CHIVALRY — HEALTH The production of wayward children by the drunken homes mounts up into the thousands every year. Unloved, without friends, without care, it is not strange that these children find their way into crime. Amusements commercialized by vice or by drink lure youth into recreation full of moral peril and almost certain moral and physical destruction. The open saloon which tempts the boy or young man to begin the drink habit thereby puts a mortgage upon his future efficiency and starts him out with a serious handicap into the industrial world where, as a victim of this habit, he may go the rounds of one of those dire cycles of cause and eflfect already referred to, and may project his family into untold misery. All this is unjust to the child. He cannot choose his parents. He does not choose his environment, that in most cases is the mold in which the pattern of his life is cast. And if he is neither well bom, well cared for, nor well trained, society has tied a weight to its own feet in the path to progress. In view of all the facts, has not the time come to include the campaign against alcohol in all the varied movements for public health and betterment? A lengthened life and increased efficiency are matters of knowledge in the first place and the practice of prudent Jiving thereafter. But how shall the people know the far- reaching dangers in the habitual use of alcohol if they are not told? And how shall those who are already dependent or weak be protected against alcohol so long as the ravages due to its sale are continued under public sanction? The International Tuberculosis Congress a full decade ago summoned to the combat against alcoholism all the forces fighting tuberculosis because of the close connection between the two evils. Some gains have been made in this respect, yet even three years ago I looked over an important tuberculosis exhibit, one of the largest in the country, and the only intimation it contained that drink has anything to do with the perils of tuberculosis was a warning of two THE ALCOHOL QUESTION AND SOCUL JUSTICE 135 words, "Don't Drink," away in a corner with some other don'ts, with no hint as to why drink should be avoided. While we are teaching the people the reasons for preventing tuberculosis and how to prevent it, let us not be so absorbed with the matter of the germ that we give no attention to the soil, and the part which alcohol plays in preparing what a French scientist picturesquely called "the bed" for tuber- culosis. Our mental and social hygiene campaigns, our work for reducing child mortality, for preventing all infectious dis- eases, for cutting down the death rate from degenerative diseases, if they are to be fair to the whole truth, must teach squarely the facts as to the possible results of using alcoholic liquors. The prevention of alcoholism in its vari- ous manifestations comes as much within the province of the medical health officer as do smallpox and typhoid fever. We work ourselves into a panic over smallpox, yet there are ten times as many deaths every year from straight, unquali- fied alcoholism, the alcoholism that is so obvious that it cannot skulk under any other name into the death certifi- cates, as from smallpox. The time has come when boards of health, local health pfficers, physicians in private practice, social workers in the opportunities given for tactful personal educational work, teachers in the public schools, and teachers in normal schools must join hands in putting an end to this scourge of humanity. It is as much the duty of boards of health to give warnings as to the dangers in alcoholic liquors as it is to warn against impure milk and water or against the fly as the carrier of disease. The cases in which the use of alcohol seems to do no apparent harm prove nothing to the contrary as regards concerted action for wiping out alcoholism. In the first place, such cases have not been subjected usually to the scientific tests to ascertain whether or not the alcohol is really doing harm. In the second place, many people have typhoid fever and do not die from it, but that fact does not make us lessen our attempts to stamp out the disease. 136 THE NEW CHIVALRY — HEALTH We are told that a great many people have tubercular lesions at some time or other in the course of their lives, but they do not all die from tuberculosis. Yet this fact does not make us cease efforts to wipe out tuberculosis. It is the possibilities of these diseases that we are fighting. If we ignore the alcoholic factor in our battle for public health, we shall leave open a great gap through which will troop new forces of the enemy. There is no use or justice in putting all the burden for saving child lives on the mothers. By all means, let us "teach mothers motherhood," but we must also teach fathers fatherhood, that they have some responsibility for the physical well-being of the child when bom, and for providing just as far as they possibly can the necessities for its continued health and development. Fathers must be taught that they cannot afford to drink for the sake of their children, and that a mother may be overworked either because she has too large a family to care for, or because the father's expenditure for drink compels her to endure unnecessary worries and economies, or even to earn money herself by outside work which cannot be spent for proper home, clothing, food, and care. With education in the facts about alcohol must go example. Social drinking customs in all classes of society are the chief root from which the alcoholic habit springs. Frankly, the would-be moderate drinker, even if he seems himself to escape personal harm, cannot escape personal responsibility for the encouragement which his own custom gives to the use of alcohol by the public at large. Is it much to ask that in the face of an evil capable of destroying health and efficiency, morality and good citizenship, you and I as individuals should commit ourselves unreservedly to the personal abstinence that will enable us without incon- sistency to help others resist the temptation of social custom and to break the train of social evils of which alcohol is a potent part? One other alcoholic force militates against public health. There is no organized industry for the sale of tuberculosis HOUSING AND HEALTH 137 germs. Our people may be careless, but we have not yet come to the point where for a consideration we allow smallpox patients to roam at large to infect the susceptible. Alcohol as an enemy to public health is more firmly entrenched than any other because it is commercialized. As soldiers of a new, healthful, happy society, let us apply to this particular health problem the same logic, the same sanity we apply to others. It is not reasonable or sensible or good economy to spend millions in caring for the results of alcoholism on the one hand and to encourage alcoholism itself on the other. Our courts, our hospitals, our insane asylums, our charitable agencies are spending millions of dollars and the priceless energies of thousands of lives in caring for the results of alcoholism. May this Congress be a call to the larger opportunity of prevention! HOUSING AND HEALTH JOHN IHLDER, PH.D., FIELD SECRETARY OP THE NATIONAL HOUSING ASSOCIATION There are two ways in which we may look at this ques- tion of housing and health, the negative and the positive. We may begin with the assumption that the inhabitants of a house are well and strong and that our concern is to prevent the house from making them diseased and weak. That is the negative way. Or we may begin by assuming that the inhabitants of a house are not up to their maximum of health and strength and that our concern is to secure houses which will help build them up to this maximum. That is the positive way. Standing as we do near the divid- ing line between a disease-ridden past and a healthful future, it is necessary for us to look at the question in both ways. The day when the staple topic of conversation was our bodily ills is passing. The day when we shall have to 138 THE NEW CHIVALRY — HEALTH find a new salutation in place of "How do you do?" is coming. But the old day is not yet quite past, the new day not yet here. So we shall begin our discussion with the negative. There are two ways in which bad housing affects health : First, by acting as the vehicle of disease; second, by so depressing vitality that we are unable to resist disease wherever encountered. HOUSING AND DISEASE Perhaps the best illustration of the way in which bad housing acts as a vehicle is given by consumption, which is sometimes called the "house disease." How consumption originated we do not know. Whether, in case it is entirely stamped out, it would reappear — given the continuation of conditions under which it now flourishes — we cannot tell. All we are sure of is that it is most widely and easily spread by contact with a sufferer or with things that he has used, and that it haunts places which are dark and damp and airless. So we find that consumption is most prevalent where people are most closely crowded together, especially where they are crowded in their homes, and that its toll is heaviest when the houses are below standard. On the west coast of Scotland there is a group of rugged islands swept by the winds of the Atlantic. The people are fishermen and farmers, out-of-doors people. But their dwellings are miserable little cabins in which they crowd together in a way almost beyond belief. A few years ago consumption was brought to these islands by some of the young people who had been servants in the cities. Now it is ravaging them worse than it ravages the slums from Which it came. The house is the vehicle, and not until the house is changed can there be hope of banishing the disease. The story of consumption in these islands is more dra- matic, more clear-cut, than is that of the same plague in the slums, for in the slums so many factors enter in that the main one is somewhat obscured. Yet the story is the same in the cities. In Edinburgh a few years ago the demolition HOUSING AND HEALTH 139 of some old dwellings that had an unenviable record for tuberculosis and the erection of new, well-planned houses caused an immediate lessening of the disCiase. Nearly every American city has its "lung block" or its house where the white plague is a permanent resident, steadily taking its toll as family succeeds family. Especially is this true in the crowded districts where houses are jammed so closely together that light and air find difficulty in entering, or are excluded entirely. But though consumption has achieved the reputation of being the house disease, there are others. Typhoid and the other filth diseases find in bad housing a vehicle admirably fitted to their needs. Recently we have come to understand that high infant mortality rates are due very largely to bad housing. So the Federal Children's Bureau is now making careful inquiries as to the character of the dwellings in which children die. Hookworm, the scourge of many of our States, does much of its worse than deadly work through bad housing. And last — ^though this is far from a complete list — ^bad housing causes inefficiency and it stimulates immorality, which in its turn is one of the most potent causes of disease. TYPES OF HOUSES The housing awakening in America is so recent that not only do most of us still fail to understand its vital impor- tance — as the people of Western Europe with their longer experience do understand it — but few of us have even thought about the different types of houses and their effects upon us, social, economic, and from the point of view of health. This is the reason we watch the coming of the tenement house, or multiple dwelling, with so little alarm. In some cities I have even found the tenement or apartment house — difference in name makes no difference in nature — classed with the skyscraper business building as an object of pride. But those cities which have had long experience with it suffer under no such illusion. They see with aston- ishment how other cities, not yet afflicted, welcome or at least quietly submit to the coming of this pest which has so 140 THE NEW CHIVALRY — HEALTH greatly increased their physical, social, and moral ills. For the multiple dwelling crowds people together until they are forced to sacrifice or lower the old, wholesome social stand- ards which add so much to the dignity and beauty of life and in addition form one of our best safeguards against the rapid spread of physical and moral disorders. Once tene- ments have secured a foothold, there is no obvious stopping place. Increasingly they pile family above family, increas- ingly they crowd their lots, until the city has become, not a community of homes, but a conglomeration of human ware- houses, until light and air are all but shut out. In New York, where the multiple dwelling has practically driven the single family house out of the older sections, an official commission is now seeking means to district the city so that regulations may be applied which will prevent the spread of the apartment house and the tenement house> to as yet unspoiled areas. In Massachusetts, where the three-decker dominates urban housing, a determined fight is being waged against it and the strong vested interests which it now represents. Are the South and the West to repeat this tragic history, must they learn through their own experience, or will they profit by the experience of others? The opportunity is still theirs. Next to the tenement in its menace is the converted house, which at most should be but a temporary makeshift, but which too often is the introducer of the tenement. Erected for one family only, it comes in the course of its declining fortunes to shelter several. Unsuited to this pur- pose, containing utterly inadequate sanitary conveniences, making almost no provision for family privacy, it causes the superficial observer to believe that the tenement which is planned for several families is a step in advance. Instead the tenement is but making tolerable and permanent condi- tions which should be considered intolerable and which should be abolished at the earliest possible moment. Much better than these are row houses, even such row houses as the Southwest has in its corrals, for they at least permit of light and air and give access to the ground. Built HOUSING AND HEALTH 141 as they may be, as they are being built in Southern Cali- fornia, they meet most of the objections from the negative point of view. But, of course, they do not measure up to the standards we shall demand in the future; for in our future city building the first consideration will be space, space for light and air and movement. The great sin will be land-overcrowding, for land-overcrowding underlies most of our preventable city ills. I recur to this matter of land overcrowding again and again, for not only is it fundamental, not only is it practi- cally impossible ever to remove once it is established, but the South now has the opportunity to prevent its ever being established. In some of the Southern cities there are already instances of gross land-overcrowding, but in none of them is it yet the rule. Ten years hence it may be too late, even as it is already too late in many of the cities along the North Atlantic seacoast, THE PEOPLE — THE IMMIGRANT In another way the South is the land of opportunity which may profit by the experience of others. Its cities are just at the beginning of a great industrial development. When the European war ends, we have every reason to expect a flood of immigrants. A large part of the flood will come to the South. New Orleans, with its new immigration station, has already made preparations to greet the alien arrivals. Galveston and other Southern ports will welcome their share. But after these people have been greeted what shall we do with them? What New York and the North did when the immigrant tide first began to rise nearly three- quarters of a century ago. New York waited until its existing dwellings were packed from cellar to roof, until it developed conditions which made its lower East Side a horror. Then it built tenements! And since then it has had reform after reform, hard-fought struggles decade after decade to gain a foot or two of yard space, to raise sanitary standards step by step above the utterly barbarous. And now, after all this bitter fighting, it has a type of 142 THE NEW CHIVALRY — HEALTH dwelling, housing 2,000 people to the acre, which every one admits is fundamentally bad, but which, now that it is firmly established, cannot be changed except in detail. Or will the South do what California is seeking to do, put its house in order so that the immigrant, after he has been greeted at our ports, may find a place where he can live decently and wholesomely, a place that by its nature will constantly form him and his children for American citizen- ship? Surely no less than this may be expected of Southern hospitality. For the immigrant, however alien he may seem upon his arrival, is first our guest and later bone of our bone, flesh of our flesh. If we cannot welcome him upon these terms, we should not admit him at all; for if we do admit him there is no thing surer than that he and his will influence if not control the destinies of America in the future. So now, before his arrival, is the South's opportunity to set its house in order. And the house needs some setting. First of all, the South must decide upon the type of dwelling it will encourage in its cities. Then it must take up with greater vigor the improvement of its sanitation. And constantly it must consider details, methods, customs. Why are window blinds made solid instead of with slats which will permit air to enter? Why are windows closed at night? Why do the negroes sleep five in a room while other rooms are vacant, and keep a kerosene lamp burning all night long until the air becomes so foul that it almost chokes one who would breathe it? Are these habits, so prejudicial to health, due to causes that might be removed by a different method of building, by more efficient public health admin- istration, by education? It will be easy, the South will be but following ancient precedent, if after the immigrant has arrived it lays all resultant ills to his discredit. The North has done so for generations. But the historian of the future will declare that our own people were responsible. They had the power to prevent and did not use it. Moreover they had and have among the submerged of their own race warnings in plenty. In towns like Portsmouth, Ohio, and Elmira, N. Y., I have HOUSING AND HEALTH 143 seen Americans of long American descent living in the lofts of stables, in the cellars of old houses. And these towns are not peculiar. Look about you and you will find others. Bad housing and its resultant ills are not the exclusive herit- age of any race or nation. They are found wherever there is ignorance and greed and neglect. They can be wiped out only where there is knowledge and public spirit and effort. PROGRESS IN SANITATION And the South has already begun. Not long ago a repre- sentative of the great life insurance companies visited thirty-two American cities, most of them in the South, to study what they are doing to improve the health of their people. He found much to criticise, but also much to com- mend. There were cities where people and officials alike were living in a fool's paradise, blind to conditions that brought sickness and death among them, and yet boasting that they were better than their neighbors. But also there were cities that are leaders, not only for America, but for the world, cities like Savannah. Savannah is one of the most beautiful of all our cities, but its location on a low-lying coast exposes it to certain diseases in a peculiar degree. So Savannah has taken up its task with vigor. It is perhaps the only American city which can say that every dwelling, even the humblest negro cabin, is supplied with pure water from city mains and has its individual sanitary water closet. In furnishing these two necessities to its people Savannah has gone a long way toward protecting them against disease and death. But even Savannah has so far failed to protect them against a danger more difficult to combat. It still permits land-overcrowding and the building of tenement houses. Were it not that the South has already begun to awaken to the need for better sanitation, I would dwell more at length upon this important phase of bad housing. There are here, as in other sections of the country, cities which are still in the Dark Ages so far as sanitation is concerned, cities which will permit their people to drink water from surface wells and to pollute that water with the drainage from 144 THE NEW CHIVALRY — HEALTH privies. But they are already in a fair way to become notorious exceptions. Baltimore, which was content for centuries with the sanitary conveniences of a camp of barbarians, has now the most modern sewer system and sewage disposal plant in the country. New Orleans has a separate commission dealing with this matter alone in order that the work may be hastened. Birmingham requires san- itary toilets for every new dwelling, negro cabins included. Richmond, until it annexed some suburbs last year, had only 950 houses without sewer connection and not a single vault where sewer connection was possible. Annapolis has sewers even in its courts and alleys. These are the cities which are setting the standard for the new South, and the others are responding. ' THE DUTY OP THE CITY So the Southern cities are beginning to shoulder their responsibility. This is chiefly a responsibility of the neg- ative kind, the responsibility of declaring, "So bad may you be, but no worse." When this responsibility has been fairly met our cities will be safe from the worst of the evils that now threaten them. Think what it will mean when there can be No more land-overcrowding. No more high tenements. No more dark, damp, airless rooms. No more privy vaults. No more dwellings without a supply of good water, No more disorderly heaps of garbage and rubbish. The heaviest burden of the poor is filth. In the city that has met its responsibilities, this burden will be lifted. With light and sun and air, with space and abundant water, with the systematic and orderly disposal of human refuse, filth will cease to play a degrading part in our lives. Then we may bid farewell to the negative and be free to give all our energy to the positive, to making of our dwellings homes that will help us to live at our best. But the positive begins before the negative ends. Our cities are constantly growing and changing. The small city HOUSING AND HEALTH 145 is transformed before we realize it into the great city with its complex economic and social problems. The commercial city becomes an industrial city with its dinner pail army. This change and growth must be guided by a clearly under- stood purpose or we shall simply repeat old mistakes and prolong into the distant future our purely negative work. In our new additions we must enforce better standards than we accepted in the old. In our new industrial cities we must think of more than one factory at a time, of more than all the factories put together. This means city planning, the building up of the city so that each of its parts will serve its purpose to the best advantage and each will contribute to the others, not detract from them. In all this constructive work the old fundamental appears again, the need of providing adequate space. With that we can work our miracle, without it we are bound and helpless. Nowhere is there a clearer illustration of the value, measured in terms of health and social well-being, of space and light and air, than is afforded by the English city of Liverpool. Seventy-five years ago Liverpool was so ravaged by disease that a special commission was appointed to inquire into the causes. It found that out of a total popu- lation of 250,000 some 38,000 people lived in 8,000 dark, damp, confined, ill-ventilated, and dirty underground cel- lars; that 86,000 more lived in 14,000 side-to-side, back-to- back court houses. There were districts in Liverpool con- taining 161 houses per acre. The city had no building or housing law and no power to enforce sewer connections. Then began the long effort to improve conditions. Cellars were gradually closed, the most insanitary houses demol- ished. One result was worse overcrowding in the remaining houses. Often in a three-room house there were from two to three families in each room. What that meant in the lowering of standards of decency and morality may be imagined. And the death rate increased. For thirty-three years the city, through its hospital com- mittee, its health committee, and its insanitary property committee, availed itself of everything that sanitary science 10 146 THE NEW CHIVALRY — HEALTH could do. It looked after the sick, removing them to hos- pitals ; it cleansed the houses inside and outside ; it disin- fected the rooms, it washed the streets and court; it made the landlords repair the houses and the drains; it did its utmost to prevent overcrowding ; and, most important of all, by partial demolition it introduced some sunlight and air and ventilation. How adequate the demolition was for the last-named purpose is still evident in existing courts. Yet at the end of the thirty-three years sickness had increased. One street had increased its mortality rate from 32.12 per thousand to 33.1 ; another from 32.1 to 34.5 ; another from 35.7 to 46.3; another from 29.91 to 65.S. (By way of measurement here are some Southern city death rates for the year 1913 : Birmingham, 17.4 ; Washington, D. C, 17.3 ; Jacksonville, 19.2; Atlanta, 17.4; Savannah, 25; Lexington, Ky., 23.5; Charleston, 27; Galveston, 18.8; Richmond, 20.4.) The local authorities finally decided that these increases were mainly due to the crowding together and bad con- struction of the houses, and to the crowding of the people in them. So considerable areas were swept clear and new, whole- some houses with open space about them were erected. Then for the first time the death rates began to fall. For the three years ending with 1873 the death rate in the Scotland division of the city was 35.1 per thousand, in the Exchange division 34.3. After twenty years of hard work it was for the three years ending with 1893 exactly the same in the Scotland division and in the Exchange it had increased from 34.3 to 36.7. But after the new houses were erected it was for the three years ending with 1913 in both divisions 29.5, a saving in life of nearly 6 per thousand. A year later it had fallen still lower.* That which makes the Liverpool figures more valuable than similar figures from many other places is that from seventy to ninety-nine per cent of the people who had lived *Data taken from Col. G. Kyffin-Taylor, M.P., in the "Trans- actions of the National Association for the Prevention of Tuber- culosis," Leeds, July, 1914. HOUSING AND HEALTH 147 in the old houses were transferred to the new ones. So there is no question of a different standard of living or a more healthy stock, Americans have at least one illustration of the effect of housing upon health to place beside that of Liverpool. There would be no Panama Canal to-day had we not first cleaned up the Canal Zone and provided good houses for the workers. You all know the story of Colonel Gorgas, who made possible our triumph where the French had failed, and who now is about to save a nation from extinction. You have all seen pictures of the houses he built, spacious, airy buildings through which every breeze might pass. Here were no solid wooden shutters to keep out the fresh air, but open space on every side to tempt it in. Screens, not darkness, kept out the flies and mosquitoes which survived his systematic cam- paigns against their breeding places. And the result was that a region which for centuries had been known as one of the worst pestholes of the world acquired a reputation equal to that of a health resort. But Colonel Gorgas found that while he could stamp out yellow fever by killing mosquitoes and by screening, this did not prevent another scourge, pneumonia. In 1906 some six hundred of the negro laborers died from this disease, more than died from all the other diseases put together. These men lived in large barracks where it was necessary for them to crowd considerably. Colonel Gorgas says that he did everything he could thiiik of to prevent the disease, but with- out success. Finally he permitted these men to put up their own cabins on land furnished by the government. They at once began to build. They brought their families to the Isthmus. In a few months five-sixths of them were out of the barracks. Pneumonia rapidly disappeared. "For," he said, "it is a well-known law in sanitation that crowding is the greatest factor in most of the infectious diseases." So it is plain what should be our guiding principles in building the cities of to-morrow: Space for sun and air, for a bit of private out-of-doors for the family, for neighbor- hood recreation, for city parks. One reason the country has 148 THE NEW CHIVALRY — HEALTH in the past produced stronger and more enduring men and women than the city is because it had room to let them grow. So we must bring this advantage into the city and give each family its own house and yard. This is going to be no easy task, for crowding means a temporary profit to some who sell or rent. It raises values in a restricted area by preventing those values being spread over a larger area. It is urged on a plausible but false basis of economy. It is cheaper to build a barrack on one lot than to build ten cottages on ten lots. But when one has figured on the more rapid depreci- ation, the extra cost for maintenance soon eats up the initial saving. And then must be added all the costs for increased sickness and inefficiency and immorality, for hospitals and charity and police. Some time ago I wrote to one of our leading real estate men in New York about this matter of increasing land-over- crowding. I told him that when I went into a city where the rule was widely spaced single family cottages I found the real estate men saying that they could make no money by following the rule, that they must put their cottages closer together or even build terraces. In a city where the terrace had developed into the row house, as in Philadelphia, I found them arguing for two-family houses. Where two-family houses had been the rule, as in large areas of Brooklyn, I found them arguing for the three-family house. And so on until on Manhattan, where the six-story row tenement is the standard, I found them arguing for weaker regulations which would permit them to build higher and to fill their lots more completely. I asked him if there is any stopping point short of one solid building filled with dark rooms in which the people will die as fast as they can move in, and so establish an equilibrium? He said that he would send me the answer later. That was more than a year ago. Later in Philadelphia where I asked the same question a real estate man replied that there is profit in following the established rule, but that there is greater profit in putting two families where one family had been. Later still, in Passaic, a real estate man replied by saying that the trouble HOUSING AND HEALTH 149 was due to a failure to realize that there is just as great, if not a greater, profit to be made by building a city out as by building it up. Perhaps there lies the secret; provi- sion of space may be made to run with, not against profit. But in any case the individual's extra profit from building up is temporary. As soon as the new rule is established he must again build higher. All that is permanent is a lower standard for the city's housing. So why should the standard not be set and kept while the standard is good? With adequate space assured about our dwellings, the field is open for constructive talent which will show us how to build better and cheaper. This talent is at work already and it is being encouraged by public-spirited organizations like the Chicago City Club, the Cleveland Chamber of Com- merce, and the Los Angeles Housing Commission. It is already producing garden suburbs like Forest Hills Gardens, the Russell Sage Foundation development on Long Island, and Fairfield, outside of Birmingham, Ala. The homes of the future will be of many kinds, fitted to our varying needs, but they will contain the fundamentals : Space, light and sun, air, water, sanitary conveniences, enough rooms and such an arrangement of rooms as will make privacy and decency possible. These houses will be bright and clean. They will be proper places in which to rear children. And that, after all, is the real test of what a home should be, because we are building for the future, and the future is with our children and our children's children. IV. THE HEALTH OF MOTHERS The Conservation of the Health of Mothers, a Pri- mary Responsibility of the State Why the State and the Church Should Require Cer- tificates Before Marriage THE CONSERVATION OF THE HEALTH OF MOTH- ERS, A PRIMARY RESPONSIBILITY OF THE STATE MRS. MINNIE U. RUTHERFORD, MAGAZINE, ARK. The word "efficiency" is said to be the most overworked word in the English language to-day, and yet the army of the unemployed grows and those who are employed continue to ask higher wages which they are too often utterly incapa- ble of earning. Meanwhile the world's most important work is relatively neglected and the social spirit is so warped that the United States troops are called upon to quell riot and bloodshed in my State and others and the fundamental reason is "inefficiency" — ^mental, manual, and spiritual. Upon women has devolved the chief care of the feeble- minded, the undeveloped, the socially incompetent ; and this demand has given her comparatively little time for perform- ing her real function of teaching and developing the normal and "super-excellent" specimens of the race. The conse- quence has been an inevitable lowering of the average standard of human quality, not below that which it was necessarily, but below that which it should be at this time in human evolution. The primary duty of the State would certainly seem to be the preservation of that health which is a necessary basis of efficiency at its source — in motherhood, here considered solely as the strongest link in the evolution of the race. But health is physical, mental, political, social, and moral, and so closely related are they that one is relatively useless without the others. Juvenal's dictum, "A sound mind in a sound body," pointed out the ideal. Body efficiency depends upon physical health certainly, but not wholly, as is evidenced by the fact that some animal can be found which can surpass, in purely physical prowess, the performances of any human, and, on the other hand, a well-developed brain in a weak body has too little means of expression in terms that will benefit the 154 THE NEW CHIVALRY — HEALTH race, and both combined would be comparatively ineffectual in an atmosphere of political, moral, and social disease. I regret that figures for our section of the country are not available. I must use those of another. New York City has 34,000 factories, in about half of which conditions obtain similar to those under which 147 girls lost their lives in the Triangle Shirt Waist factory fire in 1911 and for which a fine of $20 was imposed. One of every four wage earners is a woman, one of ten is a factory worker, one-half of whom do not work a full year and forty-seven per cent of whom earn less than six dollars per week, although eight dollars was found the lowest wage upon which a woman can live decently and preserve her health. Recently commercial greed, in the guise of canners, forced through the New York Legislature a bill annulling a more enlightened one passed by the 1913 Legislature. It permits women to work as many as one hundred hours per week, according to the report of the New York Factory Com- mission, in clattering rooms in which there are either no seats at all, or benches without backs, where the floors are constantly wet and nineteen per cent of the women cannot keep their feet dry. The commission selected fifty of these workers at random and found that they earned an average wage of $4.53 per week. In sharp contrast the Legislature of an equal suffrage State (California) enacts an eight-hour- day law and the Supreme Court of the United States sustains the law and quotes: "Woman is properly placed in a class by herself and legislation designed for her protection may be sustained when like legislation is not necessary for men and could not be sustained. Her physical structure and a proper discharge of her maternal functions — ^having in view not merely her own health, but the well-being of the race — justify legislation to protect her from the greed as well as the passion of man. . . The two sexes differ in the infiuence of vigorous health upon the future well-being of the race, the self-reliance which enables one to assert full rights and in the capacity to maintain the struggle for subsistence." A few years ago New York City had over 50,000 tene- CONSERVATION OP THE HEALTH OF MOTHERS 155 ment rooms without windows; in 1914 some 11,000 of them received "legal right," leaving thirty-eight per cent that do not yet come up to the standard. In the tenement district there are 5,000 children whose limbs are misshapen from tuberculosis of the bone, and the report adds the significant words, "due to bad housing." Some one has said that this republic is founded upon the "root-hog-or-die" principle, and if the women, as custodian of the pig, are not- given ample facilities for rooting and protection in the rooting, the probabilities are that the pig, grown a hog, will not be able to root. It is not at all remarkable that one-sixth of the children born to women working under such tenement conditions die before they are one year of age, and those who survive are too often crippled mentally and physically, further adding to the burden of womanhood. MINIMUM WAGE LAWS In Arkansas this year the minimum wage law was started upon its career in an effort to improve the condi- tions detrimental to the health of the women workers of the State. It fell into the hands of political and commercial greed, however, and emerged weak and inefficient. First, the telephone representative managed to have exempted the industries employing four or fewer women. Then the cotton mills had themselves exempted; and finally, after the bill was passed by both houses and signed by the Governor, it was further mutilated by having, in some mysterious manner, the word "mercantile" stricken out. This history but emphasizes still more the need of enfranchising the mothers who are concerned most in this sort of legislation. MOTHERS' PENSIONS That wastage of human life, the sign of which is the child in court, has been set before us by the juvenile courts of this country within the last fifteen years in letters of fire that bum into the very soul of American womanhood, and the tracing of this wastage to its source is perhaps the greatest contribution which the juvenile court has made to 156 THE NEW CHIVALRY — HEALTH the progress of the race. In a large majority of cases a home is found that does not function. The mother spirit is inoperative, usually because of poverty in the wake of vice and crime. About half of the States have, therefore, attempted to provide mothers' pensions. The mother, trying to do double duty, amid all the discriminations of the industrial world, cannot preserve, unaided, that physical and mental health necessary to the task of developing the normal and super-excellent specimens of the race, much less the greater task of bringing up the subnormal results of diseased conditions. The very least that the State can do, in self-defense, is to provide some sort of fund that will help enable the mother to preserve not only her own health, but the health of the home that will make of it, in some sense, a haven of refuge from forced neglect and resultant crime for the children. PROHIBITION OF THE LIQUOR TRAFFIC It is conceded that the feeble-minded mother is a great menace to the race, bearing more children than the normal woman, as she does, and a prey to every evil-minded, uncon- trolled man in her vicinity. Science says that the greatest contributing cause of this form of mental disease is alco- holic heredity. Dr. Leppich observed ninety-seven children conceived at the time one or both parents were intoxicated and found only seventeen of them normal, and Dr. Bezzola found that of seventy idiots thirty-five were conceived during the wine harvest when the Swiss peasant carouses. Many other investigations of scientists reveal the close con- nection between alcohol and the various forms of mental disease, as well as the physical degeneracy that causes fifty-five per cent of the children of alcoholic mothers to be stillborn, or to die within the first year or two of life. The drunkard's children are the despair of the child welfare worker, the drunkard's family the insoluble problem of organized charity. The eugenics movement finds its most implacable enemy in the liquor traffic, with its dens of iniquity and disease and its inflamed lust which demands CONSERVATION OF THE HEALTH OP MOTHERS 157 the white slave and further threatens the race through all the forms of venereal disease. The abolition of the liquor traffic would do more to keep women from the operating table of our hospitals than all the policies of segregation or non-segregation of vice. No long hours of toil, no poverty, unmixed with the alcohol problem, ever matched in menace to the health of our women, as well as our people at large, that of the legalized liquor traffic. EDUCATION AND EQUAL SUFFRAGE Dr. Davis, Commissioner of Correction of New York, says that in 1913 ten per cent of the inmates of Bedford Reformatory were illiterate, seventy per cent were not above the primary grades, and only three per cent over the grammar grades. On our farms, in this section, are growing up thousands of round-shouldered, narrow-chested, narrow-horizoned, future mothers, incapable of giving to future generations health of either mind or body, because they do not possess either themselves. They are as much a menace to the race as the shopgirls, the mill or factory girls, because of their numbers. Often the only thing they know is how to hoe and pick cotton, and that has, in their minds, no connection with an agricultural education. The schools which we maintain in the rural districts, or elsewhere for that matter, generally fail to furnish the needed efficiency to these girls, even if they attended throughout the entire term and all the grades. An Arkansas farmer's wife writes that her farm home is probably the only one in the county which has a "bath- tub and bowl," without which it is difficult to see how any standard of health could be maintained, and the worst feature of the case is the fact that there is no demand for them, no recognition of them as health-preserving adjuncts. It is no rare thing to find a husband, greatly in debt, neg- lecting his "share crop," while the wife takes it up and is obliged to surrender her earnings to settle the husband's debts in the fall adjustment. The lack of education is as 158 THE NEW CHIVALRY — HEALTH productive of parental irresponsibility as of the absence of bathing facilities. Dr. Knapp said recently, in a talk to farm demonstrators, that it is best for the race to edu- cate the women, if both may not be educated; for a woman will not "put up with" an uneducated man and children, while a man will endure any sort of woman; and further, that upon the farm woman depends the health and efficiency of the farm hand and his continuance upon the farm. Long hours, no conveniences, a soul-deadening round of cease- less drudgery, no mental outlook, no recreation — ^these destroy health of soul and body and too often reduce the farm mother to the level of the animal mother, who can minister only to the physical needs of her children. In the South the condition of the farm mother is particularly important, for we are largely a rural population. No minimum wage laws or maximum hour laws will here offer a remedy ; the responsibility of the State is proper education. The Smith Lever fund is a step in the right direction, but a more direct remedy is the radical reorganization of the public school system and the extension of the ballot to the farm woman — in other words help her to help herself. It is the educated, self -protected mother who keeps herself and her children in health, and no other kind of help will ever so effectively reach the case. I do not know that the ideal school for the purpose has yet been brought into existence, but certainly some of our States have, in part, made great improvement. If I might be allowed to attempt to express, in a remote sense and a borrowed phrase, something of my idea of a really educating school, I should say that it is a well-equipped and highly glorified democratic club, intelligently guided, instead of disciplined, the students of which use and enjoy the rights that are theirs and become citizens by practice. In this school there will be textbooks, of course, but there will be also playground, gymnasium, field, shop, a wage, law- making, and self-government. The chemistry class will make soap and the violation of the pure food law impossible, and the political science class HEALTH CERTIFICATES BEFORE MARRIAGE 159 will make the grafting street commissioner a rare thing under the sun ; and all this for girls who will, thus educated, be a very difficult commodity in the handling for the white slaver, who will know what their own health means to the race and how to preserve it with that of the entire family as they take their proper place in the government which has become more and more the organization of woman's "sphere" and from participation in which it is the blindest of folly to exclude her if the race is to grow and wax strong with that health which is the only basis of efficiency. WHY THE STATE AND THE CHURCH SHOULD RE- QUIRE HEALTH CERTIFICATES BEFORE MARRIAGE RABBI GEORGE FOX, PH.D., FORT WORTH, TEX. This matter has become one of the most important con- siderations in the minds of those who are interested in social welfare. It has assumed greater importance in recent years because of the investigations made in the number of those afflicted with the social diseases and their offspring. The social conscience has become awakened to the great wrong involved in marriages which are unhealthy, a wrong not only to the contracting parties and their offspring, but to the general social body. The matter of State regulation has been previously touched on before this conference, especially at the Atlanta conference. The paper of Dr. Schenck on "The Control of Social Diseases" is especially pertinent. Nothing that I have been able to find of late so clearly sums up the dire results of the social diseases, and I will restate them in abridged form simply to confirm what I believe every healthy-minded man and woman believes — ^namely, that it is time that the States take some action which will reduce, to some extent at least, the multiplication of diseased progeny. 160 THE NEW CHIVALRY — HEALTH Dr. Schenck gives the figures on this subject available to the year 1912, and I summarize them as follows : It is estimated that fifty per cent of the insanity in the world is due to syphilis. Paresis, general paralysis, and softening of the brain, always ending in insanity, are always due to this cause. One hundred thousand insane persons in the asylums of this country owe their condition to the rav- ages of this disease. The care of the insane and the eco- nomic loss involved in their disability cost this country close to eighty million dollars a year. Ninety-five per cent of the blindness of children is due to social diseases, particularly gonorrheal ophthalmia neona- torum. There are many who believe that locomotor ataxia and apoplexy in subjects under fifty are due to syphilis. In New York alone something like 250,000 cases of venereal diseases occur every year, and to these are due many of the diseases of the eye, ear, nose, and throat. Many thousands of cases of the viscera, of the diseases of the cardio-vascular system, of various forms of the dis- eases of the heart are due to syphilis. A large percentage of tuberculosis and many cases of bone and joint diseases are due to the same cause. Syphilis also is held responsible for a large number of cases of cirrhosis of the liver, certain types of neurasthenia and brain diseases. Seventy-five per cent of the childless marriages are due to social diseases. Eighty-five per cent of children born with syphilis and gonorrhea are either dead at birth, die very young or soon after birth, or are feeble-minded, blind, or crippled for life. There are something like 35,000 girls recruited to the ranks of prostitutes in New York every year, and every one of these becomes infected sooner or later. In a paper read before the Texas State Conference of Charities and Corrections in November, 1914, Dr. James J. Terrell has the following figures on gonorrhea : Eighty per cent of all men in large cities have had gonorrhea once or several times; forty-five per cent infect their wives; eighty per cent of all operations upon women for diseases of the uterus and adnexa are caused by gonorrhea and twenty per HEALTH CERTIFICATES BEFORE MARRIAGE 161 cent of all blindness results from the same cause. He says also that the New York Medical Journal of November 12, 1910, estimates that there were at one time one million per- sons in New York alone infected with venereal diseases, and of those eight hundred thousand had gonorrhea. The vene- real diseases contribute a sum total of morbidity of nearly double that of all other infectious diseases acute and chronic. There are something like two hundred and fifty thousand married women in the United States infected with gonor- rhea. Seventy per cent of all the married women who come to the New York hospitals for treatment for venereal dis- eases are respectable married women who have been infected by their husbands. A physician of my acquaintance who has made some effort at keeping record of his patients informs me that something like forty-eight per cent of his young male patients are victims of venereal diseases. When it is real- ized that the very stability of the young man of the land is in imminent danger through this unholy infection, we may well conclude that we have waited long enough for some kind of restriction. The public conscience has not been altogether dead to the enormous danger which threatens through such diseased marriages. Efforts have been made in several States to enact laws which will require health certificates before a marriage license can be procured. There are thus far eight States which have made venereal diseases a bar to marriage, and these are as follows: Michigan, Indiana, Utah, Wash- ington, North Dakota, Oregon, Pennsylvania, and Wisconsin. In three of these States — North Dakota, Oregon, and Wis- consin — medical certificates are required. In a recent conversation with an official of Wisconsin, the writer was told that marriage in Wisconsin had decreased greatly within the State, but that contracting parties had no difficulty in getting married outside of the State. It is confidently believed that as soon as the neigh- boring States enact laws similar to that of Wisconsin a large number of unholy marriages will be prevented. 11 162 THE NEW CHIVALRY — HEALTH 'One feels that after the citation of the above figures nothing more need be said about the necessity of enacting laws governing the requirement of health certificates. There is to the writer's notion, however, one error. This matter should not be left to the State alone. Our health is a national problem and, if good, a national asset. We ought to make the problem national in this respect, that Congress ought to pass a law or laws governing this matter. We already have a fine precedent set in the Harrison anti-narcotic law. Why not pass a national law making a health certificate a require- ment before marriage? It will take years for the States to do this. In the meantime those States that do not have it vitiate the eif ectiveness of the States that do have it. If Congress will enact uniform laws governing marriage, the State will find a way of enforcing them and we will not have to wait for the tardy action of legislators in whose minds the safeguarding of public health is often the last consid- eration. When we consider the place of the Church in this matter, the problem is quite different. Marriage is a civil contract. The Church may or may not sanction or confirm it. Thou- sands upon thousands are married without the Church or in spite of it. Few indeed consider the Church as a decisive factor. Even Jews and Catholics marry civilly alone, and we possess no records of the number of marriages performed by public officials. If the Church insisted on this requirement, marriage could be consummated without it outside of the Church. With a smaller proportion only the Church is decisive. That it should make such a requirement is not at all to be doubted. But what effectiveness would it have? There are already a number of ministers who demand a certificate of health. If it cannot be produced, marriage is consummated anyway. Dean Walter Sumner, of Chicago, as well as a number of others, have made this a practice for some years. But the effect has been admittedly small. If all the ministers could be induced to take such a stand, something might be achieved; but here again one must consider that the min- HEALTH CERTIFICATES BEFORE MARRIAGE 163 istry contains within its ranks weaklings, just as other professions have them. Again one must consider that often a minister finds that his position depends on his willingness to do certain things against which his conscience rebels. It is easy to say that one should enter the ministry rather to preserve his soul than to sell it. But bread and butter and life's necessities are very important considerations even with ministers of God, and many a preacher has officiated at a wedding which was distasteful. Of course all of this is spared him in this particular regard if his demand is backed up by the law of the State or the nation. We must not forget that we are not living in the Middle Ages. The Church to-day does not have either the power or the influence it had yesterday. In a matter so important it is next only to the civil authority. Were men still laboring under the belief in a literal hell, the Church might be able to enforce its demands. But we have grown away from this. The message of the Church is sociological rather than theo- logical. Few are afraid of hell-fire. Many, however, fear the penitentiary. It seems to the writer that the mission of the Church in the matter of requiring health certificates is rather indirect than direct, and twofold. In the first place it is the duty of the Church to use what influence it has in helping the State and the nation in enacting laws which will safeguard the public health. In the second place it is the duty of the Church to throw its whole force into the process of edu- cating its members to the terrors which await those who sacrifice themselves upon the altar of sexual lust. In this case the Church must become the handmaid of practical education. It must throw itself into the battle for body health as well as soul health. It must come down to earth and by its divine message purify that which is of the earth. It must educate its ministers to teach its members how to keep the body clean as well as how to keep the soul pure. It must affiliate itself with the more material agencies which are working for human uplift and human regeneration; it 164 THE NEW CHIVALRY — HEALTH must make itself an agency for social uplift as well as be one for spiritual aspiration. The Church must learn that a pure body cannot be the temple of an unhealthy soul; and that a soul worthy of a life to come cannot be enshrined in a body decayed by willful lust. The Church further must insist on men of power and energy, and this worldliness as well as otherworldliness. Its ministers must be as familiar with the body as with the soul ; with the latest social classic as with the latest Bible com- mentary ; with the question of life as it is as with the ques- tion of life after death. The Church must help the State or nation in its onward efforts toward social amelioration, and it must itself be an active vital force in social amelio- ration. Certainly there ought not to be any division of opinion on this very important question. Health certificates ought to be demanded. But if the State and nation will pass a law or laws to this effect, the Church will do its part. It is, however, I believe almost useless to expect that the Church demand alone will go very far toward reducing the terrors involved in the marriage of those socially diseased, as long as marriage may be consummated in a purely civil way. V. THE HEALTH OF CHILDREN Prenatal Responsibility of Parents for Children The Influence of Prenatal Conditions on Infant Mor- tality The Conservation of the Health of Children — A State Privilege and Asset Safeguarding the Health of Boys The Treatment of Delinquent Boys The Treatment of the Delinquent Girl Health Teaching in Schools The Relation of the Schools to the Public Health PRENATAL EESPONSIBILITY OF PARENTS FOR CHILDREN M. Ml. CARRICK, M.D., DALLAS, TEX. Carefully guarded in a glass case in the Metropolitan Museum, New York City, is a wonderful collection of mosaics, each one priceless, but no two alike. But a short time since I stood before this receptacle, which like an alabaster box holds but does not hide the shining treasures within. Instantly came the thought as to how like mosaics we mortals are, made up of ancestral pieces as we are. Thinking in such symbols led me to wonder how many young people realize the supreme sanctity of parenthood. How many know that the birth of their first child is not only an overwhelming event, but the most responsible act of their lives? Yet the fact remains that if this one child lives and fulfills his racial instinct he will be the progenitor of hosts of other children. How important therefore for parents to know that the racial instinct exists for the highest ends, and that it should be regarded as a sacred trust! Long ago Oliver Wendell Holmes in his masterful fashion declared that we must begin the education of children with their grandparents. We are just beginning to dimly com- prehend the underlying thought in this seemingly whimsical statement ; for we now know that we can only educate what heredity gives. The child who comes tumbling into the world from the great unknown by no act or volition of his own is entitled to the right to be well-born, to have ances- tors that will make his life a perfect mosaic. Furthermore, we should never lose sight of the fact that he is not an isolated being, separated from his kindred ; but, on the con- trary, he is one of the links in an endless chain. There are a few questions prospective parents should ask themselves. Will my child come into the world prepared for the combat of life? Will he have a well-balanced physical and mental organization? Or will he be so badly equipped for life's battles that he will hourly regret his existence? 168 THE NEW CHIVALRY — HEALTH Not many weeks ago in New York I came face to face with a pitiful case. It was at a gathering of celebrities, and a rare occasion, which makes the incident stand out as clear as a cameo. A young man of about thirty years attracted my attention. Dtiring the hours that followed I noticed that many turned to look at this young man with the soulful eyes, the gentle mouth, and the resolute chin. Several celebrities in the gathering were heard to remark : "That is the author of " (naming a best seller) ; "he is a coming man — bound to be one of the foremost men of the day." A few hours later he and I were chatting sociably in a quiet corner of a cafe. To my amazement his mood had changed from one of gentleness to extreme bitterness. His eyes blazed. His mouth was drawn. There was a look in his eyes like that of a wounded animal. His breath came and went in quick gasps. Finally tears stood in his eyes. "0, I know you will think me a weakling," he wept ; "and so I am! But listen. Never since my mother died when I was a little lad of ten years has a tear come to my eyes. The contrast to-day has been too sharp. They say I am a big man, that my name is written high for achievement; but I tell you, doctor, it spells failure. I feel it within myself that I might have been great. I despise the commonplace. My soul is crying to achieve. But I am irrevocably cursed from a prenatal life. When I think of it, I tell you I hate my parents, just as some day perhaps my little son will be hating me. I doubt whether God can forgive men their lack of control of the racial instinct when they realize, as I always have, that the mark of the beast is upon them. And to think that my beloved little son, and his children's children for generations to come, may transmit this taint of my parents and grandparents to their offspring. I tell you it is the unpardonable sin to perpetuate the species under such conditions." Morbid, you will say. Yes, but more than that. My eyes opened wide with horror as he of the soulful eyes proceeded with his pitiful tale of heredity. Then I knew beyond a shadow of doubt that all he had said was only too true — ^the PARENTAL RESPONSIBILITY! OP PARENTS 169 mark of the beast was upon him and his. When we pause to think that this man of genius with the taint of insanity and tuberculosis in his blood is only one of thousands who are bitter toward life because of some terrible prenatal blemish, some handicap that marks them for failures long before they are called from the great unknown into the flesh, ought we not to redouble our efforts in agitating this impor- tant question of prenatal responsibility of parents for children? Too long have we laid stress on the mother's responsi- bility for the well-being of her child, as if she alone con- trolled its inheritance. It is time that we began to realize that character units are transmitted from each parent and each parent's parent down the long cycle of years. And while much may be done for the child in the nine wonderful months preceding his advent into the flesh, it is in reality the months and years before that play the most important part in turning out this individual mosaic. I am sure that if mothers realized, as do we doctors, how full all the hospitals of the land are with innocent young girls, as well as older women, who have been subjected to operations that will wreck their lives, just because their mothers never taught them about these sacred things, not a mother in the world would hesitate to discuss the question of sex and parenthood with their children in the most sacred way. Not only her daughters but her sons should be taught the sacred trust of their racial instinct and the consequent welfare of unborn generations. Instead of becoming "worldly-wise" too early in life, as so many parents fear, their children would become exalted by the wonder and beauty of it all. Is it not well worth the while of parents to gain the early confidence of their children in a way that will bind them to their homes and strengthen their ideals of manhood and womanhood forever? But how can parents teach children the true history of the race if they are not acquainted with it themselves? Parents cannot commence too early to instruct their children in these vital matters — I say parents, for structural heredity is quite as important for the father as for the 170 THE NEW CHIVALRY — HEALTH mother. When the boy begins to talk about what he is going to do when he "grows up," he should be taught that his highest duty is parenthood. As he grows older, he should be made to understand what honor and decency demand of him when he aspires to husbandhood. The little girl playing with her dolls should be taught the highest reverence for motherhood, so when the racial instinct begins to awaken in her it may be regarded sacredly. Right here it might be said that the Montessori method is doing more to educate fathers and mothers, as well as their children, along the line of parenthood than any other move- ment to-day. Not a single stone should be left unturned by legislation, civic enterprise, and private philanthropy to correct the evils of heredity and to train good parents for generations to come. I wish that every woman in the world would read Margaret E. Sangster's "What Every Child Should Know." The truthful, clean-minded, frank way of the mother to teach her children preparation for fatherhood and mother- hood is set forth attractively in this little volume. Instead of the mystifying stork myth, the children are informed of their procreative powers in the simplest sort of way with illustrations from plant and animal life. Walks are taken in field and fen, where the mother points out the plants and their ways of multiplying their kind. Simple explanations are made as to how nature has endowed all animals with the same instinct that corresponds to that of the racial in human- kind. This affords an opportunity to teach the child how to care for his body. The lesson of the plants and their flower children may be followed by one of the fish and frogs. Later, another may be given on the birds and mammals, gradually leading up to the human race. Meantime, as the child asks puzzling ques- tions, he may be referred back to the plants and birds for his answer, all of which will pacify his inquisitive mind with intelligent answers. Over all these he will ponder deeply in his quiet moments alone. Nor will his education end there, for he will be eager to pass his information along to other PARENTAL RESPONSIBILITY OF PARENTS 171 little inquirers, who will listen spellbound to the wonderful story of unfoldment. The mother who already realizes the importance of pre- natal responsibility will make no mistake if she enriches the bookshelves of her young daughter's library with Margaret Sangster's "What Every Girl Should Know" series. With the help of a good mother, the wisdom gleaned from these pages may perhaps change the whole trend of a girl's life. Were all boys and girls trained by intelligent fathers and mothers along the lines indicated, they would approach mar- riage with reverence. First of all, the young man would know that he owes his prospective wife a guarantee that he is healthy and capable of procreating healthy children. He should make sure of his physical condition before marriage, and be guided by such results. Those who have insane ten- dencies, or who come of tubercular or alcoholic parents, who have heart or kidney disease and other hereditary maladies, should forego parenthood. If health conditions were closely inquired into before marriage, rather than afterwards, much of the misery of the world would be obviated. This is surely an argument for the legal regulation of marriage, which some States are already considering as a logical means of social self-defense. We have learned to our sorrow that love is indeed blind, and that it is not always safe to allow the head to rule in so important a matter as marriage. To be sure, the child has a right to be born of parents between whom there is a strong tie of love and in whom the idea of parenthood is glorified, but in addition to "parent- hood producing a mental exaltation not otherwise produc- ible," as our wise Herbert Spencer once said, the all-impor- tant physical aspect must be taken into consideration. In times past it has been the fashion to lay unequal stress on the fact that good mothers were needed. Nowadays the plea for good fathers is equally strong. Many parents won- der why the young mother cannot nurse her newborn babe. To all appearances there is lactational aptitude. Many times we physicians know that she is denied the privilege of giving "to nature what is nature's due" because her 172 THE NEW CHIVALRY — HEALTH father was a drunkard. Her innocent babe, therefore, must suffer because of the sins of his grandfather. Nothing counts so strongly in prenatal responsibility as being able to trace a healthy ancestry. If the prospective mother was a welcome child, so much the more in favor of her own babe way out on that other shore. If her own child- hood was happy and normal in every respect, regulated by a wholesome life free from hereditary maladies, she in turn will be a fit subject for motherhood. Happy indeed is her lot if her mother trained her for this high estate, while she was still playing with her dolls in the nursery. If so, she already knows that the possession of children means not only responsibility for this life, but for generations to come. She knows that her children, and their children's children, are only links in the long chain which we call life. To trace her own ancestry back even a half century or so brings her to this realization very quickly. Medical books all give us two astounding examples of this fixed fact of heredity, by diametrical accounts of the notorious Jukes and the glorified Edwards descendants. That the former family, with its syphilitic, rickety, feeble- minded, criminal progeny running into hundreds, outnum- bered the latter with its noble statesmen, judges, lawyers, and other prominent men and women, is a matter of authentic genealogy. Individual effort is needed to improve individual condi- tions. It is our duty to start our children right, to give them a better heredity, stronger hearts, better digestion, steadier nerves. In order to achieve this, women should be taught how to acquire full efficiency of the human machine. They should be prepared for the function of motherhood from the time they are bom ; yet how many mothers think so far ahead for their daughters? The prospective mother should realize at the outset that it is not pills and medicine that she needs, as a rule, but a course of preventive medicine. If she is wise, she will place herself under the care of her physician in the beginning, and not wait until it is necessary to call him for a specific PARENTAL RESPONSIBILITY OP PARENTS 173 need. If she knows how to walk, how to stand, how to keep her lungs filled with fresh air in order to furnish her blood stream with abundant oxygen for her babe, how to dress hygienically, how to eat, how to exercise — in short, how to treat the machine she controls — she will have learned already the secret of health during this period. In brief, it is merely elimination of all waste products of digestion and tissue through their proper channels. She not only wishes to fulfill her maternal functions in bearing her child, but it is her great desire to nourish him at her own breast, if possible, when he is placed in her arms ; for she knows that to nurse him under normal condi- tions is the greatest protection she can give him at the out- set, for by so doing he will never be subjected to the dan- gers of the bottle-fed babe. There is no excuse for even the poorest woman to be without knowledge along this line. The efficient Children's Bureau of the United States Department of Labor, with Julia C. Lathrop as its chief, has issued a "Care of Children Series" which may be had for the asking. The woman who knows of these monographs should make it her business to urge every other woman who does not know of them to avail herself of the privilege of sending for them. Two of these, "Prenatal Care" and "Infant Feeding," were written by Mrs. Max West, of the staff of the Bureau, a woman of university training, with experience in government research, and herself the mother of a family of young children. Both are indorsed by a large number of well-known physicians and nurses; and though their purpose is not to invade the field of medicine or nursing, they do furnish invaluable information as to hygiene and normal living. The mono- graph or prenatal care is especially valuable for the guid-i ance of the prospective mother. Too much stress cannot be laid upon the fact that it is the right of every child to have its place ready and waiting — ^to be welcome. The effect of a disturbed mental condi- tion of the mother upon her child cannot be measured. Time and again we have witnessed the deadly effect of the mother 174 THE NEW CHIVALRY— HEALTH giving her breast to her child immediately after a fit of anger, or during some extreme mental state of sorrow or fear. It is a well-known physiological fact that her milk becomes poisoned through these brain storms, and more than one babe has had spasms and possibly died as a result of nursing at the breast of a mother whose milk was thus poisoned. If the milk of the mother can be affected in this manner through her emotions, with the consequent results when the child is a separate individual, what influence must the mind of the mother have upon her unborn babe — heart of her heart, life of her life? Many men and women go through life depressed and moody, always looking on the dark side, ever lacking cour- age to meet the big issues, simply because they were unwel- come children. If fear and anger and grief paralyze the heart's action, blanch the cheeks, and have a disturbing influence upon the secretions, as we all know these varied emotions do, how much more must the mother's mental state affect her child who is drawing his life from her own ! The prospective mother must know that just as a bungling potter may ruin the beautiful vessel he has already fashioned on his wheel, by not exercising care in drying, firing, glazing, and decoration, so she, the maternal potter, may not bring to perfection the wonderful little life she is fashioning. This is a strong argument for husbands to prepare for parenthood with their wives. Were there this mutual prepa- ration for fatherhood and motherhood, the way would not be beset with so many difficulties for the young mother during the time of the unseen miracle when her child lives, moves, and has his being in her. The young husband should be made to understand how important is his influence upon the expectant mother both in caring for or neglecting her. He should realize that it is within his power to a large extent to create such qualities as he desires to see in his posterity. He should know that he has an individual respon- sibility for the race; and if this is the case, every fiber of PARENTAL RESPONSIBILITY OF PARENTS 175 his being cries out for healthy, amiable, honorable children — children that will arise and call him as well as their mother "Blessed." Friedrich Nietzsche in "The Dawn of Day" so beauti- fully describes the exalted state of prospective motherhood that I cannot refrain from quoting his words verbatim, with a hope that every woman present will emblazon them in a motto over the doorway of her chamber : "Is there a state more blessed? To do everything we do in the silent belief that it must needs benefit that which is generating in us? That it must raise its mysterious worth, the thought of which fills us with ecstasy? We refrain from much. . . . We suppress an angry word, we shrink from our own harsh- ness, as though it might instill a drop of evil into the life chalice of the beloved unknown. ... A greater than we are is coming to life. Such is our secret hope. For him we prepare everything that he may successfully come to light, not only all that is useful, but also the crowning love of our souls." In closing I wish to call your attention to a dialogue that takes place between Youth and the Old Man in that wonder- ful drama "The Lion's Whelp": Old Man : "The next century will be the century of the child, just as this century has been the woman's century. When the child gets his rights, morality will be perfected. Then every man will know that he is bound to the life which he has produced with other bonds than those imposed by society and the laws. You understand that a man cannot be released from his duty as father, even if he travels around the world. A kingdom can be given and taken away, but not fatherhood." Youth : "I know this." Old Man : "But in this all righteousness is not fulfilled — in man carefully preserving life he has called into exist- ence. No man can early enough think over the other ques- tion whether and when he has the right to call life into existence!" 176 THE NEW CHIVALRY — HEALTH THE INFLUENCE OF PRENATAL CONDITIONS ON INFANT MORTALITY PROF. HENRY H. HIBBS, JR., A.M., NASHVILLE, TENN. The term "infancy" is usually defined as that period extending from birth to the end of the first year of life, and the problem of infant mortality as the excessively high ratio of deaths to births during this period. It is obvious, however, that any study of the causes of infant mortality cannot be confined solely to the period of infancy. Children come into the world as the result of a long period of fetal, embryonic, and germinal development, and their ability to withstand the vicissitudes of life and to adjust themselves to their new environments is largely determined by the conditions surrounding them in their prenatal existence. Just as the adult carries with him into manhood the effects of the conditions with which he came into contact in infancy and childhood, so the new-born infant brings with him into postnatal life the results of a long period of prenatal and even preconceptual development; and just as in accounting for adult mortality careful consideration must be given to the period of infancy and childhood, so in any attempt to account for the problem of infant mortality a careful study must be made of the conditions surrounding the infant in its intra-uterine and preconceptual development. There are, then, two distinct periods concerned in the problem of infant mortality — ^the postnatal, or period of infancy proper, and the prenatal, or period before birth. Each of these is in turn further subdivided, as is shown in the following chart: SUBDIVISIONS OP THE PRENATAL AND POSTNATAL PERIODS OF INFANT DEVELOPMENT I. The Prenatal Period. 1. The Germinal Period before Conception. 2. The Intra-uterine Period. THE INFLUENCE OP PRENATAL CONDITIONS 177 a. The Embryonic Period. (The first three months of intra-uterine life.) 6. The Fetal Period. (From the end of the embry- onic period to birth.) II. The Postnatal Period. 1. The Period of Early Infancy. (The first three months of life.) 2. The Period of Later Infancy. (The last nine months of the first year of life.) To understand the causes of infant mortality it is neces- sary to keep these periods of infant development clearly in mind and to take into account the character of the parental stock that is united at conception, the circumstances through which the infant's organism passes before birth while in the mother's womb, the conditions of life to which it must adjust itself immediately after birth, and the influ- ences which affect its growth during the later months of infancy after the adjustment to the demands of life has once been made. During the period of early infancy, after the child has been expelled from the mother's womb by birth, and adapta- tion and adjustment to the new environment begun, its sur- vival is determined not only by the conditions with which it then comes into contact but also by the strength, adapta- bility, and fitness to meet the normal demands of life which it may have developed in the long period of germinal, embry- onic, and fetal growth. The infant may be born already diseased or malformed, it may have acquired before birth a predisposition to disease, it may be congenitally so weak that it is unable to cope with its new environment, its new temperature, and its new method of receiving food and air. The failure of such children to make the necessary adjust- ment to vital conditions and to survive creates to a very large extent, as will be shown later, the mortality of the early weeks and months of infancy. 12 178 THE NEW CHIVALRY — HEALTH THE INFLUENCE OP PRENATAL CONDITIONS ON INFANT MOR- TALITY PARTLY SOCIAL AND PARTLY HEREDITARY Closer examination of the chart will bring out the part played by heredity and by environmental conditions in determining the extent of the influence of prenatal condi- tions on infant mortality. In the broadest sense the term "heredity," or the transmission of physical or mental char- acters from parent to offspring, may be said to include all that is implied in the term, "the prenatal factors of infant mortality." On the other hand, this use of terms does not emphasize sufficiently the importance of the environmental influences which aflfect the growth and development of the infant's organism in the intra-uterine period between con- ception and birth. Better is it to say that the prenatal factors of infant mortality are the product of both heredity and the environment working together — ^the product of heredity in that it is through this process that the organism is brought into existence, and the product of the environ- ment in that environmental influences acting through the mother affect the development of the infant's organism from conception to birth. The prenatal influence of the environment may be seen, for instance, in the influence of the nutrition of the mother during pregnancy on the rate of infant mortality. As the developing organism in the uterus is entirely dependent for its food upon its mother, it is to be expected that the rate of infant mortality will be affected by the character of the food she obtains during pregnancy, as well as by the kind which the infant obtains directly after its birth. Dr. Herman Schwarz, in the first annual report of the New York Free Outdoor Maternity Clinic, shows how this occurred in the case of 2,540 infants whose mothers came under the observation of the clinic during the first nine years of its work.* Thus, the rate of mortality was 144 deaths per 1,000 births among the infants whose mothers' food was poor, 124 where it was fair, and only 62 where it was good. *1910, p. 45. THE INFLUENCE OP PRENATAL CONDITIONS 179 In the same way the character of the work which the mother does during the later stages of pregnancy and the amount of rest she takes before confinement have an impor- tant prenatal influence on infant mortality. To quote from a recent writer on this subject : "A number of investigations have shown that the state of the infant at birth is greatly affected by the conditions under which the mother has lived during the previous months. The children of working women who are able to rest during the later months of preg- nancy are to a marked degree larger and finer than the children of working women who have pursued their occupa- tion to within a short time of their confinement, even though the women who thus pursue their work may be entirely healthy and robust. Moreover, such rest is a pow- erful agent in preventing premature birth. This is an important matter, for . . . the child who is born before its time comes into the world in a relatively unprotected state, and is unduly liable to perish or else to lead a permanently enfeebled life. . . . Opportunity for completing its develop- ment is of immense and lifelong importance to the newborn infant, while the rest is also of benefit to the mother, who cannot with impunity stand the double strain of work and of nourishing the future child within her. Yet the impor- tance of such rest for women in its bearing on the elevation of the race and the lightening of social burdens is still under- stood by few."* Moreover, although this aspect of the question is not often emphasized, this adverse effect of the mother's work during the later stages of pregnancy may result from the work of mothers who are employed only in the performance of their own household duties, as well as from the work of those who are employed in gainful occupations. While it is true that the prenatal effect of gainful employment on infant mortality is much more serious in most cases than the effect of work which the mother does in her own home as a part of her household duties, it does not follow that all the empha- *Havelock Ellis, "The Problem of Race Regeneration." London, 1911, pp. 18-19. 180 THE NEW CHIVALRY — HEALTH sis should be laid upon gainful employment. All mothers need rest and care before confinement and any program for the control or reduction of the influence of prenatal condi- tions on infant mortality should include within its scope better care for all classes of expectant mothers, whether rich or poor, and whether employed in gainful or non-gainful occupations. PREVENTIVE METHODS : THE CONTROL AND REDUCTION OP THE INFLUENCE OF PRENATAL CONDITIONS ON INFANT MORTALITY The distinction between the influence of heredity in the strict sense and of the environment during the prenatal stage of infant development has been clearly drawn in the campaign for the prevention of infant mortality. On the one hand are the efforts that are being made to prevent the marriage of the unfit, the diseased, and the incapable, and on the other the efforts that are being made to improve the conditions under which expectant mothers must live and to raise the standards of "mother-care" during pregnancy. The former efforts to control the influence of hereditary tendencies usually have primarily in view the improvement of the race stock, the conservation of a desirable strain, or the elimination of an undesirable strain, while in the latter efforts to control the conditions under which the infant's organism develops between conception and birth the chief end in view is to enable each child that is to come into the world to bring with it unimpaired all the capacities that heredity bestowed upon it at conception and to give to its organism a fair opportunity to develop between conception and birth. This form of prenatal work is simply an effort to conserve and protect the developing organism before birth in the same way that we have long felt that the growing child should be protected after birth. As one writer has expressed it, "it is not enough to begin the social care of the child at birth. It has been living for nine months before birth, and it is now recognized that the conditions of its life must be guarded by society during that supremely important form- ative period." We must recognize the fact that from the THE INFLUENCE OF PRENATAL CONDITIONS 181 standpoint of infant mortality the trouble is by no means only with the fitness of the parents for bringing children into the world; too frequently it is with the fitness of the environment in which the mother must live during preg- nancy. This is not the place for an account of the specific meth- ods that have been proposed or which are now being applied in the reduction and control of the influence of prenatal conditions on infant mortality. The fact must be kept clearly in mind, however, that the importance of this aspect of the problem is not generally realized. One distinguished authority has gone so far as to say that "to-day the dregs of the human species — ^the blind, the deaf-mute, the degen- erate, the nervous, the vicious, the idiotic, the imbecile, the cretin, and the epileptic — are better protected than preg- nant women."* This is, of course, an extreme statement, but it is probably true that these dependent and degenerate classes do receive more care and especial consideration becaiise of their condition than expectant mothers do he- cause of theirs. Expectant mothers, because they are expect- ant mothers, should receive more care and consideration than they are given to-day. THE INFLUENCE OF PRENATAL CONDITIONS ON THE MORTALITY OF INFANTS IN THE EARLY WEEKS AND MONTHS OF LIFE An idea of the extent of the influence of prenatal condi- tions on infant mortality can be obtained from the following figures comparing the per cent of infant deaths which oc- curred in the registration area of the United States in 1910 at certain age periods:! Under 1 week 23.5 1 week to 1 month 14.1 1 month to 3 months 18.3 3 to 6 months 19.3 6 to 9 months 14.1 9 to 12 months 10.7 * Quoted in Havelock Ellis's "The Problem of Race Regeneration." London, 1911, p. 20. The writer does not cite the author of the statement. tU. S. Bureau of the Census: "Mortality Statistics," 1910, p. 533. 182 THE NEW CHIVALRY — HEALTH Thus, the deaths of infants are not distributed evenly throughout the first year of life, 38 per cent occurring during the first month and over half during the first three months. Moreover, the number of children dying during the first week of infancy was almost exactly equal to the number dying during the entire last six months of the period. In this truly astounding fact we see the influence of prenatal conditions upon infant mortality. The failure of such a large proportion of the babies who are bom to survive more than a few weeks or months can be ascribed only to the influence of conditions affecting them before birth, during what we have called the prenatal period of infant develop- ment. THE INFLUENCE OP PRENATAL CONDITIONS ON THE INFANT DEATH RATE FROM THE DISEASES OF EARLY INFANCY But the influence of prenatal conditions on infant mor- tality is also to be seen in the large proportion of deaths of infants which result from premature birth, congenital debility, congenital malformations, and other causes of death having their origin in conditions affecting the infant's organism before birth. It will therefore be necessary to examine the causes of the deaths of the 154,373 babies who died in the registration area of the United States in 1910. The following figures compiled from Bulletin 109 of the Bureau of the Census show the per cent of the total number of infants who died from each cause : Diseases of the digestive system 32.1 Diseases of early infancy (including premature birth, 13.1 per cent, congenital debility, 7.8, and injuries at birth, 2.4) .... 25.5 Diseases of the respiratory system (including broncho-pneu- monia, 6.9, pneumonia, 5.5, and acute bronchitis, 2.7) 15.8 General diseases (including all forms of tuberculosis, 1.6, syph- ilis, 1.1, and whooping cough, measles, scarlet fever, diph- theria, and croup, 4.0) 9.2 Diseases of the nervous system (including convulsions, 2.6, and meninigities, 1.5) 5.5 Congenital malformations 4.9 All other causes ." 7.4 THE INFLUENCE OF PRENATAL CONDITIONS 183 It will thus be seen that 32 per cent of the infant deaths occurring in this representative year in the registration area of the United States were reported as being caused by the diseases of the digestive systein, 26 per cent by the dis- eases of early infancy, and 16 per cent by the diseases of the respiratory system — nearly 74 per cent in all being reported as due to these three groups of causes. Before drawing any conclusions as to the significance of these facts it will be necessary to inquire in more detail as to what age periods of infancy are most affected by each of these great causes of infant deaths. This is possible from the following data taken from the annual report of the health department of the city of Boston for 1910:* "Fifty-five per cent of the deaths of infants under three months of age which occurred in Boston during this representative year were reported as having been caused by the diseases of early infancy (especi- ally premature birth, congenital debility, and injuries at birth), and 9 per cent by a similar cause, congenital mal- formations, while the deaths reported under all these head- ings combined caused only 11 per cent of the total number of deaths which occurred during the last nine months of infancy. In comparison the diseases of the digestive system were reported as causing 16 per cent of the deaths of the first three months of infancy, almost half of those of the second three months, 35 per cent of those of the third three months, and 40 per cent of those which occurred during the last three months of the period. In a similar manner the deaths from the diseases of the respiratory system increased from 11 per cent during the first three months of infancy to 26 per cent during the last, and those from general diseases from 5 per cent during the first three months to 19 per cent during the last three months of the period." In other words, congenital malformations and the dis- eases of early infancy are the prime factors in the mor- tality of the first three months of infancy and the diseases of the digestive and respiratory systems the prime factors *Such figures are not available for the registration area of the United States. 184 THE NEW CHIVALRY — HEALTH in the mortality of the last nine months. What, then, is the nature of these diseases which so completely dominate the mortality of the early weeks and months of life and what are the conditions determining their influence? The diseases of early infancy comprise one of the thirteen classes of causes of death in the international classification. Within it are included those infants who die of such causes as congenital debility, premature birth, injuries at birth, and the like. The group also includes such causes of death as "marasmus," "inanition," "wasting disease," "constitu- tional weakness," "congenital malnutrition," and the like. It is only necessary for the lay reader, even if he has but a small knowledge of the meaning of medical terms, to glance at these titles to see that practically all of them imply that the child was not born with sufficient strength to withstand the normal demands of life for more than a few weeks or months at most.* Clearly the deaths of infants so soon after birth as a result of such causes — ^whether they grow out of prematurity of birth, an accident or injury at birth, or to simple congenital inability to survive — must be due to something besides the influence of the environment into which they are born. It is not the postnatal environment or its diseases which really bring about their death, but their absolute unfitness to withstand the normal demands of life itself. Such deaths are clearly attributable to prenatal conditions, to heredity, and to influences affecting the child's organism before birth. THE EXTENT OF THE INFLUENCE OF PRENATAL CONDITIONS ON INFANT MORTALITY There are two other causes of death which are so closely associated in origin with the diseases of early infancy, being *The only exception is in the case of lack of care; but since the number of infant deaths reported as due to this cause is so small, the exception is of little consequence. In Boston only two and in the registration area of the United States only 132, or in each case only about one-tenth of one per cent of the total number of infant deaths in 1910, were reported as due to this cause. THE INFLUENCE OF PRENATAL CONDITIONS 185 also the result of conditions affecting the child's organism before birth, that their influence must also be counted with them in order to fully estimate the influence of prenatal conditions on the rate of infant mortality — congenital mal- formations and syphilis, the former including infant deaths resulting from some deformity acquired by the child's organism before birth (such as congenital intestinal obstruc- tion, harelip, malformation of the brain or heart, and the like), and the latter in the great majority of cases resulting from syphilitic infection before birth. In 1910 congenital malformations were reported as causing 5.3 per cent of the deaths of infants under one year of age in Boston and 8.6 per cent of those under three months, while sjrphilis was reported as causing 1.0 per cent of the deaths under one year and 1.2 per cent of those under three months of age. Combining the deaths from these two causes with those from the diseases of early infancy, it will be seen that at the very least 35 per cent of the deaths occurring during the first year and 60 per cent of those during the first three months of life and a much larger proportion still of those which occur during the first month are largely the result of prenatal conditions. This proportion, astounding as it may seem, cannot be regarded as much too large, because any infants included whose deaths may not have been "largely due" to conditions affecting their organisms before birth are probably compensated for by the returns of other infant deaths actually due to congenital debility, syphilis, congenital malformation, or premature birth, under some other heading. But even according to the most conservative estimate the influence of prenatal conditions on infant mortality must be regarded as of great importance not only through its contribution to the death rate from chief causes but from contributory causes as well; and not only upon the rate of infant mortality but on child mortality also; for many chil- dren, although their chances of life in the period of infancy are greatly reduced by congenital influences, still survive until after the end of the first year of life, thus tending to increase the death rate for later years. 186 THE NEW CHIVALRY — HEALTH COMPARISON OF THE RECENT DECLINE IN THE INFLUENCE OP PRENATAL AND POSTNATAL CONDITIONS ON INFANT MORTALITY During recent years the infant death rate for the first weeks and months of infancy has not declined as rapidly as the rate for the latter and middle months of the period. It is necessary to examine the actual figures in some detail since, as will be clear from the discussion in the previous section, they indicate that the influence of the prenatal fac- tors of infant mortality is not decreasing as rapidly as that of the postnatal factors, or as rapidly as the infant mortality rate. The following table shows the per cent of decrease in the infant mortality rate per 1,000 births for England and Wales between 1888-92 and 1908-11 by age: Under Under 3 to 6 6 to 12 Years 1 Year 3 Months Months Months 1888-92 145.4 70.5 29.5 45.4 1893-97 153.4 73.7 32.0 47.7 1898-1902 152.2 74.3 32.3 46.1 1903-07 131.1 67.3 25.9 37.9 1908-11 116.1 62.1 21.9 32.1 Per Cent of Decrease 20.2 11.9 25.8 29.3 An examination of this table shows that in England and Wales during the twenty-four years under consideration the rate of infant mortality for the last six months of the first year of life declined about 29 per cent and that for the sec- ond three months about 26 per cent, while the rate for the first three months declined only about 12 per cent. The registrar-general for England and Wales in his annual reports on births, deaths, and marriages from which the above figures were compiled also gives similar data for the city of London. The decline in the rate of mortality for the first three months of infancy was only 16.4 per cent, while the decline for the second three months was 29.1 and 31.6 per cent respectively. Thus the decline in the infant mor- tality rate for the first three months of age — ^the period so THE INFLUENCE OP PRENATAL CONDITIONS 187 largely influenced by the prenatal factors of infant mor- tality — ^was in England and Wales less than half and in London somewhat more than half as great as that for either the second three months or the last six months of infancy. Similar figures are available for this country only for the last four years. The following table shows for 1910-11 and 1912-13 the average annual number of infant deaths in the registration area at certain age periods and in addition the crude death rate for each age period per 100,000 population of all ages.* So crude a rate is, of course, open to serious objections; but it is better than nothing, and is therefore included. Average Annual Crude Number of Deaths Death Rate Age at Death 1910-11 1912-13 1910-11 1912-13 Under 1 year 151,848 153,446 268.4 248.0 Under 1 month 60,491 66,472 107.0 107.5 1 to 3 months 27,198 26,496 48.1 42.8 3 to 6 months 28,062 26,520 49.6 42.9 6 to 9 months 20,452 19,016 36.2 30.7 9 to 12 months 15,645 14,940 27.7 24.2 An examination of the table shows that during the last four years the death rate per 100,000 total population for the first month of infancy remained practically stationary. The rate for each of the later age periods decreased ; but the decrease in the rate for the period 1 to 3 months (11 per cent) was less than that for either of the later periods (13 to 15 per cent) . This same tendency may also be illustrated with figures for Boston. Thus during the same period the infant mor- tality rate per 1,000 births for the first month of infancy ♦Compiled from the Eleventh to the Fourteenth Annual Reports of the Bureau of the Census on Mortality Statistics. The four years here considered do not furnish a sufficiently long period to establish inde- pendently a definite conclusion as to the shifting of the age incidence of infant mortality in this country, but when they are supplemented by the figures already given for England and Wales and London they may be regarded as furnishing a fairly adequate indication of existing tendencies. 188 THE NEW CHIVALRY — HEALTH remained practically stationary (46.9 in 1910-11 and 46.0 in 1911-12) ; while for each subsequent age period it decreased, the decline in the rate for the age period 1 to 3 months (20 per cent) being greater than that for any other age period (11 per cent for the period 3 to 6 months, 15 for the period 6 to 9, and 19 for the period from 9 to 12 months).* The marked decline in the rate for the period from 1 to 3 months is especially interesting, since it may be partly due to the efficient "prenatal work" with expectant mothers that has been carried on in Boston throughout the four years. Perhaps if this work had not been done the decline in the rate for this age group would have been no larger than that which occurred in the registration area. Thus such figures as are available in this country reveal tendencies which are in exact accord with those shown by figures extending over a much longer period for England and Wales and for London. Now if this conclusion be accepted its significance is not difficult to discover, for, as has already been shown, the mortality of early infancy, and particularly the mortality of the first month, is largely determined by deaths from causes growing out of influences affecting the child's organism before birth — or, in other words, from the influence of prenatal conditions — ^while the mortality of the later months of infancy is largely deter- mined by the influence of conditions affecting the child's organism after birth — or, in other words, to the influence of postnatal conditions. Any changes in the incidence of mortality in these periods, therefore, is an indication that similar changes have occurred in the relative influence of the prenatal and postnatal factors of infant mortality. The conclusion seemfis well founded that during recent years the influence of prenatal conditions on infant mortality has not declined as rapidly as the influence of postrmtal conditions. In accounting for this stability in the rate of mortality for the early weeks and months of infancy, especial con- sideration must be given to the fact that deaths in the first * These figures were compiled from the Annual Reports of the Health Department of Boston. THE INFLUENCE OP PRENATAL CONDITIONS 189 weeks and months of life are not so readily affected by the action of preventive methods as those in the later months of infancy, and that the influence of the prenatal factors of infant mortality are not as easily controlled as the influence of the postnatal factors. Yet, while this is true, it should not be forgotten that not until the last few years were the methods employed in bringing about a reduction in the general death rate for all ages, as well as in the rate for the middle and later months of infancy, such as could be expected to have much influence on prenatal conditions. The movement for the improvement in the water and milk supply and for the elimination of contagious and infectious dis- eases, for instance, both of which have been important factors in the decline of the death rate for adults and young children as well as of infants over two or three months of age, have had in comparison only an incidental effect on the mortality rate for the first two or three months of life. In the campaign for the direct purpose of preventing infant mortality for a long time attention was confined primarily to the prevention of infectious and contagious diseases and to the reduction of the death rate from digestive diseases. It was not until a comparatively few years ago that any organized, systematic efforts were made to lessen the num- ber of infant deaths brought about by the action of prenatal conditions. Milk stations, valuable as they have been, were not important factors in "prenatal infant mortality" until they became "infant welfare stations" and added prenatal instruction to their work and prenatal nurses to their staffs. The method that has been adopted and found most effect- ive in coping with this phase of infant mortality is, as has already been shown, what is called prenatal work with expectant mothers. It cannot be described here more fully than has been done already except to say that it is simply an attempt to give direct instruction to expectant mothers at different times during pregnancy, usually as early as possible before delivery, in the proper care of themselves and their baby to come. This kind of work is usually carried on in the poorer quarters of the city, but this is not the only. 190 THE NEW CHIVALRY — HEALTH or even the most important phase of "prenatal care." Tha incjeasing interest that is being taken in the whole question of the effect of prenatal conditions on mortality and the increasing emphasis that is being laid upon the prenatal care of all mothers regardless of their economic or social condition will have and is having an important influence on the problem. It is to be hoped and expected, therefore, that the next five or ten years will show a greater decline in the influence of prenatal conditions on infant mortality than has occurred in previous years. THE CONSERVATION OF THE HEALTH OF CHIL- DREN—A STATE PRIVILEGE AND ASSET MRS. C. A. WATERFIELD, PARIS, TENN. If all the parents were one parent, and all the children in all the land were one child, and I that parent and my own two-year-old that child, then would you listen with conviction. You and I together to-day are that all-inter- ested only parent, for every mother and mother's son and daughter of us know that in some very mystical but mean- ing way your child and mine are the only ones since the world begun. Therefore if I think of mine and you of yours, we shall encompass the whole round sum of them. These seed-plots of civilization which we are at last dis- covering to be of great worth, much as the nation has begun at length to discover the value of young trees, are the most wonderful asset of any civilization. Citizens have in a dull, negative, but very revealing way put themselves on record to the contrary in their lawmaking bodies. It is as old as the hills to say that a State sets more store by its pigs and calves than it does by its children. It is also true that the State has long been more anxious about its revenue from the sale of liquor than it has about CONSERVATION OF THE HEALTH OP CHILDREN 191 the mind, soul, and body of its boys and girls. Has not the State acquiesced in the debauchery of the bodies of its maidens, world without end, and does it not continue to suffer without protest this eddying suck of sin to envelop the souls of a quarter of a million of somebody's girls alone, every year, not to mention the thronging battalions of boys ? Does not the State in fiery factory, especially here in the South, consent to the dwarfing and crushing out of all child- ish laughter from thousands of homes? And through dale and over hill does there not rest a fog of ignorance which robs literal millions of their birthright to the education it is within the power of the State to give? Do not blind and backward children grope along the landscape? and are not children through many portions of our Southern country miserable all their young lives from the curse of malaria, which science has clearly demonstrated is caused by the swamp mosquito, while the State leaves the sickly swamp undrained? Are not communicable diseases that twist and sag the warp and woof of the bodies of little children and blight their minds still permitted to become epidemic? Is not the mortality of babies at an astonishingly high rate for lack of proper training of mothers, through literature and otherwise? Surely these commonplace but appalling facts are old enough, new enough, and big and terrible enough, were all parents one parent and all children one child, to startle and envelop you. If we think our children are not in the classes which all or any of these terrible conditions affect, it is our stupid and unimaginative mistake. Every untoward condition in our nation has its detrimental effect on every being among us. My child and yours have not yet run the gantlet, and all along the line there is still danger to them from one or more of these evil conditions. Eear your daughter in the highest way you may, and then see her "leaving all things for the stranger" whose soul has been blighted and body ruined by the pollution of pitch. We are still so busy about the big things, which after all our flattery over it is just another way of saying our selfish 192 THE NEW CHIVALRY — HEALTH things, in our adult life, just as they were when the Son of Man and friend of little children was here, that we misun- derstand Jesus's very positive appreciation of children and think that he meant only a negative endurance when he said "Suffer the little children to come unto me." So we have used and misused and spoiled, and in great areas of life we have annihilated the very root of the race. And who will mark for us the bounds of this economic social and moral waste? Witness, will you, beyond our horizon the many unenlightened races of the earth who will continue to lag and languish through life until our children, climbing over the wreckage of our follies, have been able to see over the racial desolations of our fair earth, and with greater strength of heart and brain make the telling appeal which to-day we may truly dream of. Childhood is to-day and evermore the resource and inspi- ration of our own continuing development. How children sweeten life for us ! How their presence in a family rounds out the adult ! What we accomplish in our worldly successes is usually done for their sakes; what we strive for is for them, nuisances though we sometimes think them. Do your own imagining now — no children in your home, nor in your brother's, nor in your neighbor's — only a world of well- drilled, finished grown-ups everywhere. An adult desert! No children's laughter ! No laughter in us inspired by them ! No broken toys and childish tears to dry! No little tired heads, and prayers of innocence and trust unembittered, and whistling through the rain and pleading for the impos- sible and — . Why, a childless world of art, a childless day in your city streets, a childless New Testament, a childless history of civilization and map of the world, a society with faces like lamps blown out! There is but one place acknowledged by all of us to be without a child, and fittingly so, and we call that place — hell. What is it we now have glimpsed? No less a thing than our embryo citizenship, whose future minds shall act on the needs and difficulties and ideals of a continuing world of CONSERVATION OP THE HEALTH OP CHILDREN 193 perplexing problems. We must grow souls if they are to be fitted for their task. Nor is it best that we keep in mind only this help for future generations, though long-distance dreams are our high privilege and duty. We may reasonably hope to see in our own day and time the happy results of this campaign for health, and for our hire we may have this from Emerson : "He who helps a little child helps humanity with a distinctness, with an immediateness which no other help given to human creatures in any other stage of their human life can possibly give again." We are awaking, thank Heaven, to an Aladdin-like magic in the instruments and instrumentalities which make this help more than a passing sentiment and a haphazard impulse. And central to all these instruments is the now established blazing knowledge that a justly regarded child- hood and a rational subsequent life and citizenship have their souls rooted, even as a tree in the soil, in bodily well- being. I say this blazing fact is our best instrument to this beautiful help of children. The other instruments for the scientific execution are as yet but meagerly supplied or con- ceived. Money is being used by the millions for the creation of the conditions for better health of mankind, of cattle, of plants. We are wizards when we will. Our golden dollars are now to begin the Herculean task of bringing health to China. No one but rejoices, and yet for lack of our interest and specified attention we are rearing, as we did a half century ago, thousands and mil- lions of children to whom health will be a stranger through their three-score years and ten, if they may, crippled and inefficient, drag out their allotted time. for a Rockefeller foundation to furnish the money for a crusade of health among the children of the South! Our government is great, and we must not fix the blame on it, but on our own loch of interest, that after much pleading a Children's Bureau was authorized and equipped with only $25,000 — so little that Miss Lathrop must needs economize on the distribution of the literature which might so interest and inform the public as to put the service at 13 194 THE NEW CHIVALRY — HEALTH least on an equal footing with that of bees and oysters. How- ever, if our concern is real and our efforts intelligent, we may dispense with the financial boost and ask for and get wise laws which will set us in the way to accomplish the task. It is a marvel that our young women, untaught of any, rear their children as healthfully as they do. Our ignorance is not our fault. Youth is optimistic and marriage not a certainty. Why should a girl study motherhood ? Have we not in this country a damning censure for the girl so immod- est as to dream aloud of unborn babies? And is not the only light in which the whole vital and beautiful and holy process of procreation is ever presented to our children and youth of either sex so dimmed with morbid embarrassment, or so flickering with silly jest, that the vast majority not only reach paternity, but go to their graves with no reason- able or efficient conception of this greatest and most uni- versal business in the world? If only it were not so, and parents were ready when these responsibilities come, how different would be the story and how much the young fathers and mothers be saved of the strain which ages and unfits them for the companionship of their children when, nearing maturity, they need parents just as much. It will be differ- ent. There are those who are working at the job. In Eng- land there are schools for young mothers, and the results are vastly encouraging. In London and in smaller towns the experiment has been decidedly successful. Our American Duchess of Ma,rlborough is a great help in one of these schools. Efforts to secure literature on this subject in our own country resulted only in something very disappointing. I might have gathered a host of facts regarding the health of hogs, prevention and cure, conservation and value, etc., but little was to be had regarding children. One may find a few bulletins on one phase or other of the health of chil- dren, and some records of scattering laws regarding child labor and other specific interests, but nothing definite, noth- ing inspiring, nothing final. But the older countries have been working on the problem for a long time — England, CONSERVATION OF THE HEALTH OP CHILDREN 195 Germany, France, Switzerland, Denmark, Belgium, and others. In all of these lands the beginning of work for the children is made with the mother. Working women in Eng- land must rest so many days before and after childbirth. Money is paid by the government to the mother that she may be sure of a nurse and nourishing food, thus giving the child a healthy start. Nurseries are provided for the children whose mothers must leave them to labor. Free milk dis- pensaries are operating, meals are given in France to nursing mothers, nurses supervise whole districts under the employ of the government. That is where we find the great- est difference between the work abroad and in the United States. It is the government which is at work abroad, which socializes, broadens, and brings before the people the work that is being done, and so constitutes it an educative thing, in giving the citizens standards of attitude and practice. With us it is largely the work of individuals, churches, benevolent organizations, boards of health, municipalities, the government's Child Welfare Department rendering so far great service only in the field of investigation and record. It is amazing to learn the extent of interest, however, and the amount of effective work already done by these scattered interested agencies. Some of this is in the South, and yet the preponderance is of the East and North. Physicians are at work in research, tracing to their sources the roots of those dread diseases of infancy. Settlement houses of Churches and other organizations are teaching wholesome living to hundreds of benighted neighborhoods. Hospitals are being built, nurses are at work over the land, Parent- Teachers' Associations are busy furnishing free lunches, etc. Playground Associations are providing healthful recre- ation. Laws are being enacted against child labor, the inter- est in mothers' pensions grows rapidly, prohibition is hard at work destroying the blighting liquor traffic. The best of the literature which has come into my hands regarding these things would never have reached me but for my personal requests, and the bills accompanied it. If it might be scat- tered broadcast, free, what a daydawn of enthusiasm would 196 THE NEW CHIVALRY — HEALTH be the result ! In this literature I find that most of the work so far enterprised for children might fall under two heads, "Infant Mortality — Its Prevention," and "Medical Inspec- tion of Schools," since the growth of the sentiment for com- pulsory education will bring practically every child under its care, "Infant Mortality" deals with the mother's pre- natal care of the child from birth until several years of age. We will grow to the point when we shall demand of the father that he assume his part in this prenatal care of his child. "The Medical Inspection of Schools" takes it up there and continues its care through the period of adolescence, letting go only at the graduation of the child from grammar or high school, where it is fairly started on the road to maturity. Different cities are working at all this in differ- ing ways and with differing agencies. One of the newest factors in the field, which seems to be distinctly American, is the Board of Health nurse, who works under that control, reporting to and obeying that body. She is a walking college, instructing mothers in the care of their infants, reporting infectious diseases, unsani- tary conditions, and in every way being eyes, ears, and mouthpiece for the Board. In short, she is the Board of Health on the ground. One nurse may effectively have the oversight of a population of ten thousand. She is a pre- ventive of disease rather than an alleviation of pain, as a district nurse. She touches the life of a city at many points, may lift the ideals of a whole community, and is richly worth her hire, from $600 to $1,000 a year. She saves the lives of many infants and hundreds from the dangers of epidemic. She is the newest of a long list of instrumentalities at work for the wonderful blessing of health. The good news of many maternity hospitals, the not many free clinics, where babies may be inspected and treated, milk stations, fresh air homes, tuberculosis sanitariums and schools, better- babies contests, and other helping hands are enough to make you shout for joy. One great fight being made by those interested in this phase of the child's life is that for laws regulating the mid- CONSERVATION OF THE HEALTH OP CHILDKEN 197 wife, who attends so many of the foreign-born population and the ignorant of our land at childbirth, herself in the majority of cases so ignorant that she leaves a trail of blind babies in her wake. In 1912 in St. Louis alone seventy-five per cent of the births, in Mississippi eighty per cent, were attended only by midwives. "Safe delivery in childbirth is truly a matter of national importance." If through the period of infancy none of the lurking, unprevented, murderous goblins get him, the child will soon be entering school, enormously often a cripple or defective pupil ; and then it is that the tremendous effort is made to cure, or at least patch him up for life's inevitable struggle, by the medical inspection of schools. At the close of the year 1911 four hundred and eleven cities had undertaken such work, a growth of sixteen years. Doubtless a much increased number might be given now were there any more recent compilation of statistics. The work is not uniform, not standardized, and much less is being attempted in some cities than in others ; in lesser centers and in rural regions by the thousands, nothing. In some places physicians are paid salaries to give all of their time to the physical exami- nation of children. In others they are paid merely a supple- mentary salary for part time. In New York City in 1895 the School Department of Health appointed its first school physicians, one hundred and fifty in number, assigning them to the schools one hour a day at a salary of $30 a month. In 1902 the staff was reduced and the salary increased to $100 a month and three hours' work required. It was their duty to exclude from school children who had even ever so slight an infectious disease. Thousands of children were thus excluded and cut off from education. Many of these simple cases might have been cured in the schoolroom if the nurse had been on the spot to apply the physician's remedies, and without exposing other children. So it came about that trained nurses were employed to treat in school and to follow up to the homes and save further trouble there. In 1912 $30,000 was appropriated for their employment, and last year six hundred and fifty trained 198 THE NEW CHIVALRY — HEALTH nurses were employed. That medical Inspection is advisable for the prevention of epidemic is shown in this fact. One of the nurses in a public school in New York found attend- ing school a small boy who was convalescing from scarlet fever, pulling off the skin to startle his little schoolmates. New York was also horrified to learn, after her first exami- nation of the public schools, of the prevalence of trachoma, that eye infection which most effectively cuts off all hope of entering this country by way of Ellis Island. Experiments without number prove that mentally and morally defective children are physically wrong. If a physi- cian and nurse may rectify that wrong, they may save a child, mind, soul, and body. That is the aim of the work. It is found that the largest number of children are unfit because of adenoids, lung trouble, diseased tonsils, impaired eyesight, and defective teeth. The correction of the latter trouble must be with the dentist, hence in numbers of cities a dentist is employed and children are treated free or at very small cost. But the campaign of prevention is begun. In Cleveland, Ohio, 50,000 children are now under law scrubbing their teeth for five minutes every day, because that city investigated for herself and experimented with groups of children until scientifically satisfied that children with teeth well cared for were quicker of perception, more perse- vering in work, and had better use of all faculties of the mind than those whose teeth were neglected. Through this work parents are learning from children the importance of health, school buildings are being made more sanitary and better ventilated, play is supervised and suited to the chil- dren as health-giving, sanitary fountains are abounding, and fire prevention is being looked after. The number of children whose eyesight is bad is quite astonishing, and these are helped where possible, many and many having glasses fitted to them at little or no cost. The children are being taught to care for their own health, which is perhaps the most far-reaching benefit of all. The whole level of life is being raised. Children are hearing over and over again that immorality leads to disease, that they may be saved the CONSERVATION OP THE HEALTH OF CHILDREN 199 fate of many who have become victims of destructive vices. And this is where the too often relieved father comes into training. Let a man save his son and his son's son. Why may not "Train up a child in the way he shoud go, and when he is old he will not depart from it," apply as fitly to phys- ical as well as spiritual life? The slogan of "Safety First" will grip the child if he knows why. Let the State, which takes such cognizance of its taxable lands, of its money-making interests, of its cattle and many kinds of industries, come into court and show cause why its growing, power-possessing young population is not a greater asset. In its hands rests the future administration of all estate and commerce and industry. State, give health to your real live stock, the children of your people ; give them the surroundings which are opportunity for growth. Find every serum and preventive of every destroyer of their young life and give it to them free of charge, free help for every suf- fering child ! Give education to their mothers, make room for park and playground, build swimming pools, grant pensions to mothers, that we need no more institutions "where life goes by rule" and spontaneity and individuality languish; and watch ever for the newer, better ways as they come before you, and we shall see the youth of our land growing into a strong manhood and womanhood, eager for the great fight before them and equal to the conquest. Health will nourish the soul of the child. It has been well said : "Health was to the Jew religion, to the Greek philosophy, to the mod- ern world it will be morality." That is to say, we have prayed about the children and speculated over them ; now we are going in and try to be honest and square with them. 200 THE NEW CHIVALRY — HEALTH SAFEGUARDING THE HEALTH OF BOYS WILLIAM LUND CLARKE, LEAMINGTON, ONTARIO, CANADA To you I bring greetings from the vast army of boys millions strong, who stand, pure, good, and true, and who are doing their utmost to do the best in word, thought, and deed for themselves, their God, and the age in which they live. Greetings to you I bring from another vast army of boys, who are not so strong, pure, kind, and true, and who have not attained their best, who are a bit blighted, blasted, and withered, and who remind one of the great host of boys who might have reached manhood but did not, whose bones are scattered broadcast throughout this magnificent country. I come to discuss with you the forces which produce these classes and I trust that our association here will better equip us not to break down, not to cast asunder, but to draw together, to bind up and to make strong to-day's forces. All along the journey of life I hear men and women praying and crying, "Give us back once more the good old golden days, and once more the lost paths." But when I review the sights I have noted in the careers of misdirected or non-directed youths I am convinced of the uselessness of tears and the folly of some prayers, and I face the future with a determined grip, whispering, "Give me 'new days and unbroken paths wherein we can and will do more for youth or life in boy form than has yet been done in the bygone days along the lost paths." Traveling as I do about fifty thousand miles annually, and speaking about a thousand times to about one hundred and fifty thousand people every year in the interests of youth, in the East, West, North, and South, I am convinced that we no longer live in the old but in a new world, with a new people, with a new equip- ment — a new world because the old is not, a new people because the old are dead, and a new equipment because all is changed and a boy is a stranger even to himself, because of that change or that newness. SAFEGUARDING THE HEALTH OF BOYS 201 As I review your program I realize that you have placed in my hands the most vital of all subjects: "Boys — Their Health and Safeguards." I am indeed within bounds in saying that we cannot safeguard anything until we first of all know the things we have to safeguard. We cannot teach that which we do not know or give that which we have not got. If we accept this test of efficiency, we will see the need of action in the adjustment in the so-called old days and lost paths. Is it not true that those days and paths pro- duced not only the good boys, but the better ones and also the best ones ? I say good, better, and best, because all boys are good. I have not found thus far one bad boy, but I have found many doing, saying, and thinking bad things. I know they want to grow to be strong, healthy fellows, full of vim, life, and energy, and that they will do it if they but know how. As a lad said to me not long since: "My parents told me to be good; but, my gracious, Mr. Clark, they never told me how." This lad spoke from experience and expressed the regret of millions who might have been strong and happy men. I know that they want to grow to be men, true and kind and wholesome, that they want to live in happy homes along magnificent avenues, with beautiful sons and daughters who will one day call them father. To teach a boy these things is a father's job and a mother's business. I repeat that we cannot teach that which we do not know or give that which we have not got. If we do not know these things, tenden- cies, and forces, we lack that which we ought to have. Let us make it our business to know them. They belong to youth, that which has consumed all the past, occupies the present, and represents the future. We must one day leave all our visions, methods, and plans in the hands of youth, for we live and die as we to-day live and die in the hearts of boys and girls. Ask him what kind of a bargain he has made when he traded off the little chap he used to be for this present self that he is to-day. Ask him if he has made a good bargain or if he thinks he could make a better one if he could get 202 THE NEW CHIVALRY — HEALTH the little bright-eyed fellow back and trade once more. Tell the boy to deal carefully with himself. Youth has no bar- gain days ! It is not offered for sale in any of the markets of the world. Youth is not for sale, because it is beyond gold values. But the days are dawning and the paths are being made when youth for the first time will be drawn unto its own. When a boy I once visited a chum on a Sunday. My chum and I were walking up and down the old lane that ran through the center of his father's farm, looking over an old rail fence into a twenty-acre field of green peas, and I would like to say that green peas look good to a boy on Sunday and taste .better. My chum's dad said to us that beautiful June day, as we looked at but had not tasted his peas: "Boys, come here." Well we went, taking the shortest route, and before we had fully arrived he said: "Sit down; this is Sunday." We sat down. It was the only safe thing to do, but we were sorry it was Sunday. Power enough to drive, power enough to command, but not power enough, not Christ enough to draw two boys unto himself. That father was a fool. To-day some fathers will accuse me for saying this; but had that father eaten with us, two innocent boys, a few green peas, he could have taught us then and there how to safeguard that which is most precious to all boys — health. Remember that I say to you, you can tell to which class you belong (driving or drawing) as you accept or reject this story. A boy hoeing potatoes in a little field inclosed by a stump fence was asked by a traveler how much he got a day for hoeing potatoes, and his prompt reply was: "I don't get anything for hoeing them, but I get it if I don't hoe them." So it is with parents. Not so much for what they have said and done and thought, but, alas! so much for what they did not think and what they did not say and what they did not do. Health, beauty, and wealth might have been in millions of places, but is not because in millions of places ignorance reigns and people are not taught the power that builds health. SAFEGUARDING THE HEALTH OP BOYS 203 May I present to you these roses, and may I add that they were produced from a rosebush? Perfect as the rose- bush must have been to produce these beautiful roses, the rosebush was also produced from a little bit of rose cutting, such as I hold in my hand at this time. Needless as it is, I tell you that a man who produces such roses as these must understand all the forces that concern rose-growing, both the forces that build up and the forces that destroy roses; he knows not only how to safeguard the rose but also the bush and the cutting, knows the effect of the day life, like- wise the night life upon the roses that he grows — knows that the rose is full of life and health and the causes of disease. The job demands that he know, otherwise the roses are con- sumed. Some rose growers know more about roses than do others. But on the whole rose growers know more and teach more about roses than parents know or teach about boys. Is this fair? Is it honest? Is is worthy of our day and our generation, of our boys, of ourselves, and of our God? We are told to consider the lilies of the field. We could also consider with profit the roses and compare them with our boys, for the comparisons are true and many. First the rose cutting from the rosebush, and then with the tiny cutting we have a rosebush; and then with the rosebush, our God, and a man we have a rose, such as I have already presented to you. It belongs to the natural development of a boy that some- where or sometime between the age of fourteen and nineteen years he should expect to awaken sometime, as the morning dawns, and discover for the first time that certain secretions have been released from his natural life and that these secretions belong to a natural development and should be of no more or less concern than the releasing of a few tears from the eyes, and that the vitality consumed at this time will be replaced the next day of his own life by the eating of a single egg or a piece of toast, and that the frequency of this experience will vary in different nationalities, cli- mates, and under different conditions and continue for a long time, and should be treated alike, the first or even the last time — viz., they should thank their God that they belong 204 THE NEW CHIVALRY — HEALTH to the natural, the sound, the developing, and returning once more to the sleeping forces of youth, millions strong awaking, and arising in the morning refreshed and ready for the day's duties. Here in my hand is a letter from a boy seventeen years of age away from home and mother who paid last summer one hundred and sixty-five dollars to two quacks because he was a natural, developing boy. All shame to the present genera- tion who allow to continue to enter our homes and the lives of our boys printed circulars and booklets of the vilest type that can or do leave a printing press, all because we do not teach life and the things that belong to it. Teach them, then, to-day I say, all the natural developments that belong to health. Safeguard the health of our boys by a better understanding of youth and the things that belong to it. Certain sections of this magnificent country make laws to prohibit the use of public combs, cups, towels, and brushes. It is time — ^yes, past time — ^for a boy to be taught to carry his own outfit for the protection of his own health and safety. This is why I continue to plead with you at this time. A youth in a certain college not long since said : "My chum and I, both of us from the country and not knowing the dangers to health, left home, and to-day my chum is blind because of the unknown, unsought, and unseen germs left in his eyes from a soiled towel." We cannot know another until we know ourselves, nor can we safeguard another's health until we know how to safeguard our own. THE TREATMENT OF DELINQUENT BOYS PROFESSOR T. G. KENNEY, HOUSTON, TEX. "Cleanliness is next to godliness" and "Order is Heaven's first law" are maxims that have been handed down for ages, yet they are so clear and so full of meaning that it is safe to predict their perpetual force. THE TREATMENT OP DELINQUENT BOYS 205 We have long since learned the value of cleanliness and order. Both are necessary in the ordinary walks of life, and either is indispensable if a high standard of health is to be maintained in a school for delinquent boys. I am not going to attempt to discuss from a scientific standpoint any particular case or class of cases. It has been my privilege and pleasure for several years past to conduct a school for delinquent boys, and I find in this work a fertile field for labor. Very few boys are in a normal physical condition when received at the school. Even though they may come from a good home, their delinquent habits have made noticeable inroads on their physical condition. I know of no better way to illustrate the physical condition of the average delinquent boy when received at the school than to compare him with an abandoned auto found by the roadside the next morning after some memorable "joy ride." The torn top represents his towsled hair ; the punctured tires, his toes out through his shoes; the spattered wind- shield, his dirty face; the disfigured lamps, black rings around his eyes ; the missing laprobe, his lost handkerchief ; the changed number, his fictitious address; the tool-boxes, his pockets full of junk; the rusty levers, his cigarette- stained fingers; the weak batteries, his exhausted strength; the broken steering gear, his difficulty in going straight; and not unlike the auto, the odor is quite noticeable. •As the mechanic begins work on the dilapidated auto, so do we begin work on our subject, the new arrival. At this stage of the game he is not merely given a bath, but he is given a thorough cleansing, and this is repeated until he is clean. He is then given a new outfit of new and clean clothing. The school physician is then called and the boy is examined. If he is found to be afflicted with any specific disease, or is suffering from eye, ear, nose, or throat trouble, treatment is at once administered and the boy remains under the doctor's care until cured. If he has been exposed to any contagious disease or is suffering there- from, he is kept isolated until all danger is past. This 206 THE NEW CHIVALRY — HEALTH examination does not often disclose the fact that the boy is afflicted with any specific disease, but can in nearly all cases be summed up in this manner: "Generally run down, lost vitality, tired feeling, nervous, irritable, and in a bad frame of mind." I do not wish to burden you with statistics or details, but merely wish to outline the daily life of our boys, for I firmly believe it has an important bearing on their physical condition. They rise in the morning at six o'clock and after thirty minutes' light exercise are assembled for break- fast. They are given thirty minutes in dining hall and are not permitted to eat rapidly. At 7 A.M. all boys are detailed to school or work, half attending school in the morning, the remainder in the afternoon. At 11 :30 general recall is sounded and all are given thirty minutes' recreation before dinner, which is served at 12. From 12:30 until 1 is given to recreation, when all are again assembled at school or work until 5 p.m. Supper is served at 5 :30. The evening hours from 6 to 8 are spent in reading, playing games, and in general recreation. All retire at 8 o'clock. Thus a boy is up fourteen hours each day, four of which he spends in the school of letters, four in the school of trades, one and a half in the dining hall, and four and one-half in various exercises and recreation, the latter being divided at various intervals morning, noon, and night. Best results are ob;tained from plain, wholesome food, cleanly prepared and well cooked. Oatmeal is the favorite breakfast dish, varied of course with other cereals. Meat is given moderately, while fresh vegetables of all kinds and "homemade bread" are recommended as the staple articles for the growing boy. All dormitories must be well lighted and ventilated and sunshine permitted to enter all parts at some time during the day. Each bed must be well aired before being made up. A frequent change of clothing and systematic bathing are as essential as proper food. The cigarette is no, doubt responsible, directly or indi- rectly, for more physical wrecks among boys than any other THE TREATMENT OF DELINQUENT BOYS 207 one thing. Besides the serious effects it has on the lungs, nerves, and growth, the young boy who has become an inveterate cigarette smoker is usually addicted to the prac- tice of secret vice. If the cigarette is not done away with and a stop put to this practice, little can be done for him physically or mentally. The cigarette is entirely done away with from the beginning at the school — ^no smoking allowed. Secret vice is handled by such publicity and lack of oppor- tunity that it is soon controlled. I do not believe in false modesty or megaphone morality, neither do I believe in constantly preaching to boys on such subjects. They are live wires and may try experiments to see whether or not you have told them the truth. The "new boy" should be watched closely and not be permitted to become the center of a gang, telling immodest stories of his "past" or suggest- ing improper conduct for the future. Toilets and lavatories are not permitted to become "loafing places," but should be conducted under the strictest discipline. No talking is allowed therein and no one allowed to enter without permis- sion. No "inner doors" are used, but simply partitions with open front, thus insuring a reasonable amount of privacy and protecting modesty and at the same time eliminating opportunity for secret vice. The boy's conduct should be as closely guarded in the toilet, the "old coal room," or any other loafing place about the premises as it is in the class- room. Large and small boys should not be permitted to mingle, especially during playtime. There is good enough in every boy to predominate, if given an even chance, protected from temptation and time to develop. It takes some longer than others. Pay little heed to the man who tells you that our country is becoming bankrupt from a physical and moral stand- point. He does not know what he is talking about, and besides such assertions do not help the cause. During the past few years many agencies have been organized and are operating to study the physical and moral condition of those who have long been looked upon as a "necessary evil" or a "habitual public nuisance;" those who have never felt their 208 THE NEW CHIVALRY — HEALTH responsibility toward society in the matter of health and morals and those who are largely responsible for the phys- ical weakling and moral delinquent boy of to-day. The zealous work of these agencies in getting at the facts does not mean that physical and moral conditions are getting worse, indeed not; it simply means that they have concen- trated eifort and in an intelligent and systematic manner are getting at the root of the evil that has long existed, with the hope and knowledge that they will benefit conditions in general. The surest way in America to eradicate an evil is to lay the facts in an intelligent manner before the people. This done, we have accomplished much toward checking delin- quency, as physical weakness contributes thereto, and we must admit that many disabilities and afflictions are acquired from ancestry. We receive two distinct classes of boys at the school from a physical standpoint: The one, a once healthy lad of healthy parents, but because of dissipation and improper care has become a physical cripple; the other is in the world as the result of a union between two physical or moral wrecks, or both. The one readily responds to treatment, and it is encouraging to watch the develop- ment. The other may be treated and nourished and much improved, but the "brand" of ancestry can never be entirely eradicated or covered up. I know of an alley in a large city that became notorious a few years ago because of the number of persons that were robbed or murdered there. Special policemen were put on guard, thousands of dollars were spent in searching for and prosecuting criminals, when suddenly the "city fathers" decided to place an arc light in the alley. The solution was simple. The absence of cleanliness and order, especially among the young, is responsible for sin, sorrow, sickness, and early death, as was the absence of the arc light in the alley responsible for the crime committed there. To stress the fact that cleanliness and order, rigidly and systematically enforced, are all-important factors in boy life, I might state that our school has operated for five TREATMENT OP THE DELINQUENT GIRL 209 years, and during that time we have had an average of seventy-five boys (one hundred at the present time) . We have had no deaths or broken bones, nor epidemic of any kind. We have no hospital, and it is indeed a rare thing to find a boy in bed in the daytime. The definition of a boy is "a male child." He is all that and a whole lot more. He is a bundle of raw material, endowed with the greatest of possibilities. His future des- tiny and usefulness depend in a large measure upon his care and training as a youth. Above all, keep him clean of body and mind, direct his physical activities, whether work or play, in an orderly manner. Bear in mind that a boy is in reality much like an auto — steer him carefully and he will make the garage. TREATMENT OF THE DELINQUENT GIRL MISS ETHEL A. CLAXTON, SUPERINTENDENT HARRIS COUNTY SCHOOL FOR GIRLS, HOUSTON, TEX. How shall we treat the delinquent girl, the girl who, in nine cases out of ten, has never had a chance to really live, who has had little or no home training, and who through a love for fine clothes or pleasure has strayed far from the right? She feels no uneasiness about lying or deceiving and knows nothing of obedience. She feels that there can be no real pleasure except from the public dance hall and other places of similar character. Can we blame her for going to these places and for knowing nothing better, when society has provided these places and nothing better for her? In the majority of cases the home is no fit place for her to entertain. It was my duty once to visit a sixteen-year-old girl who had been frequenting a questionable dance hall, and try to persuade her to keep away from such places. After talking with her she said she would willingly stay away, but asked, 14 210 THE NEW CHIVALRY — HEALTH "Where may I go?" This was a question I could not answer, for there was not one wholesome amusement place in that city. How sad that this subject of amusements is not considered more seriously when it has such an influence on both the girl and the boy! They must and will have pleasure, so what a good plan it would be for all of the cities at least to make the schoolhouses well chaperoned social centers for the young people. In summing all up we are to deal with the girl who knows little of right and much of wrong. In considering this matter we must remember that many of these girls will sometime be mothers, and realizing this we should plan such training as will not only enable them to care for self but for others. When the girl leaves the old surroundings and her old associates and is placed in a school, all seems strange and it is by no means an easy task for her to forget the lessons in immorality, dishonesty, untruthfulness, one or all, which have been so instilled into her mind that she can think and talk of little else, and until she can be made to see that there is something in life worth while she will feel uneasy and much out of place. Therefore it is the duty of those in whose charge she is to begin as soon as she enters to help her become interested in her work, her study, and her play. Except in a few cases this is not so difficult, for she soon finds it interesting to do something worth while. Although a member of a class and many in the class have similar failings, we should not forget that each girl has a disposition differing from the others and that the best results can be obtained only through dealing with the indi- vidual. Therefore give her the personal attention, listen to her troubles, advise her, help her to forget self, and make her realize that you are her friend, that you believe there is good in her and that you are anxious to see it brought out. She has no doubt heard many times what a terrible girl she is. Show her the other and perhaps wholly undeveloped side, the good side, and watch the change. My experience has been that often the girl about whom everyone has some- TREATMENT OP THE DELINQUENT GIRL 211 thing ill to say proves to be the best. There is as much good in her as they thought there was bad, but it had not been brought out. Learning to obey is one of the first steps which is to be taken, and it is by no means an easy one, for the girl has known little or nothing about obedience. We want her to understand that it is not merely doing what she is told to because she has to, but to know that to obey is a lesson for her to learn in order that she may be fitted for life, that it is a fundamental law which all have to observe, and that as she is learning to obey she will be learning how to live. In many cases medical attention is needed as soon as the girl enters school and before she is physically in condi- tion to take up any duties. It is sad to think how many girls in their teens are infected, the majority, if not all, through ignorance of the terrible consequences. This makes it neces- sary to give such instruction in hygiene as will be beneficial to the girl through life. It seems to me that when the proper instruction in sex hygiene can be presented to the children of the public schools in the right way it will be a means of preventing the spread of disease, for in very many homes the parent is wholly unfitted to present the matter as it should be. Many girls have said that if they could only, have known the consequences of immorality they never would have done the wrong they did. Not only is the girl physically unfitted for life, but mentally and spiritually as well. She needs a thorough training and one which will broaden her mind. This can be given through systematic work, study, and play. Teach her to cook, clean, wash, iron, and sew, making her feel the great importance of such knowledge and that to know how to care for a home is an accomplishment of which to be proud. It is not uncommon for girls to plan ways in which they can better their home conditions by making them more cozy, and some are like the Polish girl in Pennsylvania who reasoned that she would likely marry a poor miner and it would be necessary that she know how to patch and darn well. She did marry a miner and sent me a picture of her- self in her widding dress, as she called it. 212 THE NEW CHIVALRY — HEALTH Aside from the indoor work there are the out-of-door duties through which many valuable lessons are learned. Gardening and caring for the animals and fowls are among the best means of developing the mind, soul, and body. The nervous, irritable girl soon sees in nature that calm quiet and beauty which she needs to cultivate in self. One of the girls once said: "As we watch the ugly seed develop into the beautiful plant, so we can develop." A good illustration of the value of this out-of-door life is shown in the following: A girl about sixteen years of age was taken from a back alley of a large city and placed in a school. She was nervous and quarrelsome, seeming to know little except profanity and common street gossip. Sev- eral ways were tried in which to help her, but apparently to no avail. Finally one of the teachers said : "Margaret, there is a bed of nasturtiums, and if cared for they will be beautiful. It is to be your bed to weed and to look after, but whenever you are naughty or use bad language you cannot go near it. Of course then the weeds will grow and smother the beautiful flowers. Just as you let the weeds grow in that bed, so are they growing in your life and are taking the place of the good that might be there !" Many a time when Margaret was tempted to say or do something wrong she would fly to that nasturtium bed and begin digging out the weeds. She had a beautiful bed ; and as she kept the weeds out, so in her life the bad had to give way to the good. To-day she is in a cozy little home of her own and the mother of a son. Margaret learned the lessons of self-control and how to develop the good through caring for a little bed of flowers in the heart of a big city, for the school, though having a large yard, was in the city. If one girl can learn so much from a little flower bed in the city, how much greater is the opportunity given the girls in the country, where there is space for all to work and to learn nature's way! Let us remember the great good derived from the garden work. TREATMENT OF THE DELINQUENT GIRL 213 There should be the regular study hours. They are of the utmost importance, for in most cases the girl is very backward, having left school at an early age, very few going after fourteen years of age, it mattering not whether in the first or the seventh grade. They then feel that they are too old to study, and it is not uncommon for a girl thirteen or fourteen years of age to ask if she is not too old to think of fitting herself for some position which will require five or six years more of study. Make the study period as interesting as possible and an inspiration to higher education. Much attention has to be given to reading, writing, arithmetic, etc., but at the same time the advantages of music, drawing, nature study, raffia, and other such subjects as tend to enlarge and better the mind should be given. Because a girl has done wrong many people seem to feel that she should not have the advantage along the more artistic and sesthetic lines. They say : "Keep her down ; for if you make life too pleasant she will feel it no disgrace to sin." I think she has already been kept down long enough and now she should be given every possible chance to learn how to live. If she is not feeble-minded, she will quickly see where she has done wrong. Give all the advantages possible that will be uplifting, broadening, and an inspiration to higher learning. Each girl should play as hard as she works and studies. Interest her in such games as basketball, baseball, and tennis. She will need to be taught to play, but after that side of her nature is once aroused and she begins to have the true ath- letic spirit there will be a decided change for the better in all departments. Plan evenings of dancing and playing games, also pre- pare plays, drills, and music for entertainments. These not only give pleasure but create an interest in the proper kinds of amusement, showing that there is more pleasure derived from innocent fun than from the vulgarity of such amuse- ments as they have heretofore indulged in. Let the play- time answer as a means of developing a higher moral standard. 214 THE NEW CHIVALRY — HEALTH While the teaching in every department should be spir- itually and morally uplifting, at the same time there should be set apart a time each day for religious training. As we know that throughout all the ages religion has been the strongest influence in human conduct and the mightiest of forces, so we must realize that without it the girl cannot stand. Help her to learn its importance, teach her the Bible and how to gain from it the lessons of great ethical value, also the power and goodness of our Maker. It is well to make the discipline of a school that which will put a girl on her honor from the time she enters. Often at first she appears to have little or no honor, and perhaps for a month or two she will do only because she has to. Then she usually becomes interested in her school and does because it is right to. Some form of student government is an inspiration and help. At the Harris County School for Girls we have the Stu- dent Government Circle, into which any girl may enter after having been in the school three months with good conduct. The girls appoint their officers and committees and have their meetings at stated times, a teacher always being present at the meetings, when they discuss various subjects such as ways in which they have been able to help, wrong acts committed by different members, and ways in which they can better the circle. Some of their duties are to help the teachers in various ways, look after new girls, and not only to try to better self but others. Among the privi- leges given are attendance on outside lectures and enter- tainments. These are not only pleasant, but are of educa- tional value as well. Their motto is, "True worth is in being, not seeming." The question is often asked, "What do you do with the girl when she leaves the school?" In most cases after a girl has had two years' training she is ready to be placed out. It is as unwise to place certain girls in certain positions as it is to deal with all dispo- sitions in the same way. During the stay in the school it is best to consider the girl's ability and to find out what she TREATMENT OP THE DELINQUENT GIRL 215 desires to do when leaving. As far as possible start her along that line, that she may finish her training after she leaves. Many are best fitted for housework and should be placed in good private families. The girl should be visited often and made to feel that you are still as interested in her and her progress as when she was in the school laying the foundation for her future. Encourage her to visit the school as often as she can. It is not an uncommon thing for girls to spend their half holiday each week at the school and to retain their old places in the ball team. Neither is it unusual for a girl, living in her own home, to spend an afternoon or evening, perhaps accom- panied by her husband, with the teachers who have been her true friends, who have taught her how to live. When, on the other hand, the girl does not care to return to the school, it is quite certain that she is not living up to the right standard, or, in other words, she lacks the will power needed in battling with the problems which confront her. She needs your help more than the others, so give her special attention. Although in some instances it may be well for the girl to return to her parents, she should never return to the old surroundings. May those who take part in the training of the delin- quent girl realize the great responsibility resting upon them and, with Holland, "Count this thing to be grandly true, That a noble deed is a step toward God, Lifting the soul from the common sod To purer air and a broader view." 216 THE NEW CHIVALRY — HEALTH HEALTH TEACHING IN SCHOOLS F. B. DRESSLAR, PH.D., PROFESSOR OP HEALTH EDUCATION IN GEORGE PEABODY COLLEGE FOR TEACHERS, AND SPECIAL AGENT U. S. BUREAU OF EDUCATION The methods of health teaching prevalent in our schools have in the main been far too indirect and too indefinite to be of any particular value. We have no right to blame the schools entirely for this, but we must lay a part of our failure to lack of knowledge, and to a certain extent to the unwillingness of the public to allow the teachers to teach what they felt ought to be taught. The old courses given in our schools entitled anatomy and physiology, or physiology and hygiene, and generally required by legislative enactments, were designed to fit the knowledge of health authorities twenty-five years ago. But the last quarter of a century has seen greater definite advancement in so-called preventive medicine than in all previous centuries combined. As a result the methods of health teaching are largely out of date, and as with all readjustments it has required time to educate the public to appreciate the new point of view and the significance of the newer discoveries bearing on health conservation. I am persuaded, however, that the general public has now a sufficient understanding of these facts to warrant the schools in making radical changes in those courses which involve health teaching. But before this can be made gen- erally effective many of our laws will have to be changed so as to permit the use of an entirely new type of textbook in our schools. As long as our statutes require the teaching of physi- ology and hygiene, bookmakers and publishers are going to take no risks in preparing books that cannot legally meet the requirements set for courses of study. We therefore need legislative changes, so as to require the teaching of hygiene and sanitation rather than physiology and hygiene before our school work can adjust itself properly and HEALTH TEACHING IN SCHOOLS 217 directly to health teaching. This is important, and I hope all members of this Congress will exert their influence to bring about this change in the laws of those Southern States still behind in this particular. I do not wish to suggest that there is no place in our schools for the teaching of physiology, but I do want to say that only so much of physiology should be taught in our elementary schools as will have a direct and significant rela- tion to hygiene and sanitation. A very large part of the physiology now taught is worse than a waste of time, for it confuses the children and has no direct value for them. It is almost tragic to see a teacher belaboring a child's mind with abstruse facts about bones, muscles, the intricacies of circulation, or even digestion, when that child is sorely in need of a toothbrush and dental care, better food, more freedom, and fresh air. It is worse than tragic to permit ' them for lack of the knowledge of the fundamentals of sani- tation to die of typhoid fever, malaria, or hookworm disease. Our whole school course in health work must be recon- structed, and in the remaining part of this paper I wish to suggest briefly some of the changes we must make in order to render this part of our work more vital and more helpful to the conditions that confront us. There is not time to go into the detail of methods to be employed, but our first problem is to bring to our children, and through them to the parents, some of the common but fundamental facts which really and vitally affect every home. 1. One of our most important problems, if not the most important health problem in the South, is that of securing safe, convenient, and abundant water supply for the country homes. This is a matter of such vital importance to every home that it indeed seems strange that our schools have given it practically no attention. This must be changed. If it were possible for me to represent in some objective form the morbidity and mortality resulting in one year from the use of infected drinking water in the Southern States, we would doubtless all be astounded. But what are we going to do about it? I have yet to see any public school 218 THE NEW CHIVALRY — HEALTH in our section make any thoroughgoing attempt to teach the children how to get a pure, convenient, and plentiful water supply at country homes. We must impress the teachers with the necessity of dealing with the common and necessary needs of life, otherwise these will be the last things to receive attention. It really takes a genius to appreciate the value of every- day needs. The common mind seeks from afar for things that seem to him worth while. There is no better, quicker, and safer avenue to the homes than through the schools. If we can teach the children in a simple, clear, objective way the value of pure water and how to secure it in the homes, we shall have done a very large service for health in our country districts. All who are acquainted with rural condi- tions in the South can appreciate the many handicaps of the homes due to thoughtlessness and lack of knowledge in this regard. Thousands could have pure running water in their homes at small expense and a little care. Many others could well afford larger expense and more care, and would do so if they only knew why and how. Just imagine for a moment what it would mean for gen- eral sanitation if the boys and girls in our rural districts were taught that from springs, or even. wells, they may have running water in the kitchen, at the barn, or on the lawn, at a small expense. It is too much to expect country people to keep their homes or bodies clean when water must be carried up a steep hill, or pulled out of a well with a string, or even pumped into a bucket. Let me illustrate : A farmer built a house costing approximately five thousand dollars, for he was well-to-do and was anxious to care for his family ; but there was in this house no bathtub, no lava- tory, no sanitary toilet, no convenient laundry room, no kitchen sink. All of these could have been installed for a few hundred dollars, but it never once occurred to him that it would be possible for him to have all these city conven- iences. He had never heard that it could b6 done. We shall never have bathtubs in country homes until the people are taught how they may have them and that they cannot afford to be without them. HEALTH TEACHING IN SCHOOLS 219 I suspect that if all the bathtubs in the country homes of the South were in use every hour it would take a long time for all to get a bath. But while baths seem to us essential, the lack of running water in the kitchen, in a lavatory, or for laundry purposes is still more to be deplored. Dirty hands, dirty dishes, dirty clothes, and dirty buckets are greater menaces to health than we can well imagine. But by the use of a simple force pump and a pressure tank all the conveniences mentioned are possible at a small expense. I have been greatly surprised in working with teachers to find that most of them never heard of a pres- sure tank, and practically none of them know what a hydraulic ram is, or of its uses on a farm. These same teachers could pass a good examination on technical ques- tions in physiology, such as those having to do with circu- lation, the names of the bones, the location of the flexor and an extensor muscle, the names of the cranial nerves and hundreds of other facts useless to them. They are far away from common needs and do not realize it. We shall never have passable hygienic and sanitary conditions in the coun- try districts until this fundamental need — sanitary and con- venient water supply — is thoroughly understood and met; and every rural teacher in the South should be required to teach the children the necessary facts leading to this end. 2. The next important element of health teaching is one that has been stressed by health boards in the last five years, but as yet is rarely spoken of in schools. I refer to sanitary toilets. The hookworm campaign which has been carried on in all the Southern States for the past few years has cost millions of dollars, but it has been worth a hundred times what it has cost. Not only have we gained in a direct way, but more largely in an indirect way. The chief prob- lem that has emerged through this campaign is not that of merely curing people who are afflicted with these parasites, but of securing sanitary toilets at the homes and at the schools to prevent infection from this or other diseases. Half of the farmers have no toilets at all, and thousands of public schools are in the same category. During one day I recently visited nine rural schools, one of them of the con- 220 THE NEW CHIVALRY — HEALTH solidated type, and amongst them all there were but two outbuildings, and these were unspeakably vile. The other seven had none at all; and yet in these schools they were teaching the children to distinguish between the pyloric and cardiac orifices, to bound Alaska, to memorize the chief political divisions of South Africa, and to be absolutely sure that Mt. Whitney is the highest mountain in the States out- side of Alaska. We shall never get rid of typhoid, hookworm, and other enteric diseases until people learn that human excrement is especially dangerous in this climate and that sanitary toilets are of far greater importance than the tariff or the dangers of the boll weevil. These facts can be taught in our schools in a clear and unobjectionable way, and by means of models, drawings, and demonstrations can be made to issue in better conditions in the homes. 3. The death rate from tuberculosis in the South, as far as we can find out, for we are shamefully negligent concerning vital statistics, is criminally high. There is no reason at all why the South cannot and should not be the most wholesome section in this country in this regard, for we have plenty of sunshine, a mild climate, and we have not as yet moved into a few great cities where fresh, clean air is not to be had. We have learned enough about tuberculosis to know that we can successfully fight it with fresh air, good food, and rest. But we have also learned that sunshine will kill the germs, and that perhaps most infections occur in childhood. If teachers would only take the time to learn the great importance of sunshine and pure air for health's sake, and then be allowed by those who guide in school affairs to put the children into vital possession of these facts and show them how to take advantage of these health-giving agencies, a tremendous change would in time take place. A country teacher who will teach the children how to build a sleeping porch and protect it from mosquitoes and flies, and illus- trate in this way one of the most fundamental needs of health in this part of the country, will do more real service HEALTH TEACHING IN SCHOOLS 221 than if she were to teach the whole of a two-volume edition of physiology to these children. If we would only open our houses, let in the sunshine, sleep in the open air, and fully appreciate the great value of wholesome food in the fight against the great white plague, the death rate from tubercu- losis and other diseases of the respiratory tract would be tremendously lessened. In the past few months it has been my good fortune to study the results of open-air schools the world over, and I am frank to say that I have been astonished at the wonder- ful effects which can be wrought in anaemic tuberculous children with fresh air, plenty of wholesome food, and rest. These schools have given the best demonstration ever made of the tremendous importance of these common necessities. But why should we wait until the children are sorely afflicted before supplying them with pure air, good food, and rest; why should not the well children be properly treated in order to keep them strong and well ? Indeed, why should we limit this teaching to the schools? There is no family so poor that it may not have fresh air if it will ; and there is no family so derelict that it would not do its duty better in this regard if the fundamental facts regarding the need of fresh air were thoroughly understood. Knowledge begets action, and if this knowledge is vitalized it will break down prejudices and evil habits, and inevitably lead to better and truer behavior. You can neither preach nor shock people into the heaven of good health. You can teach them, show them, and prove to them the value of truth. This takes time, but it will bring permanent and lasting results. If we could have at command for educational purposes all the money that is worse than wasted on patent medicines advertised to cure tuberculosis, we, could wage a campaign of education that would make a tremendous difference in the ravages of this scourge. But we shall never get rid of patent medicines and dangerous nostrums until the igno- rance and superstition upon which their manufacturers rely are suppressed by truth as complete as we can get. And no phase of education has so many superstitious practices to 222 THE NEW CHIVALRY — HEALTH overcome as that having to do with the health of people. This fact we must never forget, and our teaching must be simple, clear, and truthful to the extreme if we hope to succeed. 4. No more interesting story was ever recorded than that which recounts the discoveries which have put within our power the absolute elimination of malaria from this country. These facts are as yet known to comparatively few of the people in the rural districts, and I have been painfully surprised to find many teachers who still thought that malaria came from bad air. If all our country people really knew and were truly convinced that if we had no Anopheles mosquitoes there would never be another new case of malaria, then we could really hope for speedy relief. Here again is a vital opportunity for the schools, and advantage should be taken of it in all country schools especially. And may I remark at this point that such work is a thousandfold more interesting and satisfying to chil- dren than any physiology bookwork could possibly be. It is more interesting than a fairy story to them, and vastly more suggestive. In some parts of the country the school children have been organized into squads for sanitary work in the community, and especially in mosquito and fly elimi- nation they have done valiant service. 5. I shall take time to specify but one more topic, and that is the great need of immediately teaching the people how plague is transmitted and the imminent danger we are in now, and the still greater danger to which we will be exposed when the Panama Canal is open to unlimited traffic. Three years ago, prior to its appearance in New Orleans, the danger was predicted, but no one seemed to be interested. The people of the South do not even faintly realize the danger they are in, else they would bestir themselves. I very much fear that if the rats of a number of our coast cities become infected we shall not be able to rid the South of it for a generation. Every boy and girl in every school in the South should be taught the terrors of this disease and the methods of its transmission. After having lived in RELATION OP THE SCHOOL TO PUBLIC HEALTH 22'3 California and realized the awful task of convincing the people there, and reducing the rat population, I am sure I am not overstating our danger. Every school in the South ought to be organized in some way to destroy rats, and to teach the facts of this dread disease to old and young. In conclusion, permit me to say that the essentials of personal hygiene and community sanitation can be easily taught to the children of the elementary schools, and that we have now reached a period in our educational procedure where this line of work should and can be substituted for the old courses in technical physiology. We must not expect immediate revolutionary results even when this is done; but we know that in the long run painstaking, careful, and thoroughgoing instruction in matters of such vital concern to all will bring results. The biggest problem of democracy is public education. If this country does not slowly but surely solve the problems of a democratic form of govern- ment, it will be because we are unwilling to educate the people. Health is not merely a personal affair. It is more and more a community problem, and hence of vital concern to all. THE RELATION OF THE SCHOOL TO THE PUBLIC HEALTH* PROP. ROBERT GRANVILLE CALDWELL, PH.D., RICE INSTITUTE, HOUSTON, TEX. Our attitude to the social problems has been largely determined by two great motives which have dominated recent social changes. Our age is characterized, first, by a very real humanitarian spirit. The present anachronism of war makes our desire to preserve health and happiness seem ♦Bibliography: Gulick and Ayres, "Medical Inspection of Schools;" L. Burgerstein, "School of Hygiene;" L. P. Ayres, "Open-Air Schools;" Louis Stevens Bryant, "School Feeding;" Annual Report of the Public Schools of the City of Houston. 224 THE NEW CHIVALRY — HEALTH almost a mockery. But it still remains true that the genu- inely modern man, especially the modern American, is moved to consistent action, and sometimes even to sacrifice, by the wrongs and sufferings of those who are weak and dependent. The desire to help, to serve, to better the lot of others, and indignation when they suifer are feelings genuine and deep, and on them we can depend and to them we can safely appeal. Many daily incidents prove that there is a real passion for service which is among the most hopeful ele- ments in our curiously mixed and complicated human nature. Along with this there is a second motive which concerns intimately the solution of the problem which I am consider- ing. This is the desire for efficiency, a certain horror of waste, of the unnecessary loss of time, energy, and money. I do not mean to say that we are always true to this idea, but rather that it is becoming increasingly important. The strain and the competition of modern business have made us acutely conscious of the defects in our social organization which make it necessary to spend two units of time and energy where one would suffice. These two motives, one based on feeling and the other on colder reason, may well be used to develop the sense of public responsibility for the health of the school child. The immediate importance of this whole question arises from the comparatively recent adoption of the policy of com- pulsory education by some Southern States. In Texas, for example, the difficulties on account of the presence of the Mexican and the negro have been unusually great. A law which is only a beginning in the right direction has been passed, but will not take effect until September of 1916. The enforcement of even its very lax provisions will depend on the building up of an enlightened public opinion regard- ing the evils of child labor, its cruelty, its deleterious effects on body and mind, and the importance to our democracy of securing an intelligent citizenship. Here, then, in Texas at least, and also in other Southern States, we must start on a practical program which seeks to connect the school vitally with the health of the community. RELATION OP THE SCHOOL TO PUBLIC HEALTH 225 Our schools have a new responsibility, or rather an old responsibility newly recognized. To give a fair chance to each individual without regard to his birth or social posi- tion, we are to require compulsory training of the mental faculties. We take the child away from his home and his family during an important period of his life. We cannot do less than to send that same child back to his parents not only trained mentally, but also at least as well physically as we received him. At the outset we must recognize the responsibility which the changing conditions of American life and which the system of compulsory education have laid upon us in a way which we cannot shirk. The first of these responsibilities from the point of view of the public health is to provide adequate equipment in the way of schools and teaching force. It is estimated that if every child in Houston who has a right to attend the schools should apply for admission at least two thousand would be unable to find seats, and this condition is undoubtedly typ- ical. And yet these children have the right to be required to attend the schools which they are too young to fully appreciate or understand. Only so can the evils of child labor and the deterioration of the national stock be avoided. But when larger numbers are being brought into the schools, both the child and the community must be protected from dangerous contagious diseases which become even more dangerous with the increase of the enrollment. Beyond this the mere desire for efficiency, if nothing higher, should seek out and remedy those defects which most surely lessen the capacity of the child for education. Through the school physician and the school nurse, the home as well as the child may be trained in knowledge and responsibility. The great advantage of dealing with the question of health in the school rather than in the hospital, whenever that is possible, lies in the fact that the problem is dealt with at the source. The evil is prevented before it has had an opportunity to work harm to the community through the weakness of its individual members. At one time the ques- tion of the public health would have been regarded as the 15 226 THE NEW CHIVALRY — HEALTH exclusive province of the physician. To-day we see that in order to cope with disease adequately we must call in the sanitary engineer, the city official, the sociologist, and the school-teacher. In the school there is the greatest oppor- tunity to make the smallest efforts tell in permanent ways, for one is dealing with the plastic material of our civiliza- tion. The ideal of efficient citizenship justifies the provision by the State for the adequate education of children, and in all progressive communities the expense necessary for the schools is looked on with favor because the public has come to realize that every child has the right to receive such training as will fit him to hold his place as an equal with the other citizens of our democracy. So the American public school has been able to mold the sons and daughters of America, whether coming from an old stock or recently arriving from other scenes, into genuine Americans. More than any other influence, the school explains what Mr. Bryce has called the wonderful assimilative power of Amer- ican institutions. Why should it be regarded in some quarters as wise and just to have every child educated, and yet complained of as paternal and unjust to provide for the physical welfare of the child and through him of the public? Yet this complaint is the one which any reformer in this field must constantly meet. He explains the close connection between mind and body. He shows that in the changing conditions of Amer- ican life the health of the child can no more be safely left to the parent in every case than can the mental training of the same child. He proves, as can be done conclusively, that at least twenty-five per cent of the children who attend the public schools in our cities are sufferings from so-called minor ailments which may be remedied:iif taken in time, but which if allowed to go unremedied lessen vitality, dim intelligence, and retard growth. He shows how really the reservoir of our national energy is the vigorous manhood and womanhood of our children. But when he seeks to meet and remedy these conditions by providing adequate medical inspection, by securing thorough physical training, RELATION OP THE SCHOOL TO PUBLIC HEALTH 227 by feeding the children in the school when it is necessary, he is met with the complaint that he is allowing the school to take the right and proper place of the parent in the life of the child. This charge of paternalism, sometimes sincere, is more often a mere cloak to cover a desire to save expense ; for it is not hard to prove that the school is in these cases taking no place which is at all likely to be filled well by any one else. Gradually the desire for efficiency and the natural pity for those whose circumstances make them need help have won their way against the prejudices of the past. Starting with Boston in 1894, medical inspection in the schools has gained ground in American cities, until to-day it is coming to be regarded as necessary and important to have the school physician as it is to have the school principal. In at least eleven States laws have been passed providing for the examination of school children, and in two of these — Massachusetts and Colorado — provisions have been placed in the law requiring not merely notification to the parents of the defects which have been discovered, but also making it possible to compel parents who willfully neglect the matter to provide the necessary treatment. Medical inspection is found to be most efficient where, as in Houston, a trained physician gives all his time to the care of the school children. The physician's most obvious function is to guard the community and especially the school children against the spread of contagious diseases. In some cases he considers that in having done this he has actually done all that is really necessary. It is only recently that we have come to understand that a large percentage of children, regarded formerly as hopelessly lacking in intelli- gence, are after all only suffering from easily curable phys- ical defects. Take, for example, the matter of defective teeth. A campaign of public education is needed to show just what defective teeth mean to a child. It has been proved by careful investigation that children with seriously defective teeth require a year more to finish the elementary school than children whose teeth are looked after with some reasonable care. And yet this is sometimes said to be a 228 THE NEW CHIVALRY — HEALTH mere detail, unworthy of the attention of school authorities, and teachers and parents go on levying punishments on children whose real need is an efficient dentist. Where dental clinics have been instituted, as in England under the act of 1907 and in Rochester through the public-spirited generosity of one of those citizens whose mind is not above considering such details, the results of proper attention to the one question of the teeth have been so surprising as not to be readily believed by any one who has not looked into the matter. The retardation of children and the conse- quent loss of time and energy are even greater in the case of such defects as adenoids. It is not enough to say that the parents will attend to these matters, for the parents are in ignorance of the facts unless they are brought to their attention through the work of the school physician. Then in nine cases out of ten the parents will do at least some- thing. In the poorer regions of our cities, crowded with those whom poverty and prejudice and ignorance make unable to help their children even when the need is pointed out to them, the school physician should be supplemented by two other agencies — ^the school clinic and the visiting nurse. A school clinic, especially a dental clinic, is able to deal on the spot with minor defects. In England care is taken to have the parents present both at the examinations and when actual treatment is given. In this way the parents as well as the children are trained in hygiene. In actual practice, instead of lessened parental responsibility, many parents are awakened for the first time to their duty. The executive of the whole plan is the school nurse, who can go to the homes of the children and very often correct the condition which produces disease. She, too, acts as an educating force in the community. In cities where clinics and nurses are already found working under other organizations it is sometimes unneces- sary to secure any new machinery. The important thing is to make sure that every serious defect is known as soon as possible and remedied either by the parents or, when that is impossible, by the school or some public authority. RELATION OP THE SCHOOL TO PUBLIC HEALTH 22'9 To care for the physical condition of its children will cost the average city not more than 50 cents per pupil enrolled in the public schools. It is estimated that this sum will provide a school physician, the visiting nurse, the school clinic, and even an open-air school for the children suffering from anaemia and similar conditions. With such an expense, results can be attained that will be simply astonishing. In the light of the benefits which have already been secured, both in foreign countries and in some of the more progres- sive American communities, the charge of paternalism need give us little concern. More than ten years ago it was estimated by Robert Hunter that there were 70,000 children who came to the schools of New York daily suffering from a lack of sufficient food. This statement was at the time challenged as an exag- geration, but subsequent careful investigations seem to have amply confirmed it. Conditions in other cities are similar and those in the country districts are by no means ideal. The school lunch has for a long time been furnished to the children of certain European cities either at cost or without charge. The three-cent lunch of the Paris "cantine" is now famous. There, and wherever the plan has been fairly tried, the results on the mental alertness and the general health of the children have been notable. Malnutrition is as real a physical defect as any other, and appeals in a peculiar way to the enlightened sympathy of the community. The idea of providing suitable lunches in connection with the schools has recently spread from Philadelphia to other American cities, and in New York has been pronounced a success by a notably skeptical school board. Houston and New Orleans are the only two Southern cities which seem to have made a start in this direction. For our text we might go so far back as Hippocrates, who sagely said : "Old men bear the want of food best; then those that are full grown; youths bear it least, most especially children, and of them the most lively are the least capable of enduring it." A program which directly related the school to the problem of health would not be complete if it did not take quite seriously the proper recreation and the physical 230 THE NEW CHIVALRY — HEALTH training of the child, making play take its proper place in the scheme of education. Nor would it be complete if the child were not taught those elements of hygiene which make for enlightened public opinion. But these matters are already better cared for than some of the other things which we have mentioned. For the child who is especially weak and defective much can be done by open-air schools in which recreation, careful feeding, fresh air, and enthusiastic teaching are brought together in the interests of the child. The results have been so wonderfully successful that we now find schools of this type in many places. New York has four open-air schools established on abandoned ferryboats, where the anaemic child may recover health and strength without any of the ordinary surroundings of the hospital. The open-air school in Chicago is probably the only school in the United States where the scholars themselves have petitioned to be allowed to go on with their school even in vacation time. This, then, is our complete program : A democratic school system based on the principle of compulsory education, providing for adequate medical inspection, seeking to get definite results in the matter of physical defects, teaching hygiene, giving recreation facilities where they are most needed, teaching no children who are allowed to go hungry, attending to the weak and the ansemic through the open-air school, caring always for the physical welfare of the child and the community even before the teaching of facts. All this is consciously an ambitious program — like everything else worth doing, requiring genuine faith on the part of those behind it, involving real practical difficulties, and yet with every item tested in the actual experience of progres- sive communities, indorsed by practical administrators, and bringing results which amply repay in human values all the trouble and the cost. VI. MENTAL HYGIENE The Mental Laboratory in the Juvenile Court Mental Hygiene Mental Health Safeguarded by Physical Health THE MENTAL LABORATORY IN THE JUVENILE COURT GEORGE P. AUSTIN, JUDGE JUVENILE COURT, COLUMBUS, GA. When I was appointed by Judge S. P. Gilbert to the Children's Court in Columbus, I felt that my duties would not be simply the trial and sentence of juvenile offenders. Our court is to be a sort of redemptive force, scientific and humanitarian. We are to study each child and understand its mental and moral condition with a view to its correction. We are supposed to return the child to society a better prospect for citizenship. We believe that crime is as much the result of the mental condition as it is of moral depravity. In fact, the expla- nation of what is called "criminal tendency" is in the psycho- logical realm. An important feature therefore of juvenile jurisprudence is psychic. The mental condition of the child determines its whole future. Juvenile delinquency is a question of mental hygiene and therefore a phase of health conservation. I take pleasure in telling you what we are trying to do in the mental laboratory of our court in seeking to understand the minds of juvenile delinquents. In connection with the court we have perhaps the very first institution of this kind in the South. I am not to discuss juvenile delinquency nor feeble-mind- edness in general, but the "Mental Laboratory in the Juvenile Court." If any statement seems confusing or unreasonable, doubtless a thorough discussion of delin- quency or of feeble-mindedness would clear it up. The time allotted me and the breadth of such a discussion forbid. I am not going to undertake to prove statements, but simply make them. SURVEY In 1792 Dr. Phillipe Pinel recognized in insanity a mental disease and had the lunatics taken from Salpatriere 234 THE NEW CHIVALRY — HEALTH prison and placed in a hospital. About a hundred years later the world began to see that there was a mental disease of another character, a condition of arrested mental develop- ment rather than a mental derangement, an unformed rather than a deformed mind, which is known as "feeble- mindedness." It is not a new disease, but has always existed. Not until late years have we recognized its influ- ence upon the progress of the race, seen its characteristic mark upon every phase of human life, and attributed to it the responsibility for the many inequalities and irregu- larities of the world. The attention given childhood by both Church and State has been the occasion for this discovery. The public school and the Sunday school are the two main movements which have called the attention of the world to childhood. And at least a hundred years of child study passed before feeble-mindedness was recognized in its true light. Misfortune has always been the pathetic lot of the mentally backward. They are failures in life, paupers, ignorant, victims of all sorts of ills, without strength of will, tossed by every circumstance, criminals, etc. Such misfor- tunes have heretofore been looked upon as a matter of course, merely the unlucky lot of these people and that they were responsible, or that no one was responsible, for them. I hope if there is any one here who has used the expression (in speaking of some one's mistake) , "He should have had more sense," you will never say it again about any one. Very many do not have sense and therefore cannot use what they do not have. The sense of the low moron or the imbecile is little, and what there is of it is very slow. Speak of them compassionately. We believe that this condition of mentality resulting in these misfortunes and handicaps is in some instances a dis- ease to be treated, while in others it is a subnormal condi- tion to be developed; and that the proper treatment and training of the feeble-minded will right the most of these wrongs and save them in their feeble endeavor for success. To this end psychopathic laboratories for the testing of the MENTAL LABORATORY IN THE JUVENILE COURT 235 mental condition and training schools adapted to their peculiar needs have been established in a few places. Mr. William J. Harris, late Director of the United States Census, in his last report on "Feeble-Minded in Institu- tions," says: "Feeble-mindedness has been broadly defined as com- prising all degrees of mental defect due to arrested or imperfect mental development as a result of which persons so afflicted are incapable of competing on equal terms with their normal fellows, or of managing their own affairs with ordinary prudence. The feeble-minded thus defined range in mental development from those whose mentality does not exceed that of a normal child of two years to those whose mentality is as high as that of a child of twelve. A great majority of the feeble-minded are not confined in institu- tions, but live at large; many are inmates of prisons and reformatories; many others are in almshouses; some are confined in hospitals for the insane. Only a small fraction of the feeble-minded are taken care of in special institu- tions designed for that class. "With the increasing study of the defective class there arose a conviction that there were many on the borderland of mental deficiency who, though not entirely helpless, were possibly an even greater menace to society than those who were. They were not idiots, in the ordinary acceptance of the term, and the term feeble-minded was adopted in the report for 1910 and has been used ever since. "Since 1890 no general enumeration of this large and ill-defined class has been attempted by the Bureau of the Census. In 1904 and in 1910 the census was restricted to the inmates of special institutions for this class. An important factor affecting comparisons of different periods is the change that has taken place in the general methods of care for the feeble-minded. Formerly almost all this class under institutional care were in almshouses or in asylums for the insane. As late as 1890 only 16 States had provided separate institutions, and the number of such institutions was 24. In 1904 the number of institutions had increased 236 THE NEW CHIVALEY — HEALTH to 42 and the number of States making such provision was 25. In 1910 there were 63 institutions reported by 31 States. At present there are only 7 States which make no special provision for this class of defectives. [These States are all in the South.]" In 1910 there was a total population of 33,969 feeble- minded in institutions. Taking Massachusetts as a basis for comparison, there are doubtless in the United States a quarter of a million feeble-minded. This does not include those "on the border line" known as "morons." Were these counted, the number would be at least half a million. In regard to the age of those in institutions in 1910, 24.5 per cent were under 10 years of age, 28.4 per cent were between 10 and 15 years, 28.3 per cent were between 15 and 20 years. About three-fourths the total number (74.2 per cent) were therefore under 20 years of age. At least half the inmates of institutions for feeble-minded would therefore be under the jurisdiction of the Juvenile Court. A large proportion of the mentally defective in institu- tions are also physically defective — blind, deaf, crippled, deformed, paralytic, and so on. The exact percentage for these is 25.1. A pathetic fact, showing the tendency of feeble-mindedness, is the death rate, which is approximately 43 to 1,000. The death rate for the nation as a whole is approximately 20 to 1,000. IS CRIME MENTAL WEAKNESS? The statement has been made that all feeble-minded people are potentially criminal. The two great sources of criminality among children is feeble-mindedness and neg- lect, the lack of training. If it is neglected, a child' may become a criminal whether it is feeble-minded or not. A mentally defective child more easily becomes criminal than the normal child. It cannot be said that a normal child is in any sense criminal until it becomes one, and it cannot be said that all feeble-minded children are criminal in fact, though they are potentially so. The idea for centuries has been that crime is intentional violation of law. So it is with MENTAL LABORATORY IN THE JUVENILE COURT 237 the mentally normal, but not altogether so with the feeble- minded. The degree of volitional responsibility varies with the scale of mentality. In my court we have had children who did not realize that they had committed crime. Great difficulties appear when we attempt to deal with the Oriental, the Slavic, and the Ethiopian mind as we deal with the Teutonic and seek to apply the same method of scientific analysis and prognosis to all racial distinctions of mentality. The cocaine mind, the alcoholic mind, the opium mind, the syphilitic mind, or the minds with these forces of depraved ancestral heredity behind them for many genera- tions — ^no wonder the great Christian teacher speaks strongly of the "carnal mind." Can we hope to know much about it? Sometimes I am inclined to call this institution in our court a mental museum — it represents so many varied and interesting aspects of childhood's mind. THE MENTAL LABORATORY AND THE COURT We have what we choose to call a mental laboratory for the testing and grading of the mentality of each child in the court. It is a means by which the mind is measured, in its power to think, by a scientific scale of measuring intelli- gence, whether normal or below normal. A normal adult is one whose mentality is such that he is enabled to think and act in ordinary things sufficiently to become successful in an ordinary degree. A person may be able to think and act in such a way as to make him ordinarily successful as a mechanic, but in no other additiona,l calling. The failure to be able to succeed in more than one endeavor, while able to succeed in at least one, does not constitute one as feeble- minded. Few men can succeed in more than one calling. But to be unable to succeed in any ordinary endeavor of life by reason of a mental deficiency marks one as feeble-minded. Now there is an age in childhood when it should begin to understand ordinary duties and responsibilities, and on reaching this age if it does not understand them there is something wrong with its mind. Our law does not imply that this age is reached until the sixteenth year; and until 238 THE NEW CHIVALRY — HEALTH this year is reached, in my State, the child is under the jurisdiction of the juvenile court. The latitude is extended to this age by reason of the fact that there are many chil- dren whose mental age is below their chronological age. We have had offenders whose chronological age is fourteen and fifteen and their mental age as low as five and six years. Indeed there are many adult criminals whose mental age has never developed higher than five or six years. Our court has a broad application to delinquent child- hood and does not restrict its operation to trial and sentence. To correct the delinquent so the benefit will be permanent each child submits to the mental test. This enables us to know its mind and how it works and enables us to deal intelligently with it as to the method of correction and reformation. All children are not of the same grade of intelligence, and therefore the same method of reformation and correction cannot be applied to all alike. It also makes the court a kind of vocational guide for the child as we learn the exact species of mentality, whether it is literary, mechanical, commercial, professional, artistic, or other species. We find out enough about the child to know its grade of mentality and in what calling it is able to suc- ceed. Children are not under the law, but under the grace of the judge's good sense. We look at the child and not its crime, although we do not eliminate all punishment, as there is an element of correction and reformation in punishment. Are we saving the child by legal power? If the child can thus be saved, why not? Anything which saves is the gos- pel. The thing which saves, whatever it is, must be psychic. Detention houses, reformatories, probation systems, etc., are essential, but that they may be intelligently used we must know the children whom we place in them. DIRECT PURPOSE OP THE MENTAL LABORATORY The direct purpose of the mental laboratory is twofold : (1) That we may ascertain what per cent of delinquents are feeble-minded and to ascertain if feeble-mindedness, as claimed by some, is the cause of juvenile criminality; and MENTAL LABORATORY IN THE JUVENILE COURT 239 (2) that we may adopt methods of correction suitable to the grade of mentality of each child. It is recognized that the training of exceptiolial children must differ from the train- ing of normal children. Should not the judicial attitude in courts toward exceptional children differ from its attitude toward normal children? THE EXTENT OF MENTAL RESEARCH We expect to be able to tell in the relative analysis of crime and mentality just what species of crime is char- acteristic of each form and grade of mentality. For in- stance, what kind of crimes will the moron commit; what crimes will each grade of the imbecile commit ; what crimes will the higher grade idiots commit; and are there charac- teristic crimes of the Mongolian? The secret of the crim- inal tendency of childhood is found in its grade and species of mentality. If feeble-mindedness is the parent of crim- inality, and if like begets like, what crimes are born in the moronic mind, the imbecile mind, the idiotic mind ? Can we tell with any degree of accuracy and scientific certainty? We know that horseflesh begets horseflesh and human flesh begets human flesh. Can we know no more than that ? Yes, we have learned that the moronic mind is the thief, the high- grade imbecile is the lurking burglar and murderer. Why should we not be able to specify in the analysis and prognosis of a child's mental and moral character ? We say that a child is bright. Why can we not tell how bright it is? What is its mental grade and species, and what will this peculiar mentality do under certain circumstances? If we can distinguish between mental brightness and dullness, why not distinguish between grades of brightness and dull- ness, and learn the peculiar dispositions characteristic of these grades? We can measure him physically to one- thousandth of an inch or an ounce. Is our greatest knowl- edge of humanity physical? Some one has said that "against stupidity the gods themselves are powerless." But that depends upon what gods you are speaking about — not the God of science. In the physiological laboratory there is what is said to be the finest and most sensitive measuring 240 THE NEW CHIVALRY — HEALTH instrument known to science; it is the interferometer. It will measure one-twenty-millionth of an inch. But that instrument is not more wonderful than our psychological instrument known as the chronoscope. This instrument is used to record the time it takes to think. It measures time to one-thousandth of a second. As a juvenile court judge why should I not know exactly the mental capacity of the child before me? If punishment of the child and the pro- tection of society by the imprisonment of the little fellows are the only objects of the trial and sentence, then I should not care what nor how the child thinks. But if the child's reformation is the object, then I must know its mind. I dare not sit in judgment upon the child without knowing it. Our former great Chief Justice Bleckly said : "It is a great blunder to engage in crime at all; and how many subordi- nate or secondary blunders may occur in the course of a criminal transaction is a matter of uncertainty. The crim- inal acted like a fool and it is altogether unlikely that he reasoned like a philosopher. His mind went astray, and who can follow it?" The mental laboratory can follow it. For this purpose we have established it in the court in Columbus. The unphilosophic mind of the child has gone astray after crime and error. It is characteristic for it to go thus. If capital punishment is ever abolished perma- nently, it will not be by vote nor by sentiment against the death sentence and the gallows or electric chair, but when we find that species of mind that takes human life and pre- vents the procreation of this class of mental defectives. We must stop the necessity for capital punishment by a psychic interference. METHOD OP THE LABORATORY The following is the generally accepted classification of the feeble-minded: Low idiot, mental age under 1 year; middle idiot, mental age 1 year; high idiot, mental age 2 years ; low imbecile, mental age 3 to 4 years ; middle imbecile, mental age 5 years ; high imbecile, mental age 6 to 7 years ; low moron, mental age 8 to 9 years ; middle moron, mental age 10 years; high moron, mental age 11 to 12 years. MENTAL LABOEATORY IN THE JUVENILE COURT 241 This classification cannot be applied to children in every sense of the word owing to the fact that childhood is youth and the element of growth is to be considered. But it is a basis for operation in their test. In regard to any class, for instance the high idiot, the classification does not mean that a 25-year-old adult who has only the mental age of a two-year-old child is not more capable in ordinary affairs than a child of two years would be, but that his power to learn is only that possessed by a child of two years. He may be able to do many more things and more difficult things than a child of this age, but he does them automatically and not intelligently. We do not examine the child to ascertain what it knows, but what it is capable of knowing. We learn its mental capacity. We know that a normal child of twelve years has reached a certain stage of mental development. There is a standard which it should reach, and will reach if it is nor- mal. This has no reference to what the child had learned at school or anywhere, but what common sense in everyday life brings the mind to understand. It is the amount of mind it has with which to learn. If a twelve-year-old child does not reach this standard, but will reach, say, the stand- ard of a ten-year-old child, then its chronological age is twelve and its mental age ten years. This child is only ten years old, although it has lived twelve years — for two years its mind did not grow. A fourteen-year-old boy tested six years. He is backward eight years. Will he recover those years? He may and he may not. He is a thief. He is six years of age in reality; he thinks and acts like a six-year- old boy. He must be corrected as we correct the normal six- year-old child. The highest type of mentality would violate law for a large consideration, but would not, for the con- sideration that moves a feeble mind to violate law, stoop to a depravity out of all reason. The unreasonable thing is what the feeble mind is constantly doing. To shoot down a man in the dark for a few dollars is the work of an imbecile. If the mind ceases growth at six or any early years, the reasoning powers in adult life will be greatly impaired. 16 242 THE NEW CHIVALRY — HEALTH We know there are certain grades of the sense of moral responsibility. We have learned by research and compari- son that the normal twelve-year-old child, being mentally normal, is normal in the moral sense of responsibility corre- spondingly. The child who is backward mentally four or five years is backward in his moral sense four or five years. Criminality is therefore a matter of mentality. For the mental classification we use the Binet system, but have added some original devices in view of the fact that our children are delinquents. From the system used by the United States Public Health Service at Ellis Island in testing immigrants we have gotten many ideas. But our court uses a method covering a wider range than is ordi- narily used. A REVELATION OF THE LABORATORY The physical factor in comparative mental and moral development is a determining element. To our laboratory we have added apparatus enabling us to enter this field of research in a limited measure. The physiological age comprises just two years in the child's life. It is the age when adolescent instincts and traits begin the important transition, or recreative process, into adult age. The physiological age of girls is from twelve to fourteen years, and that of boys from fourteen to sixteen years. These are for normal children, though the age may vary a year forward or backward even in normal children. The average normal girl during this period develops in weight from 75.4 to 102.6 pounds, while that of the boy of the same age (12 to 14) is from 76.8 to 96.1 pounds. The difference in the growth of the height of the two for the same years is about the same. The physiological age of the average normal boy is from fourteen to sixteen years. The normal boy develops during these years from 88.2 to 111.9 pounds. During these years this physical growth exceeds the girl of the same age as the girl exceeds him in her physiological age. In all other years except her physiological age the normal average girl is com- paratively less than that of the average normal boy. In his MENTAL LABORATORY IN THE JUVENILE COURT 243 physiological age the boy's physical development is out of comparative proportion to the girl's development except in her physiological age. Why is this physical peculiarity and wonder in every normal child's life? What relation has this extraordinary fact to other elements of character? It is during the girl's physiological age, if she is normal, that her sexual signifi- cance begins. It is the dangerous age. This is the age of the girl when prostitutes are made. In the boy it is the age when his sexual capacities assert themselves. In both it is the age when boys and girls begin to pair as sweethearts in earnest. The two years' difference in the physiological age of male and female points an explanation for three things : (1) The average time between the birth of children is two years. This is not always true, but it is an average lapse. (2) The usual average difference in the age between husband and wife is two years. This is not a rule, but an average. This is accounted for when it is remembered that most mar- riages result from the mating of school children, which, as stated, usually begins in the physiological age of both sexes. (3) Records show that it is in the physiologic age when most boys quit school. At thisi age he is less inclined to study. During this age in both male and female the mentality is influenced by the superphysical condition more or less. The physiological age is the time when children in the court are hardest to correct, and they find it most difficult to win out in the fight against temptation. Our records show that the majority of the children before the court were in their physiological age and were feeble-minded. The expert psychologist by means of the mental labora- tory can note the approach or the presence of this age with- out knowing the exact chronological age. We have tested the mentality of more children of this age than any other. Feeble-minded children of the chronological ages of from twelve to sixteen are usually either physically stunted or over-fat. The physiological is a fine age if the child is nor- mal, although it may be mentally duller than usual. This amounts to nothing if the child is taken care of. As all true 244 THE NEW CHIVALRY — HEALTH education is merely fortification against animalism, the years previous to the physiological age should be properly fortified. We are striving through the mental laboratory in the juvenile court in Columbus to help the unfortunate little fellows who come before us by understanding their minds and all physical relations in such a way as to enable us to direct them unerringly toward the straight and narrow path that leads to citizenship, to success, and to heaven. MENTAL HYGIENE MISS MAUD LOEBER, M.D., NEW ORLEANS, LA. It is the intention of this paper to sketch in broad out- lines the principles and laws of mental hygiene. Mr. Clifford W. Beers, the father of the movement of the National Committee for Mental Hygiene, defines the scope of the committee as "a permanent agency for reform and education in the field of nervous and mental diseases. . . . Though the improvement of conditions among those actually insane and confined should be an important factor in shaping its policy, its most important work is the waging of an edu- cative war against prevailing ignorance regarding insanity. Thus to cure disease by preventing it is the only effective cure known. The watchword of the organization is 'Mental Hygiene.' Its purpose is the spreading of a common sense gospel of right thinking in order to bring about right living, knowledge of which is needed by the public at large if the population of our asylums is to be controlled and eventually decreased. Such an organization would be equally the friend of the physician and the patient ; also the friend of a patient's relatives to whom, when burdened with an actual or impending affliction, it would become an unfailing source of information, advice, and comfort." MENTAL HYGIENE 245 To be told that insanity is often preventable and curable is a very comforting thought. To be told that neurasthenia (nervous breakdown, nervous exhaustion), psychasthenia (morbid fear, anxiety), and neurosis can be prevented or cured is again a splendid thought. Now what are the chief causes which lead to nervous or mental disorders; the upsetting of our mental equilibrium, causing nervous ex- haustion; permitting our judgment to become slaves of the innumerable and manifold obsessions; or to afflict us with insanity itself? We are told from statistics that heredity, disease, and alcoholic abuse play the most important role in the causation of insanity. Excluding heredity, syphilis, and alcoholic excess, there remain other causes: 1. Poisons from within, toxins or endogenous poisons, as the result of some consuming disease, such as typhoid; or poisons coming from without, exogenous poisons, as abuse of opium-, tobacco, etc. 2. Physical defects, adenoids, exopthalmic goiter or deficiencies in the secretions of the ductless glands, poor nutrition, lack of muscular or outdoor exercise. 3. Psychic defects. Under this heading we may prop- erly place the lack of proper training in childhood ; the per- mitting of unbridled passions or emotions ; the accustoming of children to depend too much upon sympathy and failure to rely sufficiently upon one's self. 4. Certain occupations predispose. Let us return now to the causes and go briefly over them in turn and ascertain, if possible, the remedy or the means of prevention. (1) Heredity. Statistics again show us that this is one of the most important of all causes. As Osier said : "Pre- vention here should have begun a generation back." It is a known fact that when two imbeciles marry all their progeny will be imbeciles, and when a normal person marries an imbecile over one-half of their progeny will be imbeciles. Individuals who have weakness or instability of nervous mechanism may have acquired it from their parents who were themselves victims of nervous or mental trouble or had 246 THE NEW CHIVALRY — HEALTH been addicted to excesses of some kind. On the other hand, those individuals who are born with a neurotic temperament may not necessarily succumb to any nervous malady, if their life is so ordained as not to exceed the even tenor. As these persons are not blessed with any reserve force, undue or unusual strain for them (but which may well be within easy limits for others) may produce in these individuals a nerv- ous breakdown. We must not overlook the fact, however, that persons not born with weak, nervous systems may readily acquire nervous exhaustion through mental and physical overwork, prolonged emotional excitement, care, anxiety, or grief. "Worry is both a cause and an effect of nervous prostration." (2) Major cause is disease. The most important disease as a causative factor of insanity is syphilis. It is a recog- nized fact that paresis, the most prevalent mental disease, is but the end-result of syphilitic infection. (3) Alcoholic abuse is the third great cause of insanity. We know that twenty-five per cent of the curable cases of mental diseases fall under the heading of the two last-named causes. With this knowledge, it needs but its dissemination to enable these poor unfortunate patients to receive prompt and skillful treatment. This brings forth a most important point, and that is that of all the curable cases of insanity, regardless of causative factors, twenty-five per cent cured were in those patients who presented themselves when they had not been afflicted with the malady for a space of time not exceeding a year's duration. Too commonly do we see patients and their families inclined to procrastinate in seeking medical advice and treatment — a truly serious pro- crastination in view of the present knowledge. With these truths before us as to the great causes, we should avail ourselves of every opportunity to disseminate the knowledge which may mean happiness or despair to an entire family. These major causes should not blind us to the fact that there are many other causes and influences, call them minor, if you will, only because of their relation to the number of cases which originate from them in pro- MENTAL HYGIENE 247 portion to the number of cases traced to the causes just enumerated. These sources have their right, too, to receive due consideration at our hands. 1. To reiterate, these causes are due to some poisons, chief among which may be mentioned tobacco, opium and its derivatives, coffee, etc. The abuse of any of these habit- forming drugs is sure to lead to some disorder to our highly developed nervous systems — ^this depending, as in all things, on the reserve store of nervous force with which we were endowed at birth. 2. Physical defects. Malnutrition may produce a morbid outlook upon life, which in a person who has already inherited a weak nervous apparatus may prepare the soil for obsessions, hypochondriacs, and hysterics. Faulty func- tions of the so-called ductless glands, which glands have come to be recognized as a very important factor in the human physiology, and the irregularity in the secretions are also responsible for their quota of hysterics and neuras- thenics and paranoiacs. With the proper establishment of the normal secretions of these glands the patient again becomes normal, able and eager to assume his normal duties and responsibilities in life. 3. The third factor in our classification is psychic defect. We are familiar with the ill effects of non-controlla- ble temper, the ill effects of non-cultivation of mental poise. To allow our emotions to have unlimited play without any curbing or restraint is one of the surest methods of courting mental failure, of laying the foundations for future mental bankruptcy. Self-control, determination, judgment — the power to plan one's life and live by it — are evidences of mental health. Some systematic mental work is an excel- lent discipline for the mind to eradicate or overcome the fault of vacillation, or scatterbrain attempts at work which is a torment to the worker. 4. Environment properly includes certain occupations which, because of their highly nerve-consuming nature, are conceded to hold a very important place in our classification of causes of nervous and mental disease. We may mention 248 THE NEW CHIVALRY — HEALTH casually such occupations as brokers, bankers, teachers, stu- dents, physicians — in a word, those whose work is dependent almost, if not entirely, upon mental exertion under pressure and strain; those whose hours of work are long and who get little if any diversion or out-of-door life; those whose financial condition makes them slaves to overwork, worry, and anxiety. We all know this class and we all know many in this class who are working under these very conditions. Now that we have taken up the causes and by so doing the prophylaxis, we can with great advantage turn our thoughts to those individuals who, having been afflicted with some nervous or mental malady, have availed themselves of proper medical treatment at the proper time and have thus been cured. Now come the vital questions, "How can we prevent a relapse? What is there we can give to the dis- charged patient in the form of hope, courage, and self-assur- ance?" The after-care of these patients (those who may rightfully be considered on the borderland) is of vital impor- tance, and one which cannot be too highly rated in its value by the patient himself. The finding of employment for those who have been cured is urged that they may take their place again in the great plan of life. The feeling of trust, belief, and recognition of the discharged patients, with the neces- sary supervision and assistance at the right time, is essen- tial to final success in the observance of mental hygiene. I would therefore, in conclusion, stress the point that with proper knowledge we can materially reduce the percentage of insane persons. We can prevent, we can cure, and having cured those afflicted, we can open up again the avenues for successful lives, making them thereby an asset to the com- munity, where heretofore they had been but a burden. MENTAL HEALTH 249 MENTAL HEALTH SAFEGUARDED BY PHYSICAL HEALTH PRESIDENT SAMUEL P. BROOKS, LL.D., WACO, TEX. The general question of health in the Southern Socio- logical Congress has to do with the betterment of mankind. It recognizes the fact that man's whole nature is so inter- related that one cannot well consider any part separable from the others. The one who assigned the question knew that we do not think of mind without matter, of a normal human body without mental control, or of a spirit as a wandering jack-o'-lantern without a physical house in which to live. He knew also that mind is influenced by what it lives in as well as what it feeds on, that mental health is sanest where physical health is soundest, and that each functions best where the other is well. Since a mind lives in something, it is clear that that something must be vigorously sound. Health is a synonym of strength, as disease is synonymous with weakness. As blocks fall upon each other, so human beings act and react upon each other by as much as the contact, physical or mental, is close. Modern psychophysical transmission of knowledge is modified by the ever-rapid changes in social inventions, whether at home or abroad, among savage or civilized peo- ples. Livingston in Africa, himself a veritable dynamo of mental activity, finally succumbed to the physical environ- ment that brought down his life. His life set in motion forces that changed the face of Africa and pointed the way for others to follow. God is the psychical center of the universe. The physical facts are but manifestations of him. As he works through instrumentalities, or media, these must be sound; or to speak reverently, God himself is hindered if, the physical parts about him are not function- ing properly. What if the batteries are in trim if even one insulator is imperfect? 250 THE NEW CHIVALRY — HEALTH Old-time missionaries went forth to teach people how to die. Modern missionaries go out to teach people how to live so as not to die by preventable causes. In view of this fact it has been seriously proposed by one of the great benevolent foundations to invest large sums of money in China in the education of physicians and nurses, and the building or strengthening of existing medical schools and hospitals. This investment is not for Church propaganda, though it is a recognition of the wisdom of the plans of the Church boards which seek to stimulate the poor and ignorant, to cure the desperately diseased, and to show a better way whereby people may live in happiness. It is not difficult to see that, though the end appears to be to teach people how to live, it takes a long look for the ignorant to see that the ultimate strengthening of the minds and spirits of those now degraded by disease are to be made whole. The donors of that money and the propagators of that plan know well that they are really safeguarding the noblest attributes of man. They know that the low mental action in thought power found in men aind women of low virtue cannot dis- associate itself from the calls of the body weakened by indulgence. They know that this same indulgence is more possible where tenements are overcrowded, where liquors and opiates are easily accessible, and where vice is most abundant. They know that mere preaching, however lauda- ble, will not cure physical discomfort. They know that men learn to swim by going into the water, that physicians learn to diagnose disease by seeing those who are sick. They know that filth begets filth, that sin begets sin, that weak- ness begets weakness, that hookworms do not stimulate high thinking. In the world's history, doubtless thousands with minds atrophied have groped their way in physical blindness, a blindness due to womb poison or ignorance of attendants in childbirth. It is said that in Chicago about fifty per cent of the children bom into the world are attended by ignorant, untrained midwives, whose malpractice causes fifty per cent of the blindness and deaths of children in that city. MENTAL HEALTH 251 Yet we glibly lecture people at home how to make money, or abroad how to be saved, forgetful of the fact that life is not cut up. into water-tight compartments, or that we can't shake the responsibility of such human loss. I am not unmindful of the fact that it profits nothing to gain the whole world and lose one's own soul, yet I ask reverently if modern methods of reaching the soul may not be by way of the preservation of the body, then the mind. We are told that moral reforms are precedent to sani- tary reforms. Yet it is here believed that no moral reforms ever stand fixed unless conditioned on and in sanitary clean- liness. Sanitation is scientific, susceptible to proof to reasonable minds. Human experience justifies it. The puri- fication of streams, properly ventilated public buildings, and social laws of like character are based not on moral grounds as a means to preach a sort of gospel, but that we may have life more abundant, life physical, life mental, life spiritual — each a supplement to the other. Spiritual salvation is an individual matter, we are taught, but we know that it comes most easily where social conditions are clean and pure and wholesome. Physical health is likewise individual, yet we know that sometimes contagions overcome it. Contagious disease stops not on the sentiment of geographical or political boundaries. It leaps them all. It is world-wide in its significance. The mind must approve and lead out; however, it is weakened when clogged with sin and vice and crime and disease. The brain, the seat of the mind, is nerve tissue. Nerves are known to yield most readily to the conditions about them, such as air, heat, cold, etc. Mind takes the finger from the fire, puts food to the mouth, and runs to get warm. The mind upset by any exterior condition may not respond to the needs for sleep or rest. The bodily organs do not function. Anger is a mental condition. Anger may be begotten by bodily weakness and in turn does weaken the body that carries it. Anger is said to leave a bitter taste in the mouth. It poisons the atmosphere. It injures the minds and bodies that yield to it. Some one has said : "The toxin generated in one hour of hate would, if taken into the 252 THE NEW CHIVALRY — HEALTH system, kill eighty men." Fear, like hate, hurts. Fear of oneself, one's bad habits, one's secret sins may totally upset the mind. "For as he thinketh in his heart, so is he," says One greater than we. So also are we admonished : "Be ye transformed by the renewing of your minds." It is said that perspiration begotten by work is without the maximum of poison begotten by fear. The bodily tissues respond. The mind suffers. Each depends upon the other. Music stimulates action, invigorates nerves, drives away fear, overcomes pain, develops smiles, vitalizes growth of body and mind. The municipality that has music in its parks, where the common people share its pleasure, does a work in the fine art of development that some men can't see. Public buildings and streets and highways are not alone to respond to the utilitarian, but also to the thing beautiful. All that has been said above can be helped by rational national laws, having to do with pure food, child labor, motherhood, quarantine, and medical supervision. To my mind the highest Federal medical officer should be a member of the Cabinet, where he could represent at first hand the information available to him in peace and war, in health and sickness. His office would become the clearing house of medical information for the abolishment of fakes and frauds who parade the country over, deceiving the ignorant and killing the helpless with nostrums called medicines. The country is one the nation over. Laws that protect us from impure food and medicines should be enforced by the national government. Information brought to the Cab- inet from the people at large about adulterations would stimulate the passage of protective laws. This new department could help in proposing informa- tion for the protection of children in hazardous employ- ments, under conditions vile and unsanitary. It would help to protect child-bearing mothers from the factories, whose air and noise and disease beget death or weakness to the mother or child or both. This same office could help form national quarantine laws and could stand for their enforcement. In calling for this MENTAL HEALTH 253 new Cabinet officer, the writer wishes not to do less for hogs and hominy through the Department of Agriculture, but rather to do more for the manhood of the nation whose value cannot be measured by weight or size, dollars and cents. It is here believed that the proper education of the people is so important and so closely united with the health of the people, both mind and body, that the United States Com- missioner of Education should be made also a member of the President's Cabinet, where he, too, could tell the other departments of conditions under which our people live and grow. This position is justifiable in part, as related to the subject of this paper, on the ground that in every great city system of schools medical inspectors are employed for teachers and students alike. Sanitary inspection of all school buildings and grounds is everywhere required. Nobody questions now the wisdom of having any of the present Cabinet departments. They are all the outgrowth of time and need. If it is well that great buildings full of men should specialize in how best to advance the cause of agriculture, of labor, or of commerce, each presided over by a Cabinet officer, surely it is well that like services should be rendered the millions of school children whose minds and bodies and souls are in the care and keeping of instructors who will be helped by this exalted leadership. Thus the departments of medicine and education closely run, some- times parallel, sometimes across each other, but always related. Men the world over are vying with one another in an effort to keep healthy the markets of trade and the com- modities thereof. They spend money in the employment of experts and commissioners to study the methods of spread- ing the gospel of commerce among those who know not of its virtues. This is true, too, of governments that seek to aid labor to keep in the path of least resistance and advance in every art of mind and comfort as well as skill in the crafts. This is true of every altruistic endeavor that has for its object the alleviation of sorrow and suffering. It is 254 THE NEW CHIVALRY — HEALTH true of every effort to carry the gospel of sobriety and good breeding to those who have it not. This question cannot be limited in its application. It stops not with what has been said above. It takes note of who shall preside over public sanitariums, asylums, orphan- ages. It smiles approvingly on every little woman who as Traveler's Aid walks the platforms and meets the trains, that no young girl may fall into paths of sin. It includes the men and the knowledge and results achieved by them in Cuba as to yellow fever, the sanitation of the Isthmus of Panama, and the resultant good health of the people whereby the canal was built. It consorts with municipal engineers who have knowledge of the laying of pipes for sewers and sewage disposal tanks, of the erection of water systems, whereby sluggish and impure river water is filtered to suit the stomachs of men. There may be psychical germs, unseen by any micro- scope, that enter the mind and degrade it, but it is here believed that minds rarely fall from their exalted station unless influenced by bad physical conditions. VII. THE HEALTH OF CRIMINALS Physical 111 Health as a Cause of Crime Treatment or Punishment for the Prisoner The Old and New Attitude of the State Toward Its Prisoners The Problem of Health in Connection with Prisons PHYSICAL ILL HEALTH AS A CAUSE OF CRIME GILBERT T. STEPHENSON, WINSTON-SALEM, N. C. A NORMAL person is one whose body activities perform in a definite relationship to one another, producing an equi- librium of all vital forces which results in a condition called good health. A violent disturbance of this vital equilibrium such as to throw the whole organism out of balance produces a condition called acute disease. A less violent but more prolonged disturbance of the equilibrium produces the condi- tion called ill health. When the conduct of a person is so anti-social that the government takes notice of it as being against the public good, it is called crime. Ill health, as here defined, connotes a chronic state. I shall therefore consider for the most part the causal con- nection between crime and chronic diseases like tuberculosis and syphilis. One chronic disease, alcoholism, though ad- mitted to be the cause of more crimes than any other one thing, is excluded because its rank in the causal series is so prominent as to overshadow the others and entitle it to separate treatment. My subject expressly precludes discus- sion of feeble-mindedness or mental diseases however chronic. Physical ill health of criminals is indicated (1) by high death rate, (2) by inferior physique, and (3) by diseased condition of the body. The death rate among boys in the reformatories of England is fully twice as high and among girls over three times as high as among those of the same age in the general population. Unsanitary surroundings partly account for the high death rate, to be sure; but the physical inferiority of these delinquents is the greater con- tributor to it. Convicts are about one and one-third inches shorter in stature than the average man. Their tempera- ture is below normal and their pulse rate above normal. Pigeon breasts, poorly developed chests, and stooping shoul- ders are said to be almost the rule among the recidivists in the Wisconsin State Prison. Mr. Z. R. Brockway, formerly 17 258 THE NEW CHIVALRY — HEALTH Superintendent of the Elmira Reformatory, who has been in prison service since 1848, says: "Acute olfactories readily distinguish the odor of a mass of confined criminals — an effluvium as of caged wild animals, but different, and different also from the odor of the insane and of paupers. Their raucous voice or soft hesitancy of speech and faulty articulation are suggestive of the stigmata of the degenerate palate. Clammy or scaly hands, repulsive to the touch, also indicate degeneracy." Such degenerate and inferior bodies are inviting fields for all kinds of disease germs and particularly the tubercle bacillus. Of 2,500 inmates of the Elmira Reformatory examined, twenty per cent were in some degree infected with tuberculosis. At one time seventy-five per cent of all the deaths in the prisons of New York were due to tuberculosis. It is estimated that from sixteen to twenty-five per cent of the general prison population of this country, at least, are infected with tuberculosis to a demonstrable degree. When one considers that in the United States there are annually discharged upon society upwards of one hundred thousand prisoners, nearly one-fourth of whom are infected with tuberculosis, then he realizes that society, for its own sake if for nothing else, should be concerned about the health of its prison population. Though unsanitary prisons cause many prisoners to develop tuberculosis after they are com- mitted, it is nevertheless true that most of them were infected beforehand. The health of the criminal is in double danger — ^in that he is especially exposed to infection and, because of his inferior physique, he lacks power to resist disease. Next after tuberculosis among criminals probably come the venereal diseases. Thirty-nine per cent of the boys in the Chicago Reform School were found to be suffering from venereal infection. Of eight thousand inmates of Elmira Reformatory, forty-three per cent were, on their admission to the reformatory, the victims of venereal disease. Over forty per cent of the convicts in the Wisconsin State Prison are similarly infected. Judge Hastings, of the municipal PHYSICAL ILL HEALTH AS A CAUSE OP CRIME 259 court of Winston-Salem, who sits in judgment upon over two thousand colored offenders a year, estimates that at least sixty per cent of those charged with serious crime have venereal infection. The toxemia of syphilis seems to excite its victim to commit crimes of the most serious nature. An examination of the brain of the man who attempted to assassinate Mayor Gaynor of New York City established the fact that his act was the expression of the brain of a general paretic suffering from the effects of syphilis. Control of the social evil and venereal disease would remove one of the most frequent causes of general paresis and defectiveness as a result of which crimes are frequently committed. Taking into account all kinds of disease, one finds among criminals a very high percentage of ill health. Of one hun- dred negro prisoners in the Fulton County jail at Atlanta, twenty-two were physically defective, being diseased or maimed. Of one thousand youthful offenders in Chicago, in thirty-three per cent some sort of physical defect or abnor- mal condition could fairly be regarded as a contributing causative factor in the delinquency, and in five per cent as the major factor. Tarde, the eminent jurist and critic of Lombroso, says that the delinquent is before everything a sick man. Further statistics and expert opinion need not be marshaled to prove that the criminal is, as a rule, an unhealthy person. But what is the causal connection between his ill health and his anti-social conduct? Wherein does his physical condition stimulate or create a criminal tendency? As a direct cause of crime physical ill health may be regarded as a minor factor — that is, seldom does one com- mit an offense solely because he is sick. It is doubtless true that the irritability incident to ill health often causes one to commit crimes of passion or violence. It is difficult for one to be rational under provocation when his head or eyes are throbbing with pain or his body burning with fever. The pessimism of Carlyle's writings has been charged up to his chronic dyspepsia. Dyspepsia may as well have made crim- inals of men weaker and less disciplined. I have already 260 THE NEW CHIVALRY — HEALTH referred to the toxemia of syphilis as exciting its victims to commit crime. Other chronic diseases also produce toxins. It is said, for instance, that some of the finest writing by Robert Louis Stevenson was done under the direct stimulus of tuberculosis toxin. Who knows but that toxins like the ones that stimulated Stevenson to write so well may have excited other men to commit dastardly crimes? But leaving such hypotheses, which can never be reduced to mathematical proof, one may be sure of his ground when he asserts that physical ill health does produce conditions which, in turn, produce crime. Physical ill health produces poverty, and poverty is the direct cause of crime. In a study of seven thousand cases it was found that over twenty- two per cent of the poverty was directly traceable to sick- ness or death in the family. From thirty to forty per cent of the criminal offenders commit offenses under the direct stimulus of want. All statistics of crime show that the prison population increases during hard times. Physical ill health also encourages the use of habit- making drugs and they in turn give birth to a large brood of crimes. One suffering from a chronic disease finds tem- porary relief in medicines containing narcotics and soon becomes addicted to an overmastering habit. Mild drugs are superseded by stronger ones and the victim is soon an opium or cocaine fiend. After habitual use of opium or its alkaloid^ there is a deterioration of character, a lack of moral sense and of self control, with a diminution or total loss of energy and violation, and this lack may result in paralysis of the will. When deprived of the drug, there is an irrita- bility of temper, and finally there is nothing at which the victim will stop to obtain a supply. Lying, begging, thieving, and prostitution are, according to their ideas, justifiable. Cocaine addiction particularly is marked by inveterate lying, not as in the case of morphine upon topics connected with the habit, but also on other subjects, and often when the truth would be to their advantage. It is significant, but not sur- prising, that one-fifth of the negro criminals of Winston- Salem who have been tried ten times or more have been PHYSICAL ILL HEALTH AS A CAUSE OP CRIME 261 charged at some time in their career with having in their possession or with selling cocaine. ' Physical ill health produces or gives an excuse for vagrancy. Vagrancy has been made a crime by statute and itself fosters other crimes on the principle that the devil finds something for idle hands to do. The sick man is nat- urally disinclined to enter into competition with the well man, and if he does, he is soon forced to the wall. Crowded out upon the streets, he feels that society owes him a living of which it is cheating him and which he must get by fair means or foul. His life on the streets and in public resorts of questionable character throws him into association with criminals and he soon becomes a criminal himself. One- third of the recidivists of Winston-^Salem have been charged once or more with vagrancy. One of the chief reasons why physical ill health is a cause of crime is that it creates in the mind of the unhealthy person and also his associates a belief that, if he should be overtaken in crime, the court would deal with him lightly. He knows and presumes upon the fact that the court will not be apt to give him a road sentence, that to commit him to a hospital would be too expensive to the State, and that he will not likely be confined in a jail where he would infect others with his disease germs. The court is completely baffled by such offenders. The most troublesome cocaine dealer in Winston-Salem has no arms, he and his wife are now serving sentences for handling cocaine, and his mother was recently tried twice in one week's time for the same offense and was let go with a fine because of her advanced age. The most persistent "blind tiger" in Winston-Salem is, in fact, stone blind; and another, scarcely less persistent, has no legs. I have in mind four other incorrigible retailers, each of whom is in an advanced stage of tuberculosis, and another nearly dead with heart disease. His associates also presume upon the fact that the court will be light on the unhealthy offender. This is particularly true of violations of the liquor and drug laws. They furnish the cocaine and liquor to the unhealthy person, share the profits with them in his brief hour of 262 THE NEW CHIVALRY — HEALTH prosperity, then help pay his lawyer's fee and his fine and costs in his inevitable hour of adversity in the criminal court. In one case a negro on his deathbed with tuberculosis was arrested time and again for retailing liquor for other parties. He was too ill to be brought to trial; so he con- tinued to dispense liquor, and probably tubercle bacilli, to his customers. A physician called to see a colored man, found him in an advanced stage of tuberculosis. A few days later the patient sent to him for a certificate that he was not able to attend court. Upon inquiry it was found that the colored man had been arrested for beating his wife, and the physician very properly said that if he was able to beat his wife he was able also to attend court and take the conse- quences. The ill health of the fathers is visited upon the children as crimes. In this I do not refer to inheritance of crime. In fact, the inheritance of criminal traits or even criminal tendencies is still an open question. Dr. Edith E. Spaulding, of the Reformatory for Women, South Framingham, Mass., after studying a thousand cases could find no proof of hereditary criminal traits as such, and felt that careful observation elsewhere would bring forward evidence rather against than in favor of the theory of heredity. And Dr, Haldor Sneve, of the University of Minnesota, is of the opinion that crime as such is not transmitted from ancestors through the germ plasm. But Dr. Winfield Scott Hall, of Northwestern University, says: "That a criminal father should beget a child predestined to criminality is a fore- gone conclusion. The father exerts a hereditary influence equal to all the previous ancestors in the paternal line." And the direct inheritance of disease is scarcely less an open question. The medical profession is willing to commit itself no farther than the statement that there is trans- mission of tendency to certain diseases. Be the direct inheritance of crime and disease as it may, it is still unchal- lenged that there is inheritance of certain physical character- istics and that these with certain developmental influences and environment lead to crime. The heritage of the children of unhealthy parents is often mental and physical inferi- TEEATMENT OR PUNISHMENT FOR THE PRISONER 263 ority, bad example and environment, want, lack of training, and, worst of all, lack of discipline. Dr. Woods Hutchinson says that probably half our criminals are born so and most of the others are made so by bad hygiene and social sur- roundings in childhood. It is hard enough for the mental or physical degenerate to escape anti-social conduct under the best surroundings. But place such a one, unfortified by education or discipline, with bad associates in the midst of squalid surroundings, and nothing but the grace of God can keep him from becoming a criminal. I am not willing to say that ill health is the sole cause of crime in any given case; but I do say without hesitation that it is one of the causative links in the chain of a large per- centage of cases. Furthermore, the eradication of crime is largely a medical or sanitary problem. The new doctor is demanding to be regarded in a different light — as a pre- venter instead of a curer, as an active promoter of health instead of a mere arrester or mitigator of disease. As an eminent member of the medical profession recently said, "We doctors want to be associated in the minds of our patients with the grocer, the teacher, and the builder instead of the minister and the morgue." In like manner, the new police officer wants to be regarded in a different light — as an active promoter of good conduct and a preventer of crimes instead of an arrester or prosecutor of criminals. The administrator of the law and the physician are by the nature of their work and in practice they ought more and more to be yokefellows in their labors to rid the community of crime by first ridding it of crime-producing conditions. TREATMENT OR PUNISHMENT FOR THE PRISONER JOHN S. TILLEY, MONTGOMERY, ALA. Religion that is worth while is based immovably on two principles, the Fatherhood of God and the Brotherhood of Man. Hear the authority for this statement. The prophet 264 THE NEW CHIVALRY — HEALTH Micah, appealed to by his people to inform them what to do to please their Maker, replied: "What doth the Lord require of thee, but to do justly, and to love mercy, and to walk humbly with thy God?" The great Galilean said that the important commandments were to love God and to love one's neighbor as one's self. One of the apostles declared that true religion and undefiled was this, to visit the father- less and widows in their affliction and to keep one's self unspotted from the world. Long-distance philanthropy has brought discredit upon many of the Churches. It is not only in Dickens's novel that we find Mrs. Jellyby, who was intensely concerned about the natives in Borrioboolah Gha, but who had no time to give to those near at hand who had claims upon her atten- tion. All of us recall little Joe, the street sweeper immortal- ized by the same genius, the waif who, when ordered to "move on" by the policeman, cried out: "I am always a-moving on, sir; where shall I move on to, more than I have moved?" It is the serious responsibility of society to look into the needs of little Joe and his kind, and to provide a place, a better place, to which he may move on. The practical man of to-day has little patience with those enthu- siasts whose sympathy is predicated upon the intervention of an ocean. The failure of many religious organizations to grapple boldly with present local evils has alienated some of the strongest men and women in every locality. It is nothing short of amazing how difficult it is to arouse our people to the needs of those at our very doors. It is easy enough to secure funds to send to Belgium, a noble charity ; but in many instances the Associated Charities must beg heroically to carry on its local work. The starving family in Belgium bestirs our enthusiasm; but the widow, with her five children, in destitute circumstances, a few blocks away, must shift as best she can. The heathen in China is the object of deep sympathy and eloquent appeals, and worthy appeals; but the heathen in the laundry down the street is an object of derision. The great Galilean was not farsighted in his sympathies. He saw the misery at hand, and devoted his energies to its TREATMENT OR PUNISHMENT FOR THE PRISONER 265 relief. "I was hungry, and ye gave me meat. ... I was naked, and ye clothed me. ... I was sick, and ye visited me: I was in prison, and ye came unto me." These were his noble sentiments, and we might well emulate his example. Let us consider this morning one class of our unfortu- nates on whom little of our sympathy has been bestowed. This is the class that lives its lonely and miserable life within prison walls, in the mines, and in the other places to whose proprietors we have sold them into slavery. It reflects little credit upon us that we have seen in the prisoner the crim- inal only, and have forgotten that he is a man, a man whose body has nerves susceptible to pain, whose mental faculties can be improved or atrophied, whose better nature can be encouraged or crushed. He is a man who will return to society; is it a matter of any concern whether he comes back into our world worse than when he left it? Is it not worth while to remember that if we treat him as a beast, and crush out his every decent instinct, we will pay dearly for our brutality when he brings his depraved, dehumanized instincts back with him into society? Do we not know that he will touch us, or touch those who will touch us, and that the touch will be that of the moral leper? But, apart from this, the civilized world, after some two thousand years of reflection, is coming to realize that the interests of the prisoner himself have some claim upon those who have heard the message of him who said : "I was sick, and ye visited me : I was in prison, and ye came unto me." We are getting away from the brutality of the lex talionis, the theory of vengeance in the treatment of pris- oners. The voice of those who stand upon the watchtowers and look far out into the future of society is calling to us that we must make an effort to reform those whose feet have strayed from the path, that we must remember that, "however deeply stained by sin, he is our brother yet." We are beginning to be alarmed by the fact that although we spend a billion dollars a year in the fight against crime in America crime is steadily on the increase. Does it mean anything that last year one hundred and twenty-one thou- 266 THE NEW CHIVALRY — HEALTH sand persons were arrested in one city, Chicago? Is it of no significance that probably fifty per cent of our prisoners have been incarcerated before, some of them frequently? Suppose that the State, finding a man afflicted with conr tagious disease, should arbitrarily send him to a hospital, to be kept there three weeks and then discharged, regard- less of his condition. Suppose further that this hospital were one to which all sick people were sent and herded together, no matter what their trouble was; that the patients, after being discharged, came back again and again, their condition proving that the former treatment had caused the disease to take a stronger hold upon them, instead of curing them. Such a hospital would be abated by the authorities as a dangerous nuisance. Yet this is analogous to what goes on in our prisons. There are those who will be amused at the idea of endeav- oring to reform the prisoners. But the great world will not be deterred from its noblest impulses by the sneers of the ignoramus. "Jailbirds" they hoot with simian glee. The answer is : one of the ablest addresses ever delivered before the Southern Sociological Congress was given by an ex-con- vict. The reform of the prisoner is practicable. It is being accomplished every day in the truly modern prisons. A recent writer says that after the prisoner is convicted the judge should rise and say to the prisoner something like this : "Friend and brother, it has been determined that you have done this thing. As for your intentions, we do not presume to judge; as for your motives, they can be known only to yourself and God ; as for your act, it makes no differ- ence what it was, so long as it is dangerous to society. Your relation with society, society has a right to regulate; and society decrees that you remain in exile from it until you have shown by your conduct that you are fit to return to it. Every help will be given you, every recourse of the State will aid you, every incentive will be offered you to learn your lesson. Then, when you have learned it — ^be that time long or short — society will welcome you back again. It will not turn its back upon you, because your very return will TREATMENT OR PUNISHMENT FOR THE PRISONER 267 show that you have worked out your own salvation, that from the bitterness of experience you have learned the truth you would not or could not learn without it. Friend and brother, until that time comes, farewell, and may God be with you." "The wild dream of an impractical idealist ! The vapor- ings of a silly sentimentalist!" your ignoramus will say. Who is it that so regards the prisoner as a man made in God's image, one deserving of an effort to restore him to normal manhood? The author of the lines quoted is the warden of Sing Sing, Thomas M. Osborne. The man who has charge of the prison where are confined such men as Lefty Louie and Gyp the Blood, whose life is spent in the supervision of the criminals of New York, will hardly be classed among the sentimentalists. In one of our Western States the honor system among convicts has been used with splendid success ; the men have responded nobly to sympathetic treatment; they have been sent, without guard, hundreds of miles from the prison to do certain work. The average of desertions has been less than the average of desertions from the United States army. This plan has been tried with success in Arizona. Of this, Mr. Sanders writes : "Convicts were sent out to construct roads and bridges in various sections of the State. At some camps the inmates were on honor, while at other camps guards were used. All this was being done while the anvil chorus howled and shrieked throughout the State at the innovation. It could not be done and they knew it. But it has been done." Of course this cannot be done with every prisoner, but the fact that one patient is incurably ill is no reason for refusing to treat every patient in the infirmary. The fact that one prisoner is incorrigible and untrustworthy is no excuse for treating every inmate of the prison as a brutal degenerate. Contrast with the modern, civilized idea of reformation the actual treatment received by the prisoners in many of our jails. Only a short while ago, in a Southern State, a 268 THE NEW CHIVALRY — HEALTH convict was killed in a mine explosion. The investigation of the official records disclosed that his term had expired months before his death. What a commentary upon the great State to which he had the right to look for protection while in its custody ! "Only a worthless convict killed," will you say with heartless cynicism? What of his family, made anarchists by the injustice of it? What of his friends, and their attitude toward the government, the neglect of which made such a tragedy possible? A recent inspection of a Southern lumber camp, employing leased convicts, revealed systematic brutality which would have caused Nero to shudder. When these poor devils go back to their families and friends, their tongues, yes, and their bodies, telling the story of how the State protects its prisoners, do you think that the intelligence will make them better citizens? For every convict maltreated there are one hundred people who lose their respect for the State, which by its callous neglect, became particeps (yriminis. Only a few days ago a negro was beaten to death in a Southern convict camp, and, the autopsy proved that at the time of the beating he was suffering from pneumonia. Yet the warrant under which he was convicted concluded with the words, "Against the peace and dignity of the State." The dignity of a State which tolerates a system which permits a man with pneu- monia to be beaten to death by an inhuman guard ! The prisoners in our jails are frequently shamefully neg- lected and mistreated. The prison inspector of my own State says of the food served in the jails: "Prisoners in the jails of Alabama are fed by the sheriffs without super- vision of any kind whatever. The food usually consists of a small piece of salt side meat, about three tablespoonfuls of peas or beans, and a 'hunk' of poorly made corn bread, said corn bread being made usually of meal and water with- out grease." This is the food served, despite the fact that an allow- ance is made for this very purpose, which is abundantly ade- quate for giving the prisoners a variety of wholesome food. A white man in one of our prisons told a visitor that he TREATMENT OR PUNISHMENT FOR THE PRISONER 269 would barter his soul for a half of a lemon. The deadly monotony of the side meat, peas, and soggy corn bread had driven his stomach to revolt and his soul to desperation. Of course, he will forget all this and become a loyal citizen immediately upon his release! Of course! But why multiply unpleasant instances? Why tell of the boys in knee trousers in daily contact with seasoned criminals? Why speak of the third degree, that merciful, fourteenth-century method of extorting concessions? Why dwell upon the filth, the vermin, and the deadly germs, by which the prisoner's constitution is shattered? The white light of the twentieth century is shining to-day upon our prisoners where barbarities of the twelfth century are being constantly practiced. The spires of our beautiful churches cast their shadows across infernos, where men, some guilty, many innocent, are being, slowly but surely, transformed into beasts. The melody of the church bells, ringing out their message of peace on earth, good will to men, is wafted to camps where sick men are being flogged into insensibility. In the midst of it all there comes sounding down the centuries the voice of him who said : "I was sick, and ye visited me : I was in prison, and ye came unto me." Is it worth while to attempt to reform the prisoners? Is it only the dream of the theorist? General Brinkerhoff, late President of the National Prison Association, says: "The fundamental principles of this penology are now as well established as those of any other science; their application in England, and in particular prisons like Elmira, Concord, Mass., and Mansfield,. Ohio, has shown that crime can be so dealt with that instead of increasing (as now in the United States) it will steadily diminish." The Chief Justice of the Supreme Court of Nevada be- lieves that the purpose of imprisonment should be reforma- tion. He says : "Practically that purpose is lost sight of in the way prisoners are dealt with in most of the penitenti- aries and jails in our country." He then quotes the words of Mr. Moorfield Storey : "Our prisons are manufactories of criminals, and it is time that 270 THE NEW CHIVALRY — HEALTH we changed our whole method of dealing with convicts. In other words, we should treat criminals rather as sick men than as bad men, and our places of confinement as hospitals rather than as prisons." An authority says that it has been estimated that there are now twice as many convicts, in proportion to the popu- lation, in our prisons as there were half a century ago. Bearing this statement in mind, let us hear what some of the prominent men of this country have to say relative to our problem. The quotations below are from the Annals of the American Academy, March 13 : "The protection of society is the primary purpose ot imprisonment and the next purpose is reformation." (Theo- dore. Roosevelt.) "The statement that 'the penitentiary was not designed for a Sunday school' was met by the Governor of a Southern State with the remark, 'Nor was it designed for a revenge- ful hell.' This Governor further says: 'In a commitment which accompanies a convict to the penitentiary there is an implied judicial guarantee that, though he is deprived of his liberty as a citizen, he is still granted the right to live, and to be cared for in a manner commensurate with sound reason, good judgment, and human mercy.' " (Governor Donaghey, of Arkansas.) "In our prison and reformatory we have made provision for the employment and compensation of the prisoners, and in many cases, where families are found dependent upon prisoners, a certain portion of the prisoner's earnings is paid direct to the family." (Governor Eberhardt, of Minnesota.) "No system of punishment is justifiable or a benefit to society unless those punished are, at the end of their con- finement, better men physically, mentally, and morally, and Jess enemies of society than when their punishment began." (Governor Hadley, of Missouri.) "All of our outside men, or 'trusties' as we call them, are working without guard, and I am proud to say that now this list of trusties comprises fifty per cent of the men of our institution, and most of them receive twenty-five cents TREATMENT OR PUNISHMENT FOR THE PRISONER 271 or more per day for their labor." (Governor West, of Oregon.) "The ideal for Kansas in the management of her peni- tentiary is to make the institution a reformatory instead of a deformatory." (Warden Codding, Kansas State Peni- tentiary.) "During the i)ast four years we have had over eighteen hundred individual men working in our honor camps. These men, without guards, some fifty and one hundred, and even three hundred miles away from the prison, have created a national reputation for loyalty. Only a little over one in every one hundred has violated his pledge not to run away, which is far less than the desertions from the United States army or navy." (Warden Tynan, Colorado State Peni- tentiary.) "The penal institution is no longer regarded as a place to punish men, but a place to reform them. At last the world has heard the great Judge say, 'Vengeance is mine; I will repay ;' and leaving that to Him, we turn to helping our weak brother to become strong." (Superintendent Moore, New Jersey Reformatory.) This man further says: "The positions in which the reformatory placed them when they were paroled gave these same three hundred and thirteen young men wages aggregating $10,129 a month, nearly twice as much as they were earning when committed." "Elbert Hubbard was much impressed when a Federal Judge permitted a moonshiner to go home with the agree- ment that he should return in six months to serve his sen- tence. Every lawyer who practices in the United States courts knows that this is not unusual." A recognized authority states positively that a large per cent of the men imprisoned may be reclaimed, and adds that the records of the best prisons in the United States and England prove thjs. A few of the details of the new system are as follows : The prison force is removed from politics, as in England, where the staff is appointed by a prison commission, respon- sible to the home secretary of the government. (Currier.) 272 THE NEW CHIVALRY — HEALTH The indeterminate sentence is used. The prisoner knows that manly conduct will shorten his term. The incorrigible is confined indefinitely, and society is spared the menace of his presence. The able-bodied prisoners are kept at pro- ductive labor and are frequently paid a small daily wage; the weak and diseased are given proper treatment. The probation system provides a big brother who becomes an intimate friend of the prisoner on parole. The children's courts deal with the children as children, rather than as criminals. State officials endeavor to help the discharged man to get a start in the world. As a matter of course, this advance will be confronted in the South by the hoary bogy which has been the faithful ally of the enemies of so many forward movements — ^for example, compulsory education. This bogy is the negro question. Who that has dealt with the negro criminal does not know that he is responsive to kind treatment; and furthermore, that he is a baby in crime, as contrasted with the gunmen, the bomb placers, and the expert criminals with whom the Sing Sing authorities have to deal? The man who does not appreciate our responsibility for these people, who are here because we took them from their homes and transported them here against their will, the man whose soul is so shriveled that his heart is not touched by the tragedies of this slave-descended race, is a stranger to the spirit of the great Galilean. In conclusion, let us catch the spirit of Governor West, of Oregon, whose "creed" contains the following para- graphs : "I believe it is my duty to learn all it is possible for me to know about the problem. I welcome the enlightenment of social students and commissions, and, most of all, must know the prisoner, the officers, and the prison plant at work. "I believe I ought to do my part in the solution of the problem. *in the sweat of thy face shalt thou eat bread' is a divine edict which appeals to me, as well as to the boys in prison, and those who serve under me. "I believe in the prisoner. Some have turned down my confidence, but I believe in them all just the same. They TREATMENT OR PUNISHMENT FOR THE PRISONER 273 are savable, and they cannot get away from my good wishes for them. "I believe in plugging away and letting the critics howl. "I believe that Jesus Christ and John Howard and Abra- ham Lincoln were full of gentle sympathy and stern justice, and did all they could to help the unfortunate. I want to emulate them." "I was sick, and ye visited me : I was in prison, and ye came unto me." These words embody the noble spirit of the Master-Idealist. They would seem to require no construc- tion. Yet, after they have been ringing in the ears of the world for twenty long centuries, there are those who have not comprehended their meaning nor obeyed their injunc- tion. The combined influence of the churches can accom- plish almost anything. It is the duty and privilege of every patriot to contribute his part, large or small, toward correcting conditions which are not creditable to his people ; to work to the end that he may stand up and say with pride to all the world, "This is my own, my native land." Has not the time come when God- fearing manhood and womanhood should protest against heartless disregard of the rights of those thousands of our brother men who, in their helplessness, must look to society for protection? What have we to say in the presence of existing conditions in our prisons and penitentiaries, we who have built our beautiful churches and sung our inspiring hymns and heard from time to time the reading of the Master's words, "I was sick, and ye visited me: I was in prison, and ye came unto me?" 18 274 THE NEW CHIVALRY — HEALTH THE OLD AND NEW ATTITUDE OF THE STATE TOWARD ITS PRISONERS JOSEPH HYDE PRATT, PH.D., AND W. S. RANKIN, M.D. There is no question but that the people of this country are turning their thought to the problem of how State, county, and city prisoners should be treated and what work they should do. The old idea that conviction of a crime eliminated the convicted person entirely from the good will and any just consideration from society is becoming a thing of the past. It is to be regretted that any persons still hold to this old idea which has been the cause of so much cruelty and unjust and inhuman treatment of thousands and ten thousands of unfortunate men and women. The belief in this idea has been the reason why officials formerly con- sidered the "convicts" as collateral of the State out of which it must derive as much income as possible. The question of any moral obligation on the part of the State to try to reform and improve the condition of the convicts was not even thought of. Now there are certain facts regarding convicts that are considered indisputable, and public opinion is beginning to insist that these must be taken into consideration by State, county, and city officials in dealing with persons convicted of crime : 1. The convict is a human being and must be treated as such ; he has a sense of responsibility, honor, and discipline, and this sense can be quickened and developed. 2. Perhaps, with few exceptions, there is some good in every convict, which can be developed and made paramount in the character of the man. 3. The convict in serving his sentence is simply paying a debt that he owes to the State for certain infringements of the laws of that State; and when he has served this sentence he has paid his debt and should be in a position to become a good and valuable citizen of the State. Most convicts are ATTITUDE OP STATE TOWARD ITS PRISONERS 275 serving a first sentence and often for a crime committed on the spur of the moment, and with many of them this one crime committed represents the only black spot in their lives. 4. The State, on her part, owes it to the convict to assist him in every way to pay his debt as speedily and economically as possible and in such a way that he becomes a better man when his debt is paid than when he was convicted. 5. The attitude of the State toward the convict should be corrective and not vindictive, to uplift and not degrade him. 6. To put a man in stripes often so degrades and humiliates him that it is extremely hard, and sometimes impossible, for him to reform. 7. Hard work is a good reformer, while idleness begets melancholia. 8. Outdoor work is much more conducive to good health and a cheerful disposition than confinement in prisons or factories with no outdoor exercise except what can be obtained in a limited area of a penitentiary yard or court. 9. There must be an incentive before good work can be expected from most convicts. 10. There is a great variation in the character and working ability of different convicts. 11. In many cases families were dependent upon the convict before his sentence and are, during his incarcera- tion, deprived of that support. The State is the guardian of every convict whether he was sentenced in city, recorder, or county court, and she can make or break him, according to the treatment she measures out to him. Her rules and regulations must be just, and then she must insist upon their strict obedience. On the other hand she must be just as strict to see that those she places in charge of the convict, whether it be prison warden, superintendent, or foreman, all keep faith with the convicts and that all promises made to them of whatever character are kept. A promise to the convict is 276 THE NEW CHIVALRY — HEALTH an obligation that the State must keep, and upon the strict carrying out of such promises and the strict enforcement of just rules and regulations will depend the success of the use of convict labor. The State's guardianship of the prisoner begins with his arrest, and its first problem to consider is housing, clothing, and feeding him. From jail the convicted man may go to State's prison, to the State farm, county convict camp, State convict camp, or remain in jail to serve out his sentence. All these represent places in which the convict is obliged to live a certain portion of his life under restraint. The question at once arises, "What is a State's duty in regard to these places and the treatment of the men living in them ?" It seems to us that it is the duty of the State to make every effort to correct the criminal impulses of her prisoners and to do all things possible to create a change in their moral nature, so that when they leave their places of confinement they are not only ready but desirous of becoming law-abiding citizens and taking their place once more in society. The State then must assume the respon- sibility of looking after the moral and physical welfare of her prisoners. To-day we wish to present to you certain suggestions that we believe will, if they are put into prac- tice, greatly improve the moral and physical condition of our prisoners, will make them better men, easier to handle, more willing to work. The men must realize that the State is interested in their welfare and is trying to make men of them. The prisoner's first introduction to a State's or county's authority is in the jail to which he is committed at the time of his arrest, and then in the courthouse. The filth that he is often subjected to and the terribly unsanitary conditions that he is obliged to put up with in many of our county jails is almost unbelievable and, in reality, barbarous. As the convict leaves the jail and is taken over to the courthouse for trial, in some counties the conditions are not much better; and so up to the actual time of his conviction or acquittal he has been housed and fed worse than a great ATTITUDE OP STATE TOWARD ITS PRISONERS 277 many beasts of burden are cared for, and is tried in a court- house that has no pretense whatever to cleanliness. The effect upon the man is bound to be bad, and increases the difficulties of trying to make him live a clean life after his conviction. The first reform that should be carried out at once is the remodeling of our jails and courthouses and also a reorganization of their care, so that when a man is com- mitted to one and tried in the other he will be at once sur- rounded by everything that is perfectly sanitary and clean ; will be given clean, well-cooked, and wholesome food; and will see in the courthouse a well-lighted, well-ventilated, and clean room. The effect of such surroundings on the men when they are sometimes confined in the jail before con- viction or acquittal for weeks and months will be beneficial. Wherever the prisoner may be sent after his conviction, it should be a place kept in a sanitary condition, where he receives sufficient well-cooked, clean, and nutritious food, plenty of clean clothing, clean bed and bedclothes. The same rules should govern these places as the jails, and all should be under the supervision of the State Board of Health. In North Carolina at the present time the State Board of Health does not have any direct authority over the officials in charge of the places of confinement and the pris- oners, nor have they any authority to enforce any rules and regulations regarding such places, except when the Governor directs the Board of Health to make a special report upon some particular jail, camp, or farm. The State Board of Health, in cooperation with the Highway Division of the North Carolina Geological and Economic Survey, has de- veloped a set of rules and regulations governing the sani- tation and hygiene in these places of confinement, which it is believed will insure sanitary camps and jails and a maxi- mum healthfulness of the inmates. The camps and jails are to be visited at intervals by members of the State Board of Health, and the camps and prisons will be marked by means of a specially prepared chart, so that the conditions in the different places cannot only be compared with each other, but according to the percentage rated it will be known 278 THE NEW CHIVALEY — HEALTH at a glance whether or not the camp or prison is in a healthy condition. At the beginning it will probably not be possible for all camps and prisons to comply with all the suggestions and thus score one hundred. It is, however, something that all in charge of the welfare of prisoners should strive to attain. At the present time in the South a large proportion of our prisoners are located in camps, and while these rules and regulations seem to apply particularly to camps, they are just as applicable to jails, prisons, or State farms. The following chart has been prepared to be used in grading the camps and jails: CAMP AND JAIL SCORE CARD Name of Camp or Jail Post Office Superintendent Date Inspector Number Prisoners . Points Considered Subdivisions Score Possible Actual 1. Location Drainage, 1; winds, 1; marshes, 1; stables, 1; sewage, 1 5 2. Air, Construction of Buildings Air space, 4; sunshine, 1; lights, 1; furniture, 1; spittoons, 1; shower bath, 2 10 3. Water Supply and Equipment Analyses, .5; contamina- tion, 1; structure well, 1; pump, .5; water con- tainer, 1 ; individual cups, 1 5 4. Food, Nutrition Deduct for underweight: 5 per cent, 2; 8 per cent, 4; 12 per cent, 7 Deduct for loss of time: Over 3 per cent, 1; 4 per cent, 2 ; 5 -per cent, 4; 6 per cent, 6; 8 per cent, 8 15 5. Clothing Sufficient, 1; changes, 2; nightshirt, 2 5 ATTITUDE OP STATE TOWARD ITS PRISONERS 279 Points Considered Subdvisions Score Possible Actual 6. Bed Tick, .5 ; pillow, .5 ; pillow- case, .5; sheets, 1; cov- ering, .5; sufficient di- mensions, 1 ; cleanli- ness, 1 5 7. Bathing Daily baths, 1; general baths semiweekly, 1 ; washbasin, 1; 2 towels per week, 1; soap, 1 5 8. Sleep, Recreation, Accidents Amount sleep, 2; games, 2; magazines, 1; pa- pers, 1 6 9. Sewage Fly-proof, 2.5; toilet pa- per, 2; not dangerous to water supply, 2.5 7 10. Vermin Absence of, 8 8 11. Flies and Mos- quitoes 1 Construction and screen, 2 ; fly-breeding, 2 ; anti- fly measures, 1; ma- ! laria, 2 7 12. Smallpox Score on per cent pris- oners vaccinated 5 13. Typhoid Fever Score on per cent pris- oners vaccinated 5 14. Syphilis Absence of, 5 5 15. Tuberculosis Absence of, 5 5 16. Religious Services Provided for. 2 Total score 100 SANITARY AND HYGIENIC CAMP INDEX I wish to discuss briefly the sixteen different points con- sidered on the chart and the rules and regulations that have been prepared relating to these for the use of the superin- tendent or other ofl[icial in charge of the camp or jail. 1. Location of Camp. — In locating a camp due regard should be had to drainage, prevailing direction of winds, location of marshes and swamps, the habitation of domestic animals, and places of deposit of human excrement which 280 THE NEW CHIVALRY — HEALTH are not under the control of the camp supervisor. The camp site should be elevated and well drained. Where conditions permit, the camp should be located to the southwest of hills, forests, and other obstructions to the prevailing wind of summer and with the protection of such obstructions against the prevailing wind of the winter. Camps should be located as far as conditions will permit from marshes and swamps, and, where possible, located so that the pre- vailing wind of summer time is from the camp to the marsh rather than in the reverse condition. Camps should be located as far as conditions will permit from stables, pig- pens, and other fly-breeding places, and places of deposit of human excrement which are not under the control of the camp supervisor. A perfect score regarding this point counts five. If drainage is bad, one is deducted ; if camp is so located that prevailing winds interfere with the comfort of the convicts, one is deducted; if camp is too close to marshes, one is deducted; if in close proximity to stables, one is deducted ; if sewage is poor, o%e is deducted. 2. Construction of Buildings, Air, and Ventilation. — The buildings must be so constructed that there is sufficient air space for the maximum number of men that it is supposed to place in the building. If this is sufficient, four is scored. If the building is so constructed that sunshine cannot pene- trate freely into the building, one is deducted. If the build- ing is without lights, one is deducted. If no provision is made for the prisoners to sit down except on their beds, one is deducted. If spittoons are not provided, one is deducted. If there are no shower baths connected with the building or the camp, two are deducted. 3. Water Supply and Equipment. — ^The water supply of convict camps must be reasonably pure and safe as indi- cated by the following: (a) Analysis of at least one sample of the water by the State Laboratory of Hygiene, and the water to be re-analyzed every three to six months; (b) source of the supply so located that privies and other places of deposit of human excrement and houses and pens for domestic animals shall drain away from and not in the ATTITUDE OP STATE TOWARD ITS PRISONERS 281 direction of the water supply; (c) source of water supply not to be closer than 150 feet to any privy or other place of deposit of human excrement; (d) if well is used, it should have a tight cover with top elevated above the surface of the ground and a stone or concrete floor for six or eight feet; (e) pump should be given preference to bucket and chain ; (f ) common bucket should be replaced with a barrel or keg or other closed container with spigot; (g) each convict and each attendant should have his own individual drinking cup. If there has been no analysis made, five-tenths per cent will be deducted from the total score. If water is found to be contaminated, one is deducted. If the well is without a pump, five-tenths per cent is deducted. If there is no spe- cially provided receptacle for containing the drinking water and a well bucket is used for this purpose, one is deducted. If the men are not provided with individual cups, one is to be deducted. 4. Food and Nutntion. — ^The superintendent or super- visor of all camps, jails, and prisons is to report in duplicate to the Superintendent of the State Penitentiary and to the Secretary of the State Board of Health each month the fol- lowing: (a) Prisoner's name; (b) date of beginning of sen- tence at convict camp, jail, or prison; (c) his height; (d) weight on entering the penitentiary; (e) average weight; (f) present weight; (g) total number of working days pos- sible for prisoner during the preceding month; (h) total days of prisoner's incapacity during preceding month; (i) percentage of time lost by prisoner; (j) explanation as indi- cated on charts. It is believed that if the average weight of all the convicts at the time of the inspection is five per cent below the average weight of the men at the previous exami- nation, a score of two should be deducted from the total score; for eight per cent underweight four should be deducted ; and for twelve per cent underweight seven should be deducted. If during the interval between inspections the average loss of time of the convicts is over three per cent, one should be deducted; over four per cent, two; five per cent, four; six per cent, six; and eight per cent, eiffht. It 282 THE NEW CHIVALRY — HEALTH is believed that by keeping track of this loss of weight and time a pretty good check can be kept upon whether or not the food served is nutritious and whether the health of the convicts has been looked after. 5. Clothing. — Adequate clothes of at least two complete changes a week shall be furnished every prisoner and each prisoner shall be provided with one clean nightshirt a week. We consider the nightshirt as very essential, because the men should not be expected to wear to bed the underclothing in which they have worked all day. The day clothing should be taken off and allowed not only to dry but to air during the night. Objections have been made to the furnishing of nightshirts from the fact that many of the prisoners have never been accustomed to using nightshirts even when they were at home. We raise the point that, although this is true, we are supposed to teach something different from what they were accustomed to have and to do at home. We believe the changing of the day clothing to the nigljt clothing, whether it be nightshirts, pajamas, or another change of underclothing, is absolutely necessary to keep the bedding clean and the men in good physical condition. The providing of nightshirts or night clothes counts two in the total score. The providing of at least two changes of cloth- ing per week also counts two. Sufficient clothing for the time of the year, including shoes, stockings, etc., counts one to the total score. 6. Beds and Bedclothing. — Bed space shall be provided so that each prisoner shall have a space equal to three feet by at least six feet. This space shall be provided with either a mattress or, preferably, a tick filled with clean straw. He shall be provided with a pillow and pillowcase, two sheets, and sufficient blankets for the comfort of the prisoner. The sheets and blanket shall be of such size as to permit a thorough tucking under the foot and sides of the tick, and the top sheet in addition shall be of such length as to permit of its being turned back at least six inches over the top of the blanket. Sheets and pillowcases shall be changed once a week. Blankets shall be kept reasonably clean, and the tick shall be sunned at least once a month. ATTITUDE OF STATE TOWARD ITS PRISONERS 283 If the tick, pillow, pillowcase, sheets, and covering are provided as above, they shall each count five-tenths of a per cent in the total score; if not, five-tenths shall be deducted for each one in which the camp fails. If the men are not given sufficient space for their bedding, one shall be deducted from the score. Lack of cleanliness will also deduct one. 7. Bathing. — Each prisoner should be required to wash his face and hands at least twice daily and to have at least two general baths in previously unused water every week. Every prisoner shall be provided with soap and at least two towels a week, and each prisoner shall have his own wash basin. Each of these points, if provided by the camp or jail, will count one each in the total score. 8. Sleep, Recreation, and Accidents. — The prisoners should be allowed eight hours of sleep per day. During their recreation period they should have such diversions as checkers, chess, card games, magazines, and newspapers. If the superintendent or supervisor has the proper amount of ingenuity needed in his position, he will secure the news- papers and magazines for the use of the convicts. Super- visors and overseers should have due regard to the effect of excessive temperature on convicts. Exhaustion, heat strokes, and sunstrokes should not occur among prisoners. On the days with high temperature, over 93 or 94 degrees, and in places where the air currents are cut off, convicts should be carefully watched for evidence of exhaustion and given the necessary periods of rest to prevent the occurrence of such accidents. No overseer has the right to put a pris- oner in any place of danger that he himself would hesitate to occupy. Frequent accidents among the prisoners of a camp are a reflection upon the camp management. If the time of the men is so arranged that they are allowed eight hours of sleep, this will count two in the total score. The providing of games for use during the recreation period will also count two. The providing of magazines and papers counts one each. 9. Sewerage, — Human excrement, urine, and bowel dis- charges shall be disposed of in such a way as to prevent 284 THE NEW CHIVALRY — HEALTH the access of flies to the discharges and to prevent the discharges from washing, either by soil percolation or sur- face washing, into the water supply. To this end it is recommended, if the camp is not connected with a sewer- age system, that either a privy similar to that recommended by the United States Department of Agriculture, or the pail closet system, supplied by the National Closet Company, Sanford, N. C, be installed. If the camp is of a temporary nature, the pail system inclosed in a rough framework or canvas will probably be found more convenient. If the camp is to be more permanent, the privy mentioned above will probably be most useful. It is recommended that the pail system of the National Closet Company be used in the sleeping quarters of the convicts. Wherever the pail system is used a box of dry dirt with a shovel should be provided so that those using the closet may cover the deposit with dry dirt as a further safeguard against flies and to prevent odors. Both the privies and pail system shall be supplied with toilet paper. The suggestions regarding sewerage are considered of such importance that a total of seven is added to the score, if all of them are carried out. 10. Vermin. — There is no excuse whatever for the beds of the prisoners or the buildings to be infested with vermin, and such can be entirely eliminated if the previous regula- tions have been systematically and thoroughly carried out. If any vermin is found in the beds, eight is deducted from the total score. 11. Flies and Mosquitoes. — ^When a camp is constructed of wood, recreation room, sleeping quarters, dining room, and kitchen should be so evenly and closely constructed at all points, especially about the eaves, that screening of all windows and doors will exclude mosquitoes and flies. Where the camp is of a very temporary nature and where tents are used, and where, for reasons beyond the control of the supervisors, flies are in evidence, the following measure should be instituted: A mixture of water and milk, equal parts, with one ounce of formalin and one heaping tea- spoonful of brown sugar to the pint should be placed and ATTITUDE OP STATE TOWARD ITS PRISONERS 285 kept in shallow saucers, seven or eight of them around the kitchen, dining room, and about every place where flies tend to gather. Where it is impossible to screen, and where, not- withstanding screening, mosquitoes are prevalent and several cases of malaria have occurred, the convicts suf- fering from malaria should be thoroughly treated with quinine as prescribed in Bulletin No. 42 of the State Board of Health, and all other convicts should be given two-grain capsules of quinine before each meal as long as mosquitoes are found about the camp or other places occupied by convicts. Every precaution should be taken to eliminate fly-breeding places, and if these are absent two is counted on the total score. The screening of the camp also counts two. If malaria is in the camp, two is deducted from the total score. If the anti-fly measures have been pUt in prac- tice, one is added to the total score. 12. Smallpox. — ^The prisoners should be vaccinated at the time of their conviction and every seven years there- after. If smallpox breaks out in a camp, it is best then to vaccinate all of the prisoners unless they have been so recently vaccinated that the sore has only very recently healed. If smallpox is found in any camp, five is deducted from the total score. If all the prisoners have not been vaccinated, a certain per cent will be deducted according to the percentage of prisoners vaccinated. 13. Typhoid Feven — Considering the great success of vaccination against typhoid fever that has been obtained in the United States army, it is only right to insist that prisoners in the various camps and jails should be vacci- nated against this fever once every four years. This, according to statistics obtained from the United States army, should prevent an epidemic of typhoid fever; in fact, prevent typhoid fever in any of the camps. The existence of typhoid fever in a camp at the time of the inspection will cause five to be deducted from the total score. If all the prisoners have not been vaccinated, a certain per cent will be deducted according to the percentage of prisoners vaccinated. 286 THE NEW CHIVALRY — HEALTH 14. Syphilis. — ^^Camp supervisors should ask their camp physician to point out to them the characteristics of syphilis, and whenever a syphilitic is found in the camp he should be sent either to the prison or the State farm where he can be treated with 606. Syphilis should not be found in convict camps, and when found it will greatly score against the management of the camp and will reflect upon the interest and ability of the camp physician. Five will be deducted from the total score if this disease is found in any camp or jail. 15. Tuberculosis. — This disease is very prevalent among prisoners and is of such far-reaching importance to its victims and their associates that the supervisors of convict camps should be familiar with the initial and suggestive symptoms of this disease, and when a prisoner is found with such symptoms the supervisor should promptly call upon the camp physician for a thorough examination ; and if, on such examination, there is reasonable ground for suspecting the disease, such prisoner should be carefully watched and sent to the State penitentiary for proper treat- ment before it is too late. The State Board of Health should officially request the physician of the state penitentiary to carefully record and promptly report the conditions of pris- oners with tuberculosis sent in from camps in accordance with this rule. A camp sending in cases of tuberculosis far advanced in the stages of the disease will be severely scored against in their sanitary rating. Because a man has been convicted of crime and is kept under restraint by authority of the State is no reason that he should be sub- jected to the danger of contagion of tuberculosis. All pris- oners that have contracted tuberculosis should be kept entirely separated from the others and in camps in differ- ent sections of the State. The presence of tuberculosis in any camp will cause five to be deducted from the total score. 16. Religious Services.. — ^While it is not the intention to make it obligatory for prisoners to attend religious serv- ices that may be held in camps or jails, yet it is not believed that it is right to deprive them of all opportunity of ATTITUDE OP STATE TOWARD ITS PRISONERS 287 attending such services. Therefore there should be a chap- plain to look after the spiritual welfare of the convicts, and it would be a good plan for the State to employ regularly a minister for this purpose. It will, of course, be impos- sible for one man to visit all the camps and jails each week, but he could readily arrange with clergymen in the vicinity of the camps to hold religious services every Sunday. The men should be given the privilege and opportunity of attending such services, and I believe it will be found that the greater portion of the prisoners will attend and take part in them. If a camp or jail has not made provision so that religious services can be held, two will be deducted from the total score. If these rules and regulations are enforced, there will be the greatest change made in the reform of the prisoners. In addition to the above, there should be a physician who will visit the camps regularly and examine the" men as to their physical condition. Where no such physician is employed by the State for this purpose, arrangements should be made with a physician living in the vicinity of the camps to do this work. Every effort should be made to keep the men in good health, and no pains should be spared to this end. The men, realizing that their health is being looked after by the State, will be more and more impressed with the idea that the State is trying to make men out of them, and will do more themselves to carry out the policy of the State in regard to its treatment of its convicts. We believe the moral and physical condition of the pris- oner is very materially benefited if he can be interested in trying to improve himself intellectually; and we therefore favor a State's making some provision to give to those men who desire it certain educational facilities that they can take advantage of during a portion of their recreation periods. They should not be permitted to take this up to such an extent that it in any way would injure their health by lack of recreation. The construction of convict camps is a problem to which sufficient attention has not yet been given in many States. 288 THE NEW CHIVALRY — HEALTH We have tried to devise a camp that could readily be taken down and moved from place to place, yet is perfectly sani- tary in every respect, and is easily taken apart and moved. The camp is illustrated in the figures accompanying this paper. A provision is made for the camp to be constructed of sheet iron or of canvas. It is provided with all the neces- sities called for in the rules and regulations given above, and I believe it will be found economical and efficient. In this connection we wish to go on record as vigor- ously condemning the use of the movable steel cages that have been used in so many counties for housing prisoners. They are a disgrace to any civilized community and should not be used under any conditions, even in a very temporary camp. The reason we mention this in regard to very tem- porary camps, even where there will be no crowding of the men within the wheeled cage, is that if they are used just for this purpose the officials very soon begin to use them in a way that is absolutely barbarous. It is much better to do away with them entirely. There is no question but that it is better for a prisoner to work than to remain idle, but it is also essential that he should not be made to work an excessive amount of time or be forced to try to do work beyond his strength. The work should be useful and should be of some benefit to the pris- oner after his release. It should also be such work that the people of the State can feel that they are deriving some direct benefit from it. As stated before, we must not consider the convict as collateral out of which we are to make the greatest income. The methods that have been used by so many States in working their convicts, such as in manufacturing establishments, in mines, on farms, in turpentine forests, and in the construction of railroads, do not employ the convicts in a work out of which the State derives a direct benefit and the work is largely in the interest of individuals and private corporations. What better work can a convict be employed in doing than in the construction of public roads, considering it first from the standpoint of the greatest good to the citizens of ATTITUDE OP STATE TOWARD ITS PRISONERS 289 the State? A public road is a public necessity and it belongs to all the people of the State. Everyone has the right and privilege to ride and drive on a public road, and a good public road is a blessing to every community through which it passes. Convict labor can be employed in building public roads, so that the treatment of the convict both in regard to his labor and health will be carried out to the best advantage for the State, for the citizen, and for the convict. In the first place it engages the convict in healthful occupation. It is hard work and no man would be forced to work on the roads whom the doctor, upon examination, considered unable to do the work. It is outdoor work and, for the most part, in the country, where the air is pure and there is plenty of good drinking water ; and statistics show that the health of the convict who is employed in road construction and living in the convict camps is better than that of those in any other form of work. Of course, when we make this statement we mean convict camps that are under the supervision of competent men and governed by rules and regulations given above. In closing there is one point that we wish to bring out that you have probably noticed we have not referred to thus far, and that is the relation of the whites to the blacks. We are opposed to combining the whites and blacks in one camp, and believe they should be kept separated. Here in the South we have rules and regulations governing the social relations between the whites and the blacks, and it is not just to men who are convicted that all such rules and r^ulations should be -Oirown aside and the white men and negroes should be compelled to associate together practically as equals in the camps and jails. If it is absolutely neces- sary that they be sentenced to the same camp, then they should be provided with separate sleeping quarters and separate dining tables. In other words, we should apply to the prisoner the same regulations in this respect that would be applied if he were a free man. 19 290 THE NEW CHIVALRY — HEALTH THE PROBLEM OF HEALTH IN CONNECTION WITH PRISONS *PROP. CHARLES RICHMOND HENDERSON, PH.D., CHICAGO, ILL. The writer is grateful for the invitation to speak to and through the Southern Sociological Congress, which has already rendered a great service to the United States and to civilization. I listened to the discussions last year with profound satisfaction and patriotic joy. * Shortly after Dr. Henderson accepted the invitation to prepare this address for the Sociological Congress his physician ordered that he should leave Chicaigo for a prolonged rest in the hope or regaining his health. He went to Charleston, S. C, but the strain of over- work had been too great and soon he was confined to his room. So strong was his desire to aid in the cause of prison reform that he asked permission to dictate this address while lying in bed. This was the last work of his life, for his death occurred shortly after he dictated the last words of this speech. By special request, Mr. B. Warren Brown, Assistant to Dr. Henderson, prepared a memorial paper which accompanied Dr. Henderson's address at the Houston Congress. From this paper the following paragraph is quoted: "Certainly no man living visited more prisons than Dr. Henderson, the prison worker. As a chaplain he came into intimate contact with the social treatment of crime. For years the National Prison Associ- ation was strengthened by his presence and in 1902 chose him as its head. He helped to found and edit the Amerioan Journal of Criminal Law. His position as United States Commissioner on the International Prison Commission from 1909 until his death gave his words great weight, and in 1910 he received the distinctive honor of presiding over the sessions of the International Prison Congress at Washington. An unusual command of six languages and profound knowledge of the problems discussed in that gathering of the representatives of forty nations proved invaluable. Perhaps the theme in prison reform closest to his heart was that presented in his paper to the Sociological Congress to-day, and it is peculiarly fitting that the last words dictated by him on his deathbed were those which you have just heard read in his plea for light and air in the prison cell. Skeptical of appealing to hardened criminals, never letting enthusiasm outrun the facts, yet a champion of the indeterminate sentence and parole, Dr. Henderson was ever loyal to the best interest both of society and the offender. Any man might have been proud to have lived this life as the pris- oner's friend," HEALTH IN CONNECTION WITH PRISONS 291 Your committee has now requested me to discuss one particular phase of public health which has hitherto been greatly neglected throughout the United States. In spite of frequent protests such general neglect with all its injuri- ous consequences is always due either to ignorance of the subject or to a low sense of its ethical and spiritual impor- tance. Our religion sets the highest possible value upon the body. In a sound body were revealed the spiritual qualities of divinity. Saints, poets, and theologians have to some extent understood this lofty interpretation of pure spirit through the flesh. Painters and sculptors have caught the vision and made it glow on canvas and become radiant in marble and bronze. In the darkest times of the Middle Ages, when holy men set a low value on health and life and possessed none of the methods of modern science, the plague swept millions of human beings out of the world, the temple of God was everywhere left in ruins because the vision of the value of vitality was obscured, and ignorance paralyzed effort. The public health movements of our own happier day are inspired by a sense of the sacredness of these divine sanctuaries and directed by the achievements of the sciences of nature and of medicine, especially of preventive medicine, as seen, for example, in all their luster in the Panama Canal Zone and in the Philippine Islands. But our city police stations as a rule are still built and administered in the ancient spirit; we cannot plead the excuse of ignorance. The principles of health as related to prison structure and arrangement are well known. Briefly summarized, the more important of these principles are: abundance of sunlight and pure air, and such a structure of walls, floors, and ceiling as will facilitate the cleansing of surfaces and crevices without too great expense and labor. But even the best structure is a dead thing unless the administration is directed by the best medical authorities clothed with the legal powers of the State, and under instructions to enforce these principles wherever assemblies of human beings require prompt and intelligent, alert and vigorous action. 292 THE NEW CHIVALRY — HEALTH The causes of disease are living creatures which multiply rapidly in darkness, dampness, and dirt; and which carry on unceasing and unrelenting warfare against the human race. Many of the deadly germs pass directly from the lungs of the diseased by the sputum into the breathing organs of sound persons crowded into the same rooms. Mosquitoes, flies, and vermin are known to be vehicles of infectious diseases. The dreadful typhus fever to which my gifted and devoted young colleague, Professor Ricketts, surrendered his Jife that he might help the Mexicans, our neighbors, to escape its devastations, is carried by insects. The Southern States near the border have good reason for even an excess of vigilance wherever Mexican laborers or prisoners are found together, I have set down in two simple diagrams the two forms of structure of local prisons. One of these, diagram A, corresponds to the requirements of modern sanitary science, and it is the form generally used in the more advanced countries of Europe, by the highest authorities. I sent a copy of it to some, of the medical men of highest rank in our country and it was approved by all of them, and they united in condemning the form shown in diagram B. DIAGRAM A w w w w w w w w c c c c c c c c d d d d d Corridor d d d d d d d d d d d c « c c c c c Unfortunately the condemned form, diagram B, became popular in the United States, and large sums of money have been invested in this unscientific and inhuman type. Pri- vate mercenary interests have made it still more difficult HEALTH IN CONNECTION WITH PRISONS 293 to introduce improvements. When ignorance and greed unite, improvement is slow; but there is moral earnestness and intelligence enough in the iSouthern Sociological Con- gress to break down the barriers in the way of progress. DIAGRAM B Corridor d d d d d d d d -~ — — ■"" — — — — — — — - c c c c c c c c c c c c c c c c d d d d d Corridor d d d Remember that there is a place of detention in prac- tically all of the cities and the counties of the union. Through these unhappy abodes of human misery, disease, and depravity pass an endless procession of arrested persons. Some remain only a few hours awaiting their trial, while to others a sentence of weeks or months may be served, though local lockups and jails should be only places of detention and never of punishment. Even two or three hours spent in an infected building may be equivalent to a death sentence. Fortunately the State of Louisiana has set a good example, and deserves the honor of leadership. This great commonwealth has armed its State Board of Health with considerable authority in the campaign against disease. Under this legal authority this board has already adopted regulations having the force of law and containing a scien- tific standard for the building of local prisons by cities and counties. This is much better than merely to require local municipalities to submit their own plans to a State Board 294 THE NEW CHIVALRY — HEALTH of Charities and Corrections, which may or may not have expert sanitarians in control. It would be still better in view of the international and interstate interests involved if we could have a Federal Commission authorized to set and enforce the standards for prisons. The Louisiana regulations read as follows : "1. All jails, prisons, lockups, and camps, where pris- oners are detained or confined, must be properly constructed, ventilated, and lighted. "2. Each and every municipal, parish, or State prison, lockup, or camp must be of sufficient size and strength to hold and keep securely the prisoners contained therein ; and must contain at least four separate apartments, one for white men and one for white women, one for negro men and one for negro women, with separate apartments for communicable contagious diseases. The building shall be fireproof, screened, properly ventilated, sufficiently lighted, by day and night, adequately heated, and connected with water and sewer, including separate bathing facilities for whites and negroes. "3. All cells shall be placed against the walls, so that each cell may have one or more windows opening to the outside, to insure an abundance of sunlight and fresh air, and be provided with lavatory, drinking fountain, and water closet. Each cell shall open into a corridor which shall be provided with sanitary drinking fountain and a shower bath with hot and cold water (shower for males and tubs for females). "4. The interior of all prisons shall be painted white, floors made of cement or tile, waterproof, and incline to a drain. "5. The floors, walls, and ceiling or room and cell must be scrubbed with soap or lye and water twice a week, and the ironwork painted with white lead or asphaltum varnish (white) twice a year under the direction of the parish or municipal health officer. "6. Every room or cell occupied by any patient prisoner suffering with a communicable infectious disease, when vacated, shall be disinfected and fumigated. HEALTH IN CONNECTION WITH PRISONS 295 "7. It shall be the duty of the keeper, or manager, be he sheriff, marshal, executive or police department, or other employee, to enforce cleanliness among the prisoners and compel them to bathe their persons when entering the jail and at least once each week while confined therein. The keeper or manager shall furnish soap and individual towels and clean clothing (when the prisoner is not able to provide the wearing apparel, especially underclothing) at the expense of the municipality, parish, or State. "8. The water closets must be kept in a sanitary con- dition, connected with water and sewer if within one thou- sand feet of sewer main or lateral, or otherwise provided with water-tight containers, screened against flies and other insects, and thoroughly cleaned once a week, or as often as necessary to keep in perfect order. "9. All plans and specifications for new jails and repairs or alterations of old prisons shall be submitted to the State Board of Health for approval. "10. Cooking and eating apartments shall follow the same rules as those prescribed for restaurants and hotels. "11. Where large numbers of prisoners are confined it shall be the duty of the proper authorities in charge to provide hospital quarters with necessary arrangement, conveniences, attendants, etc. "12. Beginning July 1, 1913, the sheriff, marshal, or executive officer of the Police Department and President or duly authorized officer of the State Board of Control shall furnish the State Board of Health with quarterly reports showing the number of prisoners, white and colored, male and female, confined at that time in said prison, with a detailed statement of number of the new prisoners received, also number discharged during preceding quarter, also showing number sick, with nature of illness and termina- tion. This report shall give information relative to the physical condition of the prison, when cleaned, when fumi- gated, and when repainted, and such other data as may be required by the Coroner or Board of Health. "13. These regulations shall apply to all jails, prisons, lockups, and camps located in the State of Louisiana. It is 296 THE NEW CHIVALRY — HEALTH understood that where the word 'jail,' 'prison,' 'lockup,' or 'camp' appears in these regulations that all refer to the same subject." In spite of the obstacles set by blind tradition, we have some structures built on the modern foundation. The intel- ligent county commissioners of Buffalo inherited an abomi- nable death-trap of a jail which was a disgrace to that fair and wealthy city. They sought expert advice and engaged the services of an architect who knew the best European types ; and as a result, without unreasonable cost, they have a secure building which meets the chief modern require- ments. At Guelph, Ontario, they have a reformatory prison which has already influenced builders in other parts of America. Mr. J. L. Whitman, Superintendent of the House of Correction, Chicago, is another far-sighted official who has embodied the higher sanitary standard in the new cell- house erected under his administration. These cells are built in outer walls, and are ventilated and lighted directly from the outside. It is to be hoped that in the West and Southwest counties and cities needing new local prisons will take counsel well in advance in establishing model insti- tutions. VIII. MEANS OF PROMOTING HEALTH The Press and the Fight for National Health What Woman Suffrage Will Do Toward the Conser- vation of Public Health Organized Play and Public Health A Working Program for Rural Education Public Amusements Safeguarded for Moral Health Relation of Nutrition to Public Health A Sociologist's Health Program for the Rural Com- munity The Value of State Laboratories of Hygiene Insane Asylums as Destroyers and Restorers of Health THE PRESS AND THE FIGHT FOR NATIONAL HEALTH GEORGE WAVERLY BRIGGS, EDITOR OP THE GALVESTON NEWS, HOUSTON, TEX. "What I shall say of "The Press and the Fight for National Health" will concern exclusively the newspaper press. I shall furthermore proceed upon the postulate that the question of the national health is perceived through the perspective of its local manifestation, and can be treated by the newspaper press as a whole chiefly by the efforts of individual newspapers to improve the public health through- out the zones of their own activity and influence. The endeavor of the individual paper, addressed to the prob- lems of its own field, forms the thread of energy from which the fabric of country-wide newspaper movements for public health is woven. For the purpose of this discussion I shall assume, with- out spending time to prove, the proposition that the news- paper press is indispensable to the success of public health movements, and it therefore becomes its obligatory duty to exercise its power in their behalf. This granted, the conclusion follows inevitably that the press should face the task as seriously as it enters upon the fulfillment of any obligation which custom, precept, or continued acquiescence in popular demand or expectation has conferred upon it. To view this duty seriously is to accept the discharge of it as a cooordinate function of its professional activity, exact- ing of the sincere newspaper the same careful preparation and continuous attention that it finds to be requisite for the satisfactory performance of other obligations that it owes the public. Animated by no other impulse than a sense of duty, nor pursuing any other course than the systematic use of intelligent and studious effort, can the press, in my opinion, accomplish in the interest of public health the great results that its opportunity and facilities make practicable. The problem of public health has come to be a question 300 THE NEW CHIVALRY — HEALTH of prevention. Health is conserved in the aggregate by safeguards against contaminating influences that are sub- ject to intelligent control. The sanitary sciences have discovered the agencies of disease that it is necessary to curb, and have learned how to master them with compara- tive, if not certain or complete, success. They have prescribed codes and evolved means for the regulation of local, state, and national affairs to minimize present danger and to reduce the chance of infection from foreign sources. Public health organizations throughout the country as a rule are eflScient, alert, and indefatigable in their warfare on disease, but the sum of their accomplishment is restricted by the constant division of energy required for their supple- mentary effort to enlist the aid of the masses in public health undertakings. They are not free to utilize their knowledge and skill for the single service of direction, and thereby augment the benefits of intelligent supervision ; for the great mass of the people are not yet alive to the urgent necessity of lending their cooperation to public health work nor disposed to render willing obedience to regulations that they may profess to approve in the abstract. Whenever they may do so without penalty they are prone to evade the responsibility of individual conformity to rules of sani- tation, without which it would be absurd to assert that collective obedience were possible. The perpetual need of generating influences to induce, to coax, to wheedle and cajole, if not to frighten and compel the public into compli- ance with policies that they know to be vital to the public health, can have no other effect than to minimize the visible achievements proceeding from the service of public health boards and professional sanita!rians. The additional task of persuading the public into cooperation measurably restricts their usefulness the world over. It is not hard to arrive at the cause of this popular obduracy. In this life health is the condition of happiness, sickness the state of distress; and the man does not live who does not thoroughly appreciate the distinction between them. Whenever the choice of sickness or health is offered THE PRESS AND NATIONAL HEALTH 301 man or woman, there is no expense nor sacrifice that will not be willingly undertaken to gain the one and avoid the other. Then why is it, we ask, that our city, state, and national health authorities do not find a more cordial and immediate response to their exhortations for collective and individual aid in the conservation of public health? It is simply because, except at times of great public peril from threatened epidemic of disease, the issue in matters of public health is never drawn as sharply as it is in the indi- vidual case. Preservation of the public health is main- tained by studious attention to things in themselves more or less inconsequential, but which in the aggregate make for the physical weal or woe of the people. The public does not understand that its health depends upon constant and precise obedience to rules and sanitation. In the absence of visible and convincing evidence of serious danger the people for the most part are disposed to minimize the neces- sity of conforming to health regulations, notwithstanding their readiness to admit the soundness of the theory that imposes them. Ignorance of the jeopardy into which their carelessness plunges them; a sort of fatalistic confidence that they as individuals may do as they please without injury to themselves or to the mass; or at most a belief that enough of the population will abide the laws of sanita- tion to safeguard the community from the unseen danger, without their own concurrence — ^this it is, in my opinion, that perpetuates the deplorable attitude of indifference to public health essentials that characterizes so many of the people. Hence I do not believe that the question of the public health will be solved until the great mass of the people are implicitly and constantly obedient to the instructions that science is competent to give them. To bring about this condition of popular responsiveness is the most difficult work of sanitarians; and in the performance of it, in my opinion, the newspapers of the country are to play the most conspicuous and influential part. The prejudices that must be pacified, the apathy that must be energized into life, the 302 THE NEW CHIVALRY — HEALTH opposition that must be converted into advocacy — in short, the tremendous magnitude of the task — impart to this great mission of the press complexities that not only make it advisable, but imperatively necessary, that the undertaking of it be regarded as a serious business, demanding pains- taking preparation, continual study, and more than mediocre skill in the instructive arts, effectively to carry on and eventually to consummate. A newspaper's preparation for this important service begins with an analysis of the public health problem. The newspaper that seeks the maximum of beneficial results from its service asks itself first the question: Upon what does the public health depend? As investigation proceeds it discovers that it depends upon many things, yet so closely related are they as to form components of one compre- hensive causey-namely, the right living of men. Conditions that we are disposed to regard as menaces to the public health are invariably found to reflect improper living in one form or another. This becomes more clearly apparent if we give to right living in the material and collective sense its most inclusive meaning — ^the continuous following of methods that preserve and improve the public health from within and secure it against contamination from without. To illustrate, it would not in the full sense of the term be right living for a seacost community to apply diligently the precepts of sanitary codes to minimize the dangers of local ills if it should raise no bar to the intrusion of contagion from abroad. Per contra, it would not be right living if it employed effectively the most thoroughly efficient system of quarantine against the introduction of disease and per- mitted conditions to exist within its own area that would propagate disease. Therefore, in the sense that sanitarians use the term, right living should be defined as the pursuit of a course that safeguards the public health from the gener- ation of disease and its communication from sources not local to the community involved. Consequently I take it that the prominent function of the newspaper in its fight for public health is the inculcation of the spirit, and encour- THE PRESS AND NATIONAL HEALTH 303 agement in the practice, of right living among the people composing its reading constituency. The newspaper, of course, must know what right living is before it can impart the spirit of it or instruct in its practical side. From this fact issues the necessity of assiduous study of the problem of the public health in its various forms. I have thus far endeavored to show that the news- paper's work in behalf of the public health is wholly a practical service, depending for its efficiency upon a few fundamental things of which a thorough understanding of the subject and adequate, preparation for the task of enlist- ing the people's aid are chief. However, I do not think that the discussion would be complete without exemplifying in less abstract form the character of service which the fore- going has urged. The newspaper with which I have the honor to be connected is one of five publications published by A. H. Belo & Company, including the Galveston News, the Dallas News, the Galveston Semi-Weekly News, the Dallas Semi-Weekly News, and the Dallas Evening Journal. The Belo papers, as they are known in the Southwest, are the stanch champions of the public health and uncom- promising foes of conditions that threaten it. As their success has been notable, their long experience in the fight is valuable to this discussion for the vivid illustration it affords of policies and processes that succeed. These papers understand the public health problem because they have studied it in all its manifestations. They have devoted individual research to it, expending much time and money and employing the aid of many investigators to acquire first-hand knowledge that would assist the cause. They have made it their business to know the question sufficiently well to lead in its solution; they have adequately prepared themselves for the service of leadership. The manage- ment of the publications long since conceived the idea of grouping and systematizing the service they devote to the public welfare, even as the fundamental divisions of the newspaper business — ^the news, editorial, advertising, and mechanical departments — are organized and given entities 304 THE NEW CHIVALRY— HEALTH of their oavh within the organization of the whole estab- lishment. From a member of the staff of their public welfare department I have obtained a concise statement of methods used and purposes sought to be achieved. "The Belo publications," he writes, "have undertaken the task in this section of the United States to secure for the public health service of the country an adequate recog- nition of the important function to be performed by it, and to secure for it proper support and aid; through the appli- cation of the principles of scientific management to bring about in the conduct of its sanitary inspection work such changed methods as will result in the cleaning up of our cities ; to control the serious evil of overcrowding of rooms and dwellings; to incorporate instructive sanitary inspec- tion as part of the work of our health departments and thus teach uninformed members of society What the best standards of sanitation and living are; to find out what is the best kind of house for the wage-earner, and to stimu- late and encourage its construction. "In this battle we realize that no man and no city can win alone; that we must fight together and we must fight for each other. The city which has made a gain this year may lose it next year, unless protected by its neighbors. The city which has not yet started must have encouragement, the compelling power of example, and definite advice and assistance. So will the result of each step forward be cumulative, and as one step after another is taken each will be secured by the advance along the whole line. "We strive to prevent unnecessary sickness and prema- ture deaths. We realize that human assets of the country are worth, in dollars, about five times as much as material assets, and that while it is important ik) conserve our material assets it is more important, from a purely busi- ness standpoint, to conserve the nation's assets in human lives. We strive to suppress disease-producing conditions by giving information as to sanitary engineering, sanitary construction of streets, alleys, houses, sewerage, water, milk, and food supplies ; control of insect life, extermina- THE PRESS AND NATIONAL HEALTH 305 tion of the house fly, and educating the people on the rules of right living. "We disseminate knowledge as to the value of fresh air, clean air, clean bodies; the proper use of the bath, of hot and cold water, and of precautions against infectious diseases. "Through our five publications in Galveston and Dallas we seek to make these things the common knowledge and the common property of the people of the Southwest. Through specially organized departments we instruct our readers in self-care as a means of preserving their own health, the health of their families and their households." AH of which, I will add, means the advancement of the national health, as the health of the nation is determined in the long run by the standard of health attained and preserved by the individual; for the individual is the basic factor in the solution of the communal. State, or national problem. There is but one more thought and I have done. Experi- ence teaches that desultory service is rarely effective in any serious endeavor. Illustration of this truism is nowhere more graphically made than in the prosecution of reforms in all fields of human activity. Be it moral, civil, or economic in its purpose, the process that goes counter to the established order or idle custom of things depends more for successful issue upon perseverance than upon any other serviceable force. Disquisitions now and then upon the subject of the public health are as barren of results that count as the occasional homilies by which some newspapers think they discharge their obligation to the public morals. To elevate the thought and purify the conduct of a con- stituency to the highest degree that those consummations are possible by extraneous influence upon the mass, a news- paper must exemplify in every issue from its presses the ideals and principles that it would commend to the people as the standards of their honor and moral integrity. Like- wise, to promote the economic or political progress of the community it serves, the earnest newspaper puts forth a 20 306 THE NEW CHIVALRY — HEALTH continuous, not a cursory, effort; for it realizes that continuity of influence, and rarely intermittent preachment, brings the people into agreement with it and induces them to follow willingly wherever it leads. So, too, must it serve in the interest of the public health if it would that its service be more than a sham. Day after day, year in and year out, the newspaper finds its opportunity to aid the cause of public health and it achieves according to the persistence with which it utilizes this opportunity. While I have purposefully refrained from discoursing upon the details of newspaper treatment of the public health problem, conceiving it more in keeping with the scope of this address to discuss fundamentals upon which various methods may be formulated, I feel that I should proffer just one suggestion as to the manner of aiding the cause. As far as it is possible to do so in the instruction of the public in matters of health, the dogmatic should be avoided. It does very little good to thunder one's admonitions against a course contrary to the interest of public health. The people will not be driven and dictation invariably arouses resent- ment. Unless reason is the essence of the newspaper's exhortation, and practically its substance, it falls inevitably upon unresponsive ears. The people demand to know why a given course is wrong and rightfully expect to be told how to remedy it. If the newspaper fails to satisfy either demand, its achievement falters. The preparation which I have endeavored to stress as an indispensable part of the newpaper's equipment for assistance in the fight f6r public health — ^that, and that alone, will provide these urgent requirements. In conclusion, permit me to summarize: Being indis- pensable to the success of the fight for public health, it is the inevasible duty of the press to lend its powerful aid to the cause. To perform this duty it should regard its service as serious business which it should understand in its mani- fold ramifications and prepare itself carefully to do. Knowl- edge of what to do and how to do, fully possessed, it requires only perseverance in the undertaking to complete the sue- WOMAN SUFFRAGE AND PUBLIC HEALTH 307 cessful formula. Understanding, preparation, persistence — ^these three qualifications, in my opinion, form the founda- tion, and therefore constitute the prime essentials, of the newspapers' fight for the public health. WHAT WOMAN SUFFRAGE WILL DO TOWARD THE CONSERVATION OF PUBLIC HEALTH MRS. HELENA HOLLEY, PH.B. UNIVERSITY OF CHICAGO, HOUSTON, TEXi. I HAVE been assigned ten minutes in which to talk on suffragism in its broad generic sense, as a help toward the conservation of health, in its every phase — physical, mental, moral, civic. Pretty short time for a woman, and so big a subject! I am going to preface what I may say with two state- ments: I am a Texan, born and bred, and I have come direct from a bended knee. To begin with the concrete, I have been asked why I have become so healthy-lunged a suffragist. I have been somewhat akin to the dear old lady of whom you have read. She was in her kitchen one morning just as busy as she could be, cooking John's dinner, baking John's pies, spank- ing John's babies, and thinking about the time she had spent that morning in looking for John's lost collar button, which he swore that she had lost, and Which she finally found where he had put it away, in his Sunday shirt. Just at this psychological moment in came another woman asking her whether she wanted to vote. Her answer was, "No ! for goodness' sake, no ! I always did say if there was one thing on earth John could do by himself, for the good Lord's sake to let him do it." Yes, like her, I have been very busy; but, amid the multiplicity of my duties, I have found the time, as have 308 THE NEW CHIVALRY — HEALTH thousands of other Southern women, to know that dear old John cannot get along without us in civic matters any more than in domestic ones. Just as he needs his faithful help- mate as a conserver of health and happiness, in his home and with his babies; just as he needs her in the larger home, the school, in church, and in society — just so does he need her in that larger home, the government, and just so does he need her to help him reach that blessed home beyond the stars where the many mansions be. A bit of personal experience that has made me know what woman suffrage could do toward the conservation of health is this : There have been more unemployed in Hous- ton, as elsewhere, this winter, perhaps, than ever before. I have spent a part of my time each day helping to serve thirty or more little children with free breakfasts and free lunches. Most of these children are under twelve years of age ; most of them would go without anything to eat during the day, and all would go insufficiently fed. It would be a travesty on humanity to attempt to teach these children, or to make good citizens out of them, when they are hungry. Their fathers are unemployed. The majority, however, have widowed mothers who work out during the day, when- ever they can get the work. Would it not be an economic move to give these mothers a pension, as women have helped to do in other States, and let them stay in their homes and care for their own children, rather than care for them through social service, school, or private subscrip- tion? Or later, as statistics show too often is the case, care for them in reform schools, or, later still, in criminal institutions? Why should thousands of women, working disciples of the great gospel of physical, mental, moral, and civic health, spend their lives in trying to apply the cure to these cases, when their chances to serve humanity would be infinitely increased by having an authoritative vote as to their best prevention? Of course, woman's place is in the home, and so is man's, at the proper time. It is a very selfish woman though, in most cases, that will give all her twenty-four WOMAN SUFFRAGE AND PUBLIC HEALTH 309 hours to her own home, to the entire exclusion of the rest of the great civic life of which that home is a part. The ballot will augment a woman's chance to stay within a home, and to keep her children there under right and healthful conditions. Fortunate the woman who can spend the greater part of her time within the sheltered precincts of her own four walls. But what about our eight million women wage-earn- ers in the United States whom stern necessity forces from our homes the greater part of the time; what about the thousands of little children under fourteen years of age that are working in our Southern factories; what about the huiidred thousand that work at night, endangering health and life; what about the multiplied numbers that work from six to eleven hours per day; what about those sad- dened homes from which more than 600,000 lives are snuffed out annually by preventable accident and disease? With these great sociological problems confronting us, is it strange that those women who gladly give their lives to the alleviation and uplift of humanity should plead for an authoritative voice, so that their indirect influence may be strengthened by their direct vote? Why is it that statistics show that the greatest percent- age of insanity in the United States is among our farm women? It is the ceaseless brooding over the numerous cares alone with so little to break the endless monotony of the day's routine. Viewed from either a physiological or a psychological standpoint, a mother is a healthier, happier, broader, better mother, who changes her perspective, gets out from her home for a legitimate while, mingles with the world around her, and finds there are thousands of other homes, as well as her own, which she can help to uplift and brighten. Could she possibly spend a few minutes, a year to greater personal or altruistic advantage, than by casting her vote, along with her neighbors, to improve the condi- tions under which her home shall exist? America's men stand, the world over, for a square deal, for justice. Can we women of the land be held respon- 310 THE NEW CHIVALRY — HEALTH sible for the physical, social, and civic health of the home, when we have not an authoritative voice as to the condi- tions in and around that home? I will cite myself merely as an instance of thousands of other women. For fourteen years I have made the living, kept the home, and cared for my children, alone. If I have not made a good citizen, then my city or State should erect a monument over my failure, and on it inscribe, "She hath done what she could." I have some rights, yes. I am allowed the privilege of paying taxes, just the same as any man, and not on the instalment plan either. But not a word can I say as to how those taxes shall be spent. If a high back fence, which I did not have built, keeps me from using the alley in the rear of my home and sends my trash can to the front sidewalk; if, despite all my efforts, after a heavy rain the water stands from two to six inches deep in my back yard ; if, in the summer, the weeds in the vacant lots beside me are higher than one's head — ^not a right have I to speak one authoritative word as to a cure for those unhealthful conditions. Some say, "Use your influence." The power of one direct vote to change those conditions would bring more result than my influence, and that of twenty like me. When we send the blessed gospel of Christianity to the benighted heathen, we tell him it is for all, as free as the air he breathes. Then when you preach the gospel of sani- tation and hygiene to benighted woman, and wake us to the healthful good we may do ourselves and those around us, why do you tie our hands, and say, "All you can do, my sister, is just to come to us and complain. Not one word can you say as to the best cure for that complaint"? Mother love, the mother instinct, that God has planted within us all, wisely applied, is needed toward the legis- lative and educational solution of the great health problems that confront us; the mother instinct that will help any woman, the mother love that will help the mother — no matter what her creed, race, or color — ^to look beyond the things of graft and greed, and see the things that conduce WOMAN SUFFRAGE AND PUBLIC HEALTH 311 to the real needs of her home and her offspring — ^her child of to-day, your citizen of to-morrow. All sense develops by use. Capacity rather than achieve- ment is the truest measure of generic man. If our girls knew themselves as potent factors in the great civic life about them, instead of a thing apart ; if they were to hear mutual civic responsibilities discussed intelligently at home, by father and mother, together — ^would it not be infinitely better than having their thoughts filled, ideals lowered, and health impaired, by "the dansantes," all-night tangoes, and a ceaseless round of questionable movies? We need babies in American homes, but we do not need baby-doll mothers, who have wasted their physical strength in rounds of giddy dissipation, and have been trained from their infancy to look forward to a social debut, or a marriage with "Any- man," as the culmination of life. The universal ballot, and the training therefor, would be an economic move toward the conservation of civic health and resource. It would make, for the present, better wives and mothers and homes, and for future generations a healthier, brainier, purer citi- zenship. Yes, our girls need the educative power of the ballot; but more than all do both our boys and girls — our embryonic world-workers — ^need us. Look at Texas with her wonderful opportunity, her boundless resources — ^the greatest State in the Union, in many respects, yet ranking only thirty-eighth in educational facility and thirty-third in literacy. Look at Houston, with her magnificent system of public education ; with her nearly 25,000 children of free school age, and only about 19,000 of them in school, either public or private, and many of those for only a small part of the time. Where are our other 6,000? Some in factories, many in shops and offices and blind-alley jobs, and an alarming percentage loafing our streets and vacant lots, shooting craps and smoking ciga- rettes. We hail with satisfaction the compulsory school bill, insufficient though it be, recently passed by our legislature. It is wiser and cheaper to educate than to care for the ignorant and diseased in hospitals, asylums, criminal insti- 312 THE NEW CHIVALRY — HEALTH tutions, and houses of shame and degradation. Chicago's yearly educational bill is $1,000,000. Her vice bill is $20,000,000. In our own Southland the ratio of the cost of vice to that of education is equally as great. Yes, our boys and girls need all the strength and heart and mind and soul and votes that both father and mother possess to help them fight the great giants of sin and ignorance and disease with which they each must battle. Cooperation is the progressive slogan of this twentieth- century dawn. Our great democracy with its ever-increas- ing maze of home problems needs us all. We do not want man's place or work in life. We want our own. Leave us our babies, our frying pans, and our brooms ; but arm us with fullest legal rights in seeing that all keep true to the Mas- ter's words, in marriage vows, in working together for the health and happiness of our babies and those of countless years to come. Our men, God bless them, don't we know that they are our best friends? Don't they know that we, their wives and mothers and daughters, are theirs? Southern man of boundless courage, unafraid to cope with anything in air above, or earth beneath, or waters under the earth, /or his womankind, and yet afraid of his womankind! Willing to give the right to vote, concerning the conditions of health and morals that surround his children, to the most illiterate or degraded men that fill our land, and yet afraid to give that right to the mother of his own children ! The handwriting is on the wall. After the storm clouds have passed, with glad assurance we look forward to the fast approaching day of universal enlistment in health cru- sades, universal suffrage, universal prohibition, and uni- versal peace, all foreshowing the dawn of that great eternal day of peace which knows no night. When suffragism comes to our own Southland, God grant that we may meet our added responsibilities, as militants strong, armed with woman's surest weapons — healthy bodies (not fists) , hearts of love, brains of wisdom, and souls on fire with that zeal that comes alone from an open Bible and a bended knee. WOMAN SUFFRAGE AND PUBLIC HEALTH 313 We do not ask compulsory suffragism. Let those good women who do not want to assume this highest civic respon- sibility have that unquestioned privilege, along with the many men who fail to cast their vote. I only speak for the multiplied thousands of thinking, praying women who want the chance to stand by man's side as a world-worker — if within his home, a chance to work as an intelligent partner in everything that pertains to the health and welfare of his children; if on the outside, a chance to earn a living and safeguard the health and interests of ourselves and those dependent on us. We sincerely pray that our great Southern Sociological Congress will go on record as officially indorsing these num- bers of earnest Southern women who plead the privilege of fighting shoulder to shoulder with you in this great war Taeing waged by religion against disease, whose babies are dying at the rate of one every two minutes, whose sons and daughters went down to their watery graves in the Lusi- tania, as a mere incident in the horrors of that other kind of war, in which, God grant, neither you nor we will ever liave to take a part. Yes, you need your women as the most interested and one of the most potent factors in the solution of the great sociological problems we are here to discuss. We plead the Golden Rule. We ask that all may have a -voice and part in the onward, upward march of humanity, in this great transitional period of awakening and Chris- tian enlightenment in which we live. Ten minutes is a short time in which to talk on so momentous a subject, but just give us a lifetime in which to act and we will show what suffragism will do toward the conservation of health in its every phase. 314 THE NEW CHIVALRY — HEALTH ORGANIZED PLAY AND PUBLIC HEALTH REV. HENRY A. ATKINSON, BOSTON, MASS. Play is defined as any exercise or series of action in- tended for diversion or relaxation from work. It may be physical, mental, or a combination of both. Play is an end in itself ; it is doing a thing for the sake of the doing. Work has reference to the result to be attained, and hence work is doing a thing for a reward. The same process may be employed in either work or play. For instance, when one plays a game of cards just for the sake of the game it is play, but when the interest centers in the stake or the prize the same game ceases to be play and becomes work. Play is essential to every normal life; it is just as natural as breathing, for the desire to play is born in each indi- vidual. A boy in the city climbs a lamp-post because there is no tree to be climbed. He uses the only opportunities for play that fortune has thrown in his pathway. Men gather in saloons and in clubs, play golf, hunt, fish, attend ball games, theaters, and dances because of the desire for play and for social intercourse — a desire that is universal. This instinct for play is not easily destroyed, and while it develops very rapidly under cheerful and happy condi- tions it is not killed even by the dull grind of poverty and hardship. The deep-seated propensity of men and women to play proves its worth. This appetite- is no less funda- mental or valuable than the appetite for daily food. A man's body is neither an enemy to be fought nor an instru- ment to be used simply for pleasure, but is the engine by means of which the real purposes of life are to be accom- plished. So much depends upon having a body that is fit for its tasks that it is important to know what to do that we may be always up to the mark in physical efliciency. It is through the medium of play that this result can be best secured. Nature insists and we grasp every opportunity to meet its demands. Emerson in discussing the requisites ORGANIZED PLAY AND PUBLIC HEALTH 315 for a gentleman pointed out that first of all he must be a good animal. The body is made strong, every bone and muscle is made fit and becomes responsive to its task through play. Experimentation through play also trains the senses and brings the growing boy and girl into actual touch with the world in which he is to live. Play serves the needs of the intellect, arouses new interest, recreates strained nerves, and restores the mental balance. Play develops the finer qualities such as justice and fair play. A boy who learns in early life to take defeat gracefully, who assumes the sportsman's attitude toward the vanquished contestant, and who scorns to strike below the belt is almost certain later in life to bring these admirable characteristics into the more serious affairs which demand attention. Play has been called the recruiting office, the drill master of all physical, mental, and moral powers. Body and mind are interdependent. Just as play de- velops physical and mental strength and gives the right turn to the disposition, so it stimulates moral growth. A story is told of one of the boys in a New York school who was an inveterate cigarette smoker. No teaching nor warning could induce him to give up the habit which was undermining his health and destroying both mind and char- acter. He tried three times to qualify in an athletic contest and failed at each trial. The third time that he failed, while he was still in a dejected mood the director came to him and said: "By the way, Joe, do you use cigarettes?" "Of course I do," he replied ; "but that's got nothing to do with me not getting the badge." "Perhaps not," said the direc- tor; "I was just asking for information." The boy tried in the next contest and failed. Crestfallen he sought the director and asked him if he really thought the cigarettes had anything to do with his failure. "I am sure I cannot say," said the director; "I have known them to interfere with the success of athletes. If you could give them up, it might be worth trying; but of course you are so addicted to the habit that you could not stop even if you wanted to." 316 THE NEW CHIVALRY — HEALTH "Who said I can't give them up?" was the angry retort. "Nobody," replied the director; "but having smoked so long I just imagined you couldn't." "You will see," was the reply ; and sure enough he quit smoking and at the next trial six months later won the badge. Play became the best preacher against a dangerous habit that could possibly have been employed. The deadly monotony of the common life of to-day in its incessant toil, its planning for the future, and its carrying of heavy burdens makes a demand upon us to study the question of play and its relationship to life. The fight for better social conditions is taking hundreds of thousands of children out of the mills ; granting to men of all industries shorter hours and more pay; is safeguarding life and making it more difficult to exploit womanhood. These agencies are giving millions of people a chance for leisure and offering the opportunity for good that always comes with leisure. Formerly, when life was less complex, indi- viduals had a wider range of choice. Lives were not cramped. This is all changed ; in city and country alike we find the effects of overiVork and lack of proper play. The social spirit affects country life, but the pleasures of the country are still largely individual. Over against the coun- try we have the city with its socialized life and its offer of pleasure. The glare of the lights makes life in the city appear a happy thing to the boys and girls in the rural dis- tricts living monotonous routine lives withbut much com- panionship or many chances of pleasure. In the decade of 1900 to 1910 the population of the United States increased 21 per cent. During the same period the increase in rural districts was only 11.2 per cent. The decrease or slow increase in rural population throughout large sections of the country is due to social rather than economic conditions, and no great improvement will be made in rural conditions until the people are taught to play together. Fiske thinks the reason that farmers cannot cooperate more successfully in business is because they have never learned teamwork in play as boys. Matthew McNutt tells of his experience in a rural district where he went to serve as pastor of a church ORGANIZED PLAY AND PUBLIC HEALTH 317 during a summer. One of the lads said to him, "This neigh- borhood is so dry socially that if you should touch a match to it, it would burn up quickly." Warren Wilson in making a survey of the rural districts of Pennsylvania, Indiana, Illinois, Missouri, and Kentucky found everywhere the same need of recreational activities. "Generally throughout the farming population it was discovered that no common occa- sion or common experience fell to the country community. The tillage of the soil in these farming communities is very lonely." It is important from every moral consideration that people living in the country district should be contented and have a chance to live normal lives. The present isola- tion and hardships of life in the open country when com- pared to the opportunities for economic advancement and pleasure in the city cause a revulsion of feeling especially in the lives of the young, which leads them to abandon the farm just as soon as they have an opportunity. "I hope I will never see that dreary old ranch again," was the rebel- lious comment of a Western girl spending her first year in the city. If we note great changes in the rural districts, how much greater are the changes in the city. The modern city is the product of the steam-driven machine and is the reflex of the country. Cities have grown large just in proportion to the size of their factories. The city furnishes light, water, pavement, rules and regulations governing life, and gives very little opportunity for the individual to choose for him- self what he will do. Most of his choices are settled for him by the city. The one thing that the city has not been careful to provide is facilities for the people's play. Instead of the home being the center of activity, most of the city people live in the factory. They rest and eat at home, so that they will be fit for the demands of the factory. Michael M. Davis, writing of the exploitation of pleasure in New York City, says: "The home shrinks to a nest of boxes tucked four stories in the air, or the half of a duplex house huddled among its neighbors. There is space to sleep and eat, but not to live. The habitation becomes a sleeping box and an eating den, but often no more. Specialized industry, the 318 THE NEW CHIVALRY — HEALTH basis of a modern city, makes it possible for large numbers of people to live and support themselves within a restricted area. This crowding of population creates a human pres- sure under which most of the normal tendencies of life must find new forms or at least new modes of manifestation. This is a result of the mere fact that the physical limits of space fall so far beneath the minimum of human demand for self- expression." System is the one essential of success in indus- try. There are certain definite processes that must be done in a definite way. A fixed number of hours are devoted to the same task day after day, year in and year out. Go into any factory and see the process. Get acquainted with those who are doing the work and you will find how inevitably the worker comes to think of himself as a part of the machine. Industrialism with its system pays a j)remium on monotony. The same process carried on for nine or ten hours a day, especially if it be a process as simple as pasting labels, tending a machine, or doing any one of the thousand things that are demanded in a modern factory, is so deadening that every element of recreation is taken out of it, so that after the day's toil, when the, thousands of workers are released for their few hours of leisure, they will turn to any kind of play or excitement that will rest them. The city street is the usual playground and the crowd from the factory drift down it seeking pleasure. The boys and girls play their games in the street because it is the only place they can play. Harmless sports become exciting because they are forbidden and the fear of the "cop" gives zest to the game. The street ceases to be the exclusive playground, but is the highway to other places of pleasure — ^the saloon, the pool room, the theater, the dance hall, the moving pic- ture show, the candy shop, and the penny arcade. Most of these are bad, some of them are of questionable value, a few of them may be good, but they are all provided because it is profitable to cater to the people's love of play and because the city in its stupidity has failed to provide this essential part of the citizen's life. The play of our country is largely in the hands of men who are interested only in profits and who are for the most ORGANIZED PLAY AND PUBLIC HEALTH 319 part indifferent, careless, and morally callous in regard to the social effects of the amusements offered. The gaudy, the cheap, the loud, the subdued, the elegant, every type of play facility is offered, and people seek out these to escape the crowded turmoil of the street, to get away from the humdrum existence of factory and shop, and to escape the discomforts of home during the few hours of their leisure. Commercial enterprise and good business sense are thus doing what the city has failed to do. The saloon has built up a mighty business, not because men love to drink, but because the saloon offers the easiest opportunity for develop- ing a social life with recreation and good fellowship. It has capitalized the age-long custom of the use of intoxicating liquors and has surrounded the mere drinking of liquor with the names of enjoying sociability. The dance hall is usually controlled by the same type of man who controls the saloon. Surveys in New York, Kansas City, Chicago, and Cleveland show that there is a very close relationship between the dance halls and the saloons, and it is this fact principally that makes dancing dangerous. Thousands of young people who enjoy dancing and to whom there is no other opportunity for recreation and amusement find their way into the public dance halls — going there with the best intentions in the world, after the long day's work that has fatigued the body and which starved the imagi- nation. It is natural for them to crave the kind of excite- ment that the dance offers. Next to the dance halls in interest are the theaters, moving picture shows, pool rooms, candy shops, and cigar stores. They are also offering the chance for the people to play. There is no opportunity for a large choice, and few people in the community have the money, the leisure, and the good taste necessary to provide themselves with better facilities. Most of the people have to get their pleasures where they can find them. Commercialized play facilities are not necessarily bad in and of themselves. Most people prefer to pay their way and there is no complaint because of the cost, nor should we judge a group of men harshly simply because they have made a good business venture! 320 THE NEW CHIVALRY — HEALTH The point is this, the play facilities should be in the hands of all the people. Just as long as the people danced at home the problem of dancing was individual. Under present con- ditions in our cities dancing is a social problem. If the city is content to leave provisions for recreation in the hands of private enterprise, it should at least see that these hands are clean. The worst evils connected with the play of the people under modern conditions is in the relations that are established. Dancing under right conditions is very differ- ent from dancing in a hall that is controlled by the liquor interests. Surroundings largely determine character. Then there is the bad effect of imitation which grows up with unorganized and commercialized play. The range of law- ■ lessness in the modern dances shows the bad effect of this imitation. Worst of all the effects is perhaps the evil which follows the breaking down of the will power. Because no better opportunities are afforded, people come to follow the line of least resistance and this easy forming of judgments and choices enters into all the more serious affairs of life. The play spirit is often the cause of disaster, as Jane Addams has pointed out in her book, "The Spirit of Youth and the City Streets," but trouble arises and play becomes a danger when it is denied a legitimate form of expression, and selfish, heartless, inhuman commercialized interests are allowed a free field for the debauching of humanity and the destroy- ing of character. The average community has failed to value or control the recreational life of the people. It is usually in the dark as to the actual conditions that exist. There is the puritan ideal on the one hand and license on the other. People are indifferently selfish, inexcusably ignorant, criminally di- vided on the question of right and wrong and often pitiably small in judgment as to the expediency of any proposed plan of action, hence few communities have any play standard. In fact they do not even know what it means when a standard is discussed, have very little interest in establishing it, and almost certainly have no machinery for making the standard effective. ORGANIZED PLAY AND PUBLIC HEALTH 321 The community must come to the rescue. This means that first it must know its present recreational facilities. This information cannot be gained without a thorough study of the situation. The average person in the community knows in a vague sort of way the facts relating to the social life of the people, but very few know the facts definitely enough to be able to state them accurately and convincingly. Each person is apt to think of the particular problems from his own standpoint. The court officials know the boys and girls who get into trouble. The doctors, school-teachers, and ministers all have a partial view of what the community needs. What is needed is a study of the whole situation and the gathering of all the facts and an analysis of all the questions that enter into the life of the community. With the facts in hand they need to be tabulated and compared. It will be easy then to determine whether or not the play facilities are adequate. Knowing how many people desire to play and what their opportunities are for play, it will be easy to form a program that will meet the needs of all. A recreational standard that is worth while should answer four questions: Are the facilities for play adequate? Are they safe from the standpoint of health and morals? Are they controlled by a group of men or women in the com- munity who have the best interests of the community and its citizens at heart? Are they administered, operated or produced in such a way as not to interfere with the rights, privileges, or comforts of the community in general? The Church has no right to stand to one side and criti- cise the people's play unless it can offer something better. Too often the agencies in the community are working at cross purposes. In one of our Southern cities a sum of money had been appropriated for the purpose of establishing playgrounds. A committee of the woman's clubs had one idea as to how the money ought to be spent ; the civic feder- ation had another plan ; a feeble playground association had still another idea ; the business interests of the city wanted the playground made adjacent to the main business street so that they could sell candies and other sweets to the 21 322 THE NEW CHIVALRY — HEALTH children. The churches apparently knew nothing about the matter and expressed no interest. For seven years there was a deadlock until finally one of the churches woke up and succeeded in bringing all the elements of the com- munity together, and out of the various organizations secured members of the playground association. A site was selected, equipment purchased, a director employed, and the city had its playground. What we need more than anything else is cooperation. With it we can establish a standard and reconstruct the play life of the people; without it we will fail, our communities will be merely huddles of houses filled with disorganized groups of people easily and certainly exploited to their ruin. A WORKING PROGRAM FOR RURAL RECREATION WARREN DUNHAM POSTER, BOSTON, MASS. My purpose is to give you, definitely, concisely, didac- tically, a working program for rural recreation. What I have to say will have the literary sparkle of a time-table. I shall be very glad if you can use it like a time-table — ^to get somewhere. I can assume that we all admit the need of proper recre- ation. We know also that the recreational problem is peculiarly pressing in the village and in the open country. One great reason why boys and girls rush to the city is the obvious lack of wholesome, constructively valuable good times in the country. We know, without any word from me, that our city life, our national life itself, is dependent upon a wholesome country life, a life that will keep more country youth in the country. The city is dependent upon the country for the food it eats and — ^more important — for its leaders. The farm's greatest crop is boys and girls. The city is dependent upon them; it uses up its own humanity A WORKING PROGRAM FOR RURAL RECREATION 323 and would perish except for fresh blood and brains from the country. As a matter purely of national self -protection, then, we must do everything we can to help make country life satisfied and satisfying. One of the most necessary means to this great end — I am inclined to believe the most necessary means — is to put organized fun into country life. I shall tell my story backward. That is, the first item in my working program for rural recreation is the one that you will probably attain last. And no doubt, in your com- munities as in many others, you will begin with the last and work toward the first. 1. You must give your community a recreational focal point. You must make the recreational life of the town center somewhere. In some cases the community center will be the church ; in more cases it will be the school — ^that democratic institution that is paid for by all the people and belongs to all the people. If you have ready at hand a complete community center equipment — auditorium, clubrooms, gymnasium, play field, motion picture projecting apparatus — so much the better. Remember, however, that you can succeed without any of these useful adjuncts. Some of the most successful com- munity centers that I have ever seen are one-room country schools, without a dollar's worth of special equipment. In your community center organization be sure to give a meeting place and fostering care to clubs of all worthy sorts. Pay attention to the serious-minded clubs, the organizations of farmers and their wives that come together to discuss the economic and technical sides of country life. Don't forget the boys' debating society and the girls' sewing circle. Music formerly was the great welding force of the country life. Bring back the choral music, the singing school, and the crossroads band. Make full use of your "singing con- ventions." The simple sociable must be prominent in the affairs of your community center. Be sure to provide plays and entertainments as well as lectures upon interesting and important topics. The motion picture is a powerful aid. 324 THE NEW CHIVALRY — HEALTH Remember always that the community center must belong to the community. It cannot be imposed from the outside. Your enterprise will not succeed unless it is some- thing that your neighbors want, unless it belongs to them in fact as well as in name. If your community center is really efficient, the educa- tional extension forces of your State will be able to cooper- ate with you to the best advantage. Unless you have some sort of a community nucleus you cannot get much help from without. There must be some efficient local group with which the outside organization can deal. 2. Community consciousness is one of the greatest assets any country district or village can have. Local patriotism and local bumptiousness are two very different things. One excellent way to make your community feel itself as a com- munity, be concerned with itself rather than with the big city a hundi-ed miles away, is to encourage special day festivals. Bring the whole countryside together as one man — and woman — ^to celebrate the Fourth of July or Thanks- giving, or anything else, it doesn't matter much what. The real point is to get the folks together for a wholesome good time. Encourage pageantry. Make history local. Home- grown pageants are cheap and efficient; if your pageant really represents your community, if it really springs from the soil, country people can handle it well. 3. Make full use of the country's own peculiar assets. Do everything you can to associate the ideas of "fun" and "open country." The way the youth looks at the soil and the rocks, the hills and the creeks — his mental attitude toward them — will determine in no small measure whether he grows up country-minded or city-minded. Yours is a great service to him and to his community if, through play, you lead him to a realizing sense of the poetry, the innate religion, of country life. Reinstate the neighborhood picnics. Remember that country boys and girls, also their fathers and mothers, like to camp and swim and tramp and fish. Introduce nature study into your country schools in such a way that the pupils will learn to love and respect the out- A WORKING PROGRAM FOR RURAL RECREATION 325 door life about them, and have the very best of good times while doing it, Foster their God-given enthusiasm for probing the mysteries of nature. 4. Even here in the South, where you have achieved so much, do you really realize the wonderful service of your corn clubs and tomato clubs? Make full use of these organi- zations as recreational opportunities. Through your clubs teach all the agriculture and household arts you can, but remember that that instruction, valuable as it is, is little more than a by-product. Your great service is to bring youth together in a pleasant, wholesome way, for a common, worth-while end. Into many a country community the corn club and tomato club have brought back the joy of living. Why? Because the clubs have furnished wholesome, happy cooperation — in other words, recreation. The clubs have broken down the isolation that is the curse of rural America. See to it, then, that the joy of the doing, never the selfish striving after a cash prize, remains the actuating motive. Once the boys' and girls' club loses its recreational value, it will very nearly disappear as a socially useful agency. In the village, too, group gardening can be made a useful part of your recreation program. See that gardening is fun, not drudgery. Drudgery has its use, but not here. 5. I need not urge you to cooperate all you can with outside recreational organizations. The Country Work Department of the Young Men's Christian Association will perhaps aid you. See if the Boy Scouts, the Campfire Girls, the Audubon Society haven't something to offer you. As yet the Boy Scouts and its sister organization are both of greater value to city than to country youth, but both are working toward the country. In many cases the Audubon Society has been of immeasurable help to one-room country schools. 6. The last plank in my platform for neighborhood play is probably the one that you will adopt first. Start a play- ground. Install the actual, tangible apparatus. Buy it if you must, but, better, have the boys and girls built it. The apparatus that we built for one country school playground that the Youth's Companion started recently cost $7.40. An 326 THE NEW CHIVALRY — HEALTH outfit at another play field cost fourteen cents more. Now, when our knowledge is greater, we can obtain as good results with even less money. Of course store-purchased steel equipment looks neater and lasts longer, but it never really belongs to the community in as true a sense as does the outfit that is homemade. The playground is useful chiefly for what is done oflf of it. The playground can be called a success when the children manifest a new play life wherever they happen to be. Most country recess periods now are a riot or a time of vapid idleness. Your school and community playground must usher in the reign of organized play — on the playfield and elsewhere. Teach games. Children inherit the play spirit, but they must be taught how to play. We hope our children inherit morality, but we know they do not inherit the ten commandments. Make your competition group competition, rather than individual competition. Use such devices as the athletic badge test. Arrange your athletic meets so as to foster the spirit of achievement through cooperation, rather than of glory through personal prowess. No doubt the system fostered here in Texas by the University of Texas has this desirable feature. I haven't time, of course, to give detailed advice on these points — games to be taught, supervision, and directions for the apparatus. If you will leave me your name and address, however, the Youth's Companion will gladly send you, with- out cost, working directions and detailed information. If you wish, write direct to the Extension Department, the Youth's Companion, Boston, Mass. Moreover, we shall be glad to lend you, without cost except for express, sixty-odd stereopticon slides illustrating what I have been saying to-day. We must be assured, of course, that you will use the slides to advance the cause of neighborhood play. How will the typical country community take to these newfangled innovations? At one of the Companion's dem- onstration playgrounds I was worried on this score until the school trustee began the play by "skinning the cat" on the horizontal bar. Most farmers, much to my delight, have PUBLIC AMUSEMENTS AND MORAL HEALTH 327 admitted the need of play. In many cases they have shown a pathetic eagerness to learn how they could give their children the recreational advantage they knew they needed. Often, indeed, they will set apart a definite time for play — perhaps a Saturday half holiday. Many realize, too, that the organized exercise of the playground gives better muscle even if not more muscle than the chores and work in the fields. There are many reactionaries of course, but, as a whole, the American farmer is a very sensible and kindly person. He wants to have you prove your case. I hope that this definite, working program for rural recreation will in some small measure help you prove your case. You must prove your case. You must put wholesome fun — real fun, constructively and socially useful — ^back into country life, or there will not be much country life left to bother about. PUBLIC AMUSEMENTS SAFEGUARDED T^OR MORAL HEALTH ORRIN G. COCKS, ADVISORY COUNCIL, NATIONAL BOARD OF CENSORSHIP OF MOVING PICTURES, NEW YORK CITY Many phases of public recreation and public amuse- ments have been ably handled by other speakers on the program. It remains for me to discuss with you the super- vision of such public amusements that the welfare of the public may be adequately safeguarded. Among the amusements which command the interest of the American people there is none which has assumed greater proportion than the motion picture. Baseball has drawn its hundreds of thousands, the dances in public and private always have captured the imagination of myriads, the beach resorts are thronged with people eager for play, and the streets and fields lure the children everywhere — but the motion picture daily attracts its millions. 328 THE NEW CHIVALRY — HEALTH Public officials and motion picture exhibitors have wrestled with the problem of the physical surroundings in the motion picture houses in practically every State. They have discovered that the lighted hall is quite as satisfactory as one absolutely dark. Ventilation, sanitation, fire, and panic hazards have also been standardized. Throughout the country the playhouses of the people have been put in good physical condition. This means much to the physical and moral well-being of society. As Kipling says, it is another story when we talk of public dance halls. It is generally accepted that dancing is a wholesome form of public amusement if properly safe- guarded. Here and there throughout the United States adequate regulation has been obtained. The rest of the coun- try can learn much from Cleveland and Kansas City. The supervision also of some of the dancing places in New York is worthy of careful study. It is no longer possible, in many of the larger cities, for dancing to be an incident in an evening of drinking, or for disreputable people to make the dance the opportunity for sensuality, solicitation, and the corruption of character, or close dancing to be indulged in. Evils can be corrected by sympathetic supervision and by periodical inspection of city officials. Those earnest and thoughtful public workers who are vitally interested in the welfare of young people may well devote their attention to the vaudeville being shown for moderate prices in the theaters and motion picture houses of the country. In some of the cities there is much left undone which ought to be done and there is much done which ought not to be done. There is some health in it inter- mingled with evil. The way out is an extension of police powers to all performances or the Oklahoma City plan : "No suggestive or improper acts are permitted here. If you are in any doubt, show your act to the manager." Those skilled in the problems of bathing beaches with their accompanying amusement resorts and the excursion lines plying from the coast cities and on the rivers of the country have stories to tell of excellence and also of degen- PUBLIC AMUSEMENTS AND MORAL HEALTH 329 eracy. Eternal vigilance, poupled with skilled and sympa- thetic supervision, appear to be necessary if positive harm is to be avoided and positive good to result. Apparently it is necessary to maintain not only police and Federal super- vision, but also to work out methods which shall combine both democratic control and skilled cooperation with the management of such resorts and steamboat lines. In all these and in many other phases of amusement we are surely forced to consider the underlying question of the use of leisure time. In a very real sense we are our brother's keeper. It is refreshing to find a rapid development among the people in the assumption of responsibility for thinking their way to the fundamentals of these problems and in working out constructive programs. One of the most refreshing incidents of the past year for me has been the opportunity to learn of the operation of a great public bath maintained by the City of St. Louis under Miss Rumbold and Dwight Davis. Here, we are told, during the summer months twelve hundred people, of all ages and both sexes, are permitted to bathe for three-quarters of an hour each in finely constructed bathing pools. As thousands wait to take their turn, the entire number leave the pools, find their way to the bathing houses, and allow an equal number to take their places, all within six minutes. The people are orderly, the spirit of the place is wholesome, and the super- vision is of the most democratic sort. Some of us have discovered that the people will play. You can't stop them. It is useless, therefore, to take from any class or age those forms of amusement which possess elements of danger without substituting in their places others which have the same appeal which are self-respecting and which lack the element of social harm. Millions of people flock daily from shops, factories, stores, and even homes, where they have been earning their living, to hunt that form of relaxation which will permit them really to live. Some find their joy in study, some search for inspi- ration, many sink into sodden silence and sleep, but most rush out for change, for friendliness, and for amusement. 330 THE NEW CHIVALRY — HEALTH It is surprising that the majority do not crave violent exer- cise: walking, football, baseball, golf, tennis, and riding. They prefer rather those amusements and plays which are passive. Mr. Barrows, of the People's Institute in New York, in 1913 conducted a novel play census of about 110,000 chil- dren. A surprising fact which was brought out was that 20,000 children were watching and that 27,600 children were wandering about idly. If this is a fair statement for children with an excess of vitality, the numbers of those of more mature years who enjoy themselves passively must be much higher. Have you ever thought of the number of men and women who aimlessly loiter on the streets by night as well as by day? In any consideration of recreation questions which have to do with the moral health of the community, these thousands in every city must be carefully considered. There is also that other mass of young people who seek some violent reaction after working hours from the confine- ment and deadening power of routine work. In all our cities and towns they are to be found on the streets at night. They have shaken off the work of the day and are unwilling to spend their evenings quietly at home. They are searching for freedom, sociability, fun, adventure, and for mates. The crowds meet and separate on the corners; they pass each other on the lighted streets, they wander to and fro, forming new combinations and groups. The air is full of laughter and conversation. Many of them wander away from the lights and crowds seeking and finding those experiences which make or break life. Where do they go? What do they do? What happens? What relationships are formed? How can they be directed or assisted to find experiences which will upbuild? , All these questions must be answered by persons like ourselves. The answers must be construc- tive. Little good is accomplished by legislating present forms out of existence or by frowning upon those which are harmful. If some disappear, others equally dangerous will take their places. PUBLIC AMUSEMENTS AND MORAL HEALTH 331 We may as well admit that many forces are at work in the modern American city for breaking down home life. Most of the public and commercial amusements tend to draw people away on the basis of age or sex. Among them all, good, bad, and indifferent, the motion picture stands out as the one which is helping in a modest way to conserve the home. Thousands of families can be found nightly wending their way to the neighborhood picture show and quite as many may be discovered sitting around the dinner table discussing among themselves the ideas which were presented in this neighborhood theater. If the people mil play and you cannot stop them, our problem is a double one, both of supervision and of the creation of new forms. Whenever supervision is attempted, we discover that we defeat our own ends if it becomes formal, dictatorial, or oppressive. It is undoubtedly needed, but should have its well-defined methods and there should be a recognition of its limitations. Recreation workers throughout the country agree that there should be a higher quality and not a greater quantity. In every case, it should be accompanied by sympathy and understanding. Not all persons are fitted by nature or by training to regulate play streets, dancing, settlement houses, public parks and play- grounds, bathing beaches or motion pictures. Those who are bearing the burden and the heat of the day are the first also to recognize that the process of evolving satisfactory forms of recreation is a slow and difficult one. They rather incline to search into the heart of life itself and there find those things which people like, which they take to naturally, and attempt to organize such activities in wholesome ways. Few forms of recreation or amusement have been superimposed upon society with any degree of success. Let us freely recognize also the passivity of the multi- tudes of weary people. Their name is legion. They rush around the country in automobiles when they can afford it. They fill the bleachers at the baseball games. They flock to the theaters to see a few actors or actresses work out some dramatic idea. They get amusement from standing 332 THE NEW CHIVALRY — HEALTH on the curb of the world or sitting on their piazzas and watching the world go by. Among these pleasure seekers who desire to expend the minimum of energy are to be found ten million people in the United States who go daily to the sixteen thousand motion picture shows. In their seats their spirits are renewed while they watch the actors on the screen and have their emotions tickled by music of a certain sort. Truly, in twenty years, the motion picture has been adopted by the people of the country as one of the greatest forms of amusement! Those who find it harmful or negative or vulgar know little of humanity. Quite unconsciously it has slipped into a posi- tion which is now being recognized as second only to the church and the school as an instrument as well for public enlightenment and moral inspiration. Only those who refuse to attend or who have allowed their impressions to be fixed in the early days of the motion picture fail to recognize its power and its potentialities. To be sure, there are some who look upon the movie with suspicion. These concentrate their attention upon the char- acter of the pictures. It becomes necessary, therefore, to state to this body and to others what is being done to regu- late the pictures which are being exhibited throughout the United States and to present the facts about the personnel, the methods, and the policies of the organization which has assumed for society this difficult work. There are no attempts on the part of the National Board of Censorship of Motion Pictures to minimize the dangers. The members of this voluntary, extra-legal, and cooperative organization fully realize that the development of this great art has brought with it serious problems : 1. They have called to the attention of the people that these pictures are displayed to all classes and ages in every part of the country. 2. They recognize also that pictures which are satis- factory for adults may be far from helpful to children. 3. They call attention to the fact that almost the entire motion picture art is in the hands of those who are exploit- ing it for business purposes. PUBLIC AMUSEMENTS AND MORAL HEALTH 333 4. They have made a careful study of the effects of pic- tures upon the post-adolescent group. 5. They have not only recognized the independence of judgment of the different cities and their differences of ethical standard, but have encouraged cooperative regulation of pictures on a democratic basis with the city as a unit. 6. They have honestly tried to present the fundamental facts and the difficulties of motion picture regulation by State and nation to those persons who formulate and those who enforce public opinion. 7. They clearly understand the scope of the motion pic- ture and its possibility of presenting the great and terrible facts of life. It is inevitable that, from time to time, themes shall appear which cause resentment in the minds of certain classes, groups, or persons in individual sections of the country. All these elements of danger are recognized and are being met as skillfully and as fundamentally as a large group of experts and earnest public workers can meet them. It is useless to demand perfection. This comes only to a limited degree and by slow and painful efforts. If one hun- dred fifty volunteer social workers are unable to evolve solu- tions rapidly, it seems absurd to expect that a small, politi- cally appointed group, working under laws in the State or nation, will be able to make more rapid progress or to see that justice is done more fairly for a commonwealth or for a nation of one hundred million souls. During the past year there were placed on the market for exhibition over six thousand film subjects. These presented themes fresh from the minds of a multitude of the most skillful writers of the country. They were gov- erned by few of the limitations of the theater and the play. It was inevitable, therefore, that new problems, dealing with complex, vital themes, should be literally hurled at the head of the members of the National Board. No one could anticipate a week in advance what subtle moral problem would have to be reasoned out from the standpoint of the movie audience. It is therefore surprising that so few themes were permitted to be exhibited which offended against the fundamental morals of the country. Those 334 THE NEW CHWALEY — HEALTH which were prevented from circulation were never brought to the attention of the critical public. Such an organiza- tion as the National Board, therefore, is inevitably judged not by what it does, but by its errors of omission. May I ask you, in a very human sort of way, to consider some of the nice questions of morals? It is an easy task to exclude from public view the things which are undoubtedly bad. But how about those which may not be harmful? The border line questions of morality and conduct are difficult ones. People's opinions vary so much that it is difficult to be fair to all classes in criticising motion pictures. The World and his family are found sometimes during the week at the movies. The motion picture industry, organ- ized for entertaining folks, must deal continually with the problems that perplex all conscientious parents. It is no easy task to discern the hair which divides the false from the true! The National Board of Censorship of Motion Pictures has established standards which are the outgrowth of long experience. Some idea of the variety of rulings which have been codified for the protection of the public can be gath- ered from the following list. This organization sends advices on definite themes to the manufacturers and pre- vents the production of pictures which do not meet with public approval. A partial list includes: The prolonged success of criminals; close and detailed views of crime; deliberate arson for revenge; the senseless use of weapons; near and prolonged views of murder; the actual use of poison and stupefying drugs; contempt for officers of the law; the brutal handling of women and children; cruelty to animals; the unnatural actions of lunatics; distressing views of the insane and feeble-minded ; abandoned drinking and underworld scenes; the insincere and suggestive por- trayal of the social evil; scenes in houses of prostitution and of solicitation; the details of immoral sex relations; over-passionate love scenes; stimulating close dancing; unnecessary bedroom scenes in negligee; excessively low- PUBLIC AMUSEMENTS AND MORAL HEALTH 335 cut gowns; undue or suggestive display of the person; comedy which is vulgarly indecent; humor which offends against morals; flirtations which are sacrilegious or offen- sive to religious convictions; the triumph of evil. In passing judgment upon pictures presenting these and other themes with variations, the National Board recog- nizes that young people frequent the picture shows in large numbers. Such has been the influence of this body that certain classes of pictures have entirely disappeared. Some of the other ideas, imbedded in the list given above, con- stantly recur. The attention, therefore, of the most skilled, sane, and disinterested people is constantly required to prevent their appearance. The great mass of people are slow to act in immoral and illegal ways. They require decided stimulus to cause them to commit immoral acts. There are, however, a few in each community who are unusually open to surface influ- ences. The rest of society must be protected from these abnormal people. It may be the twentieth or the fiftieth man who follows some suggestion and injures the rest of society. It is the function of the National Board to prevent such suggestions from being made in motion pictures. It assumes the responsibility for the protection of the defense- less, the impressionable, the abnormal, and the degenerate. This work of prevention in the motion picture field may be conducted in one of two ways. It may be either destruc- tive or constructive. The destructive method of criticism simply cuts away the bad and at the time wheni opposition is strong and hatreds are engendered. The National Board believes in the constructive method. It works in the region of prevention. While entirely independent and disinter- ested, it makes suggestions to the manufacturers at a time when money can be saved and evils can be corrected at the source. It is wide-awake to the wholesome and developing standards of public morality. When these are ascertained, it passes them on to those who entertain the public. When such cooperative methods fail, when the will of the people is nullified, the National Board calls upon the city authori- 336 THE NEW CHIVALRY — HEALTH ties to enforce its decisions. Many a manufacturer of pic- tures has learned to his sorrow that this money has been wasted by defying this organization. From points as widely scattered as Boston, Milwaukee, Dallas, Kansas City, Memphis, and Los Angeles he has learned that his immoral production was a total commercial loss. The membership of the board is drawn from mature people with large knowledge of life and the fundamental belief in the wholesomeness of humanity. Among the mem- bers there are parents, professional people, educators, social workers, settlement leaders, business men, and church leaders. From time to time, when pictures are presented which introduce difficult individual or social problems, experts are invited to the meetings to advise with the mem- bers. The board is constantly seeking the judgment of the people throughout the country who know motion pictures and their effects on various people and age groups. Although located in New York, as the center of the motion picture industry, the National Board does not accept as a basis of criticism the standards of the New York stage or of its complicated, liberal, and abnormal life. In a very real sense this organization is national. It not only sends information weekly, in the shape of bulletins, of the action taken on all pictures, to four hundred and fifty persons who are cooperating throughout the country ; but it regards these individuals and groups in the powerful conters of population as, in reality, a part of the brain and sinew of the board. There is constant communication between the group in New York and those democratic indi- viduals who are puzzling over the moral effect of amuse- ments on the firing line in the different cities of the country. Their opinions and those of experts are constantly sought and are incorporated into standards which are available not only for the makers of pictures, but for the people who enjoy them. It is entirely within the bounds of truth to state that seven hundred and fifty persons throughout the country are slowly formulating principles and philosophies, while they are constantly engaged in the criticism of motion PUBLIC AMUSEMENTS AND MORAL HEALTH 337 pictures in accordance with the wishes of the American people. This whole organization is an inspiring experiment in democracy. It would have been impossible to organize such an expedition into the region of public morals before the modern democratic spirit had laid hold of the American public. It as steadily continued its explorations because of the enlightened cooperation of wise and far-seeing manu- facturers on the one hand and sane social workers on the other. A word of history may not be amiss. When in 1909 a few of these manufacturers recognized the moral elements in their pictures and of the necessity of some form of disin- terested criticism by persons whose motives were beyond question, they approached Charles Sprague Smith, of the People's Institute in New York. He recognized the dangers as well as the possibilities of such an enterprise. He believed, however, in the fundamental wholesomeness of the people and also in their power to preserve freedom of speech and thought at the same time they assisted in the elimination of those elements which were evil. With some fear and much hesitation, he agreed to gather together a group of thirty-five volunteers who should express their opinion about the moral element in pictures. An arrange- ment was made whereby all the product of the individual manufacturer should be submitted and whereby he should abide by the decision of the board. It was also agreed, at that time, that whatever executive expenses were involved in performing an effective work should be met by contribu- tions from the manufacturing group. These arrangements have been continued until, at the present time, fully ninety- nine per cent of the pictures now produced in the United States are viewed by this board. Throughout the entire cooperative arrangement, lasting over six years, there has been absolutely no attempt on the part of the manufac- turers to dictate policies, standards, or methods. They have, moreover, played fair in abiding by the decision of this board. From the beginning to the present time, no 338 THE NEW CHIVALRY — HEALTH persons have been accepted into the organization who were in any way connected with the motion picture industry. There has existed, however, a spirit of respect and friendli- ness between the individuals and organizations involved in this democratic arrangement which has enabled the National Board to present facts, arguments, and conclusions which have resulted in the continuous betterment of the motion picture. Such an arrangement appears to express democracy at its best. Here is cooperation between business and society, not only for the elimination of the bad, but for the develop- ment, in wholesome ways, of that which is good in a vast and growing art. Over against this plan are many others which are built upon the basis of law. Most of them deal with the finished product and attempt only to discipline and punish by the destruction of property. None of them have gone back to the source where ideas are born and where persons are open to reason. Those experiments in political censorship which have been tested demonstrate the fact that it is extremely dangerous for the political group to attempt to decide the infinite variety of ethical questions which are involved in the display of pictures. It is manifestly impos- sible for two or three persons, on a State Board of Censor- ship, to have that diversified and intimate knowledge of human nature which will enable them fairly and justly to decide on points of morals and conduct for from three to five million of their fellows. It is also certain that when a salary of fifteen hundred or two thousand dollars is paid, the public gets only its money's worth. A careful investi- gation also of the amount of time required for sincere criti- cism of the pictures which come into a State will demon- strate the impossibility of skilled criticism of the whole output. The National Board, on the other hand, probably have failed in some particulars. They do not assume omnis- cience. They freely acknowledge the possibility of erring. It would seem, however, that the latter method is correct. As long as they are both humble and teachable, they may PUBLIC AMUSEMENTS AND MORAL HEALTH 339 be counted upon to do their share in the solution of a national problem. People in all parts of the country are now expressing the hope that there may be some differentiation between motion pictures so that those who wish may see better films. Mothers and fathers, who are interested in the wel- fare of their children, wish to have them attend those thea- ters where they can see pictures suitable for their age as well as their moral and mental development. The pictures now exist, but exist in the midst of a complicated system for circulation from which they can be withdrawn with difficulty. As the demand increases, or is stimulated by organizations like this Sociological Congress, these selected films will be supplied. Here and there throughout the country exchange agencies have been started to meet this demand. Exhibitors also have consciously undertaken to find and display these stories. In most cases both the middlemen and the theatrical proprietors have found little response among the people of their cities who should be most interested. Without question, if this movement is to grow, there must be greater willingness on the part of parents and others to further the experiments. The National Board has given support to the idea and has also prepared monthly lists of selected pictures which, in the judgment of the members, may be shown to audiences either within or without the motion picture theaters. A further development of this same idea is an attempt which is now being made to segregate those film subjects which may be peculiarly adapted for children. Such move- ments do not contemplate the selection alone of the so-called educational film. It has been found disastrous to attempt to show a series of such pictures for entertainment and inspiration. The selection includes stories, dramas, come- dies, historical subjects, fairy tales, poems, etc., which appeal to all classes and ages. Perfection may possibly be obtained in a Eutopia or in a republic which is a modern improvement on that suggested by Plato. However, as long as public opinion controls in 340 THE NEW CHIVALRY — HEALTH these United States, progress must be made slowly and with inevitable compromises. As long as there are tolerated yellow journals, sensual books, smart magazines, musical comedies, third-rate vaudeville, easily obtained divorces, public immorality, reformatories which deform, etc., even public servants cannot go too far or too fast with motion pictures. Among all public amusements, the motion picture ranks high as a wholesome influence. It has proved to be a successful rival and substitute for the saloon. It Is playing its part in binding together the family. It is taking the young people by thousands off the street at night. It is opening the eyes of the intellectually blind and is breaking down the walls of intolerance and narrowness. It is teaching most effectively moral principles in an age when it is difficult to get the eye or the ear of the masses for such instruc- tion. The possibilities have been by no means exhausted. New forms, new methods, clearer presentation, and more remarkable results for public morality lie still ahead. The one thing necessary is the constructive thought of the leaders of America in using this mighty instrument for the welfare of the people. RELATION OF NUTRITION TO PUBLIC HEALTH MISS MARY GEARING, PROFESSOR DOMESTIC ECONOMY, UNIVER- SITY OF TEXAS Public health to the physician and sanitarian means primarily the prevention of premature death and the increase of physical efficiency through the control and elimi- nation of disease. The sociologist measures public health in terms of physical efficiency, also in terms of economic and social efficiency. He views physical efficiency as the foundation RELATION OP NUTRITION TO PUBLIC HEALTH 341 upon which all social advancement and prosperity must rest, and furthers the work of all public health agencies as a means to this end. Food is one of the three essentials to life. It is econom- ically the most important, because it is the one for which the greatest struggle must be made ; for air and water, the other essentials, are, relatively speaking, free commodities. Since the establishment of sanitary science, the demand for a clean and pure food supply as a necessary condition for health has followed the demand for a clean and pure water supply. Active campaigns have been launched against the insanitary production, distribution, and care of foods, and against their adulteration with cheap and harm- ful products. Sanitary safeguarding of foods has become a slogan for health workers, and effectual campaigns have been and are still being carried on throughout the length and breadth of our country. The nation as a whole is being aroused more and more to the great economic and social, as well as physical, loss entailed through insanitary foods. Municipalities, states, and nations are passing more and more stringent laws for their protection. Public health is concerned also with another food prob- lem which is perhaps of greater importance than that of sanitation — namely, nutrition. Rubner, the great German scientist, says : "The problem of the nutrition of the people is doubtless of the highest significance for the quality of a nation." The welfare of the race physically, morally, and mentally is dependent upon it. "As a man eateth, so is he." The process by which the body obtains nourishment has been under dispute since the time of Hippocrates. Carl Voit, a German scientist of the last half of the nineteenth century, was the first to establish the real science of nutri- tion. Some of the greatest scientists of to-day are devoting their lives to the study of this science, and feel that it is still in its infancy. As the establishment of Pasteur's germ theory revolutionized the theory of disease, so will the science of nutrition revolutionize the treatment of disease, and it is believed by many that proper nutrition 342 THE NEW CHIVALEY — HEALTH is destined to be the most effective means the world has ever known for both its prevention and cure. The body to be properly nourished must have sufficient food to furnish energy and to build and repair tissue. Food is divided into four groups, according to its chemical compo- sition : 1. Proteins, which are essentially the tissue builders and repairers, but also may furnish heat and energy. 2. Carbohydrates, which furnish heat and energy. 3. Fats, which perform practically the same function as the carbohydrates, but are more concentrated. 4. Mineral salts, which enter into the composition of all foods and are essential to all cell life and body processes. A mixture of these foods in relatively the proper propor- tions is essential to a well-balanced diet and a well-nour- ished individual. The economic aspect of nutrition is most important. Physical efficiency, as has been said before, is fundamental to all forms of prosperity. Unless a man is properly nour- ished, he has not the physical strength to perform his part in the economic world, but drops behind and probably becomes a social dependent. Sufficient and nourishing food is essential to the right social progress. In a varied diet there is greater opportunity for the food principles referred to — i. e., proteins, carbohydrates, fats, and mineral salts to be present and more correctly proportioned than in a limited diet. It is difficult for the small wage-earner, without a sufficient knowledge of foods, to select them primarily from the standpoint of nutritive value. Dietary studies made by the Russell Sage fund among various classes of working families in New York City showed that 22 cents a day was the least a man could live upon and be properly nourished. When less was expended the result was, as a rule, malnutri- tion, with the general lessening of the resistance of the body to disease. The average workingman's wages are $600 a year, and 45 per cent of this income must be expended for food, if the family is to be properly nourished and be a physical and economic asset to society. The relation of RELATION OP NUTRITION TO PUBLIC HEALTH 343 nutrition to economics is so clear that "he who runs may read." The moral and social aspects are as important and as far-reaching in their effect as the economic. Malnutrition is closely allied to f eeble-mindedness, which is an increasing social evil. Authorities tell us that "malnutrition with lessened resistance to disease is practically the rule in the mentally deficient." Crime, too, is more and more regarded as a diseased social condition. Society which does not pay a living wage to all its members, and does not provide the money and knowledge necessary to secure proper nourish- ment, is and should be held guilty also when a member becomes a criminal because of this neglect. Many crimi- nals are victims of physical and mental abnormalities which may largely be traced to malnutrition. Spargo says: "From the investigations which have been made in this country and in European countries, I am satisfied that poor and defective nutrition lies at the root of the physical degeneracy of the poor, and would justify the conclusion that the mental degeneracy evidenced by increased juvenile delinquency and crime are due to the same fundamental cause." Our eleemosynary institutions, our jails, and our reform- atories are filled with these victims. It is distinctly the duty of society, not only from an altruistic standpoint but from one of self -protection, to alleviate and eradicate these condi- tions. Disease is one of the greatest of all economic wastes. It costs the United States over $1,500,000,000 a year. It also causes a large part of our bitter social distress. Many diseases are the result of malnutrition, or improper nutri- tion. Prominent among these may be mentioned diabetes, gout, scurvy, obesity, beriberi, and probably pellagra, which is increasing in the South to an alarming extent, also many infant diseases which will be considered later. Poorly nourished individuals are always susceptible to disease owing to the general lowering of the body's power of resistance. Tuberculosis, cold, pneumonia, and typhoid 344 THE NEW CHIVALRY — HEALTH are among the most prevalent and fatal diseases to which the undernourished fall victims. In all of these, with prob- ably the exception of pneumonia, diet is considered the principal curative agent. Every child has the right to be well born, but it has also the right to be well nourished after it is born. The relation of infant mortality to nutrition has been established-beyond question. One out of every four children dies before reach- ing two years of age. It is proven that fifty per cent of these children die needlessly, their deaths being due to ignorance or neglect — a scathing arraignment against society which is so wantonly wasteful of her greatest asset, the child. Malnutrition, or poor nutrition, is responsible for most of these deaths, but there is an even more deplorable result. No statistics have been made of the many who survive such food only to swell the vast ranks of the physically, morally, and mentally deficient. Society is paying an enormous toll for this ignorance and neglect in the support of the reforma- tories, jails, and penitentiaries which are so largely filled with these more sinned against than sinning members of society. Child specialists are unanimous in agreeing that food is the all-important factor in infant mortality, and that bad housing and insanitary conditions are relatively unimpor- tant in comparison. Dr. Vincent, a noted London specialist, even goes so far as to say that "sanitary conditions do not make any difference at all: it is food and food alone that counts." The naturally fed infant has always the best chance to survive. Statistics show that three-fourths of the infants who die are artificially fed. During the past year the Home Welfare Division of the Extension Depart- ment of the Texas University has directed nine Better Babies Campaigns. The entries were divided into three classes : First, six months to one year ; second, one to two years; third, two to four years. One thousand three hun- dred and seventy-two children have been given strict medical inspection in these campaigns. The highest scores RELATION OF NUTRITION TO PUBLIC HEALTH 345 have without exception been in the first class and among the naturally fed children. There has never been a 100 per cent baby among the artificially fed. Diuring the siege of Paris in the Franco-Prussian war, despite the great poverty due to unemployment, infant mortality decreased 40 per cent. This was attributed entirely to the fact that the mothers were out of employ- ment and so remained at home and cared for their children. A similar decrease was noted during a prolonged industrial strike at Lancaster, England. It is a well-known fact that infant mortality in mill towns, where there are many women operators, is noticeably high. We may well look with grave concern upon the increasing number of married women in the South who are being forced through economic reasons to go into various industries, knowing that it has already affected, and will increasingly continue to affect, our social welfare through injury to our citizens of the future. Probably the milk stations are the most important agent in reducing infant mortality in our larger cities in the North. Some of our larger Southern cities have estab- lished similar stations with equally favorable results. Cow's milk in its relation to public health is our most important food. It is the most general substitute for mother's milk ; it is used for the older children, and consti- tutes the most important food for invalids and convales- cents. Owing to its composition, unless it is properly cared for it is one of our most dangerous foods. Its nutritional content is impaired and lowered by contamination from various sources. Toxins are developed and diseases are often traced to its contamination by pathogenic microorgan- isms. Epidemics of typhoid, diphtheria, scarlet fever, measles, and of other diseases have been traced to the milk supply. It is still disputed whether bovine tuberculosis can be communicated to human beings, but there is a growing belief that it can be. The milk stations protect the child against insanitary milk, by providing pure and good milk free, or at a greatly reduced price. 346 THE NEW CHIVALRY^ HEALTH Pure milk contains a very low bacterial count. Good milk contains the standard amount of food constituents. In addition to providing milk, regular baby clinics are held. At most of these milk stations mothers are taught to modify milk so that it will approximate the composition of the mother's milk, and are shown sanitary methods of caring for it. They are also given instructions in the care of the child, and are shown how and what to feed it when supple- mentary food is necessary, or when it becomes too old for a milk diet only. By these means thousands of infants have been saved from the nutritional diseases of infancy, such as malnutrition, marasmus, rickets, anemia, gastro-intestinal diseases, and thousands have been cured who were affected with them. Infant mortality in New York City alone has been largely reduced by these means. Municipal aid is given in many towns for such stations. Their general introduc- tion into our Southern towns by municipal aid or by private associations would do much to lower our infant mortality, and to still "the bitter cry of pain from thousands of suf- fering children." Since the physical examination of school children has become more general, it has been found that a distress- ingly large number are in some way physically defective. The percentage varies with the class of children. It is much higher in schools which draw their children from the poorer industrial class, but no school escapes entirely. The relation between these physical deficiencies and nutrition has been irrefutably established. In many cases the child may have had sufficient food, but not the proper food. School children suffering from disease related to nutrition may be divided into three classes : 1. Those coming from poor homes where lack of wages actually prevents the purchase of sufficient foods. 2. Those coming from homes in which plenty of food may be purchased, but where much of it may be low in nutri- tive value, and much may be spoiled by unintelligent prepa- ration. 3. Those coming from well-to-do homes in which care- less food habits are allowed, either through ignorance or RELATION OP NUTRITION TO PUBLIC HEALTH 347 indifference, such as eating sweets and unwholesome food between meals, going to school without breakfast, and other injurious habits. The results are disastrous in all three cases and an economic drain on the community. Functional digestive disturbances are too frequently the result and often develop into organic disease. Because of this poor nutrition, susceptibility to con- tagious diseases increases during the school term, and days and weeks are lost from school and grades repeated in consequence. Said a well-known authority on school chil- dren : "A teacher seeking explanation for inattention, dull- ness, naughtiness, and failure to keep up with class aver- ages, should remember the experiences of auto drivers who, .after testing the batteries, taking out the carburetor, look- ing over pipes and leaks, finally discovers that his gasoline tank is empty." If the source of energy is lowered or exhausted, how can we expect results? The European countries were first to discover that it was a real economic gain to feed the school children. They found that the prop- erly nourished child was able to complete work in less time and do better work than the under-nourished ones. Conse- quently one and sometimes two meals a,re furnished free if necessary, or at a very nominal cost. Half of the German cities support school meals, break- fast or dinner. Belgium, Holland, and Denmark serve meals to underfed children without cost. Sweden, Norway, Spain, and Switzerland also feed their school chilldren. Italy has fifty cities giving meals to school children, and one, Ver- cellie, compels attendance at school meals as part of educa- tion. France serves school meals in nearly every town and city at municipal expense. In England many towns have school luncheons served at public or private expense. Massachusetts was the first State in America to follow this excellent example. Miss Ellen Richards founded the New England kitchen in Boston, and, using it as a distributing point, supplied every high school in Boston with hot, whole- some lunches. These lunches have spread to every large city in the Union. Lunch rooms are now the rule rather than the exception in every well organized high school, and 348 THE NEW CHIVALRY — HEALTH have been introduced into many of the elementary schools. Teachers are unanimous in reporting better work and better health from children so fed. The South has many other nutritional problems which are vitally related to its economic and social development. Probably one of the most important of these is the rural problem. This problem involves not so much a lack of food as improper food. The inefficency of many of our farming class can be attributed to this cause. The efficiency of the farm stock has been increased 100 per cent through scien- tific feeding. It is reasonable to suppose that the efficiency of the human race might be increased proportionately by the same method. The solution of this rural problem is not easy. It is complicated by isolation, lack of education, and above all a lack of means and trained workers to carry on any organ- ized work. The negro population complicates it still further. It was never truer than it is to-day that "the negro is the problem of the South." Aside from our moral duty to the negro, it is necessary from the standpoint of self-protection that we further educational work among the race in every way in our power. Of the 9,827,763 negroes in the United States, 78 per cent live in the South; 6,894,972 live in the rural districts, or 89 per cent of the total number in the South. Disease is much greater among the negroes in propor- tion to the number than among the white race. The death rate from tuberculosis, typhoid, and venereal diseases is higher, making the race a physical menace, through these diseases alone, for disease draws no color line, and where it exists it is a menace to all. Infant mortality is often greater. While no definite information can be obtained from the statistics at hand, it would probably be safe to draw the conclusion that nutritional diseases are even more prevalent among this race than among the whites, with their inevitable accompaniment of poverty, crime, and vice. To teach the race better food habits is not an easy task. But it is one of the many which we are facing and must accom- A SOCIOLOGIST'S HEALTH PROGRAM 349 plish if we are to have better economic and social conditions in the South, for, to quote the health slogan of the Congress, "The health fight is everybody's fight." The relation of nutrition to health is self-evident. Its influence on economic and social prosperity is unquestion- able. It is a vital factor in our problem of public health and must be looked after by much the same methods which other phases of public health work demand: 1. By investigation and wide publicity of the results of such investigation. 2. By cooperation and organization. Little can be accomplished by individual efforts. 3. By education, which is the hope of the industrial class ; through milk stations and public clinics ; through our schools, especially in the South through rural schools. When the woman in the country has learned to feed herself and family properly, we shall have less poverty there, fewer tenant farmers, fewer farm mortgages, better and bigger crops, owing to the farmer's increased physical and mental efficiency. After cooperation, investigation, and organization have been carried out, then legislation may be obtained. When public sentiment is strong enough to crystallize into action, it will carry all before it. To quote the slogan of the efficient Social Committee in the Texas Federation of Women's Clubs: "If the people knew, the people would do." A SOCIOLOGIST'S HEALTH PROGRAM FOR THE RURAL COMMiUNITY L. L. BERNARD, PH.D., PROFESSOR OP SOCIOLOGY, UNIVERSITY OF MISSOURI Not the only dangers to human beings come from physical violence, although in these times of war and inter- national unrest we are too prone to forget or neglect the 350 THE NEW CHIVALRY — HEALTH subtler evils. The menaces to morals and to health have much more disastrous effects, not alone because they claim more victims by actual count, even in war time, than does physical violence, but also because they are so much more secretive in their methods, and of all enemies their approach is the most unseen. As Professor Carver says, "When people realize clearly that babies can be killed with fly- infected food as well as with an ax, they ought to be as willing to work as hard to exterminate the fly as they would to exterminate a gang of murderers who went about killing babies with axes." But the problem of getting people to realize the dangers of germ diseases and moral pitfalls is a very difficult one. Merely the relatively uneducated eye can perceive the dangers of physical violence, but it requires a mind educated in at least the rudiments of the theory of germ diseases and sanitation to apprehend the dangers to both young and old from flies, mosquitoes, tubercle, and intestinal bacilli. The one is capable of dramatic presenta- tion, while the other is for most people information of a highly prosaic character. Likewise, warfare against the one appeals really and vividly to the imagination and can be waged more or less directly, while war against bad health or bad morals requires much more thought and constancy of purpose for its plan- ning than most people are willing to give. For these reasons it may be worth while to set forth here a few suggestions for a program which may be of some value both for acquainting the people of the rural community with the hidden menace to their health and for enabling them to overcome these dangers by eradicating their causes. Good health is one of the primary conditions of a strong and progressive civilization. Where it is lacking most of the other human ills flourish also. Where it is present there is energy and will for the most difficult tasks of society. The country is behind the city in both the matter of information regarding sanitary conditions and in the appli- cation of the methods of sanitation. This is true in spite of the fact that the country has some decided hygienic and A SOCIOLOGIST'S HEALTH PROGRAM 351 sanitary advantages in the way of an abundance of sun- light and fresh air and, for a large portion of the year, of fresh food in greater quantities than the city can afford. There is also an abundance of physical exercise in the country, but unfortunately of such a one-sided character that it does not develop the body harmoniously, but tends in many cases to strain and to impair certain tissues and organs. These are largely natural advantages. For the most part the disadvantages of the country in a sanitary way are the result of man's own negligence rather than inherent in the nature of the country itself. In the country as yet there is almost everywhere less sanitary inspection, and there is consequently less sanitary control over such matters as the drainage of mosquito-breeding swamps, the disposal and destruction of noxious refuse and dead animals, the inspection of the water supply and the milk supply, and less control of diseased and poisonous animals, such as the dog infected with rabies and dangerous snakes. This lack of sanitary inspection and control is not alone due to igno- rance, but is also in large part traceable to the economic costs of carrying out such programs of sanitation, and perhaps equally as often to the lack of proper social and economic machinery or organization for getting it done. The country is also less well supplied with many of the sanitary and health aids which are coming to be relatively so plentiful in the cities, such as good physicians within reasonable calling distance, the district or visiting nurse, hospitals and dispensaries. The country also is too fre- quently lacking in such other hygienic and health aids as public and private bathing facilities, regular and well regu- lated exercise and recreation, protection from sudden changes in temperature and inclement weather. But on the other hand the country does not suffer so extensively from the health-destroying vices which are so common in the cities, especially excessive alcoholism, drug addiction, and the venereal diseases. Most of the leading diseases, in fact, are recorded in census returns as being more prevalent in the cities than in the country districts. There are certain 352 THE NEW CHIVALRY — HEALTH notable exceptions to this general rule. The rural communi- ties exceed in malaria, influenza, dysentery, peritonitis, and the diseases of the nervous and the circulatory systems, and possibly also in pellagra and hookworm. Some health authorities have also attributed much of the cities' excess rate of typhoid to rural vacations and an infected milk supply, though the responsibility probably rests more prop- erly upon the cities' infected water supply. The cities' excessive rate in certain of the largely prevalent diseases, such as measles, whooping cough, diphtheria, croup, scarlet fever, and pneumonia, is due primarily to the high con- tagiousness of these affections which operates to advantage in crowded communities. The country's excess in the diseases earlier enumerated above, on the other hand, is not traceable to the contagiousness of the diseases, but to the inferior sanitation which exists there, and in some cases to physical and nervous overstrain. Thus the comparative statistics of rural and urban health indicate clearly to us the diflSculties in each case. In the country the difficulty is clearly lack of sanitation and physical and mental hygiene. What then is our program for removing these abnormal conditions? There are a great many things that can and should be done. It will suffice liere perhaps to suggest and outline a few of the more impor- tant of these. Perhaps the primary condition for the establishment of better health in the rural community is the provision of a competent health officer and sanitary inspector, one who not only understands the dangers and difficulties of rural sanitary conditions, but who also has the legal powers and the courage to enforce the changes which are necessary. A number of States already make provision for a county health officer, but usually he has, insufficient powers with which to enforce reforms or he is paid for too small a portion of his time, or his appointment is of too political a character, to secure the efficiency which so important a function as his requires. The fact remains that rural health inspection is far behind that which is carried on in the cities, and A sociologist's health program 353 sanitary enforcement is much more nearly adequate in the cities than in the country districts. In order to secure the greatest efficiency in this work its administrative direction should center in the State Board of Health, which should have adequate powers of control over it. A closely related need for the protection of rural health is the collection and publication of vital statistics, including statistics of disease as well as of births and deaths. This function may be performed by or under the direction of the rural health officer or by a separate agency. In either case the statistics entire should be made immediately avail- able to all civic and private agencies interested in the health of the rural community. Statistics of health and of births and deaths have the same value for the rural community as for the urban ; they point out the weak spots in the com- munity's health and thus indicate where work needs to be done. By the aid of such statistics polluted water supplies, soils polluted with hookworm larvae, breeding places for flies and mosquitoes, the need of instruction in dietetics and other matters of household science and management can be indicated. It is therefore absolutely essential to proper health administration in the rural community that accurate and adequate vital statistics be collected and published. It must not be forgotten, of course, that no community, urban or rural, can be given proper sanitary and hygienic conditions unless there are proper laws prescribing mini- mum sanitary conditions and giving adequate powers to the officer or officers having the protection of health in charge. Therefore most, if not all, of our States will have to legis- late anew for the control of rural sanitation. The large essentials of the health code should be uniform over the State, as uniform in fact as are the health needs, while the problems of a purely local nature may conceivably be left to the administrative discretion of the county courts or boards of commissioners. But whatever body may enact the health laws they should be reasonably uniform, and adequate and thorough administrative enforcement should be provided for. But where adequate laws and administrative machin- 23 354 THE NEW CHIVALRY — HEALTH ery for rural sanitary protection do not exist — and such apparently is everywhere the case at the present time — much may still be accomplished through community coopera- tion, provided only there is leadership and the dwellers in the community are made to see clearly the connection between sanitary measures and improved health. The health of most of the rural communities of the South could be vastly improved without any considerable visible economic outlay merely through voluntary cooperative drainage of swamps or wet places, oiling, covering, or filling unused wells, the disposal of all wastes, and the formation of rural improvement societies or clubs for the purpose of observing properties for the detection and reporting of improperly cared for manure piles, the accumulation of rain water in bottles and barrels and other receptacles about the house, and other nuisances, and for the creation of an effective public opinion regarding these evils. Here the problem is primarily one of education and effective leadership rather than of laws, or cooperative labor rather than of a budget raised through taxation. Valuable as such cooperative enterprise must always be for the protection of rural health, with or without laws and administration, it can never com- pletely take the place of the latter, nor will it work with anything like the uniformity w^hich the other provides. No rural health program can claim even approximate adequacy vs^hich does not provide for the district or visiting nurse. The visiting nurse has been an indispensable factor in the health improvement of the cities and is coming to be recognized as one of the first objectives in rural health campaigns. Where the rural district nurse has been employed results have amply justified the expenditure required. Whether the nurse operates over the whole county or a smaller division must necessarily depend primarily upon the density of the population and the value of property for taxation, though at least one visiting nurse to the town- ship, or consolidated school district where such exists, should be the ultimate goal. In those States where town- ship divisions do not exist, commissioner districts or other A sociologist's health program 355 similar divisions may well serve as geographic units for her services. The function of the visiting nurse is normally pretty much the same in rural and in urban communities. She should be available for advice and help wherever there is illness and her services should be as much educational and preventive as curative or ministrative. Her spare time might well be spent in instructing mothers' clubs and similar organizations, in social center or institute and other exten- sion talks, in inspecting school children, and in giving occa- sional instructive talks to them regarding the care of their health and that of the community. No other person perhaps can be of equal help to a community in health protection, for no other comes so intimately into the lives of the people. It is probably desirable that a small fee, of twenty-five or fifty cents, should be charged for each visit she makes, but this fee should always be remitted upon the request of the person benefiting from her services. In no case should her salary depend in whole or in part upon the fees collected, but it should be met out of the regular funds of the county treasury, and the laws of the State should be so modified as to permit of this, where such modification is necessary. Hers is as important a function as that of any other public servant in the county. Transportation is one of the most diflScult problems to be met in this connection, but it is by no means insurmountable. Another urgent health need for the rural community is that every dweller in the country should have easy access to a hospital when there is need for such. Most of our larger cities are more or less adequately supplied with hos- pitals and in most of these there is always a limited number of beds which are available even to the very poor. Only the wealthier country people can now afford to make use of the city hospitals. There is great need of county or district hospitals in sufficient number and with facilities adequate for the care of those who cannot receive proper attention at home. In most cases the oversight of the visiting nurse will insure sufficient expert sanitary care for the person who is ill in his own home, but in a certain number of cases 356 THE NEW CHIVALRY — HEALTH either the gravity of the disease, the lack of home facilities, or some other consideration makes it highly desirable, if not imperative, that hospital treatment be available. Hospitals are, of course, expensive and rarely pay for themselves, much less would they be able to do so if operated on the scale and for the purposes here suggested. But hospitals are not so expensive as disease unchecked or improperly cared for, and this is a fact which should be more generally appreciated. In connection with the hospitals there should be provided dispensaries from which medicines may be distributed to the poor, who would not otherwise procure them, at cost or even in some cases free. Ultimately we may also hope for public physicians, though such does not seem to be immediately realizable. If the other health agen- cies here described are effective, there should be less need for the physician, and perhaps the fact that his services come high may in some degree help to reenforce the value of the counsels of the visiting nurse. Already I have mentioned medical inspection of schools as one of the distinctive health needs of the rural com- munity. Its value is now too generally recognized to require argument by way of reenforcement. To supplement it, however, there should be provided a carefully planned and well executed educational program for the improvement of rural health. Of primary importance in this program is the instruction of school children in the essential facts of sanitation and personal hygiene. In many of the better rural schools much has already been accomplished in this direction. There are now some good textbooks on the subject which teach in a practical and intelligible way the most necessary facts regarding health. Perhaps the weakest spot in the scheme is the teacher who usually has studied ancient languages or some equally esoteric subject to the neglect of such practical matters as hygiene. As a consequence she has not the experience and background to give her teaching the requisite reality. It is here therefore that occasional lectures by the visiting nurse can be most effective. There is a very pressing need that we revise the A sociologist's health program 357 course of study in the rural as well as in the urban schools until they inform us about the lives of our own times and people rather than about the lives and languages of peoples who lived a long while ago and whom we shall never see. It is indeed a poor culture which does not teach one how to live well in his own day and world. The teaching of health and hygiene in the schools will reach the young people, whom after all it is most important to reach. But we must not neglect the older people of the community, for their attitudes of encouragement or discour- agement will affect profoundly the value of the lessons to the young, as well as hasten or delay the actual application of our program to their lives. Therefore we need an abun- dance of plain, practical extension teaching on this subject. Most of our State universities are making some efforts in this direction and the State Boards of Health are frequently doing good work and can do more still. There is no good reason why health extension teaching should not be made available wherever it proves valuable. It can be carried on through local clubs, farmers' institutes, the social center where one has been developed, the rural lecture course, and even the rural church. All of the leading facts about health and sanitation can be easily and clearly presented in public lectures and through bulletins, and people will be interested in them when so offered. Of a more general educational nature, but distinctly valuable in its way, is the rural health survey. Two diseases from which the rural population suffers more than the urban are nervous and circulatory derange- ments. Clearly then more than sanitation alone, perhaps more even than health teaching, must be provided for the rural community. There is too much isolation, life is too monotonous, there is too much introspection, too much brooding over problems and difficulties by the rural dweller and too little self-forgetfulness in the presence of others. For this difficulty we must prescribe a better social life, intercourse which gives to the thought new objects of atten- tion and makes life seem less of a struggle and so little a 358 THE NEW CHIVALRY — HEALTH pleasure. Farm women especially are lacking in such con- tacts. The best remedy here is the social center which cooperates with the home. If contacts are to be broadened, as they should be, care must be taken that they be made restful rather than competitive and destructive of energy. Another indirect menace to health comes from the excessive severity and duration of labor on the farm at certain times of the year. It may not be possible to abolish seasonal labor altogether, nor to find machines to do all of the excessively difficult tasks, but a better system of farm management, more cooperation in farm labor, and a better understanding of the dangers of physical and nervous overstrain should do much to remove some of the worst evils in this con- nection. The various methods of improving rural health here suggested will not come of themselves. If we wish to see them realized, we shall have to work for them at least as strenuously as we strive for the other good things of life. THE VALUE OE STATE LABORATORIES OF HYGIENE B. L. ARMS, M.D., DEPARTMENT OP PREVENTIVE MEDICINE, STATE MEDICAL COLLEGE, GALVESTON, TEX. The subject assigned is one that interests directly or indirectly every individual in the country. That State Laboratories of Hygiene have a value I think no one will deny, but do we realize sufficiently that the extent of their value depends chiefly on the amount they are used? As there is a demand for broadening the work of the State laboratory, the work will be extended to meet the demand, and in some States the laboratories do much more than those in others. Consequently it is difficult to place a limit to their value. The day has passed when the laboratory is THE VALUE OP STATE LABORATORIES OP HYGIENE 359 called on simply to examine a few cultures for diphtheria bacilli, a few sputa for tubercle bacilli, an occasional blood for the typhoid agglutination or the malarial parasite, and a few samples of water to determine its sanitary char- acter. Now the laboratory must be ready to make exami- nations for the causative factor of any disease caused by germ or parasitic life, and where possible to furnish the anti-serum or bacterin for those diseases of a public health nature. Most of the State laboratories confine their work, and I think rightly so, to those conditions dangerous to the public, though a few make examinations that concern the individual only, as the examination of tumors for malignancy. To > the writer this latter appears wholly outside the function of a State laboratory of hygiene, and there is so much of a public health nature to be done that it seems as if this should be left for the private laboratories and hospitals. The State laboratory can render great service along the various lines of public health that will aid the health authorities to do more effective work and the people to enjoy better health. In order to accomplish the greatest amount of good there must be a good understanding of some of the limitations of the laboratory. A physician may have a case of diphtheria, send a culture to the laboratory, and get a negative report. What may be the cause of such result? There are several causes, any of which might be responsible : 1. The organisms may be localized and the physician fail to swab the right area. 2, There may be organisms present that outgrow the diphtheria bacillus on the medium. 3. An antiseptic may have been used just before the doctor made his visit. In the examination of sputum for tubercle bacilli we may fail to find the organisms in the sputum even if the patient has the disease, for they are only found if there is a breaking down of tissue and an outlet that they may be discharged in the material obtained from the lungs. All too often the material submitted is not from the lungs, but from the throat. 360 THE NEW CHIVALRY — HEALTH The examination of water for its sanitary condition may be worse than useless in that it may be very misleading. As an illustration of this I will cite two cases that came under my observation in 1913 while serving as State Bacteriologist in one of the Western States. From sources under investigation for addition to the supply of a large city four samples were submitted in bottles furnished by the laboratory. As this supply had been having a very low bacterial content no dilution was made, and the result was that one sample contained 274 bacteria per c.c, and the other three were uncountable, B. coli being present in 1 c.c. amounts of one sample. Five days later other samples were taken from the same source by the State Health Officer, immediately iced and taken to the laboratory, and the counts were 8-14-16-18 per c.c. and B. coli absent from all. From a city about one hundred and fifty miles from the laboratory eight samples were received, six of them show- ing the presence of B,. coli. The people were alarmed and asked for help. The writer was sent to make a sanitary survey and to get samples. Six were obtained from various parts of the public system, all being free from sewage con- tamination. The laboratory should only examine samples of water obtained by its representatives, and a report of inspection should accompany each specimen. How misleading the result might have been may be seen from the following: Four samples were brought in from a city about forty miles distant, and the man who brought them did not care to say anything about the source. On being told that there would be no examination without this knowledge he con- sented, and said that three were from the city supply and the other was distilled water. Further questioning brought out the fact that the latter was carefully ( ?) collected ; in fact, to be sure that no contamination could get in from the surface of the water, he had taken the bottle in his hand, put his finger on the mouth, and carried it well below the surface. As he was telling this, he was watching, and without a word being spoken he said he saw his mistake THE VALUE OP STATE LABORATORIES OF HYGIENE 361 and that no examination need be made. He had intended to have duplicate counts, one a free examination by the State and the other he intended to have made by a private laboratory. This man was honest, but suspicious, and wanted the count checked, and it is quite possible that if no questions had been asked and answers insisted upon he might have been justified, through his lack of knowledge, in feeling that a laboratory examination is a farce. These instances are cited to show why a State labora- tory should not accept for examination everything that is submitted. Sometimes the most important part of a report is the interpretation, and unless all data are at hand the laboratory man cannot draw proper conclusions, nor can his report be so worded that it will convey to the sender the necessary knowledge, and the one submitting the speci- men may not be capable of interpreting a report. Milk that was over two days in a warm mail or express car has been submitted with the statement that the sender wished to know if it was a proper food for an infant. Of course, at the time of receipt under such condi- tions it was not, but that was no evidence that it was not a proper food when sent. The laboratory examination is but one portion of the evidence and must not be accepted as more. In the fight for clean milk the laboratory is and has been of the greatest assistance, but its value lies in the fact that by this examination it is possible to find if there is something wrong; but let it be borne in mind that it does not locate the cause of the trouble. A high bacterial content of milk means one of three things: Either a high initial contamination, age, or lack of refrigeration, or a combination of any of these. An inspection will show which is the cause and point the remedy. Thus the bacteriological examination is of great value to the health authorities, as it shows if there is anything wrong. At the same time it is of inestimable value to the dairyman who wishes to have a clean, safe product; for the combination of the bacterial examination 362 THE NEW CHIVALRY — HEALTH and inspection will quickly locate the source of danger. When the dairymen realize the assistance the laboratory can render there will be better cooperation on their part and they will seek the aid offered that they may furnish the best possible product. In tracing typhoid epidemics the laboratory offers great assistance in examination of water supplies and indi- viduals, for frequently a carrier is the cause of the out- break. A carrier, as doubtless all of you know, is a person who harbors the organism but who is not himself ill. This carrier may be an individual who has recovered from the disease possibly years before, as was the case of an outbreak in New York City reported by Boldvan and Noble in the Jounml of the American Medical Association of January 6, 1912. This was a milk-borne outbreak of several hundred cases and the cause of the infection was demonstrated to be a man who had had the disease forty-six years pre- viously. On the other hand, the carrier may be one who has never, so far as can be determined, had the disease ; as, for example, the famous Typhoid Mary, who has recently been returned to quarantine for an indefinite period. A great many more instances might be cited, but these are sufficient to show the value of the laboratories in locat- ing the cause of outbreaks of this disease. Again the laboratory may be of great assistance in the prevention of typhoid, both to warn against polluted water supplies and in the production and dispensing of bacteria for the preventive inoculation. The value of this procedure is too well known to need further mention. In the diagnosis of diphtheria the laboratories are of inestimable value if they can be easily reached, for the early administration of antitoxin is of prime importance. On the other hand, in a case that is clinically diphtheria one should not wait for a laboratory report, for time is too valuable. In the release from quarantine also the laboratory report is very valuable, as it may shorten the time of quarantine ; and what is even more important from the public health THE VALUE OF STATE LABOEATOEIES OF HYGIENE 363 standpoint is the fact that the patient is not released until he is free from the organisms, or at least as nearly as can be determined. The State laboratories of the South have been doing a splendid work the past few years in the examination of feces for the presence of intestinal parasites, chiefly hook- worms, and the dispensing of the treatment for the same. In the diagnosis and treatment of rabies the work of the laboratory is well known, but it might be well to con- sider this a moment. The head of an animal may be received in a condition which renders examination impos- sible, as one seen by the writer some time since. The head of a coyote was received after being on the road during the warm weather for four days. This head had been wrapped in burlap and put in a large tin pail and covered. No ice was used and it is needless to say that the express company was very glad to get it off their hands. It was so far decomposed that the brain was but a pasty mass. A head may be sent well iced or the brain may be removed and sent in glycerin, and examination is still possible; but the laboratory man cannot do the impossible. The laboratories are a most valuable aid to any State Health Department and to each individual, for any condi- tion affecting the public health affects also each individual of the State even though he may be hundreds of miles away. They may be made more useful by using them more, nor must it be thought that the examinations are made for the physicians' benefit, as they are for the welfare of the patient and thus for the public. 364 THE NEW CHIVALRY — HEALTH INSANE ASYLUMS AS i)ESTROYERS AND RESTOR- ERERS OF HEALTH PROF. C. A. YOAKUM, PH.D., UNIVERSITY OF TEXAS, AUSTIN, TEX. VIEWED as an outcast from society, as one who was forever, unless by a miracle restored to his right mind, a wanderer on the face of the earth, the mentally sick has lived alone, feared and shunned by other human beings. Considered in league with evil because he mumbled strange charms and incantations, society has treated him, first, with respect because of the dreaded unknown; then as this respect declined, it has handled him more harshly; now, with increasing understanding, we are finally entering the period of sympathetic, scientific treatment. In certain States we can still see evidences of the period when these unfortunates were considered wholly incurable and were therefore incarcerated in what to all intents and purposes was their prison till death released them. I refer to the name "lunatic asylum," that can still be seen cut into the doorstep of the earliest State hospital for the insane here in Texas. We are better informed to-day. We know that these people are suffering from diseases that affect the mind as well as the body, and that many of these diseases are curable. Some authorities state that as high as fifty per cent of the cases are curable if treatment is begun early and is of the right sort. Now we send such patients in the early stages of the disease to hospitals for the insane rather than wait till they are ready for the asylum or prison. Ignorance, neglect, and public laissez-faire policies are the means by which we destroy the mental health of people. In the United States the 1910 census reports that there are 187,791 persons in hospitals for the insane. These con- stitute approximately sixty per cent of those suffering from mental disease in our country. From 1904 to 1910 the numbers in such hospitals increased twenty-five per cent, INSANE ASYLUMS AND HEALTH 365 while the total population of the United States increased only twelve per cent. The insane in our hospitals are increasing twice as fast as the whole population. Our statisticians are not yet certain that this is entirely due to an actual increase. More and more people are under- standing the nature of such diseases and are willing there- fore to have their friends and relatives sent to the hospital where they can be properly treated; or to go there them- selves voluntarily, when signs of approaching disease are noted. Decreasing social aloofness from such disorders also allows their discovery to be made early and permits hospital treatment in time. Notwithstanding all this, the increasing urbanization of our population and the pressure of economic and social strains tend to bring out more and more the hereditary weaknesses in the nervous system and force the consequent development of mental disorders. Fortunately medical and social sciences have striven to keep pace with the increasing numbers of such cases. The dangers of such diseases are better known. The loss of many individuals to the State, to their homes, and to the community ; the increased economic burdens on the remain- der of society; the conception that these are disease spots in the fabric of society ; that many types of mental disorder are actual menaces to innocent persons — all these facts are slowly forcing themselves on public attention. The actual treatment of such disorders is making rapid strides. D'efinite specifics are known for some of the infected cases that show mental disorder. Non-restraint and the psychological study of cases are methods practiced to-day where a few years ago they would have been consid- ered impossible or useless; trained nurses are provided for these patients as in other hospitals; skilled physicians are in attendance; the accessories of a modern hospital for acute diseases, and new methods suited especially to these cases, are supplied. Cottages, farms, village communities, and other less artificial surroundings are slowly appearing in connection with the treatment of mental troubles. We recognize that worry and bad social surroundings are 366 THE NEW CHIVALRY — HEALTH fruitful in breaking down the individual who under more hopeful conditions would continue to fulfil his functions as a member of society till met by a natural death. We know that early mental habits of living and thinking, formed in childhood perhaps, are often the antecedents of mental disorders in adult life. The problem of the mental disorder, its cure, and removal from society is thus seen to range over all the activities of public life. It is not the purpose of this paper to touch all these topics. We are forced to omit a consid- eration of the physician's training for such work, of the proper education of children and adults in matters of per- sonal habits and means of self-control, of the social worker's program as it touches such problems, of the elimination of unnecessary worries and strains incident to existing economic situations, and many other important topics. Our specific problem concerns the State institution already established. What is the duty of the State Hospital for the Insane toward certain of these problems ? We limit the discussion to the State hospitals because there is not a single State in the Union that has not assumed the duty of caring for this type of social unfitness. The census report of 1910 shows that of the total number of insane in institu- tions, 85 per cent are cared for in State institutions, 11 per cent in county and city hospitals, and only 4 per cent are cared for by private institutions. The city hospitals for the insane or mental wards in the regular city hospital show signs of increasing usefulness in this direction. The private hospital is usually too expensive to attract large numbers of patients. Our problem then concerns most directly the State hospital for the insane. What are its duties, its functions, its power, and its responsibility for the solution of the many-sided problems we have so briefly enumerated above? If the State assume the function of caring for the insane, then it must care better for those who are known to be insane; it must increase its facilities so that approximately all of those suffering shall be able to go at once to the INSANE ASYLUMS AND HEALTH 367 hospital for treatment; it must make these hospitals the very best possible, so that when there the patients will recover soon and with the least loss of time be returned to their place in the community. The second great problem, and in reality the prior one, must be to reduce the increase, to get control of the causes of mental disorder, and stop the infection at its source. Whatever the cause, it should be the State's duty to use all the means in its power to discover that cause and as far as possible to remove it. Ignorance of the cause may excuse us, but inactivity, failure to put forth every effort to find that cause, can never be excused. And since the State has undertaken to care for these socially unfit, the people of every State have a right to expect that the resources of their government will be applied to that end. There is little doubt that the State has performed its duty with respect to those in its State hospitals better than any other task it has undertaken to perform. In some States we cannot hope for much more in the performance of this part of its function. All modern methods are put into operation as soon as practicable. Millions of dollars are spent annually in this cause. Hundreds of the best- trained physicians and nurses are used in the attempt to care for and cure these patients. No State has yet succeeded in keeping its facilities growing with the increase in the numbers of patients calling for the services of the hospitals for the insane. It does not seem possible under present methods of State government that this will occur till the second problem is systematically attacked. The hope is that each State will continually strive in this direction, preparing better and better facilities for the insane until it cannot be charged that this class of ills is less well cared for than other diseases of body and soul. I am not concerned over an arraignment of the present methods of hospital management. Many things are being tried in the older and better-equipped hospitals of this country that will doubtless some day become the routine in all hospitals for the insane. Space adequate for all 368 THE NEW CHIVALRY — HEALTH patients applying and a proper classification of, and segre- gation of, the various disorders come only too slowly. Things that are to-day in some hospitals considered routine methods and equipment, as properly equipped libraries, women nurses all over the hospital, various forms of work and recreation with their trained director in charge, are but feebly attempted in the great majority. We are look- ing forward to too many things that ought to exist now. I say we, for not all of these insufficiencies are to be found in any one State hospital; but in some of them, especially in this beautiful Southern land, too much of the proper equipment is still missing. Let me emphasize one or two of the points that are of the greatest importance in the internal management of such institutions. There is a widespread tendency, partly due to low salaries, partly to the laborious routine demanded of the physician, but primarily due to the failure to understand the importance of this branch of medicine, to view the State institution for the insane as a training school for the young medical graduate. You will find that a large percentage of the assistant physicians under the superintendents are young men just from the medical school, acting apparently as internes who hope in a year or two to be prepared for general practice outside the hospital. Such men are not preparing for the work of the specialist in nervous diseases. They have no intention of learning much about mental diseases. They are more interested in those diseases that will come in their later practice. In addition to this atti- tude, they are overcrowded with work and are literally forced to limit their practice to the ordinary ills of these people. It is not uncommon to see situations where one physician has full charge of from two hundred to five hun- dred patients. There are notable exceptions to these lamen- table conditions. We cannot but hope that they will soon be in the majority. There is a place for the young phy- sician in these hospitals. It should be understood that this place means a real interneship. Young physicians should realize that they are taking this place because they wish to INSANE ASYLUMS AND HEALTH 369 specialize in nervous and mental diseases; here they have a chance to come in contact with the men who are at the head of their profession in this special field ; here they are privileged to wprk where the cases are most varied and numerous. Do these new men come in contact with men who are highly trained specialists? I am afraid not. We are still unfortunate in believing that the responsible positions in such institutions are part of the spoils of political favor. Only fifteen States mention as one of the qualifications of the chief officer that he shall be skilled in the treatment of the insane. And in some of these States this notation is not always observed. Sometimes a good man is allowed to remain in office for a number of years. It is not neces- sarily a criterion that he is the man for the place when he does so remain. Keeping up political fences offers just as good a chance for long service. New men appear in such positions with changes in administration. Whatever the character of the man in such a position, this should never happen. The general practitioner will tell you that the mental case is the most difficult in his practice. He rids himself of this case as soon as possible. Yet the State transfers the management of hospitals with thousands of such patients to a man who has had no special training, and whose experience is limited to the few that have come to him in the midst of a general practice. In no other branch of the medical profession are we so ready to assume that just any physician is capable of handling a great hospital. We would not permit such things to happen in the case of an eye and ear hospital, in a hospital for contagious diseases, in surgery, or in any other of the specialized branches of modem medicine. Arising largely from these two conditions is a third. Men in charge of our asylums are not specialists. As a result, they are slow to study the peculiar problems of such a hospital, and hence are slow to urge the needs of their institutions. Laboratories and trained pathologists are within the reach of almost every other regular practitioner 24 370 THE NEW CHIVALRY — HEALTH in the land. Specialists in other fields abound. For the difficult nervous case and the complicated mental disorder the speciahst is wanting. Five fairly well equipped psycho- pathic laboratories and hospitals exist in the United States, where there ought to be at least one in every State in the Union. Where the work of the specialist is needed it is lacking; where special laboratories for the study of these cases are demanded, we find primitive methods in use. All over the South and West there is a crying need for just a few pioneer psychopathic laboratories to educate us to their use and to study the situations peculiar to our communities. No systematic plan exists to study the preventive phases of the problem of insanity. After all, the prime need is to obtain control of disease. We must stop the increase in the number of the insane. In fact, there are some even now who look forward to the time when such diseases are stamped out or are under the control of the health authori- ties as are at present typhoid fever, diphtheria, and many other health dangers that could be named. Under this problem comes much of the extramural work of the State institution for the insane. In discussing it I shall not attempt to separate what is strictly extramural work neces- sary to the present routine of the State hospital and what should be attempted to meet the question of prevention directly. In certain of the States, notably New York and Massa- chusetts, there are voluntary agencies working in con- junction with the State authorities to find the mentally diseased,, to investigate conditions that surround such per- sons, and to care for patients discharged from the hospitals as recovered, while they are readjusting to the new situa- tions. These are problems waiting to be assumed in definite fashion by the State institutions. In the future the State will, through its hospitals, put paid workers in the field, and will be as careful to control the socially unfit as it now seeks to regulate the economically unfit. Actually on the files of our State hospitals for the insane now are data that if gleaned out and put in systematic INSANE ASYLUMS AND HEALTH 371 form would brand certain of our communities and neigh- borhoods as breeders of mental disorder and as dangerous centers from which spread feeble-mindedness and degener- ative diseases. It may not be material for extended publi- cation or for advertisement, but certainly the State authori- ties and agencies for social betterment should have such data. Homer Folks has already directed our attention to one or two instances in which a high suicide rate parallels a high percentage of insanity. The collection of data in connection with these centers of degeneration should be in progress continually. Through no State authority could the work be done better and more eflRciently than through our hospitals for the insane. This extramural work of the hospitals for the insane is in its infancy. It must in the future approximately follow the lines just laid down; and the preliminary steps in the work of prevention may roughly be summarized under such heads as the following: (1) More detailed studies of each patient brought to the hospital must be made. More com- plete histories must be taken of all cases asking for admis- sion. Additional data should be gathered by a regular assistant in the field. (2) All hospitals for the insane should agree on a tentative classification and States and communities should be mapped to show the location and prevalence of the various types of mental disorder. Such a working classification will not stop research, and will materially aid us in prevention in those future years when we know how to prevent. Finally, the work of pre- vention may begin now. (3) Workers and lecturers should move out from our State hospitals as the center doing the educational work necessary, as a definite part of all health campaigns. Such work includes, to illustrate, instruction in the formation of mental habits and ways of living and information concerning the unnoticed peculiarity that later is to appear as hysteria, neurasthenia, and kindred mental disorders of middle life. In their present form our State hospitals are failing in their full duty toward the insane. They are leaving them 372 THE NEW CHIVALRY — HEALTH in county jails and in county almshouses. They are over- crowding them in the State institution itself. They are producing a new being, the "inmate," a person who though well cannot live in society. They fail to complete recovery by not supplying a proper period for convalescence. The work of prevention is yet to begin, though opportunities are developing by leaps and bounds. I believe that if we in the Southern States had a fuller conception of the chances open to us we could here begin and carry to a successful issue one of the greatest experi- ments in the treatment and care of the insane that the world shall ever see. We have the climatic conditions, the space, the sympathy, and the brains to develop institutions that will be models the world over. We could establish village communities and surround them with large farms and other industries, run in the most scientific manner, sufficient to supply work and recreation for all patients capable of utilizing them. In these villages we could put hospitals for the insane only that would meet the rigorous demands of high-grade treatment and scientific research, and all under natural conditions that no other community can supply. Instead, we are willing to follow others and often copy conditions that are actually unsuited to our needs. At present a great work is going on. Still we must destroy thousands of lives yearly because the work is not greater. No one yet knows how many years we cut off from the sum total that might be devoted to the production of social wealth by shutting the insane in prison and jails and in overcrowded and unhealthy asylums. With a hearty appreciation of the present usefulness of the State hospital for the insane, with a full recognition of the difficulties confronting the officers of these institu- tions, I am still looking forward to the time when the aim of all such institutions will be to show a yearly decrease in the number of admissions, and when they can point to an actual decrease in the numbers of those suffering from mental troubles. IX. THE HEALTH OF NEGROES Is the Negro Dying Out? Who Cares? The Causes of Unusual Mortality Among Negroes The Negro Woman and the Health Problem City Housing of Negroes in Relation to Health The South and the Health of Negroes Recreation as Related to the Health of Negroes in Rural Communities Health Problems of the Negro Church Health the Basis of Racial Prosperity IS THE NEGRO DYING OUT? WHO CARES? W. D. WEATHERFORD, PH.D., NASHVILLE, TENN, In connection with no other topic have there been more extravagant statements and wilder guesses than concerning the number of negroes that are in the United States and the number there will be at any given time. The apostles of the race have wildly imagined that the end of this cen- tury would see two hundred million negroes in America, and some of those who are not enthusiastic have been glad to believe that death and immigration would settle our whole race question within the next fifty years^by eliminating our colored population entirely. If these two warnings of race cryers and decryers were not so dead serious, they would be ridiculous and would deserve nothing but silent contempt. Let us see what the facts actually indicate. In 1860, near the opening of the Civil War, there were in the United States 4,441,830 negroes, or 14.1 per cent of the total population of this country. In 1910 there were in the United States proper 9,827,763 negroes, or 10.7 of the total population. During this period of fifty years from 1860 to 1910 the negro population increased by 121.3 per cent, which does not look much like race suicide, though of course it must be remembered that the whites increased 203.6 per cent during the last fifty years. It should be noticed also that the rate of increase both for white and colored has been declining rapidly since 1800. The figures for this decline in proportionate increase is as follows for negroes : 1800-1820 76.8 per cent 1820-1840 62.2 per cent 1840-1860 54.6 per cent 1860-1880 48.2 per cent 1880-1900 34.2 per cent 1900-1910 11.3 per cent 376 THE NEW CHIVALRY — HEALTH The negro formed the following per cent of the entire population in each decade since 1860: I860 14.1 per cent 1870 13.5 per cent 1880 13.1 per cent 1890 11.9 per cent 1900 11.6 per cent 1910 10.7 per cent In the distinctly southern part of the United States his percentage stood in 1910: South Atlantic States 33.7 per cent South Central States 31.5 per cent West South Central States 32.6 per cent Thus we are brought face to face with two clear con- clusions : First, the relative importance of the negro as an element in Southern population is slowly but surely declin- ing; second, this decline is so slow and the number of negroes is so large a per cent that those of us who are here to-night, and the children of this generation and their children's children, will still have to face squarely the issues that arise from the juxtaposition of two very strong and differing races. The relative decline in the proportion of negroes in the United States is probably due both to a decreasing birth rate and to a larger death rate than that found among the whites. The decrease in birth rate is due to numerous causes: First, the changes in economic and social conditions ; second, later marriages ; third, greater prevalence of disease, espe- cially the social diseases; and, fourth, to the type of work done by negro women. This decline is not due to any consti- tutional change in the negro, but to environment and social and moral life. The high death rate among negroes is very alarming, being about twice as high as that for whites, although there is one encouraging thing about it — ^this death rate is not so high now as it was twenty years ago, and it is slowly declin- ing. In 1900 the negro death rate in the registration area IS THE NEGRO DYING OUT? WHO CARES? 377 was 29.4 per thousand as compared with 17.1 per thousand for whites. In 1910 the comparative fibres were 25.5 for negroes and 14.6 for whites, a decided decrease for both races. It seems quite certain that this death rate for negroes is entirely too high since almost all the registration area, when account is made of deaths, is urban, and all who know the negro know he is much healthier in the country than in the city. Let us face squarely the causes of this high death rate in the city. It is easy to say that he dies from a prevalence of tuberculosis, pneumonia, whooping cough, and venereal diseases ; but why are these diseases more prevalent among negroes than among whites? This is the real question to ask. Not, How does he die? but. Why does he die? In the first place he dies because of poor medical atten- tion. Our white physicians have done heroic and unselfish work in visiting these negro homes often without pay of any kind, and a few negro physicians, like the eloquent Dr. Eoman, who spoke just now, have done much to alleviate the suffering of their people. But, in spite of this fact, thou- sands of colored people are bom into the world without attendant physician, and they live their lives and die their deaths without any physician at their sides to alleviate the pain. In the city of Savannah, Ga., during the year 1908, out of 939 deaths of negroes, 173 adult negroes were reported as dying without any attendant physician during their sick- ness, and there were 254 stillbirths, many of which were not attended by any physician whatever. It is perfectly reason- able to suppose that many of these lives might have been saved by the aid of a competent physician. One reason why many of these families do not have a physician is because they have little money and also some race pride which for- bids their calling in a white physician. There is just one way to remedy that situation, and that is to train an ade- quate number of colored physicians to minister to their needs. Our silly prejudice against negro training has hlinded our eyes to this need for decades, and the time has come when we should recognize that a negro physician must iave the same training as a white physician and the State 378 THE NEW CHIVALRY — HEALTH should provide it, for as a layman I would judge that it takes just as much skill and training for a colored physician to deal with a tubercle bug in a colored man's lung as it would for a white physician to deal with that same bug in a white man's lung. We have for too long taken for granted that the good Lord would take care of the children, the defectives, and the negroes, and we have complacently left the whole matter to the Lord. A second fundamental reason why the death rate for negroes is so high is that of poor housing conditions, and that is largely the fault of the white people. As the negro crowds into our city we refuse to let him buy property in the respectable sections of the city, but instead jam him down into the old, musty, deserted homes of deported aris- tocracy where we provide him no paving, no drainage, no sewerage ; where stagnant water breeds disease, where filth accumulates, where no health inspection is carried on — and when he dies like sheep, we denounce him for his filth, we discuss his weak constitution, and we consign him to the place of an inferior physical race. Not only so, but some of us who are highly respectable citizens build one- and two- room shacks and wedge them in as close as sardines. We rent them out at a rate which brings twenty to forty per cent on our investment, and we live on the boulevard, on the unearned interest of our money, while these poor devils boil and sweat and fry in the death trap we have built for them. That I am not overstating the case is borne out by the report of the Bureau of the Census (Bulletin 129, page 46) , where it says : "In the decade from 1900 to 1910 the number of homes owned by negroes in the cities of the Southern States increased by 72,463, or 49.8 per cent. Undoubtedly one of the factors which has caused the decrease in the death rate for negroes from 29.4 to 25.5 per thousand, which decrease is almost universal in the cities of the South, is the increase of home ownership among the negro population. Then the report goes on to state why this home ownership has decreased the death rate, saying: "This increase in home ovraership may be supposed to have brought with it IS THE NEGRO DYING OUT? WHO CARES? 379 better housing conditions." Now this is tantamount to saying that most of the houses we white people rent to the colored people are simply death traps, and the toll we draw from these poor helpless ones is a toll on dead babies, dis- eased women, and discouraged men. Once in Cairo, Egypt, my dragoman one day told me the story of a humble priest who was invited to have a meal with a high official. When seated at the richly loaded table of the official, the priest refused to eat ; and when asked by the official why he would not eat, the priest simply replied : "In every dish of rice I see a cup of blood wrung from the veins of my fellow-countrymen and I dare not eat. Others may do as they like, but as for me I would rather earn my bread by the sweat of my brow than to live from the blood of my less fortunate neighbors." If so-called respectable citizens will persist in building death traps for negroes in unsanitary surroundings, it seems to me that our city officials should pass such regulations as will make impos- sible such wholesale murder. A third cause of this high death rate is infant mor- tality. This high rate of infant mortality is due to two causes: First, immorality as to drunkenness and vene- real disease. It is an alarming fact that in certain Southern cities 25 per cent of the negro babies are born dead and another 25 per cent die before they are one year old. The first 25 per cent of mortality is due to weakened constitution caused largely by drink and sexual excesses — and yet some white people cannot see any reason for getting rid of whisky and preaching a moral crusade. When we white people and colored people both wake up to the awful effects of alcohol on the poorer people of both races, alcohol will be everlastingly doomed. But that other 25 per cent interests me greatly. One-fourth of all the negro babies in certain cities die before they are twelve months old. Why ? Because of unsanitary surroundings, because of insufficient nourishment, because of insufficient care. Most of the negro mothers work away from home and cannot care for their children properly, even if they knew how. Of all the negro females in America over ten years 380 THE NEW CHIVALRY — HEALTH of age, 54.7 per cent are working for a living, while only 19.2 per cent of the white women of motherable age are working at some gainful pursuit. In the cities they are working quite largely in the homes of white people as domestic servants. This means that the negro mother leaves home early in the morning, leaving the baby in the hands of irresponsible young children; or else she puts it in the crib, goes out, locks the door, and leaves the little one to shift for himself all the day — going back perhaps once during the course of the day to tend it. I have visited many negro homes where this was the regular habit. I was told by one negro mother that when she left in the morning she tied a piece of bacon to one end of a string, tied the other end to the baby's toe, and then put the bacon in the baby's mouth. If perchance the baby accidently started to swallow the bacon, the consequent disturbance would cause a kicking motion and the bacon would be restored to its proper place. Ridiculous as that may sound, I have no doubt it was a true story. The negro mother is placed in this awful dilemma. If she will not work for us, we call her trifling, shiftless, and lazy; if she does work for us, she must leave her own baby untended and without care ; and if perchance a large number of them die, we accuse the negro of weak constitution and brutal neglect. If we want the negro women to cook our own meals, clean our own houses, wash our own clothes, and tend our own babies, then in the name of common justice, common humanity, and certainly in the, name of our common Christianity let us give these women a day nursery where their children may be taken care of in health and decency. I call on you women who are here to-night to go back to your homes and ask your cook, or your maid, or your nurse, if she has any children and what she does with them while she works in your home. I am thoroughly in favor of the feminist movement : I believe in the broader outlook on life for our mothers and sisters. I think women should have a share in real life and cease to be drawing-room dolls and parlor wallflowers; but, honestly and sincerely, I will feel IS THE NEGRO DYING OUT? WHO CARES? 381 a little more comfortable about some women having the ballot when they show a little more interest in the care of the baby, even though that baby may have a black skin and a kinky head. Who should care? In the first place, every man who is interested in the economic welfare of the South should care. The South's greatest need to-day is for an efficient laboring class, and the negro is certainly at present our main depen- dence. In the "Negro Year Book," edited by Monroe N. Work, it is stated that 450,000 negroes in the South are ill all the time and that the average working negro loses eighteen days per year from work on account of sickness, entailing an economic loss to our section of $75,000,000 annually. It is further stated that 225,000 negroes die annually, entailing a funeral expense of $15,000,000, and it is added that the total cost of disease and sickness among negroes is $500,000,000 annually. Now if those figures are at all accurate — ^and who would dare say they are too high? — every business man in the South must surely care about the negro death rate. There are other causes which would easily explain the high death rate of the negro, but my time does not permit their enumeration. On this phase of the topic I only want to say that all these causes are removable. If we will train more negro physicians and furnish more hospital facilities, many who now die will be saved. If we will remove whisky from the land, much of the poverty and physical debility will be removed. If we will join in a campaign of sex education and moral uplift, much of the venereal disease will go. If we will provide day nurseries for the children of working mothers, infant mortality will be greatly re- duced. If we will give these people better homes to live in, if we will give them better sewerage, better drainage, better paving, and sections free from vice and crime, then they will have larger hope and larger self-respect, more sober habits, and more healthful and normal lives. Now I come to a closing statement on the last two words of my topic. If the negro is dying more rapidly than 382 THE NEW CHIVALRY — HEALTH he ought, who cares? Who really cares? Do you? I know of no more awful indictment of the hollowness of our boasted civilization and of the mocking of our Cihristian profession than to say that there are some who seem to rejoice in" the rapid death rate of our brothers in black. Let no man delude himself: if he hate the brother of his side, then his civilization is a mockery and his religion a sham. Is the negro dying rapidly? Who cares? We answer, in the second place, that every man and woman interested in the health and happiness of the white race must care. No man liveth to himself and no man dieth to himself. Let not the family that lives on the boulevard suppose that disease can be segregated on the back alley. As long as tuberculosis, pneumonia, and smallpox exist in the alley home, there will be tuberculosis, pneumonia, and smallpox in the home of the boulevard. I thank God that in health conditions at least we are bound to be our brother's keeper, whether we will or no. Is the negro dying rapidly? Who cares? We answer, in the third place, that all who are interested in the building of high moral manhood in the white race must really care. It is a well-known fact that the life of the negro is largely in our own hands. We legislate for him, we superintend his schools, we execute the laws. He must of course lift him- self, by his own moral effort; but we make the conditions under which he must live. In other words, he is our trust. I do not say he is our burden — ^that is a cant phrase which has no real meaning. Economically speaking, he is no bur- den, and the man who says he is has neither examined the facts nor thought through his statement. The negro is not the white man's burden. He is the white man's trust. Now it is a dangerous thing to have a great trust given to you. If you use it rightly, it makes of you a man. If you use it wrongly, it makes of you a demon. Few men can have an absolute trust without becoming domineering and tyrannical. In business, politics, and religion, the giving of great power has all too frequently made men either bigots or tyrants, and often both. The IS THE NEGRO DYING OUT? WHO CARES? 383 greatest moral danger facing the South to-day is this great moral trust. What will we do with it? Will we abuse it and thus destroy our own lives, or will we be true to it and thus grow into a race of worthy men? It is a danger- ous thing for a strong and more advanced race to live con- stantly in the presence of a weaker and less advanced race. My great question is: Will we stand this awful test? Will we care enough to save our own souls? If the negro is dying rapidly, the white man must bear a good share of the responsibility. I mean in the country we give him so little training in the laws of hygiene that he does not know the art of self-preservation. I mean that we allow city landlords to build abominable huts in which the negro has to live. We allow the streets in the sections where he lives, even though within the city limits, to go without drainage, sewerage, paving, or even garbage serv- ice. We allow practices which no self-respecting* com- munity ought to allow, and all these things result in indif- ference, immorality, physical inability, and death for the negro, and we are his murderers. A city council which allows any landowner to do what I saw done in one South- ern city recently — ^build a long row of shabby houses inside the corporate limits, in a marsh without drainage or sewer- age, putting the houses up on posts to keep them out of the water, and rent those houses at forty per cent interest on his investment — any city council that will allow this is either a set of civic imbeciles or a set of knaves. Nay, more, they are a set of civic murderers. The fact that these men go to church on Sunday, subscribe to the Y. M. C. A. on Monday, make a righteous speech on Tuesday, lead the parade for the "City Aid Club" on Wednesday, and so on through the week, does not make them any less criminal. The truth is that in our day the criminal most to be feared is not the red-handed murderer or the pad-footed robber, but the men who, clothed in all their high respectability, sit in their fine offices and smile while poor devils all around them are dying for want of protection from the greed of the money shark, the lust of the landlord, and the chicanery of the cheap politician. The weeping of this people ascend- 384 THE NEW CHIVALRY — HEALTH eth to high heaven, and we raise not our hand to stay the cause of their lamentation. Men of the South, we who glory in the passing of the negro are glorying because of the red-handed murder done by our own race, and the blood of the sufferers will be on our hands. Already that blood is on our heads, already the law of retribution has begun to strike back, and whenever a black boy dies of tuberculosis he leaves behind him a train of suffering white boys who have contracted his disease. Wherever a poor, degraded negro girl passes on because of her crimes of life, she leaves some white mother and some white child suffering the pangs of an ever-present death because she has dragged with her some white man to the very jaws of hell. If the figures I have given spell anything, they spell responsibility. Instead of glorying, as some, in what seems to be the decay of the negro race, self-interest, self-instinct, self-preservation, humanity, Christianity — all unite in demanding that we stay this tide of death. The negro race is essentially a prolific race. His nature has not and could not completely change in a brief period of two or three centuries. If he has become or is becoming a waning race, it is not because of inherent racial disability, but because his environment has been unfavorable. And it should be noted that this environment may be changed. There is not a cause working for the more rapid decrease of the negro population which is not curable. If we shall give them more decent homes to live in and more decent surroundings, impurity will be less prevalent and infant mortality reduced. If we shall see to it that they have better sanitation and better training in the laws of hygiene, there will be less of tuberculosis, fevers, and death. If we shall encourage them to have better homes and help them to have a larger share in the returns of labor, if we shall cease to exploit them for our own selfish pleasure, they will begin to have more hope, more courage, and hence a better chance for a long and useful life. I cannot but believe that the bare physical life of the negro is largely in the hands of the white man. We must be true to that trust. CAUSES OP UNUSUAL MORTALITY AMONG NEGROES 385 CAUSES OF UNUSUAL MORTALITY AMONG NEGROES B. p. RILEY, D.D. In presenting the present views, it may be said that they are derived from close personal observation, experience, and sympathy for a needful race of people. An arduous labor of six years among the negroes of the country, and especially among those of the South, where fully nine-tenths of the race is found, has revealed a situation which is in some respects encouraging but in many others horrible. Two fundamental things the negro needs, one of which is at least an elementary knowledge of the means of preserving health in order to the preservation of life, and the other is a rudimentary knowledge of the principles of morality, in order to the construction of character. These two needs coalese to a large degree, and combined they furnish a ful- crum for the beginning of the elevation of the negro race. The initial theory and dream that education would effect the change necessary was an idle one, and the subsequent idea that evangelism, moving on its ordinary plane, would afford relief is an error. Valuable as each of these is, and more valuable as both are, when combined, yet they strike the negro race, taken as a whole, above the point of funda- mental need. We have partly afforded these means of relief, and then proceed to sit in rigid judgment on the negro, blame him for not squaring with the standard of the Anglo- Saxon race which has reached its standard after the strug- gles of many centuries, whereas the negro has had scarcely fifty years of advancement, and these have been years as much of hindrance as they have been helpful. No race emerging from degradation can change its character over- night. If it were possible for the negro under the conditions of the past, including all that the present affords, to be that which is ordinarily demanded of him, it would be the mir- acle of the age. 25 386 THE NEW CHIVALRY — HEALTH The negro population of the South may be roughly divided into two classes — ^the elevated and the degraded, or, more properly perhaps, the unenlightened, which shades off at last to the degraded class. This class vastly out- numbers the other. It is a noteworthy fact that the ele- vated part of the race, the intelligent, moral, self-respecting, and aspiring negro, with his good home, wholesome sur- roundings, proper food and clothing, and all else that staves off disease, is as free of unusual mortality as is any other race. It is not because one is a negro that he necessarily sickens and dies, but because he is one who does not observe the simple laws of health. It is also a fact worthy of note that in proportion to his intelligence, his disposition to be upright and clean, his morality, and ambitious industry, he is a healthy man. Worthy negroes have a practical axiom that cleanliness relates as much to character as to the physical person, and they train their children under this conception of life. The fractional decrease in the death rate of negroes between the census of 1900 and 1910, taken in connection with the entire race, is due to the fact that the negro is slowly improving in his idea of life, or, in other words, that the worthy ones are increasing every year. However, a fact offsetting this is that there is another ele- ment among them that is drifting annually downward in vice, filth, ignorance, and mortality. These facts are to be kept in view as we shall proceed with this discussion. It will duly appear as these thoughts are presented that igno- rance and negligence usually accompany disease, vice, de- basement, and criminality. These general statements enable us to get the situation more clearly before us, as they acquaint us in the outset with certain guiding conditions. Ignorance on the part of the great mass of negroes, ignorance of the commonest laws of hygiene and of sani- tation, leads to fearful disorders and to increased mortality. For a long time many have insistently urged that negro education be restricted to a knowledge of manual labor. Lying in advance of this in point of importance is a knowl- edge of the primary principles of hygiene and of sanitation. CAUSES OP UNUSUAL MORTALITY AMONG NEGROES 387 A victim of disease is at best but a poor laborer. The negro must be taught first how to take care of his health. This opens the way for the presentation of a most fruit- ful cause of disease and death among negroes — ^that of the prevalence of certain vices among the large lower class. Venereal diseases, as a consequence, induce many fatal ailments. Laxness of virtue, obtuseness of the sense of morality, and abounding ignorance as united are playing havoc with our negro population. One cannot go into a country store in the South, where such store is easily acces- sible to a large negro population, without finding in the medley of drugs all the nostrums that profess to cure vene- real disorders, when in truth their poison is never entirely eradicated from the system. I am told by country dealers that the demand for these drugs, on the part of the negroes, is enormous. Connect with this alarming fact unwholesome food, impure air, and general uncleanliness and they would seem sufficient to destroy that part of the race thus addicted. Nor is this all. Immense numbers of the young women of the race, in order to prevent conception, drink quantities of raw turpentine, bichloride, pennyroyal, extract of tansy, and tea as an extract of the cotton root, while they also indulge in douches of quinine and calomel. Unless the inter- ested physicians of their own race are to be discredited, abortion among them is also on the increase, and this among those who are the better prepared to set worthy examples to their more lowly sisters. Another source from which negroes often fatally suffer is that of the result of exposure. By this is not meant expo- sure itself, but that which succeeds. On far interior plan- tations and in the tenement districts of cities, where are immense multitudes of negroes, they often sleep in the clothes in which they labor, which becomes a source of dreadful mortality. Among other things, the negro inherits, after many generations, the indolence induced by the hot climate of his fatherland. That is the reason why he is so easily disposed to nod under conditions of inactivity. When his physical system relaxes from labor, he is disposed to 388 THE NEW CHIVALRY — HEALTH drowsiness, and often with his apparel damp from perspi- ration of toil he goes to his bed. From this and other attendant sources come pulmonary troubles, which are quite common among negroes. At least eleven per cent of the mortality among negroes comes from pneumonia, while eighteen per cent of those who die perish from tuberculosis. Another source of debility and mortality among these people is that of intoxicating stimulants. If there were no other plea to be urged in behalf of prohibition, the inroads made on this race by intoxicants are altogether sufficient. Many thousands of negroes are rigid prohibitionists, but those who drink, for the most part, drink cheap liquors, because they can be bought in larger quantities. Nor do those addicted restrict themselves to the ordinary liquors of saloons, but in order to satisfy their thirst they resort to stimulants and narcotics of different kinds. Crude alco- hol, cheap bitters, wildcat whisky, essence of ginger, cocaine when it can be had, and whatever nostrums contain alcohol, thousands of negroes drink, many of them to excess, to their own detriment and that of their offspring. Until one acquaints himself with the actual situation, he has no idea of the ruin wrought on the colored race by these narcotics and divers decoctions. Still another fruitful source of death among negroes is traceable to the housing conditions of many thousands. Both in the country districts and in the back haunts of the towns and cities, shanties are built for negro renters that are scarcely worthy the dignity of pigsties. We shall not prove ourselves worthy of our boasted American civiliza- tion till it shall come to pass that houses that are built for rent shall come under a law of inspection as to their fitness for occupancy by human beings, no matter who they are. Beneath imperfect flooring of tenants I have found pools of stagnant water, than which there can be found no more promotive cause of ill health and death. The premises are often horrible from the accumulation of filth and other breeders of disease. For some of these conditions the negro is responsible, while for many others the whites are. There CAUSES OF UNUSUAL MORTALITY AMONG NEGROES 389 should be a statute in each State stipulating the conditions of a habitation. Where a negro, even under the conditions of an ordinary laborer, prizes the value of sanitation, he generally provides them to the limit of his ability ; but the large mass of ignorant and vicious negroes, besides many who are not in that class, but who cannot help themselves, huddle together in filth and squalor, and the results are unspeakable. Often negroes are forced beyond their con- trol to live in the worst sections of towns and cities, which regions are often without drainage, sewerage, or garbage service, and are often compelled to use water from wells sunk in such quarters. On interior plantations huts are assigned for negro residence, which are left foul by the disease of those who were former occupants, while the sur- roundings are putrid, the water in wells is polluted, and the food is bad and badly cooked. It would seem from con- ditions like these, often met with in investigation, that there is nothing left the negro but to sicken and die. These are bare hints or suggestions gleaned from wide and close observation by one intent on learning the worst for humanity's sake. These causes operating and cooper- ating have a terrible effect on the offspring of the negro, and this brings me to the last result, or cause, to be named — that of infant mortality among negroes. Sad as the other aspects of the negro of the South are, this is by odds the saddest phase of all. As many as 60,750 infants die among negroes every year, being 2'7 per cent of all the deaths in the race. Put this fact in abutment on all others named, including race suicide and abortion, and there can be but one conclusion about the fate of this immensely valuable race of people. Set over against this alarming death rate of infants the fact of the declining birth rate, and the negro race is like a candle lighted at both ends. True, there is a declining birth rate among the whites also, but that of the negro is. much in excess of that of the whites. Statisticians tell us that after a careful canvass of the cities of America, it is a fact beyond dispute that negro mortality greatly exceeds that of the white race, especially 390 THE NEW CHIVALRY — HEALTH with respect to two items of vital statistics — ^tuberculosis and infant mortality. The District of Columbia is cited as a fair example of the vital statistics of the two races. Here by a comparison of infant mortality it is found that while 105 white infants under one year of age die out of every thousand, 243 colored infants die, or considerably more than twice the number. With respect to tuberculosis, 127 whites annually die out of one hundred thousand, as against 453 negroes, or more than three times as many. The question economically is, Is the negro worth saving anyhow? while the moral obligation seriously presses itself in the name of humanity and of Christianity. It is not amiss, in passing, to allude to much public indifference with respect to the negro race. I have heard the subject of the rapid decline of the negro race alluded to many times jocularly, and some- times with not a little glee. Two instances have come under my observation where in the removal of the "red light dis- trict" of cities they have been forced into connection with negro settlements. At one time, in a city not a thousand miles from where I am standing, I was appealed to by negroes to assist in preventing a calamity like this. The argument made often is, "He is nothing but a nigger," and to not a few it is conclusive. We hear much of negro progress in economic and educa- tional matters, and he is worthy of all praise for the com- mendable progress which he has made in these departments, but if the race is moving toward a premature grave, what do these mean? If ever statesmanship, public interest, philanthropy, and Christianity were challenged, it is here. What the negro needs is not a profession of white friend- ship merely: he needs aid of the sternest sort and of the most direct character. We of the, white race are under at least two unescapable obligations to the negro. One of these is that of gratitude. As white Christians we fall short of manliness not to acknowledge this, not verbally, but in a most substantial way. These now suffering and dependa- ble people were once our slaves. That which they did in the transformation of this broad land of States from a CAUSES OF UNUSUAL MORTALITY AMONG NEGROES 391 wilderness into a garden establishes the strongest claim to our gratitude, which God will not disregard, even if we do. Beyond that lies still another obligation, which is that of common humanity — ^yea, that of a common brotherhood. 'Humanity is one. There is no blood in religion. We should be shocked if it were proposed to exterminate the negro race by the bullet and the bayonet, but negligence and indif- ference may be as criminal as actual deed. It is no senti- mental outcry to say that the race is perishing, from what or because of what? Pure neglect of a favored race whose position in education and commerce is due more to slave sweat and blood than to any other cause. We need to put some conscience into this matter and less consequentiality. We have had quite enough of mawkish sentimentality expressed in learned addresses, in magazine articles, reso- lutions, and reports, and have carefully wrapped them in paper shrouds and consigned them to forgetfulness. Now let us do something for a race that has done so much for us. No sacred duty is more emphasized in our scriptures than that of the strong to aid the weak. Obligation is at least one question that has but one side. In obligation there is never an option as between choice and action. It is not a result of accident that the erstwhile negro slave is left right here under our trusteeship. God has so interwound the lives of these white and black races that their destiny is inseparable. They must stand or fall together. Scout this as we may, weave all the theories that we may please, yet the grim fact faces us alike from philosophy and history that it is impossible to have a race that is physically and morally declining, living side by side with another that stands aloof or above, and still survive untouched by the fate of the nether race. Providence has so arranged the order and condition of things that the two races must mutually aid and supplement each other. From the dependable part of the race come our laundresses, maids, cooks, and chauffeurs — our nurses, our porters, butlers, and waiters. If there be contagious dis- ease in their homes (and there is in many), they bring it 392 THE NEW CHIVALRY — HEALTH in divers ways into our homes. The settlement of this ques- tion lies in an obligatory, Christlike service to the negro by aiding him practically at different points of necessity, and not by holding him at arm's length, lecturing him in a half- scolding way, and when aiding him doing so often after the manner of tossing a bone to a hungry dog. If there were no weightier consideration than the eco- nomical one, it would still be greatly to our interest to help the negro help himself. It has been estimated that the average economic value of each negro life sacrificed an- nually to preventable disease is $1,700. It is a fact that 450,000 negroes are annually ill from avoidable disease, the cost of the sickness of whom amounts yearly to $75,000,000. It is also true that at least 45 per cent of the deaths annually among negroes are preventable. The avoidable death of 225,000 negroes every year in the South incurs the loss of $170,000,000. This is not fancy, but fact. With facts like these staring us in the face every day in the year, there is a sad lack of duty somewhere. For fear of doing too much for the negro, millions do nothing; for fear of his undue elevation, many jump on him and bear him down, uncon- scious of the fact that as he sinks they are sinking along with him. THE NEGRO WOMAN AND THE HEALTH PROBLEM C. v. ROMAN, A.M., M,.D., NASHVILLE, TENN. It is difficult to speak or write well when the intellect is too much crowded by the emotions. I feel too deeply upon this subject to do it justice; yet the subject is urgent and discussion necessary. We must therefore attempt to speak the truth for our own edification and the good of our country. Some one has estimated the range of a cater- pillar's vision. It is two-fifths of an inch. If this be true, the caterpillar sees farther than the man or woman who will not hear the truth. THE NEGRO WOMAN AND HEALTH 393 It is hard to fill the head with knowledge without filling the heart with sorrow. Much learning is often a weariness to the flesh. The history of the world is the martyrdom of man and the history of man is the martyrology of woman. It is a strange phase of human depravity that the most sorely oppressed become the most heartless oppressors when opportunity offers. Prisoners make the meanest guards and slaves the worst masters.* The unfortunate but frequent and mutual dislike of the "niggahs" and the "po' trash" in slavery days is a historical example of this frailty, while the occasional tyranny of labor leaders dark- ens the annals of our own times. Woman is indeed man's equal here. The student of history is sickened and pained by the frequency with which woman appears as the chief actor in the tragedy of "man's inhumanity to man." The imagination of Dante, seconded by the pencil of Dore, draws an awe-inspiring picture of the punishment hades offers the souls of women who on earth tortured and degraded other women. Women were the applauding spectators and frequently gave the signals for the gladiatorial butcheries of ancient Eome. Protestants were burned at the stake under Queen Mary and Catholics were disemboweled under Queen Eliza- beth. Catherine of Russia amused herself by watching the process of freezing naked girls to death by having cold water poured on them in the open air in the dead of winter until their bodies were the centers of statues of ice. The oldest and heaviest instrument of oppression that has fallen upon the life of women is the brothel ; yet from the- dawn of history in ancient Babylon to its latest manifestation in this city women have been the frequent keepers of these gates of perdition. These general historical facts are related to soften the enunciation of an unpleasant truth. We are all our own worst enemies; the negro woman is not an exception to this .*Rev. Emperor Williams, one of the strong preachers of the Methodist Episcopal Church, was in 1840 sold to a negro in Louisiana ■who treated him badly. 394 THE NEW CHIVALRY — HEALTH universal human rule. The most imposed upon unit of modern civilization, the negro woman, has too often let bad conduct increase the hardships of her condition. Of her frailties let others speak. If her sins are many, her oppor- tunities are few and her temptations great. I beseech you in the words of Dante, "Look only and pass on." It was the virtues of the negro woman that put the first word in the common language of slavery which acknowl- edged the humanity of the slave and the ethnic kinship of master and servant. "Mammy" was the first contribution to the all too scanty vocabulary of racial comity. "Uncle" and "aunty" followed. However archaic and atavistic these words may sound to-day, they were the verbal bridges over which human affection crossed the double chasm of social degradation and racial differences. They breathe a differ- ent spirit from "nigger," "coon," "darky," etc. The word "mammy" is the eloquent and lasting testimony of the white ante-bellum South that the negro woman possessed the one absolute essential moral qualification of womanhood, good'- ness. The life of the ideal woman is a symphony in which goodness is the keynote, while man's life is an oratorio of which courage is the dominant chord. There is little hope for a bad woman or a cowardly man. The good women and the brave men are the salt of the earth. All the sinful are not bad and all the weak are not cowardly. The word "sin" means etymologically to miss the mark ; and weakness some- times arises from kindness rather than cowardice. Good intentions may have a poor "aim" and a brave spirit poor judgment. On behalf of the good-hearted women of my race and of every race, whatever their moral strength or social position, I plead for opportunity to increase in goodness and to improve in usefulness. Man is nine-tenths psychical and only one-tenth physical. What he thinks is nine times as important as what he eats. We do not fully appreciate the part thought plays in our lives. Prof. Josiah Morse, an educated Southern man, recognized this factor in our racial situation and truly says : THE NEGRO WOMAN AND HEALTH 395 "When Descartes persuades his contemiporaries that animals were mere automata without intelligence or feeling, even the tender-hearted Malebranche could without hurt to his feelings kick the dog that was fawning on him. When belief in demoniacal possession was prevalent, excellent God-fearing men helped to burn, stone, and drown the possessed. The belief that their ancesters were much wiser and better than they could ever hope to become had much to do with arresting the development of the Chinese for more than two thousand years. And so the illustrations might be multiplied. "I fear that the attitude of many of our people toward the negro has been determined to a considerable extent by equally erroneous ideas. They have been persuaded by a generation of short-sighted, uneducated, and unscrupulous demagogues that the development and elevation of the negro is somehow incompatible, with the best interests of the white man; that prosperity for the black man spells ruin for the white man; that what is good for the one is bad for the other ; what is true for one is false for the other. And so this strange state of affairs has come to pass : that those traits and things we admire when possessed by our- selves and all the white world, we despise when they appear in the, negro; our virtues, when cultivated and practiced by the black man, become by some strange alchemy trans- formed into vices. Thus we recognize that education is a good thing, and those who strive for it are deserving of approbation and even praise. Likewise manliness and self- respect are commendable, and ambition and thrift and the pursuit of happiness are not to be condemned. And yet there are too many who prefer the lazy, ignorant, diseased, immoral negro, even the vicious and criminal one, to the self-respecting, progressive, property-owning, educated one. "Now it is evident that this condition cannot long con- tinue without endangering the very foundations of civili- zation. Double-dealing of this sort is bound ultimately to bring bankruptcy and ruin. Hence the urgent need, as I see it, for courage, patriotism, zeal to be spent in popular educational efforts which shall seek to bring about a change 396 THE NEW CHIVALRY — HEALTH in the prevailing attitude toward the negro similar to that which Rousseau wrought, single-handed, in the field of education proper, and later in the realms of government." What the world needs to-day is a deepening of the sense of brotherhood and sisterhood. "The seat of race antagonism is race prejudice. The united sympathy at the basis of cooperation curbs this harmful spirit. . . . To-day the adjustment of race differ- ences is the problem not only of the humanitarian, but of true citizenship. The modern ideal must be world citizen- ship." Man is his brother's keeper. Aye! and woman is her sister's keeper too. "The sins of the immoral will destroy the safety of the moral, the disease of the weakest will destroy the health of the strongest, the prejudice of the most ignorant will warp the judgment of the most learned, the lawlessness of the most criminal will blacken the fair name and drag into criminal action the law-abiding instincts of the highest citizens. We must stand or fall together. Thank God this is true ! This insures that the learned shall not despise the ignorant, that the physically strong shall not despise the physically weak, the rich man cannot scorn the poverty- stricken, the righteous cannot become self-righteous in their contempt for the morally weak."* For some reason or other, the negro's plea for brother- hood is misinterpreted. Governor Northen said on this sub- ject : "Social equality is a delusion set up by the demagogue in civic contentions to meet his ambition for place and personal power, and paraded as a device of the devil for the strengthening of the influence against the kingdom of God." What men want is not equality, but sympathy, humanity, civic justice, and human rights. I ask no fanciful elevation of my race, just only this: When you coTisider the public welfare include us. I ask that the women of my race be admitted to the great sister- ♦Weatherford. THE NEGRO WOMAN AND HEALTH 397 hood of humanity. Let the safeguards of female chastity be thrown around them and the rewards of uprightness be placed within their reach. Virtue thrives on appreciation. Let the homes of colored women be sacred and their employ- ment be without exposure and temptation. Women need the love of women and men need the love of men. How to bring this about is the great problem of civilization. Study the picture that Jesus drew of the good Samaritan. It was a man that journeyed from Jerusalem to Jericho and fell among thieves. It was a man that lay by the wayside, naked, robbed, and wounded. The priest and the Levite that passed by on the other side without offering either sympathy or assistance were men — males, I mean. The good Samaritan that gave succor and conso- lation was a man. The Great Teacher that drew the pic- ture was a man talking to men. My friends, don't you see the lesson? Had the victim of the Jericho thieves been a woman, neither the priest nor the Levite nor any othel: son of Adam would have passed without stopping. If the chance travelers in this story had been women, the parable would have had no force, for the first one would have stopped. But this is not all. If the characters in this tragedy had been all women, it would have been the hun- dredth one that stopped instead of the third one. That is to say, while one man out of three is a good Samaritan to his sex, only one woman in a hundred is willing to help the helpless of her sex. With some show of truth a cynic said : "If there were only three women in the world, two of them would immediately convene a court-martial to try the other one." The preparation of this paper has called up in my mind two painful scenes widely separated in time and place but strangely significant. A negro man was arrested for some trivial offense. He offered no resistance, but his speech or manner did not suit the policeman, who began beating the manacled pris- oner. A crowd of white men gathered around. No one offered to interfere. But there was a scowl of contempt 398 THE NEW CHIVALRY — HEALTH for the officer on every face in that crowd. So perceptible was the feeling toward the officer that he not only desisted but began upbraiding the prisoner for acting in such a manner as to compel him to use force, etc. In other words, the attitude of these respectable white men had made this officer ashamed of himself. The scene shifts to other years and another city, but in the same section of the same country, among the same kind of people — no better, no worse. A negro woman is arrested for some trivial offense. The point to which she is taken to await the patrol wagon is in a white neighborhood. A crowd of white women gather around. There is no man there but the policeman. I am on business in an office across the street and happen to be looking out of a window. The prisoner protests against her arrest, saying she is innocent, etc. (The charge is suspicion of petty theft.) She, however, makes no attempt to escape or in any way to touch the policeman. He ordered her to "shut up," which she did after the female manner — ^kept on. He slapped her over ; she got up protesting. He slapped her over again. The colored woman prisoner was protesting against the policeman striking her. The white women were looking on, laughing and jesting. The policeman was growing in importance and cruelty. A man appeared, and though he said nothing the look in his face made the policeman desist and finally do what the prisoner wanted. She was asking permission to arrange her clothing before going to town. For this feminine weak- ness she, a poor, unarmed, defenseless woman, was beaten in broad daylight by an armed man in the presence of a dozen respectable women who laughed at the brutal scene. My heart bled, not so much for the prisoner, for she was but one, a simple, ignorant child of nature, who would forget her anguish with the passing of the physical pain, but for the bystanders, who were many, whose prejudice blinded them to the fact that cruelty is cruelty, whether practiced on dog or man. A man cannot change his char- acter with his company. A man cruel to his horses will be THE NEGRO WOMAN AND HEALTH 399 cruel to his servants, and a man cruel to his servants will upon provocation be cruel to his neighbors, and a man cruel to his neighbors will eventually be cruel to his family. Opportunity and security would bring upon any of those bystanders the same treatment from the same policeman. By protecting this poor negro woman they would have been protecting womanhood, including themselves. The greatest need of the negro woman to-day is the friendship and sympathy of the white woman. This would mean a new heaven and a new earth in our race situation. I beseech the women of my race to look to the white women for counsel and guidance. This will at once reduce the difficulties of the race problem. The only irreducible factor in our race problem is the sex problem. If we can eliminate that, our troubles are over. How much needless sorrow woman's unwomanliness to woman has caused only God knows. It is the love of woman for woman and man foe man which St. Paul exalts and praises in the thirteenth chapter of 1 Corinthians under the name of Charity. Faith and Hope are but the wings of seraph Love. When Jesus gave his solemn charge to his disciples about love there were no women present. But when he said with infinite pathos and tenderness, "By this shall all men know that ye are my disciples, if ye have love one for another" (John xiii. 35) , he was talking to men only. Mr. Frederick L. Hoffman, who has been widely quoted, writes: "The vitality of the negro may well be considered the most important phase of the so-called negro problem; for it is a fact which can and will be demonstrated by indisputable evidence, that of all races for which statistics are obtainable, and which enter at all into the considera- tion of economic problems as factors, the negro shows the least power of resistance in the struggle for life."* This is an unwarranted assumption, but it is a type of that overzealous agitation which has laid undue emphasis upon the negro's susceptibility to disease and his high death *"Eace Traits and Tendencies of the American Negro." (Quoted from "The Human Way," page 59.) 400 THE NEW CHIVALRY — HEALTH rate, with the result of alarming the public instead of stirring the health authorities to activity. Segregation and not sanitation has been the response — destroying the negro's opportunity instead of improving his health. A careful study of American mortuary returns discloses no lethal diseases peculiar to the negro; the history of morals discloses no vices peculiar to African blood nor any virtues of strictly European Imeage. In the high court of civiliza- tion we are all guilty. There is, therefore, no need of any new principles in the negro's case ; and I beseech you, social workers, the clear-voiced heralds of a better day, to follow the fixed star of justice and fair play, if you would see the glorious fruition of your labor in a higher civilization. The highest egoism is altruism, and the most genuine human happiness, the most lasting satisfaction of which the mind is capable, comes from helping others. Injustice and unfairness are the ignes fatui that lead only to the quag- mires of disappointment. A teacher once asked a little boy in her nature study class what was the most wonderful thing he ever saw. After some thought, the child answered : "A chicken coming out of an egg." Being asked by his teacher if he did not know anything more wonderful than that, he said: "Yes, how did that chicken get into that eggV That child struck the heart of the health problem. How we get into the world has a great deal to do with how and when we get out of it. Infant mortality is a serious phase of the health prob- lem, but there is a still more important phase of this prob- lem that seems not to command sufficient attention. The welfare of society demands that a period of fruitful labor shall follow preparation. The most serious loss is the death of prepared people before they have repaid the expense of their training. The death of young adults is a serious draft on our progress. A long, useful life is an asset to the State. The conservation of individual health is a contribution to the public welfare. Modern altruism has greatly modified the laws of selection and survival; yet THE NEGRO WOMAN AND HEALTH 401 physical health and moral uprightness still remain the best passports to longevity. "To maintain health of body," says Quatrefages, the scientist, "one of the best means undoubtedly is to preserve the health of the soul." It is more important to maintain adults through a long period of useful vigor than to bring sickly and ill-condi- tioned children to a precarious and useless adulthood. A low birth rate among parents with sound bodies and good morals is the true remedy for the excessive infant mortality. The saddest phase of infant mortality is not the death of children which in most cases should never have been born, but the awful drain upon the vitality and morals of the parents. How my people suffer here! Unfortunately knowledge and goodness do not always go hand in hand. The spread of physiological knowledge without a corresponding increase in moral responsibility is of doubtful utility to mankind. Our enthusiastic advocates of teaching sex-knowledge to the young erroneously conclude that increased knowledge means increased morals, whereas the opposite is usually true of knowledge prematurely given. Character is man's greatest achievement and good morals his surest source of happiness. A sound body is truly safe only when controlled by a sound mind, and a sound mind finds its only proper abode in a sound body. A knowledge of these basic facts is the substance of that wisdom which is better than rubies, and to order one's life by these precepts is better than to take a city. An intelli- gent desire to be useful is the key to health. The disciples were wise when they gave heed to the questions, "What shall we eat? or, What shall we drink? or, Wherewithal shall we be clothed?" They would have been wiser still had they considered the "How" and the "When." How shall we eat? How shall we drink? How withal shall we be clothed? Correct answers to these brief questions comprehend "all the law and the prophets" on health, hygiene, and sanitation. The Master gave only the 26 402 THE NEW CHIVALRY — HEALTH key and left them to work out the details at their leisure. "Seek ye first the kingdom of God, and his righteousness; and all these things shall be added." That is, get your mind and morals right and then you will get your body right. Mind, morals, and meat is the correct order; thoughts, deeds, food. Man is what he thinks, is bound by what he does, and lives by what he eats. Religious teachers do Christianity an injustice when they state or imply that the Founder ignored the physical man. He said: "Seek ye first [not only'\ the kingdom of God, and his righteousness." In fact, he put the physical side so strong that he scared away some would-be disciples. "The foxes have holes, and the birds of the air have nests ; but the Son of man hath not where to lay his head." Possibly a majority of our destructive diseases arise from the three following sources: (1) The sexual relation, (2) The dietary, (3) Housekeeping. Woman is the determining factor in all these relations. Here is where the negro woman is the negro problem and the white woman is the race problem. The stoiy of vene- real disease is too long and pathetic for treatment here. Suffice it to say that more than twenty per cent of all our cases of blindness and more than fifty per cent of all the cases of abdominal operations have the origin here. Man has committed many grave offenses against his female con- sort, but betraying confidence with contagion and rewarding affection with disease is the meanest of them all. From this torture chamber of civilization's Inferno — ^venereal disease — woman must extricate herself, the more fortunate leading the way. The strong woman must free herself and help her sister. How to give woman the necessary knowledge and at the same time preserve her purity and trust, is the real woman question. As society is now constructed, the white woman will come into possession of this knowledge earlier and more extensively than the colored woman. I therefore beg for the women of my race the sympathy and help of the women of the more fortunate race. THE NEGRO WOMAN AND HEALTH 403 According to Grecian mythology, Sisyphus the crafty was finally doomed in the lower world to roll up a hill, without ceasing, a huge stone which, when it reached the top, always rolled down into the valley. This typifies woman's struggle for liberty. When she nears the hilltop of freedom, she loses sight of her destination and fixes her attention on those beside her or behind her. In an effort to prevent their rising she herself falls back into the valley of oppression, sometimes with them and sometimes upon them. All women up and no women down is the only safe position. The sisterhood of woman means the golden age of the world, when health will not be a problem but a possession. "The wilderness and the solitary place shall be glad for them ; and the desert shall rejoice, and blossom as the rose. . . . Then the eyes of the blind shall be opened, and the ears of the deaf shall be unstopped. Then shall the lame man leap as a hart, and the tongue of the dumb sing." Streams of joy will indeed break out in the wilderness of sorrow when women love and help each other. • I say to the colored women, do all you can to win the sympathy and support of the white women with whom you come in contact, and I assure the white women of the South that they will find the hearts of the negro women fruitful soil for seeds of kindness. If they will but scatter these seeds of kindness, the crop will be for the healing of the nation. This is a far-reaching and fundamental subject and I have only touched its outer rim. I wish, however, to make a few points clear: 1. Women, white and black, good and bad, need the sympathy of women. The worse women are, the more they need a sister's counsel and sympathy. Sympathy should not be limited by race nor kindness be guided by color. 2. There is an obligation resting upon the more fortu- nate to help the less fortunate. 3. I beg of the Southern white women to get their knowledge of negro women first-hand and class for class. 404 THE NEW CHIVALRY — HEALTH I knew a man who once tasted a crab apple. That was the beginning and end of his experience with apples. No amount of persuasion could get him to make further investi- gation. He knew apples. He was just as fair and just as well informed on the subject of apples as some people are who profess to know the negro. A Baldwin or a Pippin would have changed his opinion of apples. So the lives of such heroines and saints as Harriet Tubman, Sojourner Truth, and Amanda Smith, if known, would change opin- ions about negro womanhood. It is not easy for one human being to know another, especially when class and race dis- tinctions intervene. Africa is still the mysterious conti- nent and her people are sometimes subtle beyond the ken of the white man. The riddle of the ages is the Sphinx, a symbolic figure with the face of a negro woman. It will take a little effort to know my folks, but it will pay. If the Southern white woman will take up the race question intel- ligently, sympathetically, and earnestly with the negro woman, the only irreducible factor in our race situation will disappear. Whatever her opinion of the race as a whole, every white woman will find some negro woman worth while. 4. Negro help is not a menace to health. Dunning S. Wilson, M.D., Medical Director of the Board of Tubercu- losis Hospital, Louisville, Ky., in a recent number of the Journal of the Outdoor Life, speaking on the problem of tuberculosis in the negro of the South, said: "A theory that the negro is peculiarly susceptible to tuberculosis, especially when there is an admixture of white blood, had for years been a deep-rooted belief. The more thoroughly investigation is carried on, without any preconceived the- ories, the more surely we find that there is nothing inherent in any race which makes them relatively immune or more easily infected by tuberculosis. It may be possible that the older the civilization, the greater acquired immunity of that race, although this is by no means proven." Finally health is largely a question of morals, and morals in the last analysis is but fair play glorified. Justice is the CITY HOUSING OF NEGROES 405 best sanitation and intelligence is the best medicine. This is a general truth that covers the negro woman and the health problem. CITY HOUSING OF NEGROES IN RELATION TO HEALTH PROF. JOHN W. GILBERT, A.M., D.D., PROFESSOR OF THEOLOGY, PAINE COLLEGE, AUGUSTA, GA. THE RELATION OF HOUSING AND HEALTH THE good or bad condition of the health of any people who live in cities is due in most respects to the sort of houses in which they live, and to the environments of these houses. Broadly speaking, housing and health stand in the relation of cause and effect to each other— that is, people who live in good houses having proper surroundings, if they follow the other rules of health as they pertain to per- sonal habits, will live with strong bodies and strong minds to the limit of death from old age. The test of civilization is a people's approximation to this state of perfect health- fulness. CONDITION OF NEGRO HOUSING AND HEALTH IN CITIES In regard to health city negroes are, by the records of comparative statistics and observation, far worse off than their white fellow-citizens. The forced segregation of negroes into exclusive city settlements which have no prac- tical application of sanitary science, no pure water, no sewerage, and the herding of them either in long crowded rows of "shot-gun" shanties, or in stifling, airless, and sun- less rooms in "tenement flats," as in the North, have pro- duced a death roll from diseases nearly twice as long as that recorded for citizens who are better cared for by our urban communities. To these neglected city settlements where the fitful fever called negro living is endured, public senti- 406 THE NEW CHIVALRY — HEALTH ment permits humorous nicknames to be applied, such as "Buzzard's Alley," "Black Bottom," "Little Africa," etc. Better police protection, better school and church facilities, and better wages than are to be found in the rural districts, as well as the enchanting glamour of city life attract the negroes to the cities, where, as already indicated, they must suffer ill health from poor housing. More than one-fourth (27.4 per cent) of all the negroes in the United States live in cities having upward of 2,500 inhabitants. In 1910 negroes living for the most part in unhealthy houses amid unhealthy conditions in their segre- gated settlements constituted more than one-fourth of the total population of twenty-seven cities having upward of 25,000 inhabitants. According to the last United States census more than half of the citizens of Jacksonville, Fla., Charleston, S. C, Montgomery, Ala., and Savannah, Ga., are negroes. Beginning with those cities having more than 40,000 negro inhabitants, the order for the whole country is: Louisville, Ky., 40,522; St. Louis, Mo., 43,960; Chicago, 111., 44,103; Richmond, Va., 46,733; Atlanta, Ga., 51,902; Birmingham, Ala., 52,305; Memphis, Tenn, 52,441; Phila- delphia, Pa., 84,459; Baltimore, Md., 84,749; New Orleans, La., 89,262; New York, N. Y., 91,709; Washington, D. C, 94,446. The death rate of the negroes in the fifty-seven registra- tion cities of the last census (cities having a negro popu- lation of 2,500 or more) was 25.5 per 1,000, a decrease of 3.9 per 1,000 as compared with the census of 1900. This decrease in mortality is accounted for by the fact that within the decade between 1900-1910 there was during the same period an increase of 49.8 per cent in home ownership among the negro population. Observation shows that this decrease in mortality was not in any appreciable degree due to permanent changes for the better, such as improved housing and sanitary conditions in the negro sections of these fifty-seven cities. Says the Director of the Census: "In the case of those cities in which the decrease (in mor- tality) has been most marked, the proportion of owned CITY HOUSING OP NEGROES 407 homes is high, and it is reasonable to suppose that home ownership has been an important factor in reducing the mortality." The man who owns a home usually does what he himself can to improve the house in which he lives and its surroundings. Therefore he and his family are to that extent healthier than they would be were they dwellers in houses occupied from time to time by indiscriminate renters. The negro's complaint is not respecting segregation per se; for, other things being equal, he usually prefers to live among his own race. But his complaint is respecting the death-breeding houses and localities in which he is forced to live — ^forced by sentiment which is higher than law. The law, except in very few, if any, cases, is fair. It is the unfavorable white sentiment in the cities which works havoc with the negro's health, by authorizing the spending of a very little of the accrued or rental money on the improvement of the sanitary or housing conditions of the negro sections. The negro cannot change these con- ditions, for the wealth and the government of the cities are in the hands of his white fellow-citizens. The nearest he can come toward a change is to possess ownership of his dwelling house and yard, and education enough to care for these as best he can under the circumstances. The statistics show that deaths among negroes, as com- pared with the whites who live in better houses surrounded by better sanitary conditions, are "relatively more numer- ous for malaria, tuberculosis of the lungs, other forms of tuberculosis, pneumonia, and whooping cough," these being directly traceable to bad housing ^nd poor sanitary environ- ments. It is also found by the census that "for measles, scarlet fever, diphtheria, cancer, appendicitis, diarrhea, and violent deaths (including suicides) the distribution is noticeably higher among the whites" throughout the coun- try. These latter causes of death are not necessarily as intimately connected with poor housing as are those which cause the death of most negroes in our cities. Negroes usually live where there are flat lowlands, often holding green, scum-covered, stagnant water well-nigh all the year. 408 THE NEW CHIVALRY — HEALTH In many cities there are only open ditches, muddy streets, surface closets, and open wells in the negro sections. These conditions prevail for negroes more largely in Southern than in Northern and Western cities. The universal decrease in the negro's death rate in Southern cities is therefore due, not so much to municipal care for the "brother in black" as to his ownership of homes, better med- ical attention, and increase of education, all of which as far as they can, in spite of indifference, if not prejudice, result in better housing conditions and the promotion of good health. OWNERSHIP OP HOMES RESULTING IN REDUCTION OF MORTALITY The ownership of homes by negroes in Northern cities is far below that of Southern cities. But in the former the negroes have far better sanitary surroundings than they have in the latter. How does this fact register its results in the statistics of the United States census of the fifty-seven largest cities of the country ? "In the thirty-three Northern cities the death rate among negroes is 25.1 per 1,000, while in the twenty-four Southern cities the rate for negroes was 29.6." That is, 4.5 more negroes per 1,000 died in the Southern cities than in the Northern ones. It is reasonable to conclude that, since, as I have already set forth, home ownership by negroes in the Southern cities decreases the mortality of the race, if the negroes in the Southern cities, where the sunlight and air are not shut out as in the North- ern cities, could have healthy houses and healthy drainage, their death rate would be less than that of the negroes in the Northern cities. How long must they wait for city councils and city boards of health to give them sewerage, drainage, and other means of sanitation? How long must they wait for healthy houses to be built for them by their rent-hungry landlords? These questions constitute a prob- lem whose solution results in life and health, or in disease and death for the city negro. CITY HOUSING OF NEGROES 409 A MISTAKEN THEORY OF THE NEGRO'S VITAL ABILITY TO RESIST DISEASE Hoffman says : "The vitality of the negro may well be considered the most important phase of the so-called race problem ; for it is a fact which can and will be demonstrated by indisputable evidence that of all the races for which statistics are obtainable, and which enter at all into the consideration of economic problems as factors, the negro shows the least power of resistance in the struggle for life."* In the light of the statistics sent out from Washington this year, and in the view of the natural laws (which are even more dependable than statistics) affecting either ani- mal or vegetable life generically or specifically classified, Hoffman's statement cannot be accepted. In the first place, the United States is the only country having many negroes where separate statistics are kept for the negro. Inter- marriage with other races and the resultant mixed-blooded offsprings in South America and elsewhere than in this country would make the gathering of such statistics either impossible or, at best, absolutely unreliable. In European countries the negro population is negligibly small. But here in the United States, where statistics comparing the negro with any other race is possible, after nearly half the current decade has been passed in comparing and studying the last census figures which he adduces in proof, the Director of the Census makes the published statement this year: "The general tendency appears to be in the direction of a declining death rate for the negroes in the registration cities, the decrease being somewhat greater for negroes than for whites; as a result, the difference between the death rate for negroes and for whites in these cities was not as great in 1910 as a decade earlier." Give the negro a fighting chance to live by giving him houses and places fit to live in and the issue will be closed. ♦"Race Traits and Tendencies of the American Negro," p. 37. 410 THE NEW CHIVALRY — HEALTH ECONOMIC AND CIVIC VALUE OF THE GOOD HOUSING AND GOOD HEALTH OF NEGROES The commercial value of good housing and consequent good health ought to cause Southern business men, for selfish, economic reasons, if not for the higher ones of humanitarianism and Christianity, to provide healthful housing conditions for the laboring classes. Healthy laborers are strong and efficient. They pay in dollars and cents. To this end public education ought to be given the negro, to train him how to keep his body healthy by means of wholesome food, cleanliness, sunlight, and air. For economic reasons the city should take care of the environ- ments of its citizens without discrimination as to race or color. By the records in proportion to good housing and consequent good health is the monetary wealth of any com- munity. The Northern and Western cities are richer than the Southern cities because, for one thing, they require land- lords to build better renting houses for the laboring classes and provide better sanitation for all the people than we find in Southern cities. Poor housing, along with the saloon ever near negro sections, and the consequent poor health of negroes mean a loss to the city in real estate values, in the expense of crime, and the maintenance of courts, prisons, hospitals, and almshouses. They mean a loss entailed by the effort to stop contagious diseases. They mean a loss in citizenship. Says Jacob Riis : "You can't let people live like pigs and expect them to make good citizens." Poor housing of the negroes and poor drainage where the suds from the clothes which they wash for white people are thrown in the yards and alleys to help breed and increase mosquitoes, files, and other germ bearers coming from stag- nant pools and surface closets, mean a loss to the city by the sickness and death of men and women both white and black ; for we are so correlated and mingle with each other so closely, as employer, cook> nurse, washerwoman, etc., that what hurts or helps one does the same for the other. We are "our brother's keeper" in the matter of health and home as well as in other respects. CITY HOUSING OF NEGROES 411 POOR HOUSING AND CONSEQUENT POOR HEALTH AN INJUSTICE TO NEGROES Then there is the matter of simple justice. In cities where poor housing and no sanitation are provided for the negro he feels that he is taxed merely for the privilege of unpreventably becoming sick and dying. Renting negroes argue, too, that they help pay the taxes of the city; for in the last analysis the larger amount of taxes are paid out of the rent money. He feels that in this matter of poor housing, poor environments, and poor health he is more sinned against than sinning. So he often does not care if he is shiftless, ignorant, and dirty. He regards the money which he pays for rent as "blood money," extracted by heartless landlords with the perijiission of the city author- ities and the community. He expects to catch some disease and die if he be poor and, therefore, unable of himself to improve the sanitary conditions of his dwelling house and its surroundings. Mrs. Bacon in one of her social service appeals was not wrong when she said before the legislature of Indiana: "A man has just as much right to kill a man in the street with an ax as he has to kill him in a house"* — meaning a rented house poisoned with carbonic acid gas, and plagued with disease germs coming from its local environment. REMEDIES 1. There m/ust bean awakening of the public conscience. I do not believe that the majority of fair-minded white people know of the negro slums in our cities. If they knew of the poor housing of negroes and of the consequent menace to the health of whole cities, righteous indigna- tion would, in order to save human lives, find immediate means of destroying these death-dealing conditions along with the "red-light" houses and saloons which are permitted to operate in negro districts. Thank God, no negro owns a distillery, and not one barroom owner in a hundred is a negro. But whisky is sold in negro communities by and *"What Bad Housing Means to the Community." 412 THE NEW ClflVALRY — HEALTH for white dealers, much to the ruin of the negro's health and the destruction of his family life. 2. The education of the negroes and whites to the reali- zation of their mutvxil interdependence economically and otherimse upon each other in the matter of good health will remedy the evils attaching to the conditions of housing and health in negro communities. 3. Christianity ought and can do its share in social service and in the awakening of the public conscience to care for the negro's housing and health. THE SOUTH AND THE HEALTH OF NEGROES MONROE N. WORK, RECORDS AND RESEARCH, TUSKEGEE INSTITUTE, TUSKEGEE, ALA. The campaign for health improvement which is now going on throughout the South is at bottom economic. It is an effort to increase the efficiency of the people by improv- ing their health conditions. This is especially true with reference to the negro. Along with the movement for health improvement has come a new idea of the value of human life. During the days of slavery each negro repre- sented to his master so many dollars. Then a high estimate was placed upon the value of a negro life, for each negro death represented a financial loss to the master. After the negroes were emancipated and personal ownership ceased, little value was placed upon the life of an individual negro ; for it was reasoned that if one negro died another could be had to take his place. In recent years much effort has been given to conserving the natural resources of the nation — ^that is, its soil, its for- ests, its minerals, its waterways, and, most important of all, its people. In this connection comprehensive studies have been made of the financial loss which the nation is sustain- ing because of the waste of its natural resources. In the THE SOUTH AND THE HEALTH OP NEGROES 413 estimate of the financial loss to the nation on account of sickness and deaths a money value is placed upon an indi- vidual just as it was upon a slave. Attention is called to the fact that when an individual dies the community in which that individual lived sustains a financial loss. The South because of the negro has the highest death rate of any section of the country and as a result sustains the greatest financial loss from bad health conditions. There are in the South A50,000 negroes seriously sick all the time. Let us first of all consider the enormous financial losses which, on account of bad health conditions, the negroes of the South are directly sustaining. These losses are in doctor's bills, cost of the care of the sick, funeral expenses, and in the earnings which those who are sick and those who have to take care of them lose. Sickness each year costs the negroes in the South about $75,000,000. This is an average of more than $8 per individual. Esti- mates show that here in the South there are probably 450,- 000 negroes who are seriously sick all the time — ^that is, they are so ill that some one has to take care of them. If this sickness were distributed among the entire black population, it would mean that on an average each negro inhabitant, man, woman, and child, would be sick eighteen days in a year. A negro worker contributes annually $15 to sickness. Of the 450,000 negroes in the South who are seriously sick all the time, 112,000, or one-fourth, are wage-earners. If the sickness of these 112,000 individuals were distributed among the total negro workers, it would mean a loss to each of about ten days. The loss in earnings which negro work- ers sustain annually on account of sickness amounts to some $45,000,000. When distributed among all negro workers this loss amounts to about $15 each. In other words, each negro worker from his earnings contributes annually to sickness about $15. Prevention of deaths among negroes would increase the South' s 'po'pukition 100,000 each year. The leading authori- ties on health are teaching us that a very large percentage of the annual deaths are preventable. Hundreds of thou- 414 THE NEW CHIVALRY — HEALTH sands of people die every year who ought to live. This is especially true of negroes. It is probable that at l^ast forty-five per cent of the annual deaths among them are preventable — ^that is, with proper medical attention, proper food, proper sanitary surroundings, and proper observances by the individuals themselves of the rules of health, forty- five out of every one hundred who die could be saved. If this is true, then 100,000 of the 225,000 negroes who die annually in the South could be kept alive. This would be equal to adding to the population of the South 100,000 indi- viduals each year. It further appears that on account of the large number of negroes who are seriously sick all the time and the quarter of a million who die annually, sickness and deaths are costing the negroes of the South at least $100,000,000 annually, or an average of over $11 for each negro man, woman, and child. On the other hand, with proper sanitary surroundings, proper attention to the laws of health, $50,- 000,000 of this amount could most likely be saved. The South loses annually because of preventable deaths among negroes almost $200,000,000. Attention has been called to the great financial losses which, because of dis- eases and deaths, fall directly upon the negro. Let us next consider the enormous financial losses which the South as a section suffers from these same causes. Take, for exam- ple, the 112,000 negro workers who are seriously sick all the time. If by sanitary improvements they could be kept well twelve months in the year, there would be 112,000 additional workers who could help till the soil, work the mines, construct railroads, build cities, and do other things for the economic advancement of the South. If these 112,000 negroes could be added to the working population of any State, the development of the resources of that State would be greatly increased — ^that is, the working population of Texas would be increased 7 per cent, Alabama 11 per cent, Mississippi 13 per cent, and Louisiana 17 per cent. In addition to the large number of negro workers who are seriously sick all the time, there are every year 25,000 or 30,000 who die unnecessarily. The annual loss to the South THE SOUTH AND THE HEALTH OF NEGROES 415 in potential earnings because of preventable deaths among negroes is almost $200,000,000 — ^that is, if the negro workers who every year die unnecessarily could be kept alive and at work their earnings for the South during the normal working period of their lives would amount to almost $200,- 000,000. Tuberculosis among negroes costs the South annually enough to establish 3,500 factories in which 700,000 persons could be employed. Of all the diseases with which negroes are afflicted, tuberculosis is, in many respects, the worst. It is the cause of from 15 to 20 per cent of all their deaths. In other words, one death out of every six among them is from this disease. The burden that results from tubercu- losis is one of the heaviest that the negroes have to bear. The annual deaths among negroes from tuberculosis amounts to some thirty-five or forty thousand. It is esti- mated that each death from tuberculosis costs about $4,000. On this basis the deaths among negroes from tuberculosis cost the South annually over $140,000,000. Consider for a moment the immense amount of capital that is here lost. If this capital could be made available for use, think how many factories it would establish, how many banks it would finance, how many farms in the South it would run. In a word, if just now the South could have available this $140,- 000,000, it would go a considerable way toward relieving the prevailing financial stringency. According to the cen- sus report on manufacturing, the average capital invested in a manufacturing establishment in the South is about $45,000. The average number of employees in a factory is about 225. On this basis, the amount that tuberculosis among negroes annually costs the South would furnish the capital for 3,500 manufacturing establishments in which over 700,000 persons could be employed. The financial losses to importamt cities through waste because of the lack of the conservation of negro health is greater than all the revenues which the cities raise. Let us next consider the financial losses which through lack of improvement of negro sanitary conditions the important cities of the South are sustaining. From data given in a 416 THE NEW CHIVALRY — HEALTH recently issued volume of the United States Census Bureau on "Financial Statistics in Cities," we are able to make comparisons of the revenues which the cities of the South raise with the estimated losses to these cities because of bad health conditions among negroes. These comparisons indicate that each year the losses to cities of the South because of health conditions among negroes is almost equal to all revenues which the cities through taxes and all other sources raise. In two cities the estimated loss from negro sickness and death is equal to the total city revenues. Birmingham per capita of her total population raises in revenues $14 and through bad health conditions among her negro popu- lation loses $14 per capita. Mobile per capita of her total population raises in revenues $20 and through bad health conditions among her negro population loses $20 per capita. In three cities the estimated losses from negro sickness and deaths is greater than the revenues which these cities through all sources raise. Montgom- ery per caxpita of her total population raises in revenue $18 and through bad health conditions among her negro population loses $22 per capita. Savannah per capita of her total population raises in revenues $21 and through bad health conditions among her negro population loses $28 per capita. Charleston per capita of her total popula- tion raises in revenues $15.42 and through bad health con- ditions among her negro population loses $27 per capita. It is of course understood that the loss to cities because of bad health conditions among negroes is not so much in actual cash as it is in the loss, through waste, of a natural resource that ought to be utilized — ^that is, within these cities there are thousands of negroes who are unnecessarily sick and hundreds who unnecessarily die. These negroes, through education and sanitary improvement, ought to be kept alive and made healthy and efficient to the highest degree, in order that as a natural resource they could be fully utilized. Combined revenues raised by States, counties, and incorporated places, because of the lack of health conser- THE SOUTH AND THE HEALTH OP NEGROES 417 vation, do not equal what States lose through negro sickness and deaths. The Census Bureau a few weeks ago issued a bulletin on "Wealth, Debt, and Taxation." Among other things, information is given in this bulletin as to the total revenues raised in a State, by the State itself, by the coun- ties, and by incorporated places. A comparison of the losses which, because of the lack of health conservation, the South is sustaining from negro sickness and deaths, with these combined revenues, indicates that these losses about equal the total revenues raised in the South, by the States, by the counties, and by incorporated places. In eight States the losses sustained on account of negro sickness and deaths are greater than the total combined revenues which are raised within these States. In Alabama the combined revenues per ca*pita of the total population were $7.45 and the loss from negro sick- ness and deaths $15 per capita. In Arkansas the combined revenues were $6.37 per capita and the loss from negro sick- ness and deaths $9 per capita. In Georgia the combined revenues were $9.61 per capita and the loss from negro sick- ness and deaths $16 per capita. In Louisiana the combined revenues were $13.03 per capita and the loss from negro sickness and deaths $15 per capita. In Mississippi the com- bined revenues were $7.79 per capita and the loss from negro sickness and deaths $20 per capita. In North Caro- lina the combined revenues were $6.16 per capita and the loss from negro sickness and deaths $11 per capita. In South Carolina the combined revenues were $5.91 per. capita and the loss from negro sickness and deaths $19 per capita. In Virginia the combined revenues were $9.74 per capita and the loss from negro sickness and deaths $11 per capita. The value of a negro to-day is five times what it was in the days of slavery. In connection with this discussion of the loss which the South is sustaining because of sickness and deaths among negroes, it is of interest to note that, on the present basis of estimating the value of a human life, a Negro in the South to-day is worth several times as 27 418 THE NEW CHIVALRY — HEALTH much as he was worth in the days of slavery. The value of the 4,000,000 slaves which the war between the States freed was about two billion dollars — ^that is, the average value of a slave was about $500. On the present basis of estimating the value of human life a negro in the South is valued at about $2,500, and the nine million negroes in the South have a money value of over twenty-two billion dollars. On this basis, the loss to the South to-day when a negro dies is about five times as great as it was in the days of slavery. If then the South of ante-bellum days had an interest in conserving the health of the negroes, to a much greater degree has the South of the present an interest in conserv- ing their health. As an asset of the South negroes are worth one and a half times as much as the assessed value of all taxable Tproiperty. The value of all the land in the South is about ten billion dollars. The value of all the farm property is about twelve billion dollars. The assessed value of all the taxable property in the South is some fourteen billion dol- lars. The nine million negroes in the South are worth twenty-two billion dollars — ^that is, as an asset of the South they are worth more than all the land or all the farm prop- erty. They are worth over one and a half times as much as the total taxable property of the South. Because of their value, it is very important then that the negroes be made healthy. It is for this reason that white men and black men are working side by side to help improve their health con- ditions. By means of health imiprovement and education the efficiency of the negro can be doubled. One of the slogans of this century is efficiency. The idea of efficiency has come into the South. It is realized that for the South to take her proper economic place in the nation the efficiency of her population has got to be greatly increased. The best working machine is one in which there is the greatest amount of power generated in proportion to the amount of energy expended. From the standpoint of efficiency the negro is at present a poor working machine. On account THE SOUTH AND THE HEALTH OF NEGROES 419 of bad health and a lack of training and efficiency, he is expending about one-half the energy that he is capable of expending, and as a result is doing about one-half the work that he is capable of doing. On the other hand, because of premature deaths, the number of years that he works is about one-half of what they should be. The average life of a negro is now about thirty-five years. His period of pro- ductive work is about fifteen years. If the average length of negro life was increased to forty-five or fifty years — and this can be done by sanitary improvement — ^the length of time that the average negro could work would be increased to from thirty to thirty-five years. It is possible within this century to so improve the health conditions of negroes that their death rate would be reduced one-half and their average length of life increased one-half. Increasing the efficiency of the negro by means of edu- cation and better health conditions eqvjals adding five mil- lion additional workers to the 'population of the South. There are in the South five million negroes who are engaged in gainful occupations — ^that is, they are helping to develop the resources of the South. Now if by education and health improvement the efficiency of these five million black men and women can be doubled it will be equal to adding five million additional workers to the population of the South ; likewise, if the period of productive work of the average negro can be doubled, it will be equal to adding another five million to the working population of the South. The death rate among negroes can be decreased. Recent mortality statistics appear to indicate that the death rate among negroes is decreasing. Ten years ago the average annual death rate per thousand was about 29. Now it is about 23. As an indication of what can be done in the matter of decreasing the death rate, a recent report states that in Robeson County, North Carolina, the death rate has been reduced from 18 to 12 per thousand. This county is in a malarial district and 55 per cent of the population are negroes and Indians. The death rate of the negroes was over 40 per cent higher than that of the whites. The illiter- 420 THE NEW CHIVALRY — HEALTH acy in the county is 40 per cent higher than the average for the whole State. This record in health improvement was accomplished in three years. To the county is means a saving of 100 lives every year, or, in money value, $290,000. The most remarkable thing concerning health improvement in this county is that the death rate from preventable dis- eases has been reduced 70 per cent. White people and black people are cooperating to con- serve negro health. One of the most encouraging things in the crusade for negro health improvement is the hearty manner with which white people and black people are cooperating in this movement for the common welfare. Last year at a conference in New Orleans, called to consider how liegro health conditions might be improved, State and city health officers from all parts of the South in meetings with black men discussed the situation and advised as to the best things that should be done. The very cordial and active assistance given by State and City Boards of Health, by State Departments of Education, by white women's clubs, and other agencies to the recently held National Negro Health Week is another instance of this cooperation. The highest expression of this cooperation is the large place that is given in this Congress to the consideration of "Health and Race Relations." The negro will do his part in the creating of a greater South. In her crisis the South has found the negro dependa- ble. Was it at New Orleans in the War of 1812 when, at the call of General Jackson, he fought gallantly for the common defense? Was it in the War between the States, when the white men of the South were away on the battle- fields, that he at home cared for their women and children ? The South of to-day is facing a great economic crisis. The old system, the old methods in agriculture, and other things have become obsolete; new systems, new methods demand- ing more skill and intelligence are being instituted. In order to develop these systems to their highest degree every element in her population must be made efficient. The negro has ever had the interest of the South at heart. In RECREATION AND THE HEALTH OP NEGROES 421 this new crisis that the South is now facing, in the economic transformation that is now taking place, he can be depended upon to do his part. He is earnestly studying his own needs. He sees the great handicap which bad health has placed upon him. With the assistance of the white man he will remove this handicap. He will make himself efficient and do his part in creating out of the new South a greater South. RECREATION AS RELATED TO THE HEALTH OF NEGROES IN RURAL COMMUNITIES REV. JOSEPH A. BOOKER, D.D,., LITTLE ROCK, ARK. What is recreation? It is physical exercise. It is mental amusement. It is a diversion of mind and body from study and work. It is a restful departure from mental or physical responsibility. Very often a mere shift from one kind of mental or physical labor to another kind has the effect of recreation, and that too without much loss of time or energy. When I was a farm boy, I often chopped cotton all day by putting forward first one hand and then the other. We called that "changing hands." It would change my attitude without abandoning my job. Likewise I have picked cotton all day by wearing the sack strap first on the left shoulder and then on the right shoulder. We called that "changing sidfes" or "changing shoulders." As a plow- boy and as a woodman, I have done like shifting, and thus promoted a crude recreation and continued my work. But we do not need to follow these definitions and illus- trations to the vanishing point in order to get the most out of the subject before us; for no sort of shift at labor will take the place of real recreation. "All work and no play Gives Jack a dull day." All tool and no toy Makes Jack a dull boy. 422 THE NEW CHIVALRY — HEALTH This potent fact should be kept before all plantation owners, farm managers, rural teachers, and country preach- ers. No one can seriously studyi Nature's method of caring for her children without seeing clearly the truthfulness and wisdom of this position. WHAT RELATION DOES RECREATION SUSTAIN TO HEALTH ? Activity is the law of life. Shifts and changes are essential to healthy progress and to health itself. How much more then is real recreation conceived and promoted for that purpose? One of the fundamental lessons taught in physiology is this : "All of the tissues of the body are built, maintained, and repaired by living cells. Life and health itself depend upon the proper and continuous activity of these cells, and anything which aids in this activity, whether work or play, strengthens the body and prolongs life." If I were a practicing physician, I would enter into the techni- cality of these general principles and show in detail how some diseases are prevented by recreation, and how others are actually driven away by this proper diversion from physical labor and mental responsibility. But as a layman I have perhaps said enough on that point. I have sought the opinion of Dr. A. H. Brown, the resident physician in the institution with which I am connected, and I take pleasure in quoting him : "In systematic exercise the laws of health are brought to bear successively on every part of the human body, including the nerves, the brain, the tissues, etc. Even the extreme organs, especially the skin, sympathize with the impaired condition of those tissues which are mainly exerted. Dr. Osier, one of the best medical authorities, has said that dyspepsia, chronic constipation, passive congestion, etc., are often traceable to a lack of physical exercise. Tuberculosis, the captain of the hosts of death, the scourge of our modern civilization, finds a fruitful field from which to recruit its ghastly list among those who lead a sedentary indoor life." Of course, when we apply this to country people the statement is still correct, for they are indoors and inactive almost as much as townspeople. They do not work RECREATION AND THE HEALTH OP NEGROES 423 six days in the week and twelve months in the year. As soon as their regular work is done or abandoned, they go into winter quarters^ to come out no more till spring. When summer comes and crops are "laid by," there is nothing going on to keep up public interest, to stimulate harmless, helpful activity, unless it is a camp meeting, association, or convention. Would it not be in order, if work is out, to give these people some form of helpful recreation? WHAT FORMS OF RECREATION ARE MOST DESIRABLE FOR RURAL PEOPLE? Certainly our economics would have much to do with the answer to this question, but not all. To be sure, we could not contend for expensive gymnasiums in rural districts nor even in small towns, because, as sparsely settled com- munities, they might not justify the elaborate outlay. But there are simple forms of recreation, and parts of gym- nasiums and even cheaper gymnasiums themselves cheaply outfitted, that would prove exceedingly valuable in prevent- ing certain diseases and in promoting a higher standard of health among our rural population. However, if we cannot introduce anything expensive and new we can at least hold on to those simpler forms of recrea- tion which are as old as man and as good as gold. Foot races, leapfrog, and jumping contests; horseback-riding, swimming pools, and baseball; swinging ropes and vines, golf, lawn tennis, and croquet; fishing, hunting, trapping, and tree-climbing; picnics, barbecues, and fish fries; corn- shucking, quilting, and logrolling — ^these and many other simple forms of recreation should not only be tolerated, but encouraged; not only encouraged, but promoted in all our rural communities wherein the number of people will in any degree justify it. Owners of plantations, rural mer- chants, country churches and pastors, rural schools and teachers should thoroughly understand each other and take the lead in this promotion. It would pay any farmer or merchant to take up this part of the betterment of country life. It would pay in dollars and cents. It would pay in 424 THE NEW CHIVALRY — HEALTH the conservation of the population which is now being so rapidly undermined by migration, disease, and death. You will notice that I asked that recreation be tolerated. I do this because there seems to be no allowance made these days for such things, either by the Church or the State, the plantation owner or his neighbor. In this respect there seems to be less care for the hired freeman than there was in other days for the purchased slave. In this beautiful Southland of ours the fishponds are filled out or fenced in, the grapevines are cut down and the forests are cleared up, the blackberry patches belong to the syndicates, the fields full of rabbits and quail are posted "Keep out," "No hunting allowed." Nothing is left for our great standing armies of bread-makers to do but perform their monot- onous, non-profitable task and kill the balance of the time in sleeping or roving. Every large plantation and every com- munity of smaller plantations should be as various in its recreation and sports as an institutional Church is of branches of study, usefulness, and service. I say this for the promotion of community efficiency; and community efficiency would mean "safety first" and comfort and wealth next for each one "as his interests appeared." HOW CAN THE FOREGOING ARGUMENT APPLY SPECIFICALLY TO NEGROES? I see no reason why this argument should apply specifi- cally to negroes except in the following: 1. The great majority of the negroes are still in the rural districts. 2. The majority of negroes living in the rural districts are in the South. They are the bone and sinew of that laboring force which makes the South's meat and bread and clothes, while the larger South takes care of the banks, the railroads, the courts, and the Statehouses. 3. It is extremely desirable that the great majority of negroes remain in the rural districts. But they will not, unless inducements are made stronger and better. A recent report from the Bureau of the Census shows that of the total number of 7,317,922 negroes ten years of RECREATION AND THE HEALTH OP NEGROES 425 age and over, 5,192,533, or 71 per cent, were reported as gainfully employed. Of this vast number gainfully em- ployed, 30.9 per cent (almost one-third) were farm laborers and twenty-five per cent farmers. Other percentages which figure in favor of my argument are: Building and hand trades, 5.2 per cent; saw and planing mills, 2.9 per cent; steam railroads, 2.7 per cent— all of which should be added to the great list of country people, and then one can get an idea as to what an army of negroes yet remain in the rural districts, waiting for a better day to come. No use to say "Back to the farm" unless you put something various and superior there as irresistible attractions for them to "back to." Most of the negroes in the rural districts are loyal to the country and take pride in country holdings. In 1910 there were 893,370 farms operated by negroes. These farms were valued at $1,142,000,000. Ninety-eight and six-tenths per cent of these farms were located in the South. The increase in number of farms operated by negroes from 1900 to 1910 was 19.6 per cent. The increase in the value of these farms was 128.4 per cent. The increase of farms owned and operated by white people between the dates named was 9.5 per cent and the increase in the value of farms owned by white people was 99.6 per cent. What does this show ? You can say this shows that the negro is taking better care of his farms than the white man. You can also say that negro farms are producing larger taxes for government than white farms, if values count for anything with tax assessors and collectors. You can say finally that the negro is in the morning of his life as a farmer. Whatever you may say, I am sure you cannot say that it is a useless expense to make country life better for the negro in every way. . I am looking for the day soon to come when benefactors, philanthropists, and even men of self interest will make great outlays for various forms of recreation among the rural negroes of the South ; when merchants and real estate leaders will give the rural negroes what they deserve — ^viz., better roads, better houses, better tools and farm machin- ery, and, last but not least, systematic arrays of helpful. 426 THE NEW CHIVALRY — HEALTH healthy recreation. I was born two years the other side of the Civil War and five hundred miles this side of Mason and Dixon's line. But I was bom in a better house in my mas- ter's quarter yards than I see on the average plantation these days, built for the big house. I never knew what a log hut was till my master died and his estate was scattered. The old gentleman, John P. Fisher, had a heart for human- ity and an eye to business. POSSIBILITIES OP THE SOUTH The South is rich, vastly rich — rich in mine and forest, in field and factory, in folklore and tradition. The South is even now flinging defiance into the face of so-called pros- perity elsewhere; but the South will never come gently and finally into her own till she learns to make large and larger outlay for systematic and symmetrical development of all her rural population. We rejoice in the multiplication of railroads, in the vast outlay of funds to improve our rivers and harbors, in the modern dredge boat and drainage dis- trict, in the great war declared and waged upon the mos- quito and housefly, in the broader roads and better houses, in the rural free delivery and parcel post system. But these can only make country life profitable. If we can now inaugurate a system of recreation numerous and various so as to be adapted to the different seasons of the year, counting them in as important parts of all that is due our ^country people, we shall be able to discern new life throughout this whole Southland. Slipshod service and shiftless lives, ragged homes and burning fences, will be things of the past. The wilderness will smile in our faces, the weeping willows, polite pines, and giant oaks will line up for marching orders, and the desert shall bud and blossom as the rose. HEALTH PROBLEMS OP THE NEGRO CHURCH 427 HEALTH PROBLEMS OF THE NEGRO CHURCH L. K. WILLIAMS, A.B., D.D., FORT WORTH, TEX. THE TWO MOST MARKED AND FUNDAMENTAL ASPECTS OP CHRISTIANITY True religion has two great relations — namely, the earthward and the heavenward, or the manward and the Godward. This idea is supported by Judaism in its history and the Ten Commandments, and is reemphasized in Christ's new commandments. The test of Christianity is its power to set man right with God, and answer satisfactorily both for man and God the ever reechoing Edenic question, "Where art thou?" But the religion that would end in simply restoring man to God would be at best but a half religion, impermanent and inadequate. For it should set man right with man and answer that other primitive question, "Where is Abel thy brother?" It must also include the fact that man is a com- posite being to be saved in his complex entirety. Attempt- ing to lift man Godward, or to adjust harmoniously man's relations to man, the while forgetting that he is a social creature, inhabiting a physical body that has legitimate needs, is religious folly. THE MISSION OP THE CHURCH The Church exists as the true representative of its Head, a living vital organism, and an active agent reflecting the spirit of Christ. Its mission is clear; for he said, "As my Father hath sent me, even so send I you." He spent his life administering to the needy, both of body and soul, and this is a pathetic example to his Church to do likewise. THE EARLY CHURCH The early Church considered man as a composite being, and this, with its gospel of regeneration, individualism, and humanism, won recruits from many nations and religions. 428 THE NEW CHIVALRY — HEALTH THE DIGRESSION Many of these recruits brought into the Church their education and former religions. They did not unite readily, and the best energy of the Church was given to settling scientific disputes and theological quarrels. Pagans and some pseudo-Christians contended that the body was all, and that a true religion was destined to preserve it only. This notion led its votaries into many physical indulgences and made them slay their physical weaklings and uncomely ones. To offset the bad effects of this tendency some super- zealous Christians taught that matter was evil, and that the body, being matter, was consequently evil and should be tortured and neglected. This led to asceticism, to many evil practices and errors, and to the neglect of the social aspects of the gospel. Many theologians spent much time in building up beautiful, speculative systems, but sounded a low note on man's human needs. Coleridge in writing of the falling away of the Church in this instance said : "This was the true and first apostasy when in council and synod the divine humanities of the gospel gave away to speculative systems and religion became a science of shadows under the name of theology, or at best a bare skeleton of truth, without life or interest, alike inaccessible and unintelli- gible to the majority of Christians." The Reformation led the Church to esteem the indi- viduality of its subjects and the need of bodily as well as spiritual salvation. And to-day it can be said with Morten- sen, "The problem of the modern age is the living union of Christianity and humanism," and with Herder, "Chris- tianity is the ideal religion and religion is ideal humanity." PHYSICAL EFFICIENCY, THE BEST ECONOMIC ASSET OF THE NEGRO RACE The best wealth-producing asset of the negro race is its physical strength. The race has been free but few years ; it has not yet developed to the greatest extent its commer- cial and industrial institutions. The education and oppor- HEALTH PROBLEMS OP THE NEGRO CHURCH 429 tunities which follow technical professions for the negro race are not yet the best; while labor unions and prejudice are apparently permanent barriers to their entrance upon such work in large numbers, even if they had the best of preparation. The seeming indisposition of a great number of whites to do the roughest and most perilous physical labor, together with their ability and opportunity to do other things on the one hand, and the negro's demonstrated adaptability to do physical labor on the other, have given the latter a monopoly in the South of that work which requires sheer physical force. And he has done his work well. The South is one vast field of rich natural resources that has yielded, and will continue so to do, abundant harvests and great results in response to the magic touch of the negro. He has gone into her swamps, braved the heat of her scorching summers and the blasts of her cold winters, and turned her dense forests into laughing fields of fertility and usefulness. He has watered this broad land with his tears, sweat, and blood, while his bones scattered on every hill are a testimonial to his patient endurance and earnest efforts to promote through physical force and otherwise the prosperity of this Southland. He has lived more from the prowess of his physical strength than has any other race, and has been able to insinuate himself into the life and history of the South more through this agency than through any other. To-day no other race in America is so dependent upon its physical strength for a livelihood as is the negro. Thus whatever tends to vitiate the physical strength of the negro will certainly affect him at one of the most vital points of his life, and likewise will affect the material progress of the South. This fact is a sufficient reason for this gathering and should inspire the "Negro Church" to use its energy for the preservation of the South, the race, and itself. THE PLACE OF THE NEGRO CHURCH IN THE LIFE OF THE NEGRO RACE Before his freedom the negro believed and trusted in the true God. After freedom, the genius, autonomy, and 430 THE NEW CHIVALRY — HEALTH best aspirations of the race found their expression in the religious life of the negro; and his Church was the most acceptable and desirable field of operation. So, early after freedom, the "Negro Church" was made the clearing house for all of the race's activities and endeavors. And through- out the negro's free history the Church has occupied the most exalted place in his affection, and is to-day his final arbiter and highest court of appeal in all things. This being true, the duty of the "Negro Church" to help in the alleviation of human suffering and in the preservation of the health of its patrons is obvious and doubly binding. POINTING THE WAY 1. Inside Edification. — ^The problems of the health of the negro are many, vital, complex, and difficult of solution, and with these conditions the Church must first become thoroughly acquainted. Besides, the Church needs an awakening vision of the value of bodily strength, a sense of its opportunities, and the incentive to great accomplish- ments. It should know that the work of preserving the physical vigor of the negro race is one of pertinent bearing upon itself and will affect its growth and the tenure of its useful existence. After a close sympathetic knowledge of the health conditions of its patrons, and a conquering sense of duty, the Church needs a wise, working knowledge of the principles of effective social service. It needs culture, a general inside toning up, and should then begin its work on the masses in patience, tenderness, and love. 2. The Education of the Masses. — In this effort the Church will use the information acquired, and will continue the work of self -culture and edification, while it seeks to aid those not of its own household. It is true that this will be a slow work, but it can be done with success if the Church first wins the hearts of its followers by showing that it is interested in all of the questions that confront them. In attempting to educate the masses, the facile method would be first to get hold of the children and do the double task of educate and cure — educate and prevent. Every HEALTH PROBLEMS OF THE NEGRO CHURCH 431 Church should have its children's and young people's meet- ings. In these there should be discussed at times health questions in their physiological, moral, and spiritual aspects. It should have special sex divisions of these meetings, in which sex problems as they bear upon the race's moral and physical welfare could be studied. Then, every Church should maintain day nurseries, for so many parents must work away from home, or, if at home, the work is so strenu- ous that they have not the necessary time to give to the preservation of the health of their children. Gymnasiums, swimming pools, public bathing stations, and playgrounds in a wise social policy are essential things, and the Church should maintain them. It would be wise to organize mother's meetings, in which child-rearing, food selection and values, and kindred housekeeping and health subjects could be considered. In connection with these meetings the Church would do well to establish domestic science departments, have cooking contests, and give practical lectures on housekeeping. In the brotherhood and parents' meetings, the moral and phys- ical perils of the community should be sought, known, dis- cussed, and measures advanced to check such perils. At stated times lectures on health problems should be deliv- ered — say, each Sunday night — giving about fifteen minutes before the regular worship. Every Church should also have an intelligent, tender Social Service Committee to woi;k from house to house at all times, finding the sick and needy, relieving and advising them, and serving as a vigilant health committee. All of these functions and persons should be under a careful and sympathetic Church manage- ment. 3. A Wise Benefaction. — ^A wise social policy must fol- low a course of prevention as well as cure. The present victims of bad health produced by existing unsanitary con- ditions must be cared for while the Church is seeking to improve such conditions; and this calls for charity work and benevolent institutions. Much of the charity work, 432 THE NEW CHIVALEY — HEALTH unsatisfactory as it may be, must be done in the home of needy families. However, if the Church is to do its full duty, it must establish nurse-training schools and hospitals. Many negroes with good physicians and medicines die untimely deaths for the want of proper nursing and such conveniences as are found in well-arranged homes and hos- pitals. 4. Cooperating with the State. — ^The Church should maintain a cooperative attitude toward the State. It should teach its members that while religion is primarily indi- vidualism, it also has its social relationships; and that "no man liveth to himself." The Church should quicken the moral nature of its followers, set up religious ideals, and agitate the enactment of such laws as will promote the physical well-being of its habitats. And when such laws are enacted the Church should support them as religious and moral measures. It should support public schools as great health centers, for in them children may learn through laboratories and the study of physiology the value of strong bodies as well as strong minds. And in case of contagious diseases, where the State requires a certain course, such as vaccination and isolation, the Church should always give the weight of its influence to the State. In Aberdeen, when vaccination was first introduced, when physicians failed to convince the people of its value. Dr. Kidd first studied, then favored the measure, and led his church and consequently the whole town to the support of it. He appealed to his members thus : "You trust your souls into my hands ; why not your bodies?" The Church should support all State eleemosynary insti- tutions, and should observe in the administration of its affairs all State laws. It should construct artistic meeting- houses, well ventilated, heated, and lighted, that should be models in beauty and cleanliness for the homes of the com- munity in which they are built. In one Southern city where ten modern negro church buildings were constructed the negro population increased its number of homes owned thirty-three and one-third per cent in five years, and sev- HEALTH PROBLEMS OF THE NEGRO CHURCH 433 enty-five per cent of those who had purchased homes before this era of church-building remodeled theirs, making them modern, convenient, and sanitary. A word of precaution: The Church should not transfer to the State all of its charity work, for by so doing it would lose an opportunity to develop itself and carry in an effective way the message of soul salvation and the gospel of love, which is better than gifts. It has been said that morality, intelligence, and economic well-being are the three leading factors in the health of a people. Economic conditions are greatly influenced by laws, and since negro suffrage has been greatly restricted and the negro's political power reduced to the lowest minimum, it is apparent that there are many problems of the health of the negro that the "Negro Church" cannot solve. And I make a plea here that none should expect the race and the Church to make brick with straw, when no straw is given and when none can be gotten. Should a man belted with weights and thrown into the sea be commanded and expected to swim, and censured because he does not when really he cannot? 5. Teach Duties as to Wealth. — The Church must sound a clear note on wealth and stewardship. Idleness is a curse, and every man, according to the law of human existence and the law of right, should labor, make some- thing, and, without covetousness, save something. A close relation exists between wealth and waste on the one hand and wealth and poverty on the other, and perhaps poverty is as much a peril to good health as are ignorance and immorality. Anyway, it is an undeniable fact that a pov- erty-ridden people are generally the prey of disease and death. The Church may inspire the making of wealth by encouraging efficiency and faithfulness of service, honor, and responsibility on the part of the negro in his labors. It should teach that it is as much of religion to give one dollar's worth of work for a dollar as it is to preach a sermon or lead a soul to God. It should hold up the fact that such a course will bring larger earthly rewards, please God, and increase the wealth-earning capacity of the race. 434 THE NEW CHIVALRY — HEALTH And with this increased the race can better withstand dis- ease. 6. Preach the Gospel of Humanism and Bodily Evangel- ism. — David, contemplating the subject of the human body, remarked that man was "fearfully and wonderfully made," and to-day it is a universal verdict that the body is the greatest visible wonder of the age. For a long time scien- tists sought to define the relation that exists between body and soul; and because Christian teaching and the Church's attitude on this point was a vagrant and changeful one, so were the conclusions of science. Human culture made its closest approach to an accurate description of body and soul relation in the laconic expres- sion, "Mens Sana in corpore sano." Novalis came nearer when he said: "There is but one temple in the world, and that temple is the body of man. . . . We touch heaven when we lay our hands on the human body." Stevenson came still nearer the truth when he declared: "What the body chooses the soul loves; where the body clings the soul cleaves ; body for body, soul to soul, they come together at God's signal." But the correct relation of the human body to the soul is given by Paul when he says, "I keep under my body;" "Present your bodies a living sacrifice;" "Glorify God in your body, and in your spirit;" "What? know ye not that your body is the temple of the Holy Ghost? If any man defile the temple of God, him shall God destroy; for the temple of God is holy, which temple ye are." This shows that the body bears a close relation to the soul, and is the sacred instrument of the divinest ministries of this life. Christianity is the life of God on earth in the soul, with the body as its best medium of expression. Christ honored human flesh by his incarnation and life, and yet honors it by his occupancy of his earthly body in heaven; and while he serves the flesh at the other endj he requires the preser- vation and service of the body at this end. The gospel of human evangelism needs a renewed emphasis in the "Negro Church," and the value of home HEALTH PROBLEMS OP THE NEGRO CHURCH 435 and bodily cleanliness and the importance of physical strength should form no small part of its activities. Miss N. H. Burrough, the leading negro woman of America, has pleasingly asserted the means to be used : "The three B's ■ — ^the bathtub, the broom, and the Bible." The Church should emphasize the need of correct habits of life, the importance of rest, proper clothes and shelter, the sin of neglecting the body, and should sound no low note on the cause of disease. It should make it clear that the forces of nature are not hostile to man's health, and that disease is not a mark of divine displeasure, not the work of Satan, not a spiritual malady, not "voodooism," but the violation of some law of health ; and that the observance of hygienic laws and the use of medicines administ^ed by competent physicians are the means to be employed in preserving the health. It would be wise also for the Church to teach that the body with its needs is not the supreme object of human labor and existence; not master, but a servant of the soul. And that life should not be reduced to meat and drinks, glutton, riotous living, lust, and the illegitimate use of lawful propensities, social vice and intemperance. The sanctity of the body must be preached by the "Negro Church" as the basis of morality and the best expression of an efficient religion. It must teach that taking care of the body is as much a part of religion as faith and trust in God. And if by any the body be neglected or not con- trolled, woeful consequences will follow to such persons themselves, to their offspring, and to their Church. To the above may be added the comforting promise made in respect to the body and its future prospects. It has a place now in Christianity and it has the pledge and promise of a future quickening, resurrection and life. As there is a psychological aspect of good health, this doctrine of hope is essential to the physical well-being of the race, and should be exalted by the "Negro Church." 7. The Gospel of Love. — ^The South should help preserve the health of the negro because of his economic value, other- wise the South will lose, by this neglect, one of its best industrial assets. The preservation of the health of the 436 THE NEW CHIVALRY — HEALTH negro race, in a sense, means the preservation of the South ; then, too, the South owes the negro a debt of gratitude for his years of tireless service. Civic righteousness, indus- trial usefulness, self-interest, and self-preservation are pleasing social service motives, but the best, most powerful, and only altruistic dynamic for such a service is Christian love. It is the cement of society which takes hold and succeeds where all others fail. It invites philanthropy, will compel adequate pay for negro labor, larger appro- priations for negro schools, and better municipal provi- sions for those localities and cities where negroes live; and all of these things will promote negro health. Christian love will do away with that cold, heartless doctrine of the "survival of the fittest" and substitute therefor that Chris- tian spirit of the strong bearing the infirmities of the weak ; it will check a seeming tendency in American life to sac- rifice the weak and helpless in efforts to acquire wealth, and invite the hearty cooperation of the strong in caring for the health of negroes. Already one of the largest sanitaria of the South, at Dallas, has turned over to negroes a well cared for, well equipped department. And in Houston, where we are now assembled, negroes had from whites the offer of one of the best sanitaria in the South. This passion. Christian love, must be relied upon by the "Negro Church" to solve those economic questions of health which are controlled by politi- cal measures, and which the "Negro Church" cannot con- trol because of race prejudice and the political impotency of its subjects. This gospel of love will keep the "Negro Church" from becoming worldly, from commercializing or secularizing its endeavors, and will keep before it the souls of men as well as their bodies, striking always the golden mean between the spiritual and the material. HEALTH THE BASIS OP RACIAL PROSPERITY 437 HEALTH THE BASIS OF RACIAL PROSPERITY R, R. WRIGHT, JR., PH.D., EDITOR CHRISTIAN RECORDER, PHILADELPHIA, PA. The basis of prosperity is labor. All wealth is origi- nally obtained by means of labor, without which prosperity is impossible. And as there can be no prosperity without labor, so there can be no efficient labor without health. Especially where the great mass must do manual labor is physical health absolutely necessary. A man must be strong enough to do his best work, for the longest possible period each day, without undue fatigue or physical deterioration. He must be able to work every working day without loss of time because of ill health, and he must be able to work the longest number of years. Now in a new race there will be most prosperity where there are most people working efficiently most hours each day, most days each year, and most years during a life- time. Given two communities of 1,000 workers each, of equal moral, intellectual qualities and technical and manual skill ; if one has ten more men sick each day than the other, it will lose, being kept back not only by absence of these ten workers, but being put to additional cost for their care. Ill health breaks down prosperity, because of (a) the loss of the worker to himself and his family in lost wages ; (b) loss to society by the withdrawal of productive labor of the sick; (c) loss to the individual and family because of the cost of care of the sick members — doctor's bills, medicine, etc.; (d) loss to society because of cost and care of the sick member, and the withdrawal of other productive labor to care for the sick. It is said that the real cause of the decline and fall of Rome was not so much the moral or intellectual deteriora- tion as the fundamental physical decline. And many other nations have lost their power and privilege when disease set up its stronghold in their midst. 438 THE NEW CHIVALRY — HEALTH The problem of prosperity to-day in most tropical coun- tries is dependent largely upon the problem of health. In certain portions of Africa, the most fertile country in the world, abject poverty exists because of poor health condi- tions. Mission workers on the West Coast of Africa, as elsewhere, find that they must take experts in medicine, hygiene, and sanitation as well as teachers and preachers; for without furnishing this proper physical basis their educational and religious work is often of little avail. The problem of prosperity in Cuba was largely solved when the yellow fever was controlled by improved medical and sani- tary precautions, and so with Panama and so with other parts of the world. Not only is racial prosperity dependent upon health and retarded by ill health, because of the loss of wages, the withdrawal of workmen, the extra care, etc., but it is dependent upon the length of the working life, and is retarded by early deaths. The Scriptures say that the days of our years are three- score and ten. We ought therefore to live that long, we may assume. Now the ordinary economically dependent life begins, say, at fifteen years of age, and lasts till sixty or sixty-five. During these years the worker not only supports himself but creates a surplus. The prosperity of the individual will depend upon the kind of support he is able to give himself and family and the amount of surplus he can create. If he dies early, this surplus will not be what should be expected if he had lived longer, and conse- quently the prosperity will be diminished. HEALTH AND PROSPERITY OP THE NEGRO Applying this to the negro, what do we find? First, since we have no absolute standard of what is perfect health, or the ideal death rate, and consequently no standard of what is the ideal life length, we find it best to compare the negro with the white man, realizing that while the condi- tion of the white man may for the moment be taken as a standard for the negro, it is far from being an absolute standard. HEALTH THE BASIS OP RACIAL PROSPERITY 439 An examination of the best available statistics in our country (and our best statistics, especially so far as the South is concerned, are very inadequate) point to the fact that the mortality rate of negroes is much higher than that of whites. The rate for the registration area of 1910 was 14.6 per 1,000 population for whites, and for negroes 25.5. The rate in fifty-seven cities was 15.9 for whites and 27.8 for negroes. In twenty-four Southern cities it was 29.6 for negroes and 16:9 for whites, while in thirty-three cities of the North it was 25.1 for negroes and 15.7 for whites. In Charleston, S. C, the negro and white rates were respectively 39.3 and 18.9; in Wilmington, N. C., the rates were 26.7 and 15.6; in Mobile, 29.5 and 17.7; in Jacksonville, 24 and 16.8; in Atlanta, 25.4 and 15.5; in Savannah, 34.1 and 19.4; in New Orleans, 27.8 and 17.2; in Memphis, 28.3 and 16.8, etc. In 1910 in the registration area there was 19.7 per cent of the total negro population, and the number of deaths of negroes was 49,499. If the percentage holds good for the country at large, the number of deaths of negroes was about 250,000 for the year 1910, WHERE THE NEGRO LOSES — SICKNESS The 250,000 deaths mean what? A burden of prior sickness. I have gone over the records of two hospitals in which two hundred and fifteen negroes had been confined. I found that the average confinement in these hospitals was twenty-one days. The average wage lost was about $21.22 for men and women. A careful study of the city, however, brought the conclusion that one-fourth of the population was sick at some time during the year, and that the annual loss of wages in a city of 80,000 negroes was estimated to be about $500,000 per year. If this should hold anything like true for the negro as a whole, we would have the following facts: There would be about 2,500,000 negroes sick at some time during the year. Their sickness would cost them at least $20,000,000. Besides this, they would lose in wages alone $50,000,000 in a year, and that is a conservative 440 THE NEW CHIVALRY — HEALTH estimate. With this burden, with one-fourth of its mem- bers sick at some time every twelve months, it is difficult for the race to enjoy great prosperity. The $70,000,000 of wages lost and medical attention would add $7 to the per capita wealth of the negro in one year. But there is another way to look at it. If the census is approximately correct and the negro not only dies in larger numbers in proportion to inhabitants than the white man, but dies earlier, not only is his actual prosperity diminished, but his potential prosperity. The latest statistics of the Census Bureau show that the average age at death in this country is 39.8 years ; the same for whites is 40.4 years, and for the negroes is 33.5 years. Although by the Scripture standard the white man gets only four-sevenths of his years, the negro gets less than half of his. To that extent at least the negro is behind. But it may be argued that this low age at death is due to the frightfully high rate of infant mortality, and that therefore its economic importance is not great. I shall therefore eliminate the deaths of infants and children up to the age of fifteen years, which is the average age at which children go to work. What do we find? That the average age at death for the registration area was 55.3 years; for the whites 56.1 years, for the negroes 46.0 years. In other words, the average negro who dies after he has reached the age of fifteen years lives 10.1 years less than the average white man — ^that is, after he gets to working age, he works ten years less time, draws wages ten years less, is able to care for his family and himself ten years less than the average white man. What does this mean ? That if the negro race had as much education and as free access to the ballot and all other civic rights as the white man, it would then lag behind because its members merely die earlier. So here comes an additional loss to the negro's potential prosperity. If we could imagine the negro equaling the white man in health, and consequently in length of life, the pursuant prosperity of the race would be beyond the wildest dreams of its best friends. HEALTH THE BASIS OF RACIAL PROSPERITY 441 NEGRO HEALTH THE BASIS OF THE WHITE'S PROSPERITY But the prosperity of the negro is not alone retarded on account of his high death rate, nor is he the only one who loses. Society loses, and that means the white man loses as well as the negro. Negro health is not only a basis for negro prosperity, but for much of the white man's pros- perity; for all the negro makes is returned to the white man. But of the one billion dollars the negro receives as wages each year, he saves not more than $10,000,000 a year, and nearly all of that is put in the banks run by whites and invested in homes bought from whites. The other $990,000,000 goes to whites for the sustenance of the race, adding to the prosperity of the white race. Hence it is of as much interest then to the whites as to the blacks that the negro shall live. I have tried to estimate the loss which society sustains by the high death rate of the negro. Dr. William Farr, the great English statistician, after many years of careful study, attempted to work out a table showing the economic value of a human life, claiming that the average value of a man to society is about $300 per year. To put this into language most easily understood by the lay mind it is as follows : For the first fifteen years of his life the individual must be cared for by society. He must be clothed, fed, educated, etc., and is thus a burden to society. He has no income — all expenditure. According to the law of many of our States a child under fifteen cannot go to work. From fifteen to twenty-five the individual is not only paying for his board and care, but is producing enough extra to pay society back for the expense of the fifteen years of his childhood. At about the age of twenty-five the average individual ought to have paid back to society all that expense, and from twenty-five on he should add to the surplus of society. It is clear that if this average individual dies in infancy he is but a little social loss ; if he dies between the ages of fifteen and twenty-five, he is of less social loss, but he is never a clear asset to society, a real surplus builder, until 442 THE NEW CHIVALRY — HEALTH he is over twenty-five years of age. It is also clear that social prosperity will be enhanced in proportion to the number of healthy bread-winners who pass the age of twenty-five. If they die under twenty-five, the race must eventually die out entirely. It is therefore to the interest of society to make conditions such as will make it possible to have the largest possible number of efficient workers pass the age of twenty-five, and to remain in health and efficiency for the longest possible period thereafter. Now the negro loses 10.1 years more than whites, because of the death of the average person of fifteen years or over at the age of 46 for negroes and 56.1 for whites. For every time a negro dies society is a loser to the extent of $250 per year, or $2,525— t. e., 101 times $250, if I concede that the average negro is worth per year to society $250 instead of $300. If there are 150,000 negroes of the years of economic independence — ^that is, over fifteen years of age — who die each year, each losing on an average of 10.1 years, and an economic value of $2,525, it is clear that the economic loss to society on account of the early death of the negro is 150,000 times $2,525, which is $378,750,000. But this economic loss is not one year, but every year, as there are at least 150,000 deaths each year. It therefore may be capitalized to represent the interest at 6 per cent on $6,312,500,000, which society loses each year on account of the negroes' shortness of life. Astounding as these figures are, they represent some- thing as to the economic loss of society because of the poor health and consequent early death of the negro. Most of this loss falls to the South, and most of the South's part falls on the white man. To repeat, I do not mean that the negro loses this, but that society loses; for the negro who works in the South may be a ditch digger. He may get $1.50 a day as wages, but society gets the ditch he digs or the sewers or the street, or the railroad his labor helps to make. Where there is a country where society needs these ditches, streets, sewers, railroads, etc., buildings and bridges, etc., as here HEALTH THE BASIS OF RACIAL PROSPERITY 443 in the South, it is to the society's best interest to conserve the health of its workers as the proper basis for its pros- perity. The average man may not agree with me about this economic loss ; but if we would suppose the negro were his slave, and he lost his slave, he would directly appreciate the loss. But a free laborer is worth more to society than a slave, and in the early death of a free laborer society loses more. Or if it were mules or cows that died early we could see the loss economically. How much more valu- able is a man than a mule? Or there are those who might claim that another worker can be gotten. Such a person does not understand our economic condition, certainly not our economic needs so far as labor is concerned. With resources undeveloped as we have in the South, a million laborers could be easily assimilated and add to our prosperity. We have none to spare, none to die too early. Any man who knows how hard it is to train new hands, or even to break new horses, can appreciate the great loss in training and exchanging new workers so frequently, especially in a country where' labor is scarce. Here in the South we have a set of workers, the most willing in the world, but we are not getting out of them what we should. When we were told that our land was dying and we were not getting what we should get out of it, we spent millions of dollars in fertilizers, rotating crops, establishing experimental stations, etc. This has added to the great prosperity of the South. When we were told of the great losses occasioned by the waste of our water resources, and our forests, we spent and are spending millions of dollars for conservation, and we are adding to our prosperity. Why not conserve the life of the man who must till the soil and fell the forest? Is not the human factor as important as the merely physical? The negro dies most largely from tuberculosis. At twenty-five years of age the worker begins to pile up his surplus; at thirty-three or thirty-five years of age the 444 THE NEW CHIVALRY — HEALTH manual worker is at his height as a surplus producer. What happens to this negro? Between twenty-five and thirty-five years of age more of them die of tuberculosis than at any other age period. They fall when they should be doing most work for society. They fall when society can least afford to lose them. Of the 250,000 negroes who died last year, if the death rate of the negroes had been the same as that of the whites, only 140,000 would have died and 110,000 would have sur- vived. In other words, were the negro rate brought to the white race, 44 per cent of the negroes would not die when they do. What would this mean for the race's prosperity? for the nation's prosperity? Would it add to our prosperity to save 110,000 negroes every year? Would it add to the prosperity of the South to add 10.1 years to the average negro's life? It adds to our prosperity to conserve the life of hogs, of game, of fish, of trees. Why should it not add to this prosperity to conserve the life of man? Then we should at least labor to bring the negro death rate up to the white death rate in this country. CAUSE OP EXCESSIVE NEGRO DEATH RATE We have progressed so far now that there are few indeed who put this excessive death rate of the negro upon inherent and ineradicable race traits, characteristic only of negroes. The best students put the cause of high negro death rates in the same category with excessive death rates among whites, upon bad economic and social conditions, not race conditions. The death rate of the poor whites of Russia is higher than that of negroes in America, for they often live under poorer sanitary conditions than negroes in America. The death rate of whites in many Southern cities, where there are poor sanitary regulations, is higher than that of the negroes in some Northern cities which have first-class housing and sanitary conditions. The death rate of negroes in some Southern communi- ties has decreased remarkably with improved sanitation HEALTH THE BASIS OP RACIAL PROSPERITY 445 and better education. The average age has increased, the average length of the economic life has increased in the past twenty years. There has been enough progress made to indicate what can be done if proper steps are taken. No investment the South could make to-day would pay her better than the investment in negro life extension. The South is losing billions of dollars to-day. To reclaim these she can afford to spend millions. The negro needs to be taught the rules of health and sanitation. Such teaching will make him mentally more alert, morally better, physically more fit, and industrially more competent. Ignorance takes its toll by tens of thou- sands each year, and the white man pays. Five thousand sanitary inspectors and teachers could be put in the South to-day, and would add to the prosperity of this section. Careful study of negro living conditions is absolutely necessary that the public conscience may be aroused and the proper remedies may be applied. I am convinced that the reason Christian white people are not sufficiently aroused is because they do not know the facts. So long as work calls the negro to the city he is going. No sentiment can keep him back. But he should be pro- tected from the venal landlords. The houses he rents should be passed upon by a fair system of sanitary inspec- tion. The landlords will get higher rents, of course, as tenants will be able to work longer. The negroes of this country could pay more rent, because they would pay less for drugs and the undertaker. They thepiselves would be better off, because they could be at work on the days some one in each family is sick. Give the negroes plenty of water and better sewerage in this section where they live. Make it easy to keep clean. This is far more necessary than segregation laws. Establish hospitals where negroes may have the best care under negro physicians. I say negro physicians with no feelings against the whites; but experience has shown that a competent negro physician can handle the health question, especially in its social aspect, best among his people. 446 THE NEW CHIVALRY — HEALTH Cooperate with the Church. Indeed a new social concep- tion is needed by the ministry. The vicious fatalistic doctrine of "every man must die when his time comes" leads to carelessness of health, while the too great emphasis on the after life causes the present life to be too frequently discounted. But little or nothing can be done without the coopera- tion of white and black. And since both are to gain, this cooperation should not be difficult, especially when we view the question, not as a racial question, not for arguments as to racial superiority or inferiority, not to inflame racial prejudice and hatred, but as a common sense business proposition affecting the prosperity of this Southland to which both races are bound and which both should equally love. X. THE CHURCH AND THE CONSERVATION OF HEALTH Health — The New Attitude, the New Knowledge, the New Responsibility Modern Miracles of the Church in Health Conser- vation The Sunday School as a Health School The Challenge of the Church to Keep Children Out of Heaven The Primary Function of the Church — To Save Life Physical Health Championed by the Church The Program of the Church as the Conserver of Social Health War on Disease— A Worthy Objective for a Reli- gious Crusade HEALTH— THE NEW ATTITUDE, THE NEW KNOWL- EDGE, THE NEW RESPONSIBILITY DEAN J. L. KESLEE, D.D., WACO, TEX. I. THE NEW ATTITUDE Heine, that singular literary genius, that master of the human spirit in its superbest flights — Heine used to say that "the holy vampires of the Middle Ages had sucked away so much of our lif eblood that the world had become a hospital ; that only a long and invigorating course of the tonics of life could make free from danger the open air of nature; that our first duty is to become healthy." The inmates of Heine's world-hospital, however, begin to show signs of convalescence. The earth-tremor at sun- rise shakes off the hideous nightmares of yesternight. The crusade for health is abroad and the "open air of nature" is its chief asset. This is the new attitude. To this "open air of nature" all the arts of healing owe divine allegiance. The science of preventive medicine, or hygiene, has joined hands with literature and religion, the school and the Church, in this triple and tonic ministry to wholesomeness and health. The world is good again and the world is beautiful ; and it isn't bad to be healthy and happy. Happi- ness is the chief guest of life and the chief nourisher at life's feast, and sadness life's chief murderer. The morbid isn't clean gone yet, but the worship of it is — or ought to be. Nature, good, clean, wholesome nature, has come back into fashion. This is the new modernism. I congratulate you who to-day in this health crusade put on the toga of a new citizenship in this great commonwealth of the arts of healing; you who assume and democratize to-day this new social task and take up arms against the distempers that pester our life; you who to-day take upon yourselves the vows of a new knighthood and do it all as private citizens of the kingdom of God, as sworn enemies to disease and the crimes that threaten to invade the very citadels of our civic life and our national efficiency. 29 450 THE NEW CHIVALRY — HEALTH Heretofore this task has been professional only, more or less occult, the doctor's mystery and monopoly. It was only yesterday that the sun rose above the unprofessional health horizon. To-morrow it will be high noon and all the wine vats will be overflowing with new wine. Over the border life's persistent calls press upon us out of life's persistent suffering. Among these calls the divinest that ever came to human capacity is human need; the divinest work, the work that you and I can do to help and heal; the divinest mission, the mission of life to life for life's necessities. This is the new attitude: on the banner of the Crescent, Force and War; on the banner of the Cross, Love and Peace. The slogan of the crescent, "Slay the infidel;" the slogan of the cross, "Preach the good news, heal the sick." This is a great world we enter — ^this world in league with life and at war with life's disharmonies; this world whose palm trees grow on the banks of the rivers of peace. Here every miracle of the healer's knife lays under tribute the heart of the universe. The surgeon is coworker with Him "who worketh without hands ;" "who layeth the beams of his chambers in the waters ; who maketh the clouds his chariot; who walketh upon the wings of the wind." Nature is God's divine mercy seat and ministry and manifesta- tion. We must walk her ways or walk life's paths of pain. All life is God's and all life's ministries: "O blind, blind seeker to the primal cell. Tracing this spirit with dissecting knife. Dost thou not hear in every passing bell, In pain and darkness, in sin and doubt and strife. The voice that breathes through heaven and earth and hell, Sun, moon, and farthest star, 'I am the life?' " How different is this spirit from that of the ancient time! Heine, in his "Religion and Philosophy," speaking of the gorgeous fever-dream of the Middle Ages, says: "Nature herself appeared in those times fantastically dis- guised; but notwithstanding that man, occupied with abstract metaphysical speculations, turned peevishly away NEW ATTITUDE, KNOWLEDGE, EESPONSIBILITY 451 from her, yet at times she awoke him with a voice so solemnly sweet, so deliciously terrible, so enchanting, that he involuntarily listened and smiled, then shrank back with terror and sickened even unto death." With this intro- duction he goes on to tell us the story of the nightingale of Basle. It was in the month of May. The world was full of song. The woods were full of flowers. Spring had spread her feast of green. And the slant rays of the sunrise smote with flame the dew-pearled morning. It was in 1433 at the great Ecumenical Council in Basle. A party of ecclesiastics were walking in the grove among the trees engaged in learned and pious conversation when suddenly they stopped trans- fixed before a blooming linden tree from whose boughs a nightingale poured forth a stream of luscious song — so sweet that these pious men, a moment ravished, stood in astonished ecstasy till at length one, having recovered from the wholly natural response to the delights of nature, made the sage suggestion that the nightingale was a devil in the form of a bird and that he strove to lure them away from their pious conversations to the pleasures of the senses. Whereupon they all, making the protective sign of the cross, put their fingers into their ears and fled away, con- juring the devil meanwhile with pious formulae. Straight- way, the story has it, the nightingale flew away laughing in acknowledgment of the indictment, and those who heard it sickened that very night and soon afterwards died. This view of nature would be laughable if it were not so terrible. It is of the warp and woof of that time when whatever was sweet and lovely was accorded to the devil, and the sweetest and loveliest was the most diabolical. Health was below par and healing was a lost art. Who- ever heard the nightingale sing or felt any other wholly delightful sensation, must needs make the protective sign of the cross and mumble pious incantations. As Heine says, "The true Christian, like an abstract specter, walked tim- orously, with closed senses, amidst the loveliness of nature." Opposed to this spirit is that of the old Catholic priest of our own time. Traveling among the great Rocky Moun- 452 THE NEW CHIVALRY — HEALTH tains, he was asked why he, an old man of eighty years or upward, was traveling about the world at a time when most men prefer to live quietly at home. The old man said: "I had a dream. I dreamed that I died and went to heaven. And when I knocked at the gate and Peter opened it, God met me and said, 'How did you like that beautiful world I gave you?' I awoke. I thought of the forty years I had preached about the beauty of the next world, and yet I had never thought of the beauty of this. I determined to see some of the beauties of this good world God gave me. That is the reason I'm traveling about the world." You will not be surprised when I confess that I regard the old man's attitude as wholly appropriate; and you are prepared to hear me say that I am in entire sympathy with Browning when he says, "God must be glad one loves his world so much." In the history of our race we were first slaves of nature, as seen in the demons that plagued the footsteps of fear in ancient mythology and superstitions, and then we became students of nature, and then masters, turning whithersoever we will these mighty forces into the stream of wealth and health and healing. We are made to be masters — ^to subdue the earth and possess it. It would seem to-day as if everything had conspired to incite us to the pursuit of natural knowledge. Nature her- self has gone her full length to excite within us a sane curiosity and to compel inquiry. She baptizes our duties in our interests. She dissolves our work in our appetites. She commands us by our own capacities and our own neces- sities. She feeds us by her daily natural miracles. She satisfies our intellectual hunger and our natural craving for beauty. She exhilarates us with the conspiracy of life in the contest of living. She secretes health and healing from innermost cellular repositories whose products are the antitoxins that neutralize the toxic encroachments on life's central fires, and all these hostages of health are in league with the deep divine recesses of life. To all this she gives us the key: to the doors of health, to open them; tq the doors of disease, to keep them closed. NEW ATTITUDE, KNOWLEDGE, RESPONSIBILITY 453 IL THE NEW KNOWLEDGE It is a great task we take up to-day, but we have at our command the hostages of heaven in the laws of life that are known and the veracities of nature that never fail. Our tasks are rare life tonics — so fresh, so new, so full of hope and healing! In the last quarter of a century we have learned more about life, more about disease, its cause and cure, more about surgery, more about infection and immu- nity and sanitation and preventive medicine than all the pre- ceding centuries of medical research had ever revealed. It was not till 1876 that sufficient evidence was obtained to bring an intelligent indictment against a single bacterium as the cause of disease, and not till 1882 was the bacillus tuberculosis convicted as the cause of the "great white plague" by Robert Koch, of Berlin. This was the first absolutely satisfactory proof ever given and by the most brilliant single research, perhaps, ever made and with the most far-reaching results. It was Robert Koch, the great doctor, and his compeer, Louis Pasteur, of France, the great biologist, who proved the material origin of infection, and not only showed it to be a natural phenomenon but proved that man on earth had power over nature to heal diseases. From that day to this our maladies have yielded to the march of science and the surgeon's knife. Every day brings us new marvels and heartens us with new hopes, and new heroisms are added to the cloud of witnesses of the immortal dead. The vistas of our landscape grow larger and broader and brighter. We more and more reach out to know and to utilize all the forces of nature and to mediate all the streams of healing to prevent and to cure the maladies of man. Already the day dawns and God fills all the banners with fair winds and sails all the seas and coasts all the shores of life. He can never be boycotted again till the hands of science are paralyzed, nor banished from his world of life again till the skill of biologist has lost its cunning. Already it is daybreak on the hills: the white wings of the morning move tremulously ; a freshness is in the air, and 454 THE NEW CHIVALRY — HEALTH somewhat of worship and expectancy is in the slumbrous quiet of the plains. The new teacher has come with new knowledge for the new time to meet new responsibilities. This knowledge and responsibility are pervasive and enlist all mankind in a common service, a task as old as Jesus and as new as yesterday. You, young ladies and gentlemen, are to go out into this new world to help and to heal, to give life and to give it more abundantly — ^to walk hand in hand with God, hand in hand with him who walked the hills of Galilee healing the sick. "Here," not "enough to watch the Master work," but to work with the Master. Than this Galilean physician, I leave you no higher ideal as learner, or teacher, or healer of men. We are beginning to face the problem of the conser- vation of our national resources. It is a matter of solici- tude lest we lay robber hands on future years. But we shall yet face that "greater problem," as Roosevelt calls it, "of our national efficiency." And you who to-day sit before me shall fight in the van when life and efficiency are put first in life's achievements — if you rise to the height of the call of life in trumpet tones from the word of God and in the bitter cry of human pain. Since disease is a natural phenomenon, and not only yields to natural treatment but likewise can be prevented to a large degree by natural means ; and since these means are available to intelligence and have already, to a marvel- ous extent, been added to our assets and have been made tributary to life; and since prevention is better than cure — what is to be our attitude to the "health movement" which even in its infancy promises so much for human betterment and for a higher standard of citizenship? It must be an attitude of more than assent. It must be a crusade. With the zeal of Peter the Hermit, and the sanity of Paul the apostle, we must build the walls of pre- vention stronger than the assaults of disease. We can heal but a handful. We can prevent our thou- sands of contagions. Let us first follow this method from NEW ATTITUDE, KNOWLEDGE, RESPONSIBILITY 455 the ancient night to the fullness of the new knowledge. The modest Jenner more than a hundred years ago with his cowpox vaccine stands dimly in the gloom before daybreak while the world of medicine was still without form and void and darkness brooded over the face of the deep. It was there in the night that the morning star of preventive medi- cine rose. Then Pasteur, the great biologist, in 1865 showed how to prevent the silkworm malady that was laying waste all Southern France, spreading famine and pestilence in its course, and causing an annual loss to France alone of 100,000,000 francs. Again in 1881, just thirty- four years ago, having in February announced the pro- tective value of his attenuated splenic fever virus, he was summoned by the Secretary General of the Society of Agri- culture to the experimental farm at Melun. He went. There he inoculated six out of ten cows and twenty-five out of fifty sheep with his protective vaccine. Twenty-six days later he returned with virile splenic germs and alternately inoculated a protected and a non-protected animal. Two days later were gathered there of the flower of France, senators, farmers, doctors, veterinary surgeons, newspaper reporters, to see if the God of Elijah would come down to seal the word of the prophet with divine fire from heaven. There was doubt, hesitation, much skepticism as they approached, but when they reached the grounds a great shout went up: the crowd went wild. Already twenty-one of the unprotected sheep were dead and the rest were dying while the protected were in their usual health. The four unprotected cows had great swellings on their shoulders, intense fever, while the six protected were well and hearty. On that day the bands of the night were broken and the doors of preventive medicine swung wide open. Still again in 1885 it was clear daybreak when Pasteur prevented the development of rabies, or hydrophobia, in Joseph Meister, of Alsace, and now we crown him chief among the apostles of life. 'Twas sunup just ten years later when Kitasato and Behring's antitoxin treatment of diphtheria made a new 456 THE NEW CHIVALRY — HEALTH epoch in this vast new world of prevention and cure of disease. The discovery had been made five years earlier, but it took time to overcome the alien attitude of ignorance and our professional inertia. If any antivivisectionist objects to the death of a few sheep and cats, I say that for the death of every animal thousands of human beings live to-day. Then came the era of the discovery of disease carriers : Lord Ross in India in 1898 gave us the marvelous story of the cycle of the Plasmodium of malaria in the Anopheles mosquito and the means to stamp out this plague of the swamps. Two years later a still more hazardous task was undertaken by Drs. Reed, Lazear, Carroll, and Agrimonte to solve and abolish the yellow fever problem. Lazear was the first to lay down his life, and because he died thousands live to-day. They risked death to find out the cause and to sink forever this scourge of life. They found it, and they walk to-day immortal among the dead. Of elephantiasis and dengue and their mosquito carriers, of the ticks and Texas fever and the spotted fever of the Rocky Mountains, of the tsetse fly and the sleeping sickness and its allied distempers, of the house fly and its more than a million cases every year of typhoid and similar infections in America, I have not time to speak. But the means are at hand and prevention is not a remote hope. Besides these is our more or less recent knowledge of water-borne epi- demics, milk-borne epidemics, dust-borne epidemics, and those borne by infected foods. The water problem is an immense problem with its great reservoirs, its filter plants, its sanitary supervision, its aqueducts. The water plant that supplies New York City rivals the Panama Canal. The milk problem is an immense problem with cities like Chicago using 1,000,000 quarts daily from 12,000 farms, and New York receiving her supply from 35,000 farms and 700 dairies located in a half dozen States. The danger of infection is immense and the inspection is inadequate. Dust and tuberculosis and the tenement house and adulterated foods and the patent medicine nuisance and child labor, and NEW ATTITUDE, KNOWLEDGE, RESPONSIBILITY 457 to all this is added the human carriers of disease to com- plicate the problem. But knowing the danger we no longer walk in the dark. It has been said that the ancients plucked the flowers of literature and art and life; but> however that may be, they have certainly left us a good deal of fruit to gather. The health tide is to-day at the flood. Yonder on the banks of the Main, at Frankfort, Ehrlich has sent forth his medicine to cure our direst malady, the malady which runs its secret course and lays more innocent lives on surgeons' tables, perhaps, than any other, and taints deepest the helpless offspring's blood. It looks hopeful. We are fighting a winning battle. In the lifetime of the young among us, half the diseases that mock us to our graves may be but a memory and a history. This, with many new anti- toxins and vaccines, as typhoid, with the increasing impor- tance of the ductless glands and psychic influence, is part of the new knowledge. Already tuberculosis has decreased over 59 per cent and typhoid over 65 per cent, and what shall we say of the others that are gone and forgotten ! III. THE NEW RESPONSIBILITY Still the battle fronts us: The right of the child to a chance at life; the need of general information among the people. The young woman, educated in many things, with many evidences of culture, beautiful and desirable, with much that is attractive and indispensable, is yet often entirely helpless, without resource, perplexed and defeated at the cry of her first child. Its physical nature she does not understand; its intellectual nature is only a problem to her; its moral nature is left to drift, hoping for a rift in the cloud after sunrise. More than half of the graves, the little short graves, are sacrifices to Moloch on the altars of ignorance. More than fifty Titanics go down in the sea of disease in the Southern States every year — and because we have not provided for life. Still we are making progress. From 1900 to 1910, by the census figures, the death rate of the first year of child life had decreased 20 per cent, the 458 THE NEW CHIVALRY — HEALTH second 45 per cent, from the fifth to the tenth 30 per cent, an average of 10 per cent from 20 to 50 years, and it has increased perceptibly after our allotted threescore years and ten. Twenty years ago only one city in the United States had medical inspection for the schools ; fourteen years ago only a handful (about three, I think) ; nine years ago forty-four; four years ago over three hundred. And the school that does not have medical inspection now is a byword and disgrace. This inspection is for two purposes: to prevent con- tagious diseases and to correct physical defects. We have made but a beginning. Not all the children are sufficiently provided for yet. Still the bitter cry is heard where there is no answering hand. But when they are looked after and the defects remedied, as in the case of adenoids, the senses are sharpened, the vigor augmented, the prospect for good citizens takes the place of the prospect of the poor- house, the jail, and the asylum. Some inspection in rural districts, a few doses of thymol rightly administered, and a little sanitary knowledge to prevent ground infection with hookworm would increase the school attendance more than compulsory school laws, would add enterprise, stimulate scientific farming, and raise the price of land more than all the land booms and real estate agencies combined. For, after all, what makes the country develop is men — healthy men, men of enter- prise, good citizens and good neighbors. The country needs sanitation as well as the city. According to the best sta- tistics 60 per cent of the country wells are infected with sewage bacteria, which, of course, indicates danger of typhoid infection. The State can afford to invest in intelligence because of the added efficiency of its citizenship; but intelligence without health is a poor investment. To invest in intelli- gence without providing for health to make it effective is bad economics. Biology, in recent years, has been busy in its mission of healing; it guides the surgeon's knife, its antitoxins recruit NEW ATTITUDE, KNOWLEDGE, RESPONSIBILITY 459 our natural forces, its vaccines discipline the bodily powers against disease and establish immunity, its medicines heal the infirmities that for long years have burned to ashes the temples of health, its tonics touch the psychic springs of strength with freshening cordials, it kindles anew the fires on the altars of life where yesterday they burned low, it has been about the Master's business, surely, healing the sick. Everywhere sanitaria arise, hospitals, Pasteur insti- tutes — ^temples of science, 'tis true, yet temples more and more consciously working at the kingdom of God — "doing good," "healing the sick," what the Master did. More and more science is to lay under tribute every factor and force of the natural world as contributions to the service of humanity, and so is to fulfill the law of Christ — ^the law of service. Science, with its constructive program of sanitation, lays under tribute all the social and religious forces, settle- ment work, missions, and every vital movement for human betterment moral and physical. Healing the sick and in her latest surgery almost raising the dead, with new Insight into old truths and new ores from the mines of knowledge, with hope and good will and no bitterness, science presses into the kingdom with hands full of healing and hearts full of love. She comes not with force and fagots, but with fellowship and service; not with creeds, but Christ. What biology has made possible, religion is under obli- gation to make prevail. This can be done in part directly and in part indirectly through the teaching and the regular ministries of the Church and Church institutions; through the pulpit, religious papers, religious schools; through the teachers and health inspectors in the public schools ; through the school and city nurses, in their daily missions of mercy ; through the State, the county, the city health officers, who should be the most superbly equipped men, expert in all the methods of sanitation and prevention; through physicians and general practitioners everywhere, as conservators of the common life; through the daily papers as champions of public health and clean cities, as chief makers of public sen- 460 THE NEW CHIVALRY — HEALTH timent and builders for humanity; and finally through a strong, central, unified national health department, deliver- ing to the people through their local agents the information necessary to the healing of the nation. These agencies and all others, individual and public, assume a responsibility which is not only important but enormous. There is not a pesthouse or infection spot in our city but that we, individually and socially, are the moral sponsors for, if we do not join our forces for their abolition and for a new declaration of independence of individual and social contagions. For no man liveth to himself and no man dieth to himself. We have a common responsibility ; we bear a common heritage ; we live a common life ; we serve a common humanity in the name of a common God. MODERN MIRACLES OF THE CHURCH IN HEALTH CONSERVATION SAMUEL ZANE BATTEN, D.D., PHILADELPHIA, PA. The redemption of the human race is the supreme con- cern of man here below. In this larger end all lesser ends are included, or by their relation to this process all other processes derive meaning. On the one side this means the deliverance of man from everything that is dark and evil and tragic, and on the other it means the rebuilding of life in righteousness, health, and joy. We are here con- cerned with one aspect of this great purpose — ^the salvation of man from unnecessary disease and suffering and the deliverance of society from human waste and loss. I. THE SON OF MAN CAME TO SAVE LIFE FOR THE KINGDOM OF GOD It is not necessary here to consider in detail the meaning and scope of this great conception of the kingdom of God. MODERN MIRACLES OF THE CHURCH 461 It may be said for one thing that the kingdom of God, so far as it relates to this world, is a society of people. On this subject of the kingdom the greatest confusion prevails ; many people seem to live in a fog bank and never to have done any real thinking. They speak of the kingdom as if it were a state of being, a sublimated something up in the clouds, something far away from concrete things, a king- dom of bodiless spirits and unknown conditions. In much of the current teaching concerning the kingdom of God there lurks a fallacy which bewilders many. It is admitted that people are members of this kingdom, but there is something implied in this which few seem to have con- sidered. Thus we are told by a professor in a theological seminary in a formal address at the opening of the year's work that the kingdom of God is "spiritual and not social." Just what meaning he attached to these words one is unable to guess. The words seem to assert an antithesis between the social and spiritual as if the two were exclusive and dis- connected realms. He seems to imply that the kingdom is an unorganized number of bodiless spirits living out of relations with one another in blissful isolation in some cloudland. The kingdom of God in this world is composed of real people, living men and women. They are human beings of flesh and blood, of heart and brain, of body and spirit. The only man we know is a being made up of a body and spirit; man is not a body alone or spirit alone, but body and spirit are so interknit and interdependent that neither can be considered apart from the other. The only people we know are beings who are born and grow, who eat food, wear clothes, live in houses, need fire in winter, who buy and sell, who are subject to physical conditions, who must have air and sleep, who live together in communities as friends and neighbors, workers and citizens. These people so long as they live in this world must cultivate the soil, mine the coal, smelt iron, transport commodities from one place to another, and have some kind of industrial and political life. 462 THE NEW CHIVALRY — HEALTH The program of the kingdom implies the redemption of the whole life of man. There are few words that have suffered more at the hands of men than the word "salva- tion." Many men have made it the synonym of rescue, thus taking it in a negative sense and missing its positive meaning. Some have construed it wholly in terms of the soul's life, thereby limiting its scope and giving it an unreal significance. Others have taken it in a purely individual sense, thereby narrowing its larger meaning. As a matter of fact the diameter of the word circumscribes an orbit that is as wide as the purpose of God and as inclusive as the being of man. The Son of Man has come to save the life of man — ^that is, he has come to save man, the whole man, spirit and mind and body. He has come to save a man's days and years for the kingdom and its uses. He has come to save a man's lifetime, his powers, and his talents for the kingdom. More than that, he has come to save man from missing the mark in life and to use life for its true ends ; and he has come to save man's capacities and to unfold their possibilities, that not only the man who is may be saved but the man that may be is created. The only salvation that has any meaning, that is worthy of God and has meaning to man, is the salva- tion of the whole man. Jesus Christ has come that men may have life and may have it more abundantly, life spir- itual, life mental, life physical. He has come to save the whole man and not a mere segment and fragment of a man. The life of man is a unit and it is hence impossible to save him by piecemeal. The Son of Man ministered to the whole need of man. According to the Gospel record, Jesus worked for the whole man, and he never made any distinction in value between work for the soul and work for the body. In fact he spent a larger part of his time ministering to what men often call the temporal and material needs of people. In the Nazareth synagogue he outlined his program, showing that he had come to save the whole life of man. (Luke iv. 17-20.) At a later time he gave as a crowning proof of his ministry the fact that the lame walk, the lepers are cleansed, the deaf MODERN MIRACLES OP THE CHURCH 463 hear, the dead are raised up, and to the poor the gospel is provided. (Matt. ii. 4, 5.) It may be said that the Churches have usually given these words in an almost wholly spiritual sense and inward application, but in so doing they have prevented the plain teachings of the Master and missed the power of his example. One other thing may be noted here: these works of healing and saving were an essential part of Christ's saving ministry. He came to reveal the love and helpfulness of God, and he revealed these by helping men whenever they needed help. He came to fulfill a complete ministry, and so he was interested in the whole life of man. These works of healing were as evidences of his divine commission. These works of healing he included among the things the Father gave him to do. Thus when about to heal a blind man he declared that he must work the works of God while it was day. (John ix. 14.) Some people have tried to make a distinction among the works of Christ, regarding some as spiritual and primary, and others as physical and incidental. But this is unworthy of the Christ himself and is an utterly false distinction. There is nothing secondary and incidental in the life of the Son of Man. Whatever he did was a part of the Father's will and had a necessary place in his program. II. THE CONTINUING MINISTRY OP CHRIST The Son of Man not only healed and helped people him- self, but he directly commissioned his disciples to do the same thing. Twice he sent out companies of disciples, and in both instances he gave them explicit instructions: "As ye go, preach, saying. The kingdom of heaven is at hand. Heal the sick, cleanse the lepers, raise the dead, cast out demons." The disciples carried out this commission and reported these services. We are told that he rejoiced in spirit and lifted up his heart in gratitude to God. At the close of his ministry he said to his disciples, "As my Father hath sent me into the world, even so send I you," and he gave them the direct promise: "The works that I do shall ye do also; 464 THE NEW CHIVALRY — HEALTH and greater works than these shall ye do, because I go unto the Father." The early disciples accepted their commission from the Master and for a time at least performed a ministry of healing. But very soon this aspect of their ministry fell into the background and was lost almost entirely to the Church's program. It may be said that in our time there has appeared a group who claim the power of saving people from disease and suffering. They do this by denying first of all that there is any such thing as disease and sickness. This doctrine may be satisfactory enough for those who are well, but it is sadly discredited by the facts in the case. It is necessary that we go back to first principles and record our Christian commission. The first part of the commission the disciples in all ages have accepted, and in a way they have sought to fulfill it. In all generations there has been a succession of evangelists and preachers whose calling has been honored and whose work has been success- ful. The second and third items in this commission the disciples generally have not accepted and have not fulfilled. And yet these are no less a part of Christ's program and are no less vital in the progress of the kingdom. Preaching the Gospel is one of the divine means of extending the kingdom, but it is not the only means; the other means are just as vital and just as Christian. It is quite as important that men cast out demons and take up stumbling-blocks as that they preach the gospel to men and women. It is just as Christian to make straight paths for men's feet lest that which is lame be turned out of the way, and to secure for all the conditions of a human and healthful life, as to teach men the Bible and to seek the salvation of their souls. In all times we have honored the work of the preacher and we have done well. Preaching is a divine means of winning the world unto God and it must never be minimized. But it is not the only means or the exclusive way. The apostle mentions the various workers given by Christ to his Church — apostles, prophets, teachers, workers, gifts of healing. MODERN MIRACLES OF THE CHURCH 465 governments, tongues (1 Cor. xii. 28-30; Eph. iv. 9-14) — and declares that all are necessary and all entitled to honor. The commission to help men as they have need and we have opportunity is binding upon the Christian disciple- ship. The Gospels show that Christ threw the very empha- sis of eternity upon the duty of helping people. In the parable of the judgment he shows how the destinies of men, their fitness and unfitness for the kingdom, are revealed in the way they have fulfilled and neglected the simple humani- ties of life — feeding the hungry, visiting the prisoners, nursing the sick, and helping the weak. The only fatal heresy here and hereafter is aa unloving heart and an unserving life. m. THE CAUSES OP DISEASE In these latter days a principle is coming into common use that has many applications and will produce marked results. Things have causes. This principle seems com- monplace enough, but it is revolutionary doctrine and is destined to work a greater change in human thinking than was wrought by the change from the Ptolemaic to the Copemican system of astronomy. Things have causes. Then everything in this world has a cause. Then disease and blindness, crime and poverty have causes. Then these causes can be known by man. Then man by dealing with causes can change results. What are the causes of disease ? Are they divine or human causes? The time has been when man believed that sickness was due to Satanic influences that were permitted in some way to torment man. Insanity and epilepsy were believed to be caused by evil spirits. Other afflictions were due to evil powers; in fact every form of disease was charged up against some particular demon. It must be confessed that there is something almost Satanic in the many diseases and plagues which have afflicted mankind and have devastated the earth. But no intelligent man to-day believes that disease is due to evil spirits or demonic influences. The time has been also when men attributed the disease and suflfering of man to the will of God, The Mohammedan 30 466 THE NEW CHIVALRY — HEALTH believes that disease is a matter of fate and that heaven fixes the death. He believes that one is flying in the face of Providence who calls in a physician, and the one who talks about sanitation is tempting the lightnings. There are many people in Christian lands who hold pretty much the same view. This is one reason perhaps why some good old women "enjoy poor health." They suppose that it is due to some mysterious providence and is a sign of God's gracious discipline of the soul. The plague and pestilence are entered as "visitations of Providence" for the sins of men. Parents whose children have been killed by diph- theria and dysentery have been told that God had sent this affliction to discipline the soul, and they have been taught to be submissive and reconciled. It must be said that this providence has established the relation between cause and effect, and when we allow evil causes and conditions to exist the law of God brings penalty and disaster. But the man who believes in God, the God and Father of Jesus Christ, knows that the will of God is the sweetest, gladdest, bright- est thing for man and for the world. He knows that not sickness but health is the will of God, not disaster but life is the will of heaven. He knows that Heaven does not ordain sickness, that men themselves determine the death rate, that disease and sickness are due to their ignorance and neglect. The selfishness, the sin of men, the most Satanic thing about disease is the brutal selfishness of men, their wicked indifference to their fellows' welfare, the criminal neglect of sanitary measures by society. We are driven back to the conclusion that disease and sickness have causes, and these are knowable, human, social causes. It does not lie within the scope of my purpose to consider in detail these causes, but a few of them may be mentioned. First of all we may note that much sickness and suffer- ing are due to the ignorance and vice of men. There are certain conditions which hedge up man's life in this world, certain laws that must be obeyed if man would live and prosper, Man has been very slow in learning these condi- tions and slower still in obeying these laws. The results MODERN MIRACLES OP THE CHURCH 467 of this ignorance and disobedience are seen in the high death rate and the large amount of sickness. People are indif- ferent to the laws of health and so they must pay the pen- alty in suffering and loss. They eat improper food and some eat to excess. Many neglect the simple rules of hygiene with reference to sleep, air, exercise, and rest, and nature exacts a heavy forfeit. Some are running the pace that kills and are wearing out their heart and kidneys. Then when they break down and die their friends blame heaven and talk about the mysterious ways of Providence. In many cases, perhaps in most, it is a sin for an adult to be sick. It means that he is either grossly ignorant of the laws of health, or he violates these laws in self-will. But ignorance is a sin where knowledge is possible. There is some truth in the Japanese proverb: "There is no remedy for fools." We must recognize the fact also that much sickness and suffering is due to the vices of men. In all times men have known that offenses against purity have entailed heavy consequences upon the race. But it is only in modern times that we have realized the prevalence of venereal disease and the frightful suffering it causes. In the hospitals of New York City in one year there were treated 243,000 cases of venereal disease. In the hospitals of that city the same year there were treated 41,585 cases of other infectious and contagious diseases. This means that there were six times as many cases of venereal diseases treated as of all the other infectious diseases, such as tuberculosis, small- pox, diphtheria, and typhoid fever. When we remember that venereal diseases are the cause and condition of other diseases, the indictment against them is pretty heavy. Fully 85 per cent of the operations for women's troubles are due to venereal infection. Nearly all cases of paresis and loco- motor ataxia are due to this one cause. This is not all, but these two things, alcoholism and venereal disease, are responsible for many of the inherited and constitutional defects of men. We know to-day that these are what may be called racial poisons — ^that is, they 468 THE NEW CHIVALRY — HEALTH have the fatal power of affecting and developing human life and thereby causing defects in the human constitution. These two things are responsible for nearly all of the feeble- mindedness and epilepsy. When the syphilitic taint is present in one or both parents, few children are born nor- mal, and not more than two per cent live beyond infancy. Nearly every case of blindness is due to venereal infection. These two things are responsible for much tuberculosis and many nervous disorders, in that they mean an impaired constitution that is susceptible to disease and early yields to the first attack. In the most literal sense, the sins of the fathers are visited upon their children unto the third and fourth generation. Truly humanity pays a heavy toll in sickness and death for the vices of man. But we must note briefly some other causes, industrial and social, which affect human beings and are responsible first and last for much disease and suffering. In all times men have known that exertion induced fatigue, and fatigue was often followed by serious consequences. But it is only in recent times that we have learned the real nature of fatigue and have discovered its seriousness. All exertion means the expenditure of power and the waste of tissues. In normal cases where the exertion is not excessive the waste is removed nearly as fast as it is created and thus the balance of the body is maintained. But in other cases where the exertion is prolonged and excessive this waste is created faster than it can be eliminated. It therefore remains in the system and is disseminated throughout the body. Now note the relation between fatigue and our modern industrial development. In our time we have created certain conditions that greatly increase the amount of fatigue and so greatly increase the amount of sickness. In these times we have changed the meaning of the word manu- facture from hand-facture to machine-facture. Man has invented all kinds of machines for doing the work of the world, but thus far he has invented no mechanism for tending these machines. This work must be done by people, MODERN MIRACLES OF THE CHURCH 469 and by the nature of the case it is largely mechanical and uninteresting. We find that the constant use of any set of muscles, even in the most mechanical routine, soon induces fatigue. The investigations of Claperode and others show that there is a direct relation between the routine of the work and the amount of fatigue. Thus where the work is easy and interesting very few toxins of fatigue are found; where it is difficult and yet interesting a few are found; where it is easy and tedious many are found; where it is difficult, tedious, and uninteresting very many toxins are present. (Prof. I. E. Ash, in the American Journal of Sociology, November, 1913.) In view of the fact that manufacture to-day is largely by machinery, and the tending of machines is tedious and uninteresting, the seriousness of the situation appears. But when we note the further fact that a large propor- tion of these machine-tenders are women and young peo- ple, the situation assumes a double seriousness. For we find that this fatigue is more serious in the case of women workers than in the case of men. Two Swiss writers — Schuler and Burckhardt at Basel — ^found that in cotton mills where both sexes are employed the amount of morbidity among men and women was as 100 to 139. The strain of industry tells upon woman's more sensitive organism more quickly and more seriously than upon man's more resistent system. This overstrain and fatigue of woman reacts in three definite ways: in heightened infant mortality, in a lowered birth rate, and in an impaired second generation. In English cities - there is found to be a direct relation between the industrial employment of women and the rate of infant mortality. Thus in the non-textile towns the rate of infant mortality from 1894 to 1905 was 150 per 1,000 population. In the textile towns the death rate of infants was 182, rising in some towns to 208 per 1,000 of popula- tion. In Prussia it is found that about 22 per cent of all infants die during the first year; but while the mothers were engaged in certain dangerous occupations we find the appalling infant mortality of 65 per cent. Our modern 470 THE NEW CHIVALRY — HEALTH industrial development is making possible an increased production of material goods, but it is exacting a heavy penalty in an increase of sickness, a heightened death rate, and an impaired second generation. But we must note another social cause of much disease and sickness. It has become very certain that there is a direct relation between sanitary conditions and the mor- bidity and mortality rate. Thus in Berlin it is found that the death rate in one-room families is 163.5 per 1,000; in two-room families it is 22.5 per 1,000 ; in three-room fami- lies it is 7.5; and in four-room families and over it is 5.4 per 1,000. In Scottish cities it appears that boys from one- room families are 12.9 pounds lighter and 5 inches shorter than boys of the same age from four-room families; and girls from one-room families are 14 pounds lighter and 5.3 inches shorter than girls of the same age from four-room families. In Johnstown, Pa., it is found that the death rate of infants in certain sections of the city was 271 per 1,000, while the death rate of infants in other sections was only a little over 50 per thousand. In the Seventh Ward of Philadelphia, with bad housing conditions, the death rate from tuberculosis is 447 per 100,000 of population, while in the Thirty-F6urth Ward, with better housing condi- tions, the death rate from the same disease was only 100 per 100,000. Such figures from many cities could be quoted indefinitely and they would all confirm the one conclusion. Wherever investigation's have been made and statistics gathered, they show a direct relation between unsanitary conditions and the death rate. A morbidity and mortality map of any city will show very clearly that much sickness and a high death rate are always found in connection with overcrowded rooms and unsanitary tenements. There are several diseases that are responsible for a large proportion of the sickness and deaths among men. The plague, cholera, yellow fever, smallpox, typhus, and diph- theria are some of the historic scourges that have swept over the world and have caused innumerable deaths. These are caused by the presence in the body of minute germs MODERN MIEACLES OF THE CHURCH 471 which waste and destroy the system, and these are all filth diseases in that the germs develop in filth and are spread by neglect. The same is true concerning typhoid fever and dysentery, including with the latter summer complaint, cholera infantum, and similar diarrheal diseases. These diseases one and all are due to polluted water, infected milk, dirty food, and poisoned air, and many of the germs causing these diseases are carried by flies and mosquitoes. Tuberculosis, "the white plague," one of the most common and deadly of all diseases thus far, is what may be called a "crowd disease." It is due to a germ which develops in the human system. But it does not develop unless the system is itself reduced by overcrowding, bad air, defec- tive nutrition, and general neglect. However, it is highly contagious and is easily communicated to others. The sum of the matter is this, that disease and sickness are due to human and social causes. These causes can be known and they are within the control of man and society, and so man and society are responsible for fully ninety-nine per cent of the sickness that occurs. We must now gather up the threads of our discourse and must show the relation between religion and the death rate. We must show how (Christian men may fulfill the healing and saving ministry of Christ and may perform the "greater works" that he promised. IV. THE MIRACLE OP PREVENTION In these times man is learning some lessons which are changing his whole conception of life and are enabling him to achieve some good results. 1. Man is learning that God is in his world, its causes, its life, its sustaining power, its animating spirit. Along with this goes the truth that God is a God of law and order knd method. In times past men have made a distinction between the will of God and the laws of nature, and so they have pitted one against the other, and have supposed that one excluded the other. To-day we are entering into the larger and truer truth and are seeing that what we call law 472 THE NEW CHIVALRY — HEALTH is the method of God. "The facts of nature are the incar- nations of his thought." Law is not a substitute for the divine will, but an expression of it. The laws of nature are God's method of operation. Nature is thus an authentic and visible revelation of God and every fact of nature is a disclosure of his presence. Nature is not a rival of God, but the discovery of his method. Some people suppose that when we know how a thing is done we rule God out of the process. But the exact opposite is the case. We enter into the purpose of God just so far as we see how he works. Every bit of new knowledge of nature is so much more knowledge of God's ways of working. Some day we will see this more clearly than many see it now. Some day we will see that the scientist interpreting nature's method is the prophet interpreting God's will. Some day we will appreciate the attitude of Agassiz, who used to say to his class before performing an experiment, "Now we will ask God a question." Some day we will see that the scientist studying the book of nature and the theologian studying the Scriptures are both studying the will of God. 2. This will of God because it is his will is a good will to man. But this will of God because it is a will of order works by law and method. God is a being of goodness and love and his will for man is one of blessedness and joy. But God governs the world by law and method, and so man can be blessed only in God's way. Obedience to God and his laws means life and blessedness to man. Disobedience to God and his law means loss and death. All things work together for good to those that love God and obey his law, and the obverse is true. All things work together for ill to those who disobey God and cross his law. Health, strength, life come to those who obey. Sickness, suffering, death come to those who disobey. 3. To-day we can work the works of God in healing the sick by preventing sickness and keeping people well. To-day we have learned that all the dark and tragic things that afflict our humanity have causes that can be known and recorded. Disease and crime, poverty and blindness, feeble- MODERN MIRACLES OP THE CHURCH 473 mindedness and misery have causes that are human and social. To-day the modern conscience demands that we find these causes and deal with them. To-day we can prevent much sickness, reduce the death rate one-half, provide that no person shall be blind or lame, and save the last life from tuberculosis. We will heal the sick by keep- ing people well. We will feed the hungry by creating an industrial system where every one can earn and eat his daily bread. Once we were content to build hospitals; to-day we teach the laws of sanitation. Once we were satisfied to nurse the consumptive girl; to-day we demand a sanitary home for every one. Once we built orphanges; now we want to know why children are orphaned. Once we were content to run a Red Cross Society; now we insist that the slaughter shall stop. This is our modem way of continuing the ministry of Christ and working miracles in his name. 4. And now the truth is sun-clear. Man learns to work the works of God by knowing God's laws and working in harmony with his methods. We know what are the causes of disease and suffering. We know the great divine laws of health. Then we are working with God when we honor his laws and work in harmony with his method. This work along what men have called natural lines is sacred and spiritual work. I like that proposition of Agassiz that *'a natural law is as sacred as a moral principle." We honor God when we recognize the fact that he is a God of law and method and when we work in harmony with his law. This then is our modern way of continuing the saving ministry of Christ and doing "the greater work" he promised. During his ministry he opened the eyes of a few blind people. We may not be able to open the blind eyes, but we can do an even greater thing in knowing the causes of blindness and taking necessary precautions to preserve the sight. We may not be able to cast out demons by our word; but we can outlaw and destroy such things as saloons and red light districts. During his ministry 474 THE NEW CHIVALRY — HEALTH the Master healed several hundred sick people. We may not be able to heal the sick by our word; but we can deal with the causes of disease and can keep thousands of people from becoming sick. The Master healed a few cripples and set them on their feet. We may not be able to straighten the crooked limb, but we can deal with the child and can perform wonders in preventive surgery. We may not be able to restore the father to his family, but we can make machinery safe and keep men from being injured. We may not be able to call four dead persons back to life as did the Master; but by applying our conscience and our religion we can reduce the death rate at least one-third and every year keep half a million people from dying. SUMMARY AND CONCLUSION First, the Churches must teach people the wide scope of Christ's redemption and must make them know that health is a Christian duty. The Churches must teach men that the same 'God who gave us the Ten Commandments gave us the laws of health, and they must teach men that it is just as sinful a thing to break a law of health as to break one of the Ten Commandments. More than that the Churches must teach us all to take thought for others and to be careful lest our negligence bring disaster to others. They must teach men that it is just as wicked a thing to kill a family by renting them an unsanitary tenement as to throw strychnia in the milk bottle. They must teach that every unnecessary death is a community crime, and the Churches must arouse men to apply their intelligence and unite their forces and live out their faith by selecting efficient public officials, by having a good Board of Health, and by transforming community life. Second, we must go behind results and deal with causes. Thus far we have been content to feed the hungry, to nurse the sick, to rescue the perishing, to lift up the fallen. It is all very well to rescue the outcast; but it is better to abolish the white slave traffic. It is well enough to take the sickly child out of the slums, but it is more sensible to abolish MODERN MIRACLES OP THE CHURCH 475 the slums. It is well enough to feed the hungry family; but it is more Christian to create an industrial order where every man can earn and eat his daily bread without scanti- ness and anxiety. It is well enough to build an orphanage; but it is more religious to protect machinery and keep the fathers alive. The time has come for us to find the causes of poverty and sickness and deal with these. Never again will we be content to fatten over results when we can remove causes. There is something as nonsensical as it is irreli- gious in running a rescue mission when you can abolish slums and close up saloons. There is something as foolish as it is unchristian in nursing sick people and running a hospital when you can keep people well by abolishing bad housing and providing pure water. The last thing is this: We must realize that this work of preventing social evils is religious and spiritual work. Men have always believed that it is a spiritual service to nurse the sick, to visit the prisoner, to feed the hungry family, to care for the fatherless child. But many to-day do not see that it is just as spiritual service to study the causes of poverty, to organize a Board of Health, to start a crusade against dirt, to teach people the laws of health. Is it a Christian thing to nurse a consumptive girl? Then it is just as Christian to secure a good housing code and abolish slum tenements. Is it a spiritual service to care for the dying infant in the slums? Then it is even more spiritual to abolish dirt and give the child clean milk. Twenty-five hundred years ago the prophet Elijah met the mockers of his day by the challenge, "The God that answereth by fire, let him be God." Forty years ago some mockers in England declared that every church in the land ought to be abolished, beginning with Spurgeon's Taber- nacle, and Spurgeon met these men with the challenge: "The God that answereth by orphanages, let him be God." To-day men challenge the Churches to show that they are Christian and are doing God's work, and we meet this question with the counter challenge : "The God that makes Christian cities and laughing children, let him be God." 476 THE NEW CHIVALRY — HEALTH THE CHALLENGE TO THE CHURCH TO KEEP CHILDREN OUT OF HEAVEN REV. C. A. WATERPIELD, PARIS, TENN. It will not be going too far, perhaps, to say that the popular thought concerning the Saviour's words, "Suffer the little children to come unto me, and forbid them not ; for of such is the kingdom of heaven," has been that they were given as a sort of model epitaph for the tombs of the young, that they were intended to guide the thought, secure the consolation, and provide a text upon the death of the juve- niles, even as the Lord's Prayer was offered as a pattern for the world's petitions. Until most recent years the Church's relations to children have apparently lain somewhere between those of the nurse and the undertaker, with a somewhat closer approximation to the latter. This has not been true of everybody in the Church, to be sure; nor has it at any time been a correct deduction from the faith of the Church's Founder or of its great Book. But the outlook and duty of the Church, by and large, have been interpreted in the dim religious light of this melancholy misunderstanding. "Lord, thou hast been our dwelling place in all genera- tions," ran the opening words of the ritual at the funeral occasion. And when men yet conceived that the Lord's residence did not extend to earth, but was confined to the far blue tents of the skies, it became the easy inference that the very proper thing for little people to do was to die and go on to this celestial dwelling place of all the Christian generations, even to the bosom of the Lord in his home in heaven. "Man that is born of woman is of few days, and full of trouble," the solemn ceremony continued. And the bereaved were, in a way, often in a way tenderly congratu- lated and praised on having assisted the Almighty in seeing to it that the world's stock of trouble that the race was THE CHALLENGE TO THE CHURCH 477 born unto and was meant to be full of should be undimin- ished. At the same time, with an inconsistency which was easily lost sight of in the emotions natural to the event, these godly parents were consoled by being reminded that their darling was now and so soon well out of it. "He cometh forth like a flower," the voice went on, "and is cut down: he fleeth also as a shadow, and continueth not." And the minister and the hearers, with hearts stricken and with heads bowed, had come to feel that in some holy and mournful way they were the appointed florists of the house of many mansions, and providential factors in hastening the little shadow-lives along to heaven, lest they linger too long here for the Heavenly Father's rule and pleasure. "In the midst of life we are in death," fell the fateful obsequies with the falling clods; and the solemn consola- tion was given or understood that against a condition and an ordinance so open and so universal, even if inscrutable, it was the Christian's distinguishing virtue to supply an unmurmuring resignation. In many instances the posi- tive assurance was provided that in some veiled but sacred fashion the contributory parties were fulfllling the will and enhancing the glory of the Creator in having made so early and innocent an offering to this death-ih-life order of the world. For old and young alike, the octogenarian and the infant, the flower-like face of the little girl and the weather- worn countenance of the grizzled veteran were put away with the same undiscriminating sorrow and ceremonial; even as all alike were expected to hear the same sermons, accept the same theological tests of discipleship, sing the same songs, read the same books, play the same games or no games, eat the same food, wear the same clothes (some- times altered), do the same work for all the same hours, and withal give the same outward demonstrations of faith and loyalty, and profess to the same inward experiences of the Spirit in their daily lives. These things we do all know, it may chance some of us are rather particularly delighted to hear. 478 THE NEW CHIVALRY — HEALTH What we do not all understand, and some may not be so pleased to consider, is that the Church in the composi- tion of its membership, even if not in the proper construc- tion of the social order, is an organic and vital part of the same unfinished, groping, progressing world over which the church bell rings its notes like silver rain, and casts the shadow of its spire like the scepter of the King. These citizens who comprise the membership of the Churches breathe the same air, drink the same water, use the same railways, postofRces, pastimes, pills, and news- papers with other people. Hath not a church member eyes? Hath not a church member organs, dimensions, senses, affections, passions — fed with the same food, hurt with the same weapons, subject to the same diseases, healed by the same means, warmed and cooled by the same winter and summer a world-man is? If you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die? And is it on the whole a disqualifica- tion for a normal and progressive life that the churchman will generally go farther than the Elizabethan Jew and not only buy with you, sell with you, talk with you, walk with you, and so following, but also eat with you, drink with you, and pray with you? If it be neither necessary nor gracious here to claim the superiority of the churchgoing classes in enlightenment over other sections of society in this country, yet surely it will go with the mere saying that the people of the Churches will, in the natural and inevitable course of things, imbibe, develop, and reflect the general ideas with respect to such matters as health, childhood, and heaven which prevail throughout the country and the time along whose thorough- fares they go to church, and under whose sod they bury their dead. The Church — at least in this country — ^the Church and the people cannot long remain far apart in thought or attitude toward such a matter as health and physical life. A famous and brilliant young surgeon from the city came out at the call of a country doctor for a capital operation. THE CHALLENGE TO THE CHURCH 479 At luncheon, to which the physician was good enough to invite his minister, the city expert, with that tendency of most men who know one thing thoroughly to assume equal familiarity with other subjects, discoursed of many mat- ters, including all about politics, and came around at length with equal certainty, as most men do, to the topic of religion. Nothing could exceed the assurance of his contempt and the finality of his disposal of the Church's belatedness and inefficiency of teaching on all practical affairs. Whereupon one innocent and altogether scientific inquiry ended the lecture, apparently to the entire satis- faction of everybody but that of the specialist: "Doctor, when were you an attendant on the activities of any church?" "O, not since I was a boy, twenty years ago." "Doctor, that measures a long span in the development of this country, no less in the thought and service of its Churches than in the making of its hay and the manufac- ture of its medicine." So, for the Church's mournful funeral rites and inade- quate and wholesome view of childhood, what has been the corresponding interpretation and attitude of childhood outside the Churches? Where twenty years ago were our kindergartens, story hours, graded schools, juvenile libra- ries, children's specialists and hospitals, the outward open- ing door of the public school, the playground adapted and supervised, the whole modern prophylactic of a right sense and science of childhood's value and childhood's challenge? Could the child's funeral of twenty years ago have been more mournful than the child's treatment in pneumonia, deprived of both water and air? Or the ignorance of the Church concerning his right to live on the earth less absurd and devastating than the obliviousness of the school to his right to think — ^that is to say, to live rationally and humanly? And to-day if something more than 2,000,000 infants die yearly under the age of twelve months, 250,000 of them in this country, without any too much general protest on the part of the Church, it surely will not be forgotten that 480 THE NEW CHIVALRY — HEALTH it was but twenty years ago, the good year 1894 A.D., when the medical inspection of schools was first conceived and introduced in America. The passing of the barbarism of no water or air for a child in fever has been accompanied by the introduction also of a new burial ceremony for chil- dren, in which the prayer of Moses, which was meant for a profound reflection on the life of men on the earth in general, is succeeded by the intensely dramatic and human story of David's grief for his child. And if the Church has even yet no more than begun to assess a sane valuation of childhood, hear Mr. Edward H. Pfeiffer's vast little tragedy of childhood in two brief and terrible stanzas : Scene: A Slum Street. Time: Now — and How Much Longer? It's crawly and it reeks of mire; Its flesh is fishy to the bone; It huddles near a gfutter-fire, And sighs and coughs and weeps alone. In nameless filth its scabby feet Lie numb — ^its soul is undefiled! Come, Master, enter this our street; Back to its kingdom lead this child. Who would not under such world conditions for children piously and with a mournful pleasure see them early and well out of it? Nobody can be satisfied with the strain in which this argument is going. None less than the speaker. But is it not the simple if unwelcome truth that, along with the enlightened physician, the efficient sanitarian, and the trained and conscientious social worker, there has appeared at times the half-informed and half-earnest social camp- follower also? That, as a certain restless spirit on one occasion gathered with the sons of God, from his mere roaming to and fro in the earth, so we meet now and again the modern social rounder, even as we have hitherto had to deal with the religious rounder to our sorrow? Our many-sided ex-President has given us no more striking and far-reaching delineation than in his reference to "the THE CHALLENGE TO THE CHURCH 481 fool fringes of every reform." It will be well for us to face the fact that child welfare and social progress in general along with other reforms have not been obstructed by all other ignorance and opposition combined so much as by the shallow knowledge and the fickle support of these mental moths and moral adventurers who, when the sons of God came to present themselves before the Lord, make it a place of enthusiastic sociological excursion; and who to-morrow will be off on another excursion with a newer name and a lighter obligation. It is as scientific and as social to keep as it is to acquire. If it were no more than a petty professional scuffle between churchmen, on the one hand, and physicians and social workers, technically so called, on the other, for preemi- nence in the conservation of childhood, we might well pass it off with a smile, a whistle, or a yawn as the mood inclines. But what we are after and must have is nothing less than the scientific and indispensable coalition of all the worthy forces and factors belonging to this field of service. Let the Church, then, and the social institutions, though not necessarily identified, let the physician and the preacher, the sanitarian and the social organizer, the newspaper, the parent, and the public get out into the light of their com- mon task and their common duty. With the spectacle of children by the myriads — ^more in number doubtless than all the forces now arrayed on the European battlefields — skulking and cowering in disease and ignorance and fear along the walls of the world, their faces like lamps blown out, and with an infant under twelve months old gasping out its life every ten seconds within the bounds of Chris- tendom alone, it is going to require the most thorough enlistment and organization of all forces available to stem the mournful current of that vast funeral procession, and to rekindle the light of hope in the face of childhood. What, therefore, can be either less scientific or less ethical, in the face of the tragic issues involved, than for the self-styled scientist on the one hand or for the preten- tious and resentful pietist on the other to wrangle along 31 482 THE NEW CHIVALRY — HEALTH the road on the heels of this modern tragedy of childhood, as did the disciples in the face of the impending shadows of the Cross, having no apprehension of any elements in it all beyond certain pet physical facts or professional interests? As we have the pure milk faddist — as pure milk alone with, say, an additional diet of pickles and tea, will aflfect little in reducing infant mortality; so all that the most perfect diet, sanitation, inspection, and education can accomplish for children will be but an unfinished thinking and a burnt-out experiment, if an adequate spiritual and human interpretation of childhood is left out. If, as is held in some quarters, the problem of pure milk, for example, is purely a scientific problem and has nothing to do with the baby, but with the milk alone, if "the greater part of such work is done by people who never held a baby in their arms," yet somebody must see to the bottle that contains the milk, somebody must have a mind to the condi- tion of the baby's stomach, and another to the state of the laundry, yet others to the plumbing, the screening, the wages and recreation of the father, the employment and relaxation of the mother, the health of hundreds of children with whom the other children of the household attend school, their personal habits, the city's streets, together with the state and national regulations concerning pure food and drugs. And where shall it all end this side that whole ganglion center of ideals, incentives, and organiza- tion of life in the community which is the Church? How far beyond the milk bottle and the simple home we are led ! What are we rearing babies for after all? And there looms up your whole human raison d'etre. The problem becomes now one of discovering the causes of causes, and to formu- late and direct them beyond the gloomy funeral on the one hand and beyond the blind alley of a blear-goggled materi- alism on the other. And instead of the smart fling that certain workers engaged "have nothing to do with the baby, but only with the bottle" or nipple on the bottle, the whole social consciousness (or conscience, if you will) is THE CHALLENGE TO THE CHURCH 483 to have the value of a baby in its thought, the image of a child before its face, and in its heart the love of life on the earth and in the skies. It is no less idle than it is unjust to call such a pjea a mere preaching. It is nothing more, nor is it anything less than a call for a sensible and just recognition of the elements — all the elements — ^that go into the solution of the problem. A certain surgeon had operated for appendicitis. The work had been a brilliant triumph and was apparently finished. The incision had been sewed up, and the keen- eyed, deft-handed group of which the doctor was the center were in smiles while engaged in cleansing instruments, changing clothing, and wheeling the patient to his room. Suddenly, in a low voice, like the sound of a knife across the operating room, a nurse exclaimed: "Hold, doctor, I am one sponge short." Now, had not the operation been a success? Was not the skill of the physician confirmed? What could he have to do with a dirty sponge? Neverthe- less the stomach was reopened. What the result would have been, had the missing sponge been left unnoticed, is a scientific and grim certainty. One wonders why it should be a hard thing to get and hold a hearing for the equal certainty of equally fatal results in child welfare only a little farther up the line, if every detail is scrutinized up to a certain point ; but the dirty sponge of a low-grade ideal and social incentive of life is left in the delicate social organism to wreak its destruction later. Children, like grown people, let us learn, are to be supplied not simply with something to live on but with something to live for also. When the motive, the whole human expectancy and potential worth is omitted from the invoice of childhood's value and the challenge of child- hood's right, and we are left only with a bottle to fill or a funeral to hold, the living principle is exhausted in the case, and our scientists, social uplifters, and ecclesiastical depressors, God bless them all ! are of a class with the little boy who, while playing in a back street, found a dead cat and cried to the other little boy: "See, here's a perfectly good cat somebody's thrown away!" 484 THE NEW CHIVALRY — HEALTH This is your real child welfare worker, according to a great social worker in an address before the American Public Health Association : "He or she who deals not with the baby alone, or with the mother and baby, but with the father, the little brothers and sisters, the grandparents, the aunts, the cousins, and the neighbors, each and all of whom, in every act and relation of life, are inextricably bound up to its health and happiness." And was the poet speaking the scientific truth or dealing in "mere poetry" when he said, "For so the earth is every way Bound by gold chains about the throne of God"? Here, then, is the challenge and the duty of the Church in respect of children — ^namely, to set up and to maintain the scientific integrity, the whole sanctity of the social program with regard to them. Mr. Alfred Noyes'has a real poem, a wonderful poem of childhood. But it is an unfinished poem. The talk of the Church is to write out in the fair, clear terms of life the missing stanza at the end of Mr. Noyes's song. Here is the poem which he calls "a SPELL FOR A FAIRY" Gather, first, in your left hand (This must be at shut of day) Forty grains of wild sea sand Where you think a mermaid lay. I have heard that it is best If you gather it, warm and sweet. Out of the dint of her left breast, Where you see her heart has beat. Out of the dint in that sweet sand Gather forty grains, I say; Yet, if it fail you, understand There remains a better way. Out of this you melt your glass, While the veils of night are drawn. Whispering, till the shadows pass, "Nixie — ^pixie — leprechaun !" THE SUNDAY SCHOOL AS A HEALTH SCHOOL 485 Then you blow your magic vial, Shape it like a crescent moon, Set it up and make your trial, Singing, "Elaby, ah, come soon!" Bring the buds of the hazel-copse, "Where two lovers kissed at noon; Bring the crushed red wild-thyme tops. Where they murmured under the moon. Bring the four-leaved clover also. One of the white and one of the red; Bring the flakes of the May that fall so Lightly over their bridal-bed. Drop them into the vial — so. Swing their incense to the dawn, Singinig, as you come and go, "Nixie — pixie — leprechaun !" And, if once will not suffice. Do it thrice! If this fail, at break of day, There remains a better way. Bring an old and crippled child — Ah, tread softly, on tiptoe — Tattered, tearless, wonder-wild. From that underworld below; Bring a wizened child of seven. Reeking from the city slime. Out of hell into your heaven. Set her knee-deep in the thyme. Feed her, clothe her — even so! Set her on a fairy throne. When her eyes begin to glow Leave her, for an hour — alone. You shall need no spells or charms On that hilltop, in that dawn. When she lifts her wasted arms. You shall see a veil withdrawn. There shall be no veil between them. Though her head be old and wise. You shall know that she has seen them By the glory in her eyes. Now, one more "if." If this at length should fail to bring the fairies, or if it should fail to keep the fairies, or 486 THE NEW CHIVALRY — HEALTH if it shall be found, in the great sequel, that it is not fairies but angels, the very messengers of God that the old and crippled child is looking for, that all the children are looking for — not only to feed and wash and warm but to enlighten, grow, and use the children — then, as I was saying, this is the challenge of the Church, to write, to fill out, and to make good that wanting stanza. It is no mean task. Let her be about it. THE SUNDAY SCHOOL AS A HEALTH SCHOOL HENRY P. COPE, D.D., GENERAL SECRETARY OF THE RELIGIOUS EDUCATION ASSOCIATION, CHICAGO Perhaps the most important step is to begin to think of the Sunday school as really a school. It has only just begun to assume that character. Hitherto it has been usually an aggregation of younger children, gathered by custom or tradition, compelled to sit in groups and listen to amateur sermons by untrained teachers. A modem Sunday school is, first of all, a school of life. Its business lies not with dead languages nor with dead peoples, but with those who live to-day, whose lives make to-morrow and who have the very real and immediate prob- lems of living before them now. It is time to realize this, that here is a school to train children and young people in the art of living. It is a school of life, not of literature, not of dogma, but for the purpose of making lives of a certain type and ideal. If the Sunday school is to teach life, it cannot dodge the fact that life has physical foundations. Training lives is not a matter of dealing with sublimated souls alone. We have tried that too long, content if only some hypothetical part of the person attained an imaginary state of feeling, content to save souls and let bodies and conduct, mind and THE SUNDAY SCHOOL AS A HEALTH SCHOOL 487 morals go on their way robbing, despoiling, or betraying humanity. It is easy to talk about saving souls, but it is quite different when you think of taking little Mary Jones, half-starved, handicapped by sicknesses, and muscularly undeveloped, and then getting her trained to take up the Whole work of life, developed into fullness of ideal woman- hood, to serve her day. The Sunday school has to get down from the clouds, out of the habit of golden streets, and realize concrete condi- tions here. If it is to grow Christian character in all the boys and girls of a community, it must furnish the soil, the physical conditions, and the physical substratum of that type of character. The Sunday school becomes then a health school for the highest and only adequate motive in the search for health — ^that is, in order that fullness of personality may develop. It so fully accepts its life-purpose of training persons to their character fullness that it lays on all the community the obligation of giving these persons their full physical inheritance and removing from them physical handicaps. The Sunday school has a larger task than that of teach- ing hygiene and sanitation. It sets a new valuation on these things ; it demands health, not for the sake of pleasure and comfort, but for the sake of people, in order to give every one a chance to be all that he might be. It claims, for the sake of the higher life of the spirit, the right of every one to freedom from the handicaps of disease, of stunted development, and from the fruits of ignorance. It is the educator of the opinion of its community on the importance of paying full measure of service and devo- tion to the highest needs of man by attention to the bases of character in health. It will, in teaching its children how to live, lay upon them the moral obligations of health. It will cease to waste breath trying to find out whether Peter's wife's mother got over her fever or not, and turn its atten- tion to cultivating in young people a clear conscience against all fevers to-day, a religious demand for right condi- tions of living. 488 THE NEW CHIVALRY — HEALTH This school, however, is often more than a one-day school now; it has become the school of the Church, meeting in many places for a definite period every day. When the time schedule permits, in this manner much direct teaching of the laws of health may be attempted. Parents especially should be organized into classes in the churches and taught the principles of the foundations of the right life in their children in the care and nurture of their bodies. Parents can be trained through such classes to do that which the public school never can do, give the direct moral training which the child needs, especially as to bodily functions. The Sunday school must be more than a Sunday school; it must be a school in which the Church teaches day by day all that is necessary of religious conduct and ideals. Above all this school is a school of health as it gives to its students a new and higher valuation of life, as it furnishes them with adequate motives for fullness of life. It exists to teach men the art of life in divine terms. It interprets every function of life, not in terms of its imme- diate service alone, but of its ultimate purpose and effect. It cannot despise the body, because it sees the body as the servant of the life of the spirit. It cannot despise the physical well-being of others, because it knows that fair and full grown men and women can never be until we have the right soil of physical conditions and the full backing of health and strength. Because the Sunday school exists to serve the kingdom of right and peace and full life it will train its people not only in a knowledge of spiritual ideals but also in the practice of their realization here and now. It will turn from the dead past to the living and palpable present. It will teach how the new Jerusalem is built; it will guide to service for the sick, to ways of health for men, to definite, immediate endeavors to furnish men the fullness of physical well-being for the sake of growing the full and efficient and rightly minded man. It will be the school of service to make society the soil of the soul. THE PRIMARY FUNCTION OF THE CHURCH 489 THE PRIMARY FUNCTION OF THE CHURCH— TO SAVE LIFE PROF. JOHN C. GRANBERY, PH.D., SOUTHWESTERN UNIVERSITY, GEORGETOWN, TEX. The wording of the subject was not chosen by me, but I accept it, and if permitted to make clear the meaning of certain terms I think that I am prepared to defend it. On the start, however, we are challenged by a way of defining the Church's primary function which is far more current. Is it not the chief business of the Church to save souls? This way of putting the case is so strongly established in the conventional thinking and acting of the Church that it cannot lightly be disposed of, but must be taken seriously. First, it behooves us to locate and define this "soul" about which we are concerned and which the Church must be the means of saving. What and where is the soul? I recall that some years past a popular magazine purported to give photographs of the soul of a rat, caught just as the soul of the rat was leaving its body. Yet science knows nothing of such a soul in either rat or man. Psychology has to do with all our mental life, but takes no account of a separate faculty or function called the soul. The unwar- ranted assumption that it is possible to isolate individual souls and save them one by one underlies much well-meant effort and accounts for the unsatisfactory, one-sided char- acter of the results from a vast expenditure of energy and earnestness. Let us deal with reality and not fiction. Does not this reduce life to a materialistic, atheistic basis? Is it not a denial of our spiritual birthright? By no means. Emerson was once asked: "Why, man, don't you know you have a soul?" "No," he replied, "I thought I was a soul." It seems, then, that the soul we thought we had lost has been found. But it is not a thing apart. It is the personality, one's total being as a spiritual existence, one's essential life. In the light of this fact we may again 490 THE NEW CHIVALRY — HEALTH consider our subject: "The Primary Function of the Church — To Save Life." It is the business of the Church, not to save "souls," which in that sense don't exist, but to save people, to save lives. The Bible, however, speaks of the soul, does it not? Yes, in the sense of the life: "Man became a living soul." (Gen. ii. 7.) Upon reflection would you suppose that the lament of the Psalmist, "No man cared for my soul" (Psa. cxlii, 4) , had any such signiflcance as that commonly given the words in evangelistic services? Our Lord's words, nevertheless, seem clearly to differentiate the soul, when he asks, "What is a man profited, if he shall gain the whole world, and lose his own soul?" The passage is important in substantiation of our very position when taken in its context and consistently translated. Matthew xvi. 25, 26, as given in the Authorized Version, reads as follows : "For whosoever will save his life shall lose it: and whosoever will lose his life for my sake shall find it. For what is a man profited, if he shall gain the whole world, and lose his own soul? or what shall a man give in exchange for his soul?" The word, however, translated in the first instance "life" and in the second instance "soul," is the same, and the Revised Version is consistent when it reads : "For whosoever would save his life shall lose it : and whoso- ever shall lose his life for my sake shall find it. For what shall a man be profited, if he shall gain the whole world, and forfeit his life? or what shall a man give in exchange for his life?" Or, if you choose, in each instance render the word "soul," and read: "For whosoever will save his soul shall lose it: and whosoever will lose his soul for my sake shall find it." Such a rending would, however, be disastrous to many a sermon projected upon an individual- istic basis. We have not yet thoroughly disposed of the familiar proposition that it is the main business of the Church to save souls. We must examine this word "salvation." It will not do to assume that we all understand and are agreed as to what it means. We are told that society will be saved THE PRIMARY FUNCTION OF THE CHURCH 491 if only we succeed in getting saved all the individuals com- posing it; and that if a man is "soundly converted," is "born again," his outward relations will become properly adjusted according to the Christian ideal. The statement is faulty at several points; To label the orthodox evan- gelical conversion "salvation" is a begging of the question. To assert that as a matter of fact the average convert who claims to have gotten right with God is right with his fellow men according to a truly ethical standard of conduct is to contradict experience. The rule assumes the thing to be proved, and as a matter of fact it does not work. I do not mean to intimate that the man is a hypocrite, or that he is anything but exemplary in his family life, regular in his church duties, and kind to the poor. Even in busi- ness he may be righteous according to conventional busi- ness morality. But he may at the same time be a pro- nounced individualist, unsocialized in his thinking and conduct. Until he does come to a realization of his social duties and the social character of sin and salvation it is a misuse of words to say that he is "soundly converted." How "soundly"? Is it inherently probable that the well- groomed and well-meaning man who piously walks down the church aisle with the collection plate, who enjoys the sermon, ©specially if it is the "old-fashioned gospel," without too much of this modern sociological talk mixed in — ^that this man who has amassed a fortune in a few years exem- plifies in his business relationship even approximately the principles of the Sermon on the Mount? Does he really try to do so? The fact is that the old atomistic conception of salva- tion is founded upon a failure to apprehend the organic and interdependent character of everything that lives. We are not as sands upon the seashore, contiguous but inde- pendent, all going to make up one big shore, but we are members one of another. If men are to be saved, their bodies must be saved, the environment must be saved, the community must be saved. We did not choose in what country or age we should be bom, nor were we consulted as 492 THE NEW CHIVALRY — HEALTH to our ancestry. As the apostle Paul says, we are debtors. All that others have suffered and hoped and striven for Is written in our natures. We are the product even of the defeats and disappointments of life. Under these circum- stances how unscientific it is to talk about punishing a criminal on account of his sins against society ! Certainly society should be protected against dangerous persons, but you will not be prepared to punish him on account of his personal wrongdoing until yon know his father, his grand- father, the circumstances of his birth and rearing, and examine from the standpoint of a criminologist the bumps on his head. It is common now to speak of society as an organism, because, like an organism, society undergoes growth, its parts become differentiated both in structure and function, and are mutually dependent. Biology furnishes the most useful analogies for a study of society. ■ In human associa- tions interdependence is realized in the highest degree. Each man conditions every other. He takes up so much space, diminishing the available space on the earth, and increases the demand for food and the potential labor supply. There is psychic interaction — intercommunication of thought, feeling, and purpose. Men are responsive to each other's moods. Under these circumstances how is it pos- sible to isolate an individual soul and save it, cutting it loose from the intricate, interminable network of psychic bonds that unite us? It might seem that under the organic concept individual responsibility tends to disappear, and the poignant sense of sin that has played so large a part in religious life no longer has place. But such is not the case. The trans- lation of the old religious values into modern social terms is suggested by one of the topics on this program: "The Challenge to the Church to Keep Children Out of Heaven." If it is true that 300,000 children under a year of age die annually in the United States, malnutrition being respon- sible for eighty-five per cent, and if one-half of those who die would live if known measures were applied, then it THE PRIMARY FUNCTION OP THE CHURCH 493 would be more appropriate to speak of their being mur- dered than of their dying according to the will of the Lord. "The times of this ignorance God winked at; but now commandeth all men everywhere to repent." (Acts xvii. 30.) Well has it been said that smallpox, malaria, yellow fever, and typhoid are no longer diseases ; they are crimes. A church in the open country holds all-day revival meet- ings year after year, never suspecting that the responsi- bility for the anaemic condition of some who must be "saved" over again annually lies at her own door, unsani- tary conditions about the church and the schoolhouse caus- ing the hookworm to flourish. The Hebrew prophets held before the people the hope and ideal of a redeemed community. There was in their consciousness no sharp distinction between material and spiritual blessings. In the same paragraph and in the same sentence both aspects appear. In the very heart of the most exalted passages we read how "they shall build the old wastes, they shall raise up the former desolations, and they shall repair the waste cities, the desolations of many generations." (Isa. Ixi. 4.) It is interesting in connec- tion with the good roads movement of our time, so vitally connected with all our higher life, to see the emphasis placed by the old prophet on the necessity for casting up a highway for the people to pass over on their return to their beloved country. In the redeemed community all of life is hallowed. "In that day shall there be upon the bells of the horses. Holy unto Jehovah," and even the cooking utensils shall be holy (Zech. xiv. 20, 21) — ^which would hardly be possible if defiled with impure, malnutritions food. In the redeemed city no unclean thing has place, for "the streets of the city shall be full of boys and girls playing in the streets thereof." (Zech. viii. 5.) "And they shall call them, The holy people, The redeemed of Jehovah : and thou shalt be called. Sought out, A city not forsaken." (Isa. Ixii. 12.) In the most precious and spiritual Psalms there is a blessed physical side. "Blessed Jehovah, my soul: . . , who forgiveth all thine iniquities; who healeth all 494 THE NEW CHIVALRY — HEALTH thy diseases; who redeemeth thy life from destruction." (Psa. ciii. 2-4.) "For he will deliver thee from the snare of the fowler, and from the deadly pestilence. . . . Thou shalt not be afraid for the terror by ni^ht; nor for the arrow that flieth by day; nor for the pestilence that walketh in darkness, nor for the destruction that wasteth at noonday." (Psa. xci. 3, 5, 6.) The Church devotes herself to the work of saving life in the name of him who "himself took our infirmities, and bore our diseases" (Matt. xiii. 17) ; and in ardent antici- pation of the day when we can say: "Behold, the taber- nacle of God is with men, and he shall dwell with them, and they shall be his people, and God himself shall be with them, and be their God. And God shall wipe away all tears from their eyes." (Rev. xxi. 3, 4.) PHYSICAL HEALTH CHAMPIONED BY THE CHURCH DEAN J. L. KESLER, WACO, TEX." Some years ago a missionary statesman was asked what he considered the first qualification for a good missionary. He answered: "To be a good animal." Physical health, it is everywhere admitted, underlies and conditions human efficiency. Wholesome responses to moral stresses are the normal fruits of physical well-being; while the pull and drag on human life toward moral mud are often traced to a disordered digestion or an unbalanced nervous organiza- tion — in other words, to ill health. Criminality itself is one of the dividends which society reaps from the abnor- mal brain-storms of pathological origin. Health is the first asset of the nation, the community, the home. It may be that the dihurch has not always been a cham- pion of physical health. Indeed, there may be a modicum of truth in Heine's subtle remark that the holy vampires of the Middle Ages had sucked away so much of our life- PHYSICAL HEALTH CHAMPIONED BY THE CHURCH 495 blood that the world had become a hospital. But, however that may be, it cannot be doubted that health was a chief purpose and pursuit of the Master, and no Christian phil- osophy can consider it less than a chief good without repudiating the work of the founder of the Christian Church. A chief good it certainly was considered in the -temple of the great prophets of the Hebrews back to whom the Christian religion dates its origin. Would it not be anomalous if health were not a part of the program of the Church of Him who went about the villages of Galilee proclaiming the good news and healing all manner of sick- ness? Certainly we cannot follow Christ and neglect disease. If the Church is in league with Him who came to give life and to give it more abundantly, then it is in league with life's first necessity, physical health. I do not mean to say that all social maladjustments are due to physical degeneracy or ill health; but I do mean to say that many of them are, I do not mean to say, however desirable physical health may be, that it will heal all life's disharmonies; but I do mean to say that it conditions the higher life on many levels and that we shall never have adequate morality and social poise till we have adequate health and its wholesome responses to normal contents. The Church stands for, or should stand for, everything good. The Church stands against, or should stand against, everything bad. Religion, of which the Church is the proper organ, is the champion of human well-being and of the big brotherly life. Lucian, speaking of the early Chris- tians, in derision said : "Their Master has persuaded them that they are brothers." And so we are, both by nature and necessity. Christianity only brings us into the con- sciousness of our relations, and makes us aware of what is always and everywhere constitutional to human life. This consciousness of brotherhood, bounded by neither race nor country, reaches a helping hand to sick life everywhere. No ill can betide humanity anywhere that the brotherli- ness of its binding love was not meant to heal. No good can reach out its kindly ministries which we are not under obligation and necessity to make prevail universally. This 496 THE NEW CHIVALRY — HEALTH is the task of Christianity. It is a social task, and it includes physical health as a chief pursuit and propaganda, even as printed in the program and pursuit of Jesus. Eeligion adds no peril but love and love's sweet sacrifice and service ; it subtracts no satisfaction but hate and hate's deep bitterness and gloom. Wherever, therefore, the sharp dissonance of disease lames "the hurt children of our race," the Church seeks and ought to seek the healer's wand in serum and surgeon's knife, and build its hospital and nur- sery beside its chapels of worship. It is part of our task because it is part of the need of humanity. Religion was meant to minister to the whole of life. The Church must help the community. Reciprocity and necessity are brothers. The Church cannot succeed if the community fails. The ideal and goal of the Church is an ideal com- munity, what Jesus called the kingdom of heaven. And we cannot approach an ideal community without health. Again, better even than healing is prevention, the knowledge and practice of sanitary law by which life escapes the invading germs and the doctor's bitter medi- cines. The days of pain, the waiting for health's return and the sunlight on the hills — ^these shadowed years may never come, if we sink the ships of disease before they beach upon our shores. Prevention is better than cure. To-day life's chief enterprises and hope are centered in one word, and that one word is prevention. For this, every institution for the public good — ^the Church chiefest of all — must stand, must invest its strength, must be the cham- pion for and in the name of religion and humanity. Just as I had reached this point I laid down my pen and took up the afternoon paper, and on the editorial page a distinguished bishop was quoted as saying that a Church should have nothing to do with clean-up campaigns, physi- cal culture propaganda, unemployment, tuberculosis Sun- days, and such like things. To which the editor adds that this utterance of the bishop "exactly accords with the great commission: 'Go ye into all the world, and preach the gospel to every creature.' " PHYSICAL HEALTH CHAMPIONED BY THE CHURCH 497 The trouble with the editor was that he didn't read far enough in selecting his quotation in proof of the bishop's contention. Among other things immediately following are these : "In my name shall they cast out devils," and "They shall lay hands on the sick, and they shall be healed." And at another place where the same commission is given, the writer goes on to say, "Teaching them to observe all things whatsoever I have commanded you." A sample of the "all things whatsoever" is as follows: "And when he had called unto him his twelve apostles, he gave them power against unclean spirits, to cast them out, and to heal all manner of sickness and all manner of disease," and adds this specific command: "As ye go, preach, saying. The kingdom of heaven is at hand. Heal the sick, cleanse the lepers, raise the dead, cast out devils: freely ye have received, freely give." These samples of the kingdom herein specified do not seem to correspond with the bishop's restrictions. After this, we are told, he sent out other seventy also, and these he commanded, saying, "Into whatsoever city ye enter, and they receive you, eat such things as are set before you ; and heal the sick that are therein, and say unto them. The kingdom of God is come nigh unto you." There are just two ways, as it seems to me, of finding out what Jesus meant for us to do: First, by finding out what he himself did; and, second, by finding out what he set his followers to doing. In regard to both of these ways we have definite and convincing information. He himself proclaimed the good news and healed the sick, and he sent out twelve and also the seventy to do the same things. What shall be our conclusion, therefore, as to the mission of the Church to physical ills? To me there is but one answer: The Church is missionary to the body also. "Know ye not that your body is the temple of the Holy Ghost?" It is only too clear that the bishop and the editor limited too closely the Church's function. The business the Master had to do included healing the sick, and the business the 32 498 THE NEW CHIVALRY — HEALTH Master has for us to do and definitely sets us to doing includes healing the sick and the prevention of disease also. I asked a missionary the same day, Dr. Lockett, of Africa, what he thought about it. He said certainly Jesus included healing in the mission of Christianity. Two- thirds of the records of his deeds are the records of heal- ing. It seemed to him as it seemed to me that Christianity must look after men's bodies as it looks after men's souls. The actual physical good to health and life is the one appeal that pierces between the close-knit armor of age-long super- stition against the lovely and beautiful ideal of a just civi- lization which Christianity proposes and requires. This ideal is so fine, its attainment so remote, its hope so fascinating, its life so heroic, its battlefields so command- ing, its stake so immense, that I may be allowed to say that I count it perilous to change in any particular whatsoever the task which Jesus set us to do. The method of the doing of the task may be changed, but the task never. He cer- tainly sent his first followers on definite missions of healing. And to-day, wherever human love lifts the burdens of sick life and nurses it back into health again, the crowd and throng of uplooking humanity from the depths of the wilderness of ills press into the new kingdom, even as they did when Jesus and his apostles healed in Galilee. This is true in all the mission fields, including the block on which your own church stands. While the people still treat as sophistry the new creed, they yet yield to the new life which brings healing and fulfills itself in ministries of love — inasmuch as I was sick and in prison and ye ministered unto me. A life which radiates righteousness, peace, joy, good news for the physical, industrial, social, aspirational, worshipful faculties cannot be hid and will not be barren. The Church has one supreme peril, as I see it. It is the danger of the short look. It is the danger of the little vision, the danger of its walking by on the other side of maimed life, the danger that it fail to be as big in the task it sets itself as the demands of the Christian religion — that is to say, as big as the claims of human life in its cry for human help. PHYSICAL HEALTH CHAMPIONED BY THE CHURCH 499 Christianity is humanitarian. Poverty is a chief cause of ill health; and so is industrial bondage and unemploy- ment. Against social wrongs the ancient prophets cried out, and so must the Church to-day. We must turn off the inflow. We must abolish the conditioning factors. Wherever poverty or oppression or cornered revenue or suppressed opportunity limits intellectual or spiritual aspi- ration or physical health, Christianity, real Christianity, unsheaths, and ought to unsheath, the sword of the prophet to break life's bondage and set life free. In all such cases there is more than one kind of clean-up campaign indi- cated. The first business of Christianity is to give life a chance. Physical health has its basis in good heredity. Every child has a right to be well-born. It ought to pass the first gateway into life unchallenged. But in order to be well-bom there must be good ancestry in a good environ- ment. In nature only the fit survive. In education and religion we try to make as many as possible fit, but we cannot purify the germ-plasm. In eugenics we try to provide that only the fit shall be born. This gives better material, offers a better investment, insures better divi- dends, makes possible a better citizenship and a nobler society. There is no greater cruelty than to preserve the defective and diseased to be parents of a progeny of wretchedness to burden society and make sure the deca- dence of the race. Here the Church may join the state, or be its forerunner, in requiring health certificates before marriage and lend its powerful infiuence for the enact- ment and enforcement of suitable laws to prevent the repro- duction of the physically, socially, and morally unfit ; to eliminate the blight and crime against the unborn; and to eradicate those diseases properly labeled "the black plague." According to our last census 300,000 infants die annually. More than half of these are sacrifices to igno- rance and poverty. Ignorance and poverty are great mur- derers. Children ought not to die like that. They were meant to live. They come at too high a cost to be cast 500 THE NEW CHIVALRY — HEALTH away on the scrap heap with indifference. They mean too much. Has the Church nothing to say in delivering this knowledge and relieving the causes of poverty of which this slaughter of the innocents is the outcome? If it hasn't, then it ought to go out of business and let something take its place that does have something to say ; for this is what Christ came to do, and his agency, the Church, ought to do it or retire from the field. In Buffalo, N. Y., some fifteen years ago one man in one year by sending information to each mother at the birth of her child, even without the relief of poverty or an ideal sanitary environment, saved over 1,500 children and reduced infant mortality one-half. To my mind it is worth while for the Church to champion a cause like that, though it be carried out by the civic order. By sanitary knowledge and sanitary methods imper- fectly administered the death rate has decreased in recent years from 25 or 30 per 1,000 to 14 in many of our cities ; and fifteen years might be added, on the average, to every human life, if we had some way to deliver sanitary knowl- edge and sanitary habits to the people. It is a religious problem. It is the Church's responsibility and task as well as the State's. Pure food is a first essential to good health, and not only pure food but suitable food properly prepared. Certainly the church can thunder from every pulpit with prophetic fire against those adulterated foods which are merely cheapened in their contents and sold under wrong labels, because it is dishonest; and with even greater indignation against those with harmful admixtures, because it is mur- der. How many weakened or lost lives lie at the door of public supplies of infected or poisoned food, milk, water! To have an epidemic of certain infectious diseases is a community crime. The other day in Montana a man entered suit against the city for damages in a case of typhoid from the water supply and won it. We know how. We can prevent. We need to develop a public conscience, and I know no other institution so well suited to such a task as the Church. Public supplies of personal necessities are PHYSICAL HEALTH CHAMPIONED BY THE CHURCH 501 safe only in the presence of two things — intelligence and conscience ; and both of these the Church is under contract to furnish. And what shall I say of pure drugs properly labeled, the wretched and growing army of drug fiends which the new Federal antinarcotic law so pitifully exhibits, and alcoholism with its racial drag and distressing complica- tions, as controllable factors in physical health? Alcohol is a racial poison, limiting the individual and putting its blight on generations yet unborn. Shall the Church fold its hands and have nothing to say? Science has found out something of its relations to physical efficiency and eugenics ; and the Church is joining its forces for the crea- tion of public sentiment in order that laws may be enforced for the protection of mankind. Must the Church throw up its hands, acknowledge its impotence, and keep silence, forsooth, because it has no legal power to enforce its own commandments? It doesn't do it in other matters. It has a right, and shall always have a right, to discuss all ques- tions of morality and justice and right and wrong, high principles of life, whether they are to be settled at the polls or not. It has, and shall always have, so long as the social spirit of Jesus stirs it to its task, everything to do with molding public sentiment, influencing legal action for health and morals and industrial righteousness, and enforc- ing civic law. To do less than use its influence on the side of right and life would be nothing less than a crime. It would be monstrous. The problem of poverty with its low feeding and bad housing, breeding disease and multiplying the death rate and the social evil, this is a problem both civic and reli- gious. These overcrowded, badly ventilated, dark, damp, filth-reeking, vermin-infected, germ-laden places have been rightly called moral and physical pesthouses. These breeders of vice and disease where sanitatioif and decency are impossible are the problem of every human being who has left in him any lingering interest in humanity. Some years ago in Glasgow in bad housing conditions the death 502 THE NEW CHIVALRY — HEALTH rate stood at 55. By law these houses were demolished and repaired. The death rate fell to 14, while in the remaining houses in the immediate vicinity, not included in the act, the death rate remained at 53. Poverty, vice, and disease form a triple, unholi/ alliance in our American cities. I said poverty, not the poor. Brotherly love, the Church, the social settlement, the State, the civic order may well work together on this distinctively human or rather inhuman problem. The Church, at least, cannot hold up her skirts and walk by on the other side and be guiltless. More than opiates and relief are needed. Social surgery is needed also, and a new order, where opportunity is unfenced and free, where competition and the law of hate shall yield to cooperation and the law of love. Why should the Church join in this campaign for health? First, it is its mission. Second, it is its opportunity. Third, it is its necessity. If it does not do it, it will be sidetracked for something that will do it. If it is pure religion and undefiled to visit the widow and the fatherless in their affliction, is it not purer religion to prevent the affliction ? And when the Church, the organ of religion, can and does not wield its influence to put all this program of prevention on the map, must it be surprised when the world and workingmen repudiate it as Christ did the priest and Levite who went by on the other side and left the sick and wounded to shift for himself? They went on to their punctilious church service and neglected the simple human appeal. Isn't that what we do when we forget physical health and its neglected contagions? That religion that is concerned about the Church and forgets the i)eople, that is concerned about ritual and for- gets life, that is concerned about speculative dogma and forgets the wounds of him who fell among thieves, whether on the road to Jericho or in modern social, commercial, and industrial holdups, will find its pews empty, no matter how elegant the preacher, nor how chaste his diction, nor PHYSICAL HEALTH CHAMPIONED BY THE CHURCH 503 how beautiful and ornate the edifice in which it worships. All these things I love, but not above justice and mercy, the chief words and functions of religion. I for one join Christ against the church dignitaries, the priest and Levite, who go on to church in their stovepipe hats and immaculate collars and leave the wounded man to the unchurched Samaritan. I join the Samaritan in the health campaign, though the temple at Jerusalem turn me from its doors. Wherever a human hand meets another human hand helpfully, there is the only true Church that ever was or ever will be. Something like this Ruskin said. Something like this my heart responds to. Something like this Jesus planned his Church to be in its functional activity. The good Samaritan would not have been welcomed into the synagogue, but a greater than the synagogue made him the ideal of the function of religion and the Church for all time. I am for the Churches, every inch of them, but I am for the Churches doing their duty. It is magnificent to see them falling into line even as in New Testament times. If it is good for the good Samaritan to help the man who fell among thieves on the road to Jericho, when he was physically disabled, it is better to break up the thief gang and make the road safe. If the Church is committed to the cure, it is committed still more to the prevention. Our ultimate goal is a new environment and a regenerate society, readjusted and redeemed. A new order cometh. THE PROGRAM OF THE CHURCH AS THE CON- SERVER OF SOCIAL HEALTH PROF. HENRY BEACH CARRE, PH.D., NASHVILLE, TENN. Shall the Church become a conserver of social health? and if so, what shall be its program? These are the two questions which we wish to answer, but in the interest of 504 THE NEW CHIVALRY — HEALTH brevity we shall not attempt to answer the first question separately from the second, but proceed at once to the con- sideration of the program which we believe the Church should adopt, and let this program, along with the reasons therefor, constitute our answer to both questions. In planning a program for the conservation of social health we must keep in mind the processes which are at work in all social progress, since the same processes that are at work in the solution of other social problems are operative in the field of health also. Broadly speaking, there are three great processes, or stages, through which social advance is made. First the stage of discovery, experimen- tation, and agitation; secondly, the stage of education and objective demonstration; thirdly, the stage of legislation and law enforcement. The first stage is that of the proph- ets, the explorers, the scientists. The second stage is that of the teachers, those popularizers of knowledge who take the things of the laboratory and show them to the people; it is also the stage of the philanthropists, men who, while not themselves pathfinders in thought, are sufficiently in advance of the crowd to listen to those who are. They are the Pharaohs who listen to the Josephs and upon their recommendations make provision, during the seven years of plenty, for the seven years of famine. They are the Mor- rises who understand the purposes of the George Wash- ingtons well enough to back their revolutionary schemes with cash and thus make possible new republics. They are the Isabellas and Ferdinands who have enough faith in the C'olumbuses to fit them out with ships and send them across unknown seas to demonstrate the truth of their theories and discover new worlds. The third stage is the stage of the lawmakers, the representatives of the people, the men who formulate and crystallize in the statutes of the State and wishes of the majority. What the dreamer saw in his night vision, or the scientist patiently worked out in his laboratory, what the educator and philanthropist appreci- ated and desired to pass on to their fellow man, that has now become the property of the people. Being the law of the THE PEOGRAM OF THE CHURCH 505 State, it is now the right and privilege of all. When the courts have passed the laws in review and determined that they do not violate the principles of government nor infringe the rights of the citizens, and when the executives see that the laws are enforced, then the process is complete. The path which the lonely thought pioneer blazed through the jungle has now become a great highway over which vast multitudes proceed in safety to the El Dorado which lured him on in spite of swollen streams and mias- matic swamps. Thus it comes to pass that "The thoughts which great hearts once broke for we breathe cheaply on the common air." The vaccination theory for which Dr. Jenner was ridiculed and abused in the eighteenth century is, in the twentieth century, the law of many lands, and smallpox no longer ravages those countries. The views of a lone theorist are now the working principle of millions, and in so far as smallpox is concerned their social health is conserved. It happens in social advance as in religious progress that the fathers killed the prophets and the sons build their sepulchers. In our progress toward State and national health we have advanced much farther in the first of the three stages of social progress than we have in the second and third. Our scientists are far ahead of our educators and philan- thropists on the one side and of the State on the other. They know enough right now to prevent nearly one-half of the deaths of the country. Modern medical science is asking to-day, not one lone cripple, but forty-two per cent of the sufferers of the nation this question: "Wouldst thou be made whole?" The answer comes back as it did that day at the Pool of Bethesda, "Sir, I have no man ... to put me into the pool, but while I am coming another steppeth down before me." The reply of medical science is : "Take up thy bed and walk." But here the parallel breaks down. These suffering millions do not obey the voice of science; they do not take up their beds and walk as did the man to whom the words were first spoken. On the contrary, they languish on them and die. It is the reproach of our day 506 THE NEW CHIVALRY — HEALTH that nearly every other person whom we put beneath the sod fills a premature grave. There is long life, one hundred per cent efficiency, and robust health at hand for vast multi- tudes, yet they perish in sight of it all. It is the tragedy of tragedies that the light of medical science has come into our twentieth-century world and men still live in the dark- ness of disease and death rather than in the light of health and efficiency. Our problem then is to get the people as a whole to make use of the knowledge which is even now available, to take the facts and theories which our health experts already possess and write them into the laws of the land. Our attention must be directed chiefly to the second and third stages of social advance rather than to the first. The scientists have done their part of the work and done it well ; what is needed is that the teachers and philanthropists shall demonstrate to the people at large the truth which the scientists have discovered and through this process of edu- cation eventually get the people to demand that the State act upon this truth and pass laws in accordance with it. Who is to undertake this task? What group of men or what institution can assume the responsibility of educating a nation? At the present time, no single agency is able to undertake in its entirety a task so gigantic. The medical profession with its associations and societies cannot do it. Philanthropic organizations, however so many they may be and however well endowed they may be, cannot do it. The Church vvdth all its educational equipment cannot do it. Even the State with its great resources cannot do it. Each of these agencies may do something; some of them may do much; but none of them can do all that needs to be done. A work so stupendous and so important requires that each and all of them contribute their share to this nation-wide work of education in health. Only in the combination of the three do we find all the resources that are needed for the vast educational work in contemplation. The necessary scientific knowledge is at the command of the medical and allied sciences; the surplus wealth is possessed by the phil- THE PROGRAM OP THE CHURCH 507 anthropists, their organizations, and the citizenship that may still be enlisted in the service which these organiza- tions are endeavoring to perform; educational facilities of inestimable capacity are in the hands of the Church and State. It is because the Church is a gigantic educational insti- tution that we may demand of it that it become a conserver of social health. The pulpit is an educational force of far- reaching possibilities; so is the Sunday school. They are both more educational to-day than they were formerly, and in the future they will be still more educational. The same may be said of the various societies of the Church, such as the young people's and missionary societies ; also the numer- our clubs, guilds, and committees, such as the Boy Scouts, the Camp Fire Girls, the committees on social service and the like; these are all basically educational. Together they constitute a congeries of educational forces which cannot be duplicated outside of the Churches. There is no other institution nor group of institutions in the country that can do the kind of educational work which the Churches through their numerous departments are doing and can be put to doing. Let us take stock of this educational equipment of the Churches and determine what their possibilities are in the event that they could be utilized for educating the nation in matters of health. First, there are the church houses themselves, located within reach of every one, and consti- tuting the first requirement of a national health university — namely, buildings and grounds. Secondly, the Churches assemble within their walls week by week a vast number of people of all ages; thus the second requirement of a university is met — namely, a student body. A third factor in such an institution is also present — ^namely, the faculty, including its administrative and teaching branches. This faculty is found in the pastors, the Sunday school teachers, and other directors of the thought and activities of the Churches. In addition to these regular workers of the Churches, as they are at present constituted, each local 508 THE NEW CHIVALRY — HEALTH Church may make use of a greater or less number of resi- dent physicians, professors, and teachers in local institu- tions of learning, nurses, directors of athletics, and others. The teaching force may be further enlarged through the use of county and State officials, members of boards of health, inspectors, heads of public institutions, members of the faculties of the State and other universities, as well as the representatives of various foundations and associations which are working in the interest of social health. There are thousands of well-equipped men and women, whose hearts are aglow with enthusiasm for this gospel of physical soundness, who would be glad of the opportunity to address groups of men, women, and children on Sundays and on other days in the interest of personal and public health. The Churches can give them the opportunity of doing this, and at the same time enlarge indefinitely the faculty of this nation-wide university of health. What is lacking to complete this national school of health ? One and only one necessary factor — a curriculum ! Here are buildings, grounds, student body, and faculty — all capable of being converted into a mammoth university of the fine art of proper living, the mastery of which art will make for a healthy, happy, long-lived, and efficient nation. Can the Churches take the next step and add the cur- riculum? The answer to this question is largely a matter of wil- lingness on the part of the Churches. If they think the conservation of national health to be important enough to warrant provision for it in their curriculum, the materials for such a curriculum stand ready to hand in the records of laboratories, in scientific treatises, municipal. State, and national reports and publications, along with addresses and papers innumerable. This material is waiting to be levied upon and used for the healing of the nation. Are the Churches willing to make use of this mass of valuable material and turn it to account in the fight for national health? It is not our aim in this paper to detail for the Churches a program of health conservation. Our main purpose has THE PROGRAM OP THE CHURCH 509 been accomplished if we have shown, as we believe we have, first, that the problem of conserving social health is chiefly an educational problem; secondly, that the Church is an educational institution of national significance ; and, thirdly, that it is entirely practicable for the Churches to utilize the materials for health education already to hand, and thus have a large share in this indispensable work of health con- servation. Should the Churches take up this work, every pulpit may become a platform from which the principles of social health shall be expounded. Every Sunday school. Church guild, club, and society may become a dispenser of the gospel of salvation from disease and premature death. In accordance with its missionary spirit, the Church should carry this gospel to all parts of the coutttry, but par- ticularly to those parts where it is most needed — namely, the congested and tenement sections of our large cities and the rural districts. In order to serve their large missionary territory, the Churches should provide health exhibits which should be taken from place to place. Along with the ex- hibits should go lecturers, who in addition to explaining the exhibits would also carry lantern slides and motion picture films. It is impossible to estimate the benefit that such evangelists of health would carry to the tenement districts of our large cities and to the rural districts, especially the mountain sections. Think of the revelations they could make of the causes and effects of typhoid fever, tuberculosis, hookworm, malaria, infant, and social diseases! At com- paratively little outlay the Churches could carry on a vast amount of such work, not only adding joy and happiness to countless multitudes thereby, but also adding to their effi- ciency and thus contributing immeasurably to the economic values of the nation. In conclusion we must call attention to an essential element in any program which the Churches may frame for the conservation of social health — namely, the altruistic element. The educational and philanthropic work which is necessary to the saving of a nation's health will call for vast outlays of altruistic endeavor. There can be no social health without sacrifice any more than there can be individual 510 THE NEW CHIVALRY — HEALTH salvation without sacrifice. Only through the disinterested love of those who have put their faith in the gospel of health is society to be saved from disease and death. In the fact that this disinterested love is more fully developed in the Churches than in any other institution of society we find a strong reason why the Churches should offer their vast educational facilities for the training of a nation in the art of healthful living. Finally, let it be observed that in advocating a program for the Churches as conservers of social health we are not seeking to divert them from their main task; we are not leading them off into some morass to die, but are opening new fields of activity in which they may spend themselves, and in thus spending themselves find a new and a larger life. In this way the Churches themselves will exemplify and experience the saving power of the gospel of love which it is their chief task to herald and make real in a self- centered and egoistic world. WAR ON DISEASE— A WORTHY OBJECTIVE FOR A RELIGIOUS CRUSADE REV. CHARLES S. MACPARLAND, PH.D., GENERAL SECRETARY OF' THE FEDERAL COUNCIL OF THE CHURCHES OF CHRIST IN AMERICA The Christian faith, both in its form and in its insti- tutions, has always been militant in varying degree. Some- times, to our sorrowful historic recollection, its militancy has had unworthy objectives, because of sad misleadings through the perverted conscience of mankind. This militant spirit is now finding significant expression in the new social impulse of Christian faith, and perhaps its most concrete declaration is what is known as the social WAR ON DISEASE 511 creed of the Churches unified in behalf of Protestant Chris- tianity, set forth by the Federal Council of the Churches of Christ in America. The hostile critics of this social platform, I am con- vinced, have in the main been critical because it was the attack of the Churches, in behalf of mankind, upon private and selfish interests ; and while it is true that some of these censors have been honest in their concern lest social service should impair the interests of the spiritual life, the main body of the critics have, knowingly or unknowingly, let loose their strictures because their social creed, demanding equal rights and justice for all men in all stations of life, has simply found the vulnerable points of moral sensibility, and they are, to use the words of Paul, kicking against the pricks of conscience. Of the sixteen articles of this social faith, many are frankly in the interest of physical health. Thus it seems to us, says the Federal Council, that the Churches must stand "For the protection of the family by the single standard of purity, uniform divorce laws, proper regulation of mar- riage, and proper housing; "For the fullest possible development for every child, especially by the provision of proper education and recrea- tion; "For the abolition of child labor; "For such regulation of the conditions of toil for women as shall safeguard the physical and moral health of the community; "For the protection of the worker from dangerous ma- chinery, occupational diseases, and mortality; "For suitable provision for the old age of the workers, and for those incapacitated by injury; "For a release from employment one day in seven ; "For the gradual and reasonable reduction of the hours of labor to the lowest practicable point, and for that degree of leisure for all which is a condition of the highest human life." 512 THE NEW CHIVALRY — HEALTH All of these articles may also be comprehended in one other, which reads, "The Churches must stand for the con- servation of health." When these united Churches spoke these words they seemed new, if not strange; and yet, strangely enough, we have here, if it be reversal merely, a reversal in significant degree to both the Old and New Testament Gospels. For when we come to think of it the books of the Old Testament have whole chapters, and indeed whole books, on the conser- vation of health. The first four books of the Law of Israel constitute the story of the war on disease — a war which was commanded and led by Jehovah and his chosen cap- tains; and to the effectiveness of this warfare is due the marvelous permanency of the Jewish race. Not only is the conservation of health a part, and a large part, of the Hebrew code of ethics, not only are divine rewards and punishments meted in accordance with these laws of health, but they were also embodied in the very ritual and worship of Israel. Long before Paul spoke the word, the Jew was teaching God's command that men should make of their bodies a living sacrifice holy and acceptable to the Infinite. Here in the South our religious leaders are battling for the inspiration of the Old Testament Scriptures, and surely if they themselves believe the faith for which they fight they must be ready that the Churches of the South should take the part of leadership in the battle for human health. Jesus divested the Jewish religion of much of its form- alism. He seems even to abrogate some of its laws by their fulfilment, but we do not find him finding any fault with the Hebrew war upon disease. While the Gospels give us no story as to the bodily appearance of the Master of mankind, the impression which we have is surely that Jesus had a healthy physical life. We read many stories of his weariness, but none of enfeebling sickness. He plucked the corn upon the Sabbath day in the interest of physical health, and said that man was lord of the Sabbath, and that the Sabbath was made for man, WAR ON DISEASE 513 and that David was justified in using the elements of sacred worship for the conservation of health. It would appear also that the followers of Jesus were healthy men, and the utterances of the Master, both rhetorically and explicitly, breathe the spirit and have the charm of a wholesome phys- ical life. More significant still than this is the healing ministry of Jesus. Cut out from the Scriptures the story of the phys- ical ministrations of the Master and, quantitatively, there is not much left. If there are those among our Churches who would stay this great crusade of ours, they must first turn ruthless higher critics and find many errors and inter- polations in the Bible. Jesus seems to be stopping every moment to bring back some sick body to the glow of health. And he makes no artificial distinctions between the healing of the soul and the healing of the body. There even seems to be a certain identification between physical health and spiritual life. And it is interesting to remember that the one Gospel which records this human ministry of Jesus in the fullest detail and with the finest emphasis was written by Luke, the beloved physician to the bodies of men. The specious sacro-sanctity of our day which makes its trifling distinctions between the helping of men's souls and the helping of men's bodies finds no warrant in the spirit and attitude of Jesus. We have sincere religious men to-day who are always losing their sight of the man in their search for his soul, but in this they lose the pathway of their Lord. The same spirit and attitude of Jesus prevails through- out all the New Testament. The gospel of Paul is that of the physician of the body as well as the soul. Thus through- out the whole of the Scriptures we find a sense of the sanc- tity of health. No wonder then that the early Church caught this spirit, and that its monasteries became upon every hillside and every mountain top a symbol, not only of spiritual retreat, but also of physical regeneration. We have a good many ready critics who are always ready to cudgel the Church and take a jab at the preacher, and 33 514 THE NEW CHIVALRY — HEALTH who are eternally proclaiming the dismal failure of the Church to meet her social tasks. And yet, throughout all her history, the Church of Christ has been the healer of men's bodies as well as the savior of their souls. There are no servants of humanity who have larger opportunity to show forth the spirit of the Master than the physician and the nurse. One of the most touching pictures in all the galleries of Europe is that by Luke Fildes of the physician, with his serious, anxious face, bending over the form of the little child. There are few finer symbols of the spirit of the Great Physician than in those of our number who lead the warfare upon disease and who manifest the one great emblem of Christian discipleship, the sacrifice of self. The critics have simply lost sight of the source because the stream itself has become so large. But now, it must be candidly admitted, the Christian Church faces a new task. She may go back to the physical ministry of Israel, but she must not go back to Israel's therapeutics. Her new crusade is that of the engineer as well as of the physician and the nurse. She has always dealt in a spirit of self-sacrifice and has inspired that spirit with the effects of disease, but now she is called to the larger task of a warfare against its hidden, subtle causes. To avow that the Church may be the inspiration for the healing of disease, but not the spir- itual force to lead men in their holy fight against its causes, is the same as to aver that we may reform a drunkard but may not war upon the devilish liquor trafiic, as indeed, sad to say, some men do seem to think. But may it not be that this greater task is the fulfillment of the Master's prophecy to his disciples that they should do greater works than his, because he was with the Father? The reason that the Federal Council's social platform seemed so new, when it really was not new, was that it marked this departure from measures of social amelioration to measures of prevention. We have awakened to the fact that we have failed because we exercised our healing minis- trations with the results while the causes went on unchecked. We have developed a system of industry and WAR ON DISEASE 515 a type of civilization which, together with our lingering individualistic conception of Christianity, have brought to us great forces both of good and ill. In one pastorate I discovered over thirty cases of most terrible disease, all of them traced back directly to one industrial occupation upon which that city had amassed its wealth. The physicians of the city had been so busy dealing with effects that they had failed to note the causes. The Churches had visited the hospitals when they should have visited their righteous wrath upon the factories and mills. Under our present industrial system and our modem methods of population, no ministry of healing can prevail. It has got to be a militant warfare which reaches into every nook and corner of our common social life. Our great captains of industry can no longer go on making their contributions to our hospitals and our asylums, while our industry maims and mangles and stifles our human brothers. Those wh6 control our lands and estates can no longer satisfy themselves with even the most lavish gifts for cure, while their tenements kill off our babies beyond the count of Herod. But I was asked to emphasize the warfare upon disease as a worthy objective for the Christian Church. Is it her task? Is it her business ? Let us go back again to the min- istry of Jesus. John the Baptist doubted him. He sent his disciples to ask of him, "Art thou he that should come, or do we look for another?" The answer of Jesus was brief and without a moment of hesitation: "Go and shew John again those things which ye do hear and see: The blind receive their sight, and the lame walk, the lepers are cleansed, and the deaf hear, the dead are raised up, and the poor have the gospel preached to them. And blessed is he, whosoever shall not be offended in me." Jesus made his healing ministry of men's bodies a sovereign test of his own Messiahship and his spiritual Lordship. But again; upon only one occasion did the Sovereign of mankind declare the moral determinance of human destiny. He pictured the final judgment only once in all 516 THE NEW CHIVALRY — HEALTH his preaching; but here again he never spoke more clearly, he never spoke with less qualification, and these were his words of judgment: "When the Son of man shall come in his glory, and all the holy angels with him, then shall he sit upon the throne of his glory; and before him shall be gathered all nations; and he shall separate them one from another, as a shepherd divideth his sheep from the goats : and he shall set the sheep on his right hand, but the , goats on the left. Then shall the King say unto them on his right hand. Come, ye blessed of my Father, inherit the kingdom prepared for you from the foundation of the world ; for I was an hungered, and ye gave me meat : I was thirsty, and ye gave me drink: I was a stranger, and ye took me in: naked, and ye clothed me: / was sick, and ye visited me: I was in prison, and ye came unto me. Then shall the righteous answer him, saying. Lord, when saw we thee an hungered, and fed thee? or thirsty, and gave thee drink? When saw we thee a stranger, and took thee in? or naked, and clothed thee? Or when saw we thee sick, or in prison, and came unto thee? And the King shall answer and say unto, them. Verily I say unto you. Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me. Then shall he say also unto them on the left hand. Depart from me, ye cursed, into ever- lasting fire, prepared for the devil and his angels: for I was an hungered, and ye gave me no meat : I was thirsty, and ye gave me no drink: I was a stranger, and ye took me not in : naked, and ye clothed me not : sick, and in prison, and ye visited me not. Then shall they also answer him, saying. Lord, when saw we thee an hungered, or athirst, or a stranger, or naked, or sick, or in pirson, and did not minister unto thee? Then shall he answer them, saying, Verily I say unto you. Inasmuch as ye did it not to one of the least of these, ye did it not to me. And these shall go away into everlasting punishment: but the righteous into life eternal." Jesus made the healing of men's bodies a determining test of the eternal judgment of mankind. But still further, WAR ON DISEASE 517 perhaps the most sacred scene in Christian history is that of the transfiguration of the Master. He had been upon the mountain. His face did shine as the sun. His raiment was white as the light. A bright cloud overshadowed him. The Divine Voice proclaimed his Lordship. It was the revelation of his spiritual sovereignty. It was his highest moment of spiritual exaltation. Here, if ever, he was away from earth. But the next scene follows in the very next moment. It is the picture of the transfigured Master at the foot of the same mountain with a lunatic kneeling at his feet to receive his touch and his word of physical healing. Jesus made the healing of men's bodies the natural expression of his own personality at the moment of his highest spiritual exaltation. Is the war on disease then a worthy objective for the Christian Church? The answer of Jesus is that it was the test of his own Lordship; that it was the measure and the expression of his own spiritual life; and that it is the final determining factor in the moral judgment of mankind. There is then a spiritual significance in this crusade for health. It is an expression of reverence for human person- ality. It is the answer of the Master's question, "How much is a man better than a sheep ?" I have sometimes been in the hospital when the phy- sician has brought in together the great strong man with life pulsating through all his being and the frail, weak brother with pallid face and trembling step, who has brought them together and has taken the blood and the life of the one and has put it into the other. It is a parable of the Christian spirit, so far as the Christian spirit is the spirit of Christ. There are those who tell us that we must always have war. They mean the kind of war that they are fighting across the sea. And they are partly right. We must have war. The fighting spirit in men remains. Christianity must always be militant. And we shall always have men fighting each other unless we can give to mankind new objectives for the militant spirit. 518 THE NEW CHIVALRY — HEALTH And the new order must come, both here and there, by the same great spiritual transformation, the appeal of a higher imaginative pity, the conservation of human heritages, the unwillingness that even one of these little ones should perish, and above all by diverting all that is high and holy in the fighting spirit of man by setting before the eyes of men the great moral equivalents of war, so that mankind's scarlet sins themselves may be as white as wool, as they shall, instead of fighting each other, fight for each other, the moral battles of our humanity against disease, injustice, inhumanity, and every subtle foe of our common human progress. For we have not yet even tested, except in a very timid way, what this newer humanitarianism may do to bring forth heroism, courage, and endurance, and the very wrath of man may yet be made by God to praise him ; for even now, down in their hearts, as Ruskin declared, men worship the soldier, not because he goes forth to slay, but to be slain. This is the kind of warfare that gives the highest expres- sion to our Christian faith; the willingness to suffer for others. The culture of the Cross is gained, the lesson of the school of Calvary is learned, the law of Jesus is fulfilled, not when we see the beauty of his sacrifice and learn by it to bear our own sorrows patiently. Not by the bearing of our own, but of one another's burdens do we fulfill the law of Christ. Let us take one example. The most beautiful thing in all the world is motherhood. And yet nothing in our modern civilization has been more degraded by physical neglect than motherhood. Modern industry and our modem and inhuman methods of the distribution of population are the violators of its sanctity. What does God think of mother- hood? In the fullness of his goodness and his glory God was to come among men. It was by a very simple way. He found, first, a good and pure and holy woman. One by one he was to take every relation of human life and invest it with a divine meaning, and he began With motherhood. "And the angel came in unto her, and said, Hail, thou WAR ON DISEASE 519 that art highly favored, the Lord is with thee." Many pages of learned disquisition have been written to interpret this, and most of them have never touched its deeper meaning. It is, a strangely materialistic mind that lowers the sublime and beautiful idea of this transcendently told story by making it the subject of a cold and hard analysis. Is the story true? To ask the question is to show that we have missed its deepest meaning. "And the angel answered and said unto her. The Holy Spirit shall come upon thee, and the power of the Highest shall overshadow thee: therefore also that holy One that shall be bom of thee shall be called the Son of God." The first mark of the incarnation was the illuminating of moth- erhood with its divineness. And over every mother, if she will but look and listen, is the angel. Upon her is the shadow of the Holy Spirit, and "Heaven lies about us in our infancy." "The Soul that rises with us, our life's Star, Hath had elsewhere its setting And Cometh from afar: "Not in entire forgetfulness. And not in utter nakedness. But trailing clouds of glory do we come From God, who is our. home.'' No diviner task awaits the Church than her crusade for motherhood, a sweet, wholesome motherhood. Take another great question which absorbs so much of our serious thought — ^the question known as sex hygiene. Shall the Christian Church make war in this realm? Who can if she does not? Men are trying other methods. They are proceeding upon the assumption that the motive of fear can work the moral transformation. But statistics certainly do not warrant their conclusions. Others tell us that if we give men enough knowledge they will behave themselves. And yet, so far as we can learn, neither students of medicine nor their companions, the nurses, who have more knowledge than anybody else, behave themselves any better on the whole than other classes of people. You cannot make war- 520 THE NEW CHIVALRY — HEALTH fare in this realm with any but spiritual weapons — ^by what Dr. Cabot has so beautifully called "the consecration of the human affections." I went the other evening to a sacred service of ordina- tion. It was the ordination of missionaries to the foreign field. But they were all kinds of missionaries. There were the preachers; there were the physicians; there were the nurses and the deaconesses, the industrial teachers — and the beautiful thing about it was that they all knelt together and bowed their heads, and the hands of sacred ordination were placed upon all of them, and they all went out — ^the preacher and the doctor and the nurse and the teacher — with the same holy ordination for the same sacred task. Here we are to-night with our varied tasks. Some of us are preachers, some of us are doctors, some of us are teach- ers; but in this great task to which we are committed we were all of us divinely committed by our Master two thou- sand years ago, and the task of one of us is no more sacred than the task of the other. The disciples, then, must go to the Mountain of Trans- figuration with Jesus. The next hour of the day they must go down with him upon the plain of human life to heal men of their diseases. But mark this, they cannot do his work upon the plain unless they have been upon the mountain top with the Master, so that they may come down radiant with the light that shines from his face. "The world sits at the feet of Christ, Unknowing, blind, and unconsoled; It yet shall touch his garment's fold And feel the heavenly alchemist Transform its very dust to gold." Is war on disease a worthy objective ftor a religious cru- sade? The answer is the answer of the Master, who made his own ministry for human health the sovereign proof of his Messiahship, the expression of his own spiritual life, and the arbiter of the eternal judgment of men. "Inasmuch as ye did it, or as ye did it not, ye did it, or ye did it not, to me." WAR ON DISEASE 521 And so we have thousands upon thousands of men maimed and mangled in our industrial life, thousands upon thousands of our women, our children, and our babies, who in the name of Christ himself stretch out their hands to his holy CJhurch. Is war for health a worthy crusade in the name of religion? Let me close with another of the most sacred scenes in our Master's life. It is the story told by the physician dis- ciple, Luke, and this is the way it reads : "He went out into a mountain to pray, and continued all night in prayer to God. And when it was day ... he came down . . . and stood in the plain ; . . . there went virtue out of him, and healed them of all their diseases." "Where cross the crowded ways of life, Where sound the cries of race and clan, Above the noise of selfish strife. We hear thy voice, Son of man! In haunts of wretchedness and need, On shadowed thresholds dark with fears. From paths where hide the lures of greed. We catch the vision of thy tears. From tender childhood's helplessness. From woman's grief, man's burdened toil, From famished souls, from sorrow's stress. Thy heart has never known recoil. O Master, from the mountain side, Make haste to heal these hearts of pain, Among these restless throngs abide, O tread the city's streets again." My dear friends of this Congress — doctor, nurse, social worker, guardian of health, warrior of the white plague, wearer of the red cross, minister, teacher — upon you all I would have placed the hands of sacred ordination for this crusade of the Master, in the name of the Father, and of the Son, and of the Holy Ghost. Amen. XL ORGANIZATION Constitution and By-Laws of the Congress Officers and Committees Houston Plan The Social Program of the Congress Resolutions on National Department of Health Membership Index to Speakers, Writers, and Officers Index to Subjects CONSTITUTION AND BY-LAWS OF THE CONGRESS PURPOSES AND MEMBERSHIP The purposes of the Southern Sociological Congress are to study and improve social, civic, and economic conditions in the South. Its membership shall be composed of all persons interested in its work who shall register their names and pay the annual fee. The members shall be of the following classes: Regular members, |2 per year; sustain- ing members, $10 ; life members, $100. Any person paying any of these fees shall receive a copy of the proceedings and of any other publications of the Congress. Delegates to the Congress may be appointed by the Governor of each State cooperating with it, by Mayors of cities in these States, and by organizations and institutions engaged in social service, and, upon payment of the membership fees, shall be entitled to all privileges. MEETINGS The Southern Sociological Congress shall meet once each year, at such time and place as may be designated by the Committee on Time and Place. During each meeting the President shall appoint a committee of five members whose duty it shall be to determine the time and place of the next meeting, the amount for local and general expenses to be raised by the local committee, and announce its conclusion within three months after its appointment. All invitations from cities shall be referred to this committee. There shall be a local committee in each city having a meeting of the Congress, and it shall be the duty of this committee to pro- vide any necessary funds and make all local arrangements for the meeting satisfactory to the Executive Committee. OFFICERS The officers of the Southern Sociological Congress shall be a President, First and Second Vice Presidents, a General Secretary, a Treasurer, a Publicity Secretary, a Program Secretary, a Membership Secretary, and a Corresponding 526 THE NEW CHIVALRY — HEALTH Secretary for each State. All of these officers shall be elected annually by the Congress upon nomination of the Committee on Organization. COMMITTEES The standing committees shall be an Executive Com- mittee; a committee on each subject which it is proposed to discuss at the next meeting of the Congress, to be appointed by the Committee on Organization; and a committee, com- posed of the Chairmen of these standing committees, whose duty it shall be to report a social program before the close of the Congress, and to which committee all resolutions shall be referred without debate. The Executive Committee shall consist of the President, the Treasurer, one member from each Southern State, to be elected annually by the Congress, together with the ex-Presi- dents of the Congress. The members of the other standing committees shall likewise be elected annually. The President shall at the opening session appoint a Committee on Organization, whose duty it shall be to select topics for discussion and nominate officers and committees for the following Congress. The Executive Committee shall have power to transact all necessary business in the interim between the meetings. It may appoint sub-committees to attend to matters of detail. Meetings of the committee shall be called by the President, and five members shall constitute a quorum during the sessions of the Congress and three members in the interim between meetings. DUTIES OP OFFICERS The President shall be the chief executive officer and Chairman of the Executive Committee of the Congress. He shall generally supervise the work of the committees, and shall have power to accept resignations and fill vacancies among the officers or committees. In the event of a vacancy in the office of President, it shall be filled by the First Vice President; and in the event of a vacancy in the office of First Vice President, it shall be filled by the Second Vice President. CONSTITUTION AND BY-LAWS OP THE CONGRESS 527 The General Secretary shall be ex officio Secretary of the Executive Committee. He shall conduct the corre- spondence of the Congress with officers, committees, and others under the direction of the President. He shall dis- tribute the announcements and programs and keep a correct roll of members. He shall receive all membership fees and proceeds of sales of the reports of the proceedings, and pay the same promptly to the Treasurer. He shall receive such compensation and allowance for expense as may be fixed by the Executive Committee, and shall perform such other duties as shall be ordered by the Executive Committee. The Treasurer shall receive and disburse all moneys of the Congress. All disbursements shall be made only upon the order "of the General Secretary, approved by the Presi- dent or by some member of the Executive Committee to be named by the President. The retiring President of the Congress and the General Secretary shall have charge of the editing and publishing of the Proceedings. The Corresponding Secretaries shall endeavor to stimu- late interest in the Congress in their respective States, and shall render annual reports to the General Secretary as to social, civic, and economic progress within the said States. PROGRAM AND PROCEDURE The program for each annual meeting shall be arranged by the President in consultation with the Chairman of each standing committee, and it shall be submitted to the Execu- tive Committee for its approval. All papers shall first be presented to the Executive Com- mittee before they are read to the Congress. AMENDMENTS These by-laws may be amended by a majority vote at any meeting of the Congress, provided that all amendments shall first be submitted to the Executive Committee. 528 THE NEW CHIVALRY — HEALTH ORGANIZATION OF THE CONGRESS OFFICERS President Samuel P. Brooks, LL.D., Waco, Tex. First Vice President Oscar Dowling, M.D., New Orleans, La. Second Vice President Miss Belle H. Bennett, Richmond, Ky. Founder Mrs. Anna Russell Cole, Nashville, Tenn. General Secretary J. E. McCulloch, Nashville, Tenn. Treasurer J. H. Dillard, Nashville, Tenn. Publicity Secretary Rev. C. A. Waterfield, Paris, Tenn. Program Secretary Dr. W. D. Weatherford, Nashville, Tenn. Membership Secretary Rev. W. W. Alexander, Nashville, Tenn. EXECUTIVE COMMITTEE Samuel P. Brooks, Chairman Waco, Tex. Ex-Gov. Ben W. Hooper Newport, Tenn. Ex-Gov. William Hodges Mann Richmond, Va. Seale Harris, M.D Birmingham, Ala. C. H. Brough, Ph.D Fayetteville, Ark. Edwin C. Dinwiddle, M.A Washington, D. C. Arch C. Cree, D.D Atlanta, Ga. Lincoln Hulley, Ph.D., LL.D DeLand, Fla. C. S. Gardner, D.D Louisville, Ky. Prof. B. C. Caldwell .Natchitoches, La. Miss Elizabeth Gilman Baltimore, Md. F. L. Watkins, M.D Jackson, Miss. L. L. Bernard, Ph.D Columbia, Mo. J. H. Pratt, Ph.D Chapel Hill, N. C. Jerome Dowd, Ph.D Norman, Okla. Judge J. A. MoCuUough Greenville, S. C. Mr. Whitefoord R. Cole. .Nashville, Tenn. Prof. C. S. Potts, M.D Austin, Tex. James Hardy Dillard, LL.D Charlottesville, Va. Prof. E. H. Vickers, Ph.D Morgantown, W. Va. Mr. J. H. Dillard, Treasurer Nashville, Tenn. J. E. McCulloch, General Secretary Nashville, Tenn. STATE CORRESPONDING SECRETARIES Judge W. H. Thomas Montgomery, Ala. Mrs. Minnie U. Rutherford Magazine, Ark. Mr. Walter S. Ufiford Washington, D. C. Mr. Marcus C. Fagg Jacksonville, Fla. Judige George F. Austin Columbus, Ga. Mr. Charles Stull. Louisville, Ky. Prof. W. 0. Scroggs Batpn Rouge, La. Mr. J. W. Magruder Baltimore, Md. Dr. A. A. Kern Jackson, Miss. Mr. Roger N. Baldwin St. Louis, Mo. Mr. G. T. Stephenson Winston-Salem, N. C. Dr. W. D. Matthews Oklahoma City, Okla. Lieut.-Gov. Andrew J. Bethea Columbia, S. C. Mr. C. C. Menzler Chattanooga, Tenn. Mr. R. J. Newton Austin, Tex. Dr. J. T. Mastin Richmond, Va. Miss Nola McKinney Fairmont, W. Va. ORGANIZATION OF THE CONGRESS 529 STANDING COMMITTEES I. THE GOVERNMENT AND HEALTH Seale Harris, M.D., Chairman, Birmingham, Ala. John S. Tilley, Secretary, Montgomery, Ala. Ex-Gov. B. B. Comer, Birmingr ham, Ala. Frank Glass, Birmingham, Ala. Mrs. Chas. Henderson, Montgom- ery, Ala. Mrs. B. D. Thames, Greenville D. T. MoCall, M.D., Mobile, Ala. W. W. Harper, M.D., Selma, Ala. Mrs. Margaret Randall, Florence M. G. Cunniff, Crown King, Ariz. M. A. Auerbach, Little Rock, Ark. J. L. Green, M.D., Hot Springs C. W. Garrison, M.D., Little Rock Prof. A. P. Bourland, A.M., Washington, D. C. Surgeon-General Rupert Blue, Washington, D. C. C. JE. Terry, M.D., Jacksonville Prof. Arthur Williams, Talla- hassee, Fla. Ellen J. Stevens, M.D., Jackson- ville, Fla. William F. Brunner, M.D., Sa- vannah, Ga. Frances S. Bradley, M.D., Atlanta J. N. MoCormack, M.D., Bowling Green, Ky. Mrs. Lafon Riker, Harrodsburg Oscar Dowling, M.D., New Or- leans, La. Miss Jean M. Gordon, New Or- leans, La. W. O. Hart, New Orleans, La. Pres. J. H. Apple, Ph.D.^ Fred- erick, Md. Miss Gertrude B. Knipp, Balti- more, Md. Mr. J. W. Magruder, Baltimore William Burdick, M.D., Baltimore F. L. Watkins, M.D., Jackson E. A. Roan, M.D., Wesson, Miss. Mrs. J. H. Fox, Jackson, Miss. Mrs. Clarence Baxter, Kirkville, Mo. L. A. Halbert, Kansas City, Mo. Col. J. L. Ludlow, Winston-Salem Mrs. Mark Quinerly, Greenville, N. C. Mrs. Kathryn Ray, Roswell, N. M. J. W. Duke, M.D., Guthrie, Okla. Mrs. W. W. Momyer, Muskogee Miss E. McClintock, Columbia Judge J. A. McCullough, Green- ville, S. C. Prof. G. A. Buist, Greenville, S. C. R. E. Fort, M.D., Nashville Olin West, M.D., Nashville, Tenn. Mrs. J. E. McCulloch, Nashville Thomas B. King, Memphis M. L. Graves, M.D., Galveston Frank D. Boyd, M.D., Fort Worth R. J. Newton, Austin, Tex. Hon. George E. Barstow, Barstow Ex-Gov. Wm. Hodges Mann, Richmond, Va. E. G. Williams, M.D., Richmond Mrs. Kate Waller Barrett, Alex- andria, Va. Prof. T. D. Eason, Farmville, Va. Samuel B. Montgomery, King- wood, W. Va. Miss Elizabeth Cummins, Wheel- ing, W. Va. W. C. Etzler, M.D., Wheeling Members at Large Lee K. Frankel^ New York City Prof. Andres Osuna, Saltillo, Coahuila, Mexico Don Salvador Ortega, M.D., New Guatemala, C. A. James B. Reynolds, New York City John Ihlder, Ph.D., New York City Miss Cora Frances Stoddard, Bos- ton, Mass. II. THE SCHOOL AND HEALTH Dean J. L. Kesler, Chairman, Waco, Tex. Prof. P. W. Horn, Secretary, Houston, Tex. Prof. W. F. Feagin, Montgomery Mrs. W. L. Murdoek, Birming- Miss Mary Moore, Athens, Ala. ham, Ala. 34 530 THE NEW CHIVALRY — HEALTH Pres. Andrew Sledd, Ph.D., Greensboro, Ala. Prof. C. O. Case, Phenix, Ariz. Prof. Georige B. Cook, Little Rock, Ark. Pres. J. C. Putrell, Ph.D., Fayette- ville. Ark. Miss Caroline B. Phelps, Conway Prof. Ernest L. Thurston, Wash- ington, D. C. Rev. A. J. McKelway, Washing- ton, D. C. Commissioner Philander P. Clax- ton, LL.D., Washington, D. C. Pres. Lincoln Hulley, Ph.D., DeLand, Fla. Prof. W. N. Sheats, Tallahassee, Fla. Mrs. T. P. Warlow, Orlando, Fla. Pres. W. L. Pickard, Macon, Ga. Prof. M. L. Brittain, Atlanta, Ga. Miss Martha Berry, Rome, Ga. Prof. J. A. Sharp, Young Harris Prof. Barksdale Hamlett, Frank- fort, Ky. Pres. Wm. G. Frost, Berea, Ky. Miss Frances Ingram, Louisville Prof. T. H. Harris, Baton Rouge Mrs. John Shuttleworth, Shreve- port, La. Mrs. Ida H. Friend, New Orleans Prof. B. Bates Stephens, Annap- olis, Md. Wm. H. Welch, M.D., Baltimore Prof. W. H. Smith, Jackson, Miss. Mrs. James Houston Price, Mag- nolia, Miss. James H. Fox, M.D., Jackson Chas. A. EUwood, Ph.D., Colum- bia, Mo. Prof. G. B. Mangold, Ph.D., St. Louis, Mo. Member Jacob Billikopf, Kansas City, Mo. Prof. Howard A. Gass, Jefferson City, Mo. Prof. E. C. Branson, Ph.D., Chapel Hill, N. C. Supt. J. Y. Jojmer, Raleigh, N. C. Mrs. Charles C. Hook, Charlotte Dr. W. L. Poteat, Wake Forest Prof. Alvan N. White, New Mex- ico Mrs. S. F. Culberson, Portales, N. Mex. Mrs. Charles R. Hume, Anadarko Prof. R. H. Wilson, Oklahoma City, Okla. Pres. C. W. Stewart, Muskogee Pres. H. N. Snyder, Ph.D., Spar- tanburg, S. C. Prof. J. E. Swearingen, Colum- bia, S. C. L. Rosa H. Gantt, M.D., Spartan- burg, S. C. Chancellor J. H. Kirkland, Ph.D., LL.D., Nashville, Tenn. Prof. F. B. Dresslar, Ph.D., Nash- ville, Tenn. Prof. S. W. Sherrill, Nashville Prof. H. H. Hibbs, Jr., Nashville Pres. Robert S. Hyer, LL.D., Dal- las, Tex. Mrs. Helena Holley, Houston Supt. W. F. Doughty, Austin Prof. A. Caswell Ellis, Austin Pres. (Miss) Mattie P. Harris, Roanoke, Va. Supt. W. F. Drewry, M.D., Peters- burg, Va. Prof. R. C. Steames, Richmond Prof. Morris P. Shawkey, Charles- ton, W. Va. Mrs. James McCoach, Sistersville at Large Alexander Johnson, Vineland, N. J. III. THE MEDICAL PROFESSION AND HEALTH W. S. Rankin, M.D., Chairman, Raleigh, N. C. L. B. McBrayer, M.D., Secretary, Sanatorium, N. C. W. H. Sanders, M.D., Montgom- ery, Ala. Ex-Gov. R. M. Cunningham, Birmingham, Ala. Mrs. H. P. Cole, Mobile, Ala. Mrs. J. G. Hammils, Glendale, Ariz. J. T. Searcy, M.D., Tuscaloosa Pres. J. H. Reynolds, Ph.D., Con- way, Ark. Mrs. C. H. Garrison, Little Rock D. F. Singleton, M.D., Fort Smith John A. Ferrell, M.D., Waking- ton, D. C. ORGANIZATION OF THE CONGRESS 531 Miss Isabel Lamb, M.D., Wash- ington, D. C. Prof. St. George Richardson, Ocala Fla C. F. Kemp, M.D., Key West, Fla. Mrs. W. S. Jennings, Jacksonville C. H. Lavinder, M.D., Savannah H. F. Harris, M.D., Atlanta, Ga. T. D. Coleman, M.D., Augusta Mrs. Victor Kreigshaber, Atlanta W. L. Heizer, M.D., Bowling Green, Ky. Mrs. Lewis W. Davis, Ashland John D. Trawick, M.D., Louis- ville, Ky. C. C. Bass, M.D., New Orleans Mrs. Savery Lewis, Ruston, La. Howard A. Kelly, M.D., Balti- more, Md. Lillian Welch, M.D., Baltimore J. R. Dobyns, Jackson, Miss. W. S. Leathers, M.D., Jackson J. W. Young, M.D., Grenada John Zahoisky, M.D., St. Louis D. E. Broderick, M.D., Kansas City, Mo. M. E. Ravenel, M.D., Columbia Charles L. Minor, M.D., Asheville Mrs. T. W. Lingle, Davidson Charles O'H. Laughinghouse, Greenville, S. C. Mrs. N. P. Laniglin, Santa Fe F. H. Clark, M.D., El Reno, Okla. Sessler Hoss, M.D., Muskogee Mrs. G. A. Brown, Mangum, Okla. J. W. Babcock, M.D., Columbia James A. Hayne, M.D., Columbia Mrs. Frank Gary, Abbeville, S. C. Prank A. Jones, M.D., Memphis John T. Barbee, M.D., Jackson S. S. Crockett, M.D., Nashville Len G. Broughton M.D., D.D., Knoxville, Tenn. H. K. Beal, M.D., Fort Worth W. M. Brumby, M.D., Waco, Tex. Henry Hartman, M.D., Galveston Powhatan S. Schenck, M.D., Nor- folk, Va. E. C. Levy, M.D., Richmond, Va. Allen W. Freeman, Richmond Mrs. W. K. Smith, Clifton Forge William H. McLain, M.D., Wheel- ing, W. Va. A. P. Butt, M.D., Davis, W. Va. Miss Lucy E. Prichard, Hunting- ton, W. Va. Member at Large John G. Bowman, Chicago, III. IV. THE PRESS AND HEALTH George Waverly Briggs, Chairman, Galveston, Tex. Rev. C. A. Waterfleld, Secretary, Paris, Tenn. William Ryan, Birmingham, Ala. W. T. Sheehan, Montgomery, Ala. Frederick G. Bromberg, Mobile Frederick I. Thompson, Mobile Mrs. W. H. Seymour, Montgom- ery, Ala. Mrs. George Crowley, Yuma Mrs. Sol Schoenfeld, Little Rock Morgan Smith, M.D., Little Rock Rev. A. C. Miller, D.D., Little Rock, Ark. Mrs. Henry C. Rainey, Washing- ton, D. C. President William F. Blackman, Winter Park, Fla. Mrs. Leiight Monroe, Miami, Fla. William Cole Jones, Atlanta, Ga. William D. Upshaw, Atlanta, Ga. F. A. Merrill, Athens, Ala. Mrs. Harvie Jordan, Atlanta, Ga. Miss Linda Neville, Lexington Rev. H. C. Morrison, D.D., Wil- more, Ky. Rev. E. G. B. Mann, Lexington D. D. Moore, New Orleans, La. Mrs. Mertis Morehead, Shreve- port. La. Mrs. Charles G. Summers, Balti- more, Md. Rabbi Sol L. Kory, Vicksburg Mrs. W. R. Wright, Jackson Rev. P. I. Lipsey, D.D., Jackson J. H. Garrison, D.D., LL.D., St. Louis, Mo. George F. Damon, Kansas City Miss Mabel K. Howell, Kansas City, Mo. C. B. Spencer, D.D., LL.D., Kan- sas City, Mo. Clarence Poe, Raleigh, N. C. 532 THE NEW CHIVALRY — HEALTH Mrs. Palmer Jerman, Raleigh, N. C. Mrs. W. H. White, Silver City Mrs. Charles W. Durand, Okla- homa City, Okla. Prof. Josiah Morse, Ph.D., Colum- bia, S. C. President E. M. Poteat, D.D., LL.D., Greenville, S. C. Rev. T. N. Ivey, D.D., Nashville M. B. Morton, Nashville, Tenn. Rev. E. E. Folk, D.D., Nashville Rev. W. D. Bradfield, D.D., Dal- las, Tex. Members W. J. Phillips, Los Angeles, Cal. Hon. John Temple Graves, New York, N. Y. Rev. J. E. Clark, D.D., Nashville Miss Decca Lamar West, Waco Carrie Weaver Smith, M.D., Dal- las, Tex. President James Cannon, D.D., Blackstone, Va. Rev. J. T. Mastin, D.D., Rich- mond, Va. Mrs. J. H. Drewry, Clifton Forge Prof. E. H. Vickers, Ph.D., Mor- gantown, W. Va. Mrs. George W. Johnson, Parkers- burg, W. Va. at Large W. A. Evans, M.D., Chicago, 111. W. T. Ellis, Swarthmore, Pa. Warren Dunham Foster, Boston V. RACE RELATIONS AND HEALTH James Hardy Dillard, LL.D., Chairman, Charlottesville, Va. W. D. Weatherford, Ph.D., Secretary, Nashville, Tenn. Rev. B. F. Riley, D.D., Birming- ham, Ala. Prof. J. L. Sibley, Montgomery Prof. Monroe N. Work, Tuskegee Pres. J. G. Snedecor, D.D., Tus- caloosa, Ala. Rev. R. G. Bowers, D.D., Little xtOPK A TK Prof. L.'m. Favrot, Little Rock Prof. T. S. Staples, Conway, Ark. Walter S. Ufford, Washington General W. H. Bixby, Washing- ton, D. C. W. G. Brorein, Tampa, Fla. Rev. Edwin W. Waldo, West Palm Beach, Fla. Miss Lucy H. Tapley, Atlanta, Ga. J. D. Hammond, LL.D., Augusta A. G. Fort, M.D., Atlanta Rev. John Little, Louisville, Ky. Prof. F. C. Button, Versailles Mrs. Maud R. McClure, Louisville Bishop W. P. Thirkield, D.D., LL.D., New Orleans, La. Prof. B. C. Caldwell, Natchitoches Prof. W. O. Scroggs, Baton Rouge Robert Garrett, Baltimore, Md. Albert Holt Stone, Dunleith, Miss. Prof. A. A. Kern, Ph.D., Jackson A. T. Stovall, Okolona, Miss. Roger N. Baldwin, St. Louis, Mo. C. M. Hubbard, St. Louis, Mo. Rev. H. K. Boyer, D.D., Winston- Salem, N. C. J. D. Maynard, M.D., Knotts Island, N. C. Jerome Dowd, Ph.D., Norman Prof. Josiah Morse, Ph.D., Co- lumbia, S. C. Lieut. Gov. Andrew J. Bethea, Columbia, S. C. Prof. Lewis P. Chamberlayne, Ph.D., Columbia, S. C. Miss Grace Biglow House, St. Helena Island, S. C. Dean George W. Hubbard, M.D., Nashville, Tenn. C. V. Roman, M.D., Nashville Bolton Smith, Memphis, Tenn. Prof. W. S. Sutton, Austin, Tex. Rev. A. J. Barton, D.D., Waco Rabbi William H. Greenburg, Ph.D., Dallas, Tex. Pres. H. B. Frissell, LL.D., Hamp- ton, Va. Maj. R. R. Moton, Hampton, Va. Prof. Jackson Davis, Richmond, Va. Prof. D. B. Purinton, Ph.D., Mor- gantown, W. Va. Members at Large W. L. Clark, Leamington, Ontario George W. Coleman, Boston Dr. Owen R. Lovejoy, New York C. F. Dole, Jamaica Plain, Mass. Rev. C. J. Ryder, D.D., New York J. H. Kellogg, Battle Creek, Mich. OEGANIZATION OF THE CONGRESS 533 VI. THE CHURCH AND HEALTH Bishop W. R. Lambuth. M.D., D.D., Chairman, Oakdale, Cal. Prof. Henry Beach Carre, Ph.D., Secretary, Nashville, Tenn. J. B. Wadsworth, Huntsville, Ala. Rev. H. H. Hibbs, Birmingham W. C. Gillespie, Phenix, Ariz. Rev. Forney Hutchinson, Little Rock, Ark. Prof. C. H. Brouigh, Ph.D., Fayetteville, Ark. Mrs. Minnie U. Rutherford, Magazine, Ark. Rev. Charles Wood, D.D., Wash- ington, D. C. E. C. Dinwiddle, Washington Miss Emma Tucker, Enterprise Rev. James G. Merrill, Lake Helen Mrs. O. D. Weatherell, Tampa Mr. John J. Eagan, Atlanta, Ga. Rev. C. B. Wilmer, Atlanta, Ga. Rev. Richard H. Bennett, D.D., Atlanta, Ga. Rev. D. B. Gray, D.D., Atlanta Rev. W. F. McMurray, D.D., L-Ruisville, Ky. Prof. C. S. Gardner, D.D., Louis- ville, Ky. Rev. J. S. Lyons, D.D., Louisville Rabbi Emanuel Sternheim, Baton Rouge, La. Prof. John M. Fletcher, New Or- leans, La. John A. Scales, M.D., Shreveport Rev. A. S. Hartman, D.D., Balti- more, Md. Mrs. H. M. Wharton, Baltimore Rev. Henry A. Atkinson, Boston Bishop Theodore D. Bratten, D.D., LL.D., Jackson, Miss. Mrs. C. W. Cochran, Meridian J. R. Bingham, Carrollton, Miss. P. H. Enochs, Fernwood, Miss. Rev. B. P. Fullerton, D.D., St. Louis, Mo. Hanford Crawford, St. Louis, Mo. Rev. John A. Rice, D.D., LL.D., St. Louis, Mo. President W. A. Harper, Elon College, N. C. President W. L. Poteat, LL.D., Wake Forest, N. C. Rev. J. L. Cuninggim, Durham J. W. Long, M.D., Greensboro Rev. J. E. Carpenter, D.D., Mus- kogee, Okla. Rev. Samuel Z. Batten, Phila- delphia, Pa. Rev. John E. White, D.D., Ander- son, S. C. Rev. M. L. Carlisle, Greenville A. T. Jamison, Greenwood, S. C. Rev. Carey E. Morgan, D.D., Nashville, Tenn. Dean C. K. Benedict, Sewanee Rev. J. W. Bachman,. D.D., Chat- tanooga, Tenn. Dean W. P. Tillett, D.D., LL.D., Nashville, Tenn. J. A. Witherspoon, M.D., Nash- ville, Tenn. Rabbi Henry Cohen, D.D., Gal- veston, Tex. Rev. Peter Gray Sears, D.D., Houston, Tex. Mrs. Nannie W. Curtis, Waco President C. M. Bishop, D.D., Georgetown, Tex. Barton Myers, Norfolk, Va. Prof. J. R. Howerton, LL.D., Lex- ington, Va. T. S. Southgate, Norfolk, Va. Mrs. Rebecca R. Altstaetter, Wheeling, W. Va. G. M. McCulIoch, Bluefield Archdeacon B. M. Spurr, Mounds- ville, Va. Members at Large Rev. Orrin G. Cocks, New York City Charles S. Macfarland, Ph.D., D.D., New York City William I. Haven, New York City Charles Stelzle, New York City Rev. Samuel Z. Batten, D.D.,. Philadelphia, Pa. Rev. Henry Stiles Bradley, D.D., Worcester, Mass. Rev. T. A. Moore, D.D., Toronto, Canada 534 THE NEW CHIVALRY — HEALTH VII. TRAVELEKS' AID AND HEALTH Orin C. Baker, Chairman, New York, N. Y. 0. L. Steele, Secretary, Mobile, Ala. By special resolution at Houston, a committee was appointed to have change of Travelers' Aid on the program of the Congress. This committee will work in conjunction with the Committee on the Church and Health. The committee consists of: Mrs. Paul Israel, New Orleans Mrs. Samuel Lumpkin, Atlanta Mrs. C. W. Cochran, Meridian Mr. Sam McDonald, Memphis Miss Edna Sandlin, Birmingham Mrs. Elizabeth Bacon, Greenville Miss Lena E. Brokew, Jackson- Mrs. Angelina M. Clay, Chilli- ville, Pla. cothe, Mo. COMMITTEE ON ORGANIZATION Dr. Seale Harris, Chairman, Birmingham, Ala. Miss Caroline Berry Phelps, Secretary, Conway, Ark. Dean J. L. Kesler, Waco, Tex. Judge George F. Austin, Colum- Prof. C. S. Potts, Austin, Tex. bus, Ga. Mr. Gilbert T. Stephenson, Win- Mrs. B. W. Barnwell, Sewanee ston-Salem, N. C. SOCIAL PROGRAM AND RESOLUTIONS Dr. Seale Harris, Chairman, Birmingham, Ala. Dean J. L. Kesler, Waco, Tex. Mr. George Waverly Briggs, Gal- Dr. W. S. Eankin, Raleigh, N. C. veston, Tex. Dr. James Hardy Dillard, Char- Mr. Orin C. Baker, New York lottesville, Va. Bishop W. R. Lambuth, Oakdale TIME AND PLACE Dr. W. D. Weatherford, Chairman, Nashville, Tenn. Dr. James Hyde Pratt, Chapel Dr. Arch C. Cree, Atlanta, Ga. Hill, N. C. Dr. William States Jacobs, Hous- Dr. Maud Loeber, New Orleans ton, Tex. AUDITING COMMITTEE Hon. John H. DeWitt, Chairman, Nashville, Tenn. Mr. W. R. Cole, Nashville, Tenn. Judge Lewis T. Baxter, Nashville SPECIAL COMMITTEE ON THE CHURCH AND HEALTH Dean J. L. Kesler, Chairman, Waco, Tex. Rev. C. A. Waterfield, Secretary, Paris, Tenn. Rabbi Henry Bamstein, Houston Dr. W. D. Weatherford, Nashville Rev. Peter Gray Sears, Houston Dr. Samuel P. Brooks, Waco, Tex. Mrs. Anna Russell Cole, Nashville Dr. W. L. Poteat, Wake Forest Dr. Samuel Z. Batten, Phila- Mr. J. E. McCulloch, Nashville delphia. Pa. HOUSTON ORGANIZATION GENERAL COMMITTEE Hon. Ben Campbell P. W. Horn Edgar Odell Lovett R. E. Burt Rufus Cage Dr. C. C. Green ORGANIZATION OF THE CONGRESS 535 Dr. W. H. Martin Dr. A. Philo Howard Dr. Sidney M. Lister Dr. F. J. Slataper Dr. E. F. Cooke Judge W. H. Ward Joe S. Rice Ennis Cargill Mrs. W. C. Corbett Mrs. Herbert Godwin B. W. Armstrong Mrs. Elliott Cage Mrs. J. W. Neal Mrs. F. A. Reichardt Mrs. Edgar Odell Lovett Mrs. J. W. Lockett Dr. Elva A. Wright Abe M. Levy Harry T. Warner Miss Julia Ideson Sinclair Taliaferro Miss Ferdie Trichelle Mrs. Ella S. Heyer Mrs. R. W. Knox Mrs. Ed Kiam Mrs. J. Edward Hodges Miss Jessie Jordan Sterling Myer Frank B. McCurdy Miss Annette Finnegan Mrs. Lockhart Wallis J. H. Freeman J. J. Settegast Mrs. R. E. Patterson George M. Bailey Mrs. Z. F. Lillard Mrs. A. H. Warley Mrs. Alexander Peddie Mrs. Henry Dannenbaum Dr. R. T. Morris Dr. Sidney Israel Dr. F. J. Burkey Dr. Belle A. Eskridge Rev. Robert Carroll Rev. C. S. Wright Rev. J. W. Mills Rev. William States Jacobs Rev. J. L. Gross Rev. Peter Gray Sears Rev. Thomas J. Windham Rev. H. H. Morehead A. A. Wagnon L. J. Power William A. Wilson Mrs. W. B. Sharp. Mrs. J. Lewis Thompson Mrs. Robert T. Morris Miss M. A. Smith Mrs. Helena Holley Mrs. Grace Engblad Miss Martha Schnitzer Mrs. Pat Dougherty Mother Yates Henry J. Dannenbaum J. Lewis Thompson L. A. Graham Judge Norman G. Kittrell A. D. Foreman W. L. Lubbock Rev. Rev. EXECUTIVE COMMITTEE Mr. Rufus Cage, Chairman Mr. Maurice Hirsch, Secretary Mr. J. S. Cullinan Mr. J. J. Burkey Father J. M. Kirwin Mrs. J. L. Thompson Prof. P. W. Horn Prof. L. L. Pugh Dr. C. C. Green Mrs. W. B. Sharpe Mr. William A. Wilson Mr. B. B. Gilmer Mr. H. C. Schumacher Mr. E. J. Hussion Rev. P. G. Sears Mr. Max Andrews Mr. Andral Vann PUBLICITY COMMITTEE Mr. C. E. Kepple Mr. C. C. Maes Mr. Paul Edwards Mr. J. R. Montgomery CHAIRMEN OF SUB-COMMITTEES Reception, Mrs. Maurice Hirsch Membership, Mrs. Mabel Frances Smith Exhibit, Mrs. Fred T. Wilson Registration, Mr. C. G. Carter Sunday and Monday Afternoon Mass Meetings, Prof. P. W. Horn Monday Afternoon Parade, Dr. J. F. Burkey Ushers, Mr. D. W. Duller 536 THE NEW CHIVALRY — HEALTH HOUSTON PLAN By the hearty cooperation of the people of Houston the Congress program for Sunday and Monday was made pos- sible. It is earnestly recommended that members of the Congress adopt a similar program in their own cities as soon as feasible. The important features of the Houston Plan are: SUNDAY 1. All Churches open for a health message at the morn- ing services. 2. Mass meeting of Sunday schools and young people's societies in the afternoon for health program. 3. Citizens' rally at night to study health questions. MONDAY 1. Morning health institutes culminating in public address at eleven o'clock. 2. Health parade in early afternoon, followed by — 3. Mass meeting of public schools and other educational institutions and social service agencies for the consideration of the health of children. 4. General meeting of citizens to consider and adopt plans for improving the health of the city and community. THE SOCIAL PROGRAM OP THE CONGRESS 537 THE SOCIAL PROGRAM OF THE CONGRESS It was the sense of your committee that for this year the Congress should reaffirm the program adopted at the Congress in Nashville in 1912, as follows: To us it seems that this Congress must stand — For the abolition of the convict lease and contract sys- tems, and for the adoption of modern principles of prison reform. For the extension and improvement of juvenile courts and juvenile reformatories. For the proper care and treatment of defectives, the blind, the deaf, the Insane, the epileptic, and the feeble- minded. For the recognition of the relation of alcoholism to dis- ease, to crime, to pauperism, and to vice, and for the adop- tion of appropriate preventive measures. For the adoption of uniform laws of the highest stand- ards concerning marriage and divorce. For the adoption of the uniform lawi on vital statistics. For the abolition of child labor by the enactment of the uniform child labor law. For the enactment of school attendance laws, that the reproach of the greatest degree of illiteracy may be removed from our section. For the suppression of prostitution. For the solving of the race question in a spirit of help- fulness to the negro and of equal justice to both races. For the conservation of health for the individual, for the community, and for the nation. For the closest cooperation between the Church and all social agencies for the securing of these results. 538 THE NEW CHIVALRY — HEALTH RESOLUTIONS FOR THE ESTABLISHMENT OF A NATIONAL DEPARTMENT OF HEALTH Whereas sanitarians estimate that more than 600,000 persons die needlessly and that more than 6,000,000 are ill each year from preventable diseases, a greater number than have been killed and wounded in the European War up to this time; and whereas the economic loss through the United States from preventable diseases is estimated at one biUion and a half dollars annually; and whereas our gov- ernment has done very little toward aiding the State and local health authorities in the campaign against tuberculosis, typhoid fever, malaria, pneumonia, and other preventable diseases; therefore be it Resolved, 1. That the nation's greatest need is an ade- quate department of health with a cabinet officer at its head. 2. That the greatest possible piece of constructive legis- lation that could be enacted by the Democratic party is the establishment of such a department of health. 3. That the Southern Sociological Congress urges Presi- dent Wilson and the United States Congress, if possible, to enact such legislation during the coming session of Congress. 4. That copies of these resolutions be sent to President Wilson and to each of the Senators and Congressmen in the States comprising membership in the Southern Sociological Congress. Committee on Resolutions. MEMBERSHIP LIST 539 MEMBERSHIP LIST Note: Names marked with a star (*) are sustaining members, those marked with a double star (**) are life members, all others are active members. ALABAMA Miss Louise Allyn, Athens Bishop J. W. Alstork, Montgomery Mrs. Ophelia L. Amigh, Birming- ham Rev. C. A. Bowen, Montgomery Sydney J. Bowie, Birmingham Prof. Lee Bidgood, Tuscaloosa Frederick G. Bromberg, Mobile Walter S. Buchanan, Normal Rev. O. V. Calhoun, Andalusia Dr. A. P. Camphor, Birmingham Geo. G. Crawford, Birmingham Hon. R. M. Cunningham, Bir- mingham J. B. Ellis, Selma Miss Elizabeth Fonde, Mobile Dr. T. H. Frazer, Mobile Rev. Carey Gamble, Huntsville Mrs. Julius G. Goldstein, Mobile Judge W. I. Grubb, Birmingham Miss Emily Hallowell, Calhoun Dr. Seale Harris, Birmingham Prof. William H. HoUoway, Tal- ladega Mrs. J. F. Johnson, Pairhope Dr. E. P. Johnson, Atlanta Miss Louisa Jones, Florence Mrs. Mary R. Jordan, Woodlawn J. L. Kaul, Birmingham Mrs. S. Kirkpatrick, Selma L. P. Lathram, Luveme Dr. U. G. Mason, Birmingham J. D. Matlock, Ensley Miss Julia F. MacBrein, Hunts- ville *Miss M. v. McCormick, Hunts- ville Miss Helen MacLean, Birming- ham Dr. Daniel T. McCall, Mobile J. Sterling Moran, Thorsby R. S. Hunger, Birmingham Mrs. W. L. Murdock, Birmingham Dr. Thos. D. Parke, Birmingham Dr. W. D. Partlow, Tuscaloosa Miss Nora B. Ray, Florence Dr. J. T. Searcy, Tuscaloosa Mrs. M. W. Searight, Birming- ham Prof. J. L. Sibley, Montgomery Dr. J. Ross Snyder, Birmingham O. L. Steele, Mobile R. E. Tidwell, Birmingham *Hon. Wm. H. Thomas, Mont- gomery Miss Charlotte R. Thorn, Cal- houn Hon. John S. Tilley, Montgomery *Miss Grace T. Walker, Hunts- ville Judge C. E. Thomas, Prattville *Dr. Booker T. Washington, Tuskegee Mrs. Annie K. Weisle, Birming- ham Miss Susan McD. White, Hunts- ville S. C. Williams, Montgomery Prof. Monroe N. Work, Tuskegee Alabama Girls'' Technical Insti- tute, Montevallo University of Alabama, Univer- sity Public Library, Birmingham ARKANSAS Dr. Jos. A. Booker, Little Rock Dr. C. H. Brough, Fayetteville Mrs. Lucy Payne Critz, Searcy Miss Nellie Denton, Fort Smith Mrs. A. G. Dickson, Paragould Leo M. Favrot, Little Rock Mrs. Joseph Frauenthal, Conway Isaac B. Gardner, Little Rock Dr. Charles E. Hayes, Little Rock Hebrew Relief Society, Pine Bluff Dallas T. Hemdon, Little Rock University of Arkansas Library, Fayetteville 540 THE NEW CHIVALRY — HEALTH ARKANSAS— Continued Central College Library, Conway Mrs. Minnie U. Rutherford, Mag- Hendrix College Library, Conway azine Mrs. Lula A. Markwell, Little Mrs. Sol Schoenfeld, Little Rock Rock D. F. Singleton, Fort Smith Mrs. W. H. Pemberton, Little Ellis Souter, Magnolia Rock Prof. S. Staples, Conway Miss Caroline B. Phelps, Conway J. W. Wade, Little Rock CALIFORNIA R. S. Gray, San Francisco Mrs. Edward Metz, Stanford Mrs. Daisy Lambuth, Oakdale University Miss Mary Lambuth, Oakdale W. A. Nulsen, Los Angeles Bishop W. R. Lambuth, Oakdale Wiley J. Phillips, Los Angeles Univ. of California, Berkeley Mrs. A. B. Reading, Auburn Oakland Free Library, Oakland CONNECTICUT Mrs. Wm. H. Baldwin, Jr., Wash- Yale University Library, New ington Haven COLORADO Miss Harriet L. Butler, Boulder DELAWARE Coleman DuPont, Wilmington DISTRICT OF COLUMBIA Wm. H. Baldwin, Washington Dr. Thos. J. Jones, Washington Gen. W. H. Bixby, Washington Prof. Jesse Lawson, Washington Miss Nannie H. Burroughs, Dr. A. J. McKelway, Washing^ton Washington R. Walton Moore, Washington Mrs. Anna J. Cooper, Washington Dr. J. E. Mooreland, Washington Miss Laura R. Church, Washing- Hon. Chas. P. Neill, Washington ton Henry E. Pellew, Washington Edwin C. Dinwiddie, Washington Dr. D. Butler Pratt, Washington HoWE^rd University Library, Chas. H. Shorter, Washington Washington Walter S. Uflford, Washington Miss Julia C. Lathrop, Washing- >Rev. Chas. Wood, Washington ton C. G. Woodson, Washington FLORIDA Mrs. Mary McLeod Bethune, Dr. A. H. Freeman, Starke Daytona Geo. C. Gibbs, Jacksonville W. A. Blount, Pensacola Frank E. Jennings, Jacksonville Miss C. M. Brevard, Tallahassee Public Library, Jacksonville Dr. J. T. Brown, Miami John B. Stetson University Li- Prof. N. W. Collier, Jacksonville brary, DeLand Marcus C. Fagg, Jacksonville G. E. Mabry, Tampa Rev. John E. Ford, Jacksonville Dr. James G. Merrill, Lake Helen MEMBERSHIP LIST 541 FLORIDA— Continued Prof. C. K. McQuarrie, Gaines- ville Mrs. Potter Palmer, Osprey Frank B. Shutts, Miami Dr. Chas. E. Terry, Jacksonville Miss Emma Tucker, Enterprise Rev. Edwin W. Waldo, West Palm Beach Mrs. 0. D. Wetherell, Tampa Prof. N. B. Young, Tallahassee GEORGIA Miss S. E. Abbott, South Atlanta Rev. George F. Austin, Columbus Rev. R. H. Bennett, Atlanta Miss Cora E. Borchers, Macon Mrs. L. J. Bradley, Cartersville Mrs. Alford E. Buck, Atlanta Carnegie Public Library, Atlanta Bishop R. A. Carter, Atlanta Rev. Arch C. Cree, Atlanta E. C. Dargan, Macon Miss Nannie C. Davis, Tallulah Falls Mrs. A. G. P. Dodge, St. Simons Island Prof. Lawton B. Evans, Augusta Hon. Wm. H. Fleming, Augusta Bishop J. S. Flipper, Atlanta J. A. Fulton, Columbus Rev. J. M. Glenn, Macon Claude Gray, Locust Grove Dr. B. D. Gray, College Park Mrs. Joel G. Greene, Cartersville Dr. J. D. Hammond, Augusta Miss Clara W. Hasslock, Mil- ledgeville Rev. W. H. Hopkins, Atlanta Dr. L. G. Hardman, Commerce Miss Mary Harper, Elberton R. A. Hemphill, Atlanta A. F. Herndon, Atlanta Mrs. F. G. Hodgson J. M. B. Hoxsey, Atlanta Miss Chloe Jackson, Atlanta Miss Fee Kamensky, Atlanta Dr. Rufus R. Kime, Atlanta George E. King, Atlanta Rev. Theo. B. Lathrop, Atlanta J. M. Long, Atlanta Miss Rosa' Lowe, Atlanta Dr. H. C. Lyman, Atlanta Mrs. W. E. Mansfield, Atlanta Charles H. McCord, Atlanta F. A. Merrill, Athens Miss Flora Mitchell, Atlanta Col. Frederic J. Paxon, Atlanta H. E. Perry, Atlanta E. Philips, Columbus Miss Eleanor Raoul, Atlanta Mrs. W. G. Raoul, Atlanta Rev. R. M. Rigdon, Warthen Miss Lillian Rule, Valdosta Prof. J. A. Sharp, Young Harris Frank R. Shipman, Atlanta Miss Lucy H. Tapley, Atlanta Mrs. M. L. Troutman, Rome Mrs. Laura L. Turner, Atlanta Pres. Edward T. Ware, Atlanta Edgar H. Webster, Atlanta Dr. G. W. Westbrook, Commerce **Hon. W. Woods White, Atlanta Rev. Chas. E. Wildman, Thomas- ville Hugh M. Willett, Atlanta Rev. C. B. Wilmer, Atlanta Miss Marian Woodward, Atlanta Miss Mary M. Woods, Athens Miss Annie G. Wright, Augusta ILLINOIS Miss S. P. Breckenridge, Chicago A. M. Bruner, Chicaigo W. T. Cross, Chicago Dr. George C. Hall, Chicago Illinois State Library, Springfield John Grerar Library, Chicago Chicago Public Library, Chicago Baptist Missionary Training School Library, Chicago Judge Julian W. Mack, Chicago Miss Joanna P. Moore, Chicago Robert E. Park, Chicago Julius Rosenwald, Chicago Dr. Graham Taylor, Chicago INDIANA Amos W. Butler, Indianapolis Indiana State Library, Indian- apolis 542 THE NEW CHIVALRY — HEALTH IOWA State University of Iowa Library, Iowa City KENTUCKY Dr. W. T. Amiger, Louisville Mrs. M. B. Belknap, Louisville Miss Belle H. Bennett, Richmond Rev. R. G. Bowers, Paducah Mrs. Desha Breckenridge, Lex- ington George Lee Burton, Louisville Prof. F. C. Button, Versailles J. V. Chapman, Frankfort John B. Chilton, Eddyville Miss Corinne B. Conrad, Dry Ridge Dr. G. B. Eager, Louisville Mrs. Mark E. Eastin, Sturgis *Mrs. Thos. H. Elliott, LaFayette Roy L. French, Frankfort Prof. Wm. G. Frost, Berea Dr. C. S. Gardner, Louisville Fred Gemert, Louisville Dr. W. L. Heizer, Bowling Green Rev. B. F. Horton, Richmond Miss Ruth Huntington, Hindman Henry Klauber, Louisville Rev. John Little, Louisville Southern Baptist Theological Seminary Library, Louisville Louisville Free Library Lexington Public Library, Lex- ington Mrs. Maud R. McLure, Louisville Miss Susan B. Merwin, Louisville John L. Patterson, Louisville Miss Katherine Pettit, Pine Mountain Mrs. W. J. Piggott, Irvington Rev. J. E. Savage, London Miss May Stone, Hindman Charles Strull, Louisville Dr. J. A. Stucky, Lexington Miss Pauline F. Witherspoon, Louisville Miss Nell Whaley, Paris LOUISIANA C. R. Brownell, Morgan City B. C. Caldwell, Natchitoches Prof. C. Cottingham, Pineville Charity Organization Society, New Orleans *Dr. O. Dowling, New Orleans Dr. J. M. Fletcher, New Orleans C. M. Fletchinger, New Orleans Mrs. Joseph Friend, New Orleans Miss Jean M. Gordon, New Or- leans W. O. Hart, New Orleans Mrs. Paul Israel, New Orleans New Orleans Public Library Howard Memorial Library, New Orleans Dr. Maud Loeber, New Orleans Clarence F. Low, New Orleans Augustus M. Mayo, Lake Charles Prof. O. R. McGuire, Dry Prong Daniel D. Moore,- New Orleans Miss Agnes Morris, New Orleans Miss Roberta Newell, Natchi- toches Dr. N. P. Moss, Lafayette Miss Martha Nutt, New Orleans Wm. O. Scroggs, Baton Rouge Mrs. F. Shuttleworth, Shreveport Rev. Emanuel Stemheim, Baton Rouge John L. Sutton, New Orleans Dr. R. H. von Ezdorf, New Or- leans Mrs. S. F. Williams, New Orleans MARYLAND Pres. Joseph A. Apple, Frederick Mrs. C. N. Athey, Baltimore Mr. Robert Biggs, Baltimore Hon. Charles J. Bonaparte, Balti- more Robert Garrett, Baltimore Rev. Wm. Lindsay Glenn, Emmor- ton Miss Elizabeth Oilman, Baltimore Library Johns Hopkins Univer- sity, Baltimore Washington County Free Library, Hagerstown J. W. Magruder, Baltimore Dr. J. H. Pleasants, Baltimore Gen. Lawrason Riggs, Baltimore MEMBERSHIP LIST 543 MARYLAND— Continued Geo. Schwarzenbach, Cumberland Social Service Corporation, Bal- timore Eugene E. Stevens, Chevy Chase Isaac L. Thomas, Baltimore DeCourcy W. Thom, Baltimore Mrs. H. M. Wharton, Baltimore J. LeRoy White, Baltimore MASSACHUSETTS Dr. Henry A. Atkinson, Boston Harvey H. Baker, Boston Mrs. Hezekiah A. Brayton, Fall River George W. Coleman, Boston Prof. E. E. Craig, Quincy Mrs. H. F. Day, Boston Rev. C. F. Dole, Jamaica Plain Warren Dunham Foster, Boston Boston Congregational Library Harvard College Library, Cam- bridge Mass. Agricultural College Li- brary, Amherst Simmons College Library, Boston Mrs. Mary C. Reynolds, Swamp Scott Miss Cora F. Stoddard, Boston University of Minnesota Library, Minneapolis MINNESOTA Public Library, Minneapolis MISSISSIPPI Prof. Wallace A. Battle, Okolona J. R. Bingham, Carrollton Rev. Geo. D. Booth, Laurel Bishop Theo. D. Bratton, Jackson J. P. Carr, Vicksburg Rev. J. R. Carter, Jackson D. W. Coken, Parchman S. A. Corley, Farrell Bishop E. Cottrell, Holly Springs Miss Lee Elkin, Meridian Rev. N. A. Edmonds, Newhebron *P. H. Enochs, Fernwood I. C. Enochs, Jackson Alex Fitzhugh, Vicksburg James Herman Fox, Asylum Miss Clara Graves, Laurel Rev. R. B. Gunter, Louisville Wm. T. Holmes, Tougaloo Wm. H. Holtzclaw, Utica Mr. G. T. Howerton, Starkville C. H. Kirkland, Laurel Rabbi Sol L. Kory, Vicksburg W. P. Kretschmar, Greenville Jas. R. Leavell, Oxford Dr. W. S. Leathers, University J. B. Lehman, Edwards MISSOURI Roger N. Baldwin, St. Louis Hon. J. Fairbanks, Springfield H. M. Beardsley, Kansas City E. A. Fredenhagen, Kansas City Mrs. Ida M. Becks, Kansas City W. C. Gordon, St. Louis *Prof. L. L. Bernard, Columbia Dr. Chas. A. EUwood, Columbia General Library, Agricultural College Camegie-Millsaps Library, Jack- son Z. Z. Linton, Fernwood Rev. P. I. Lipsey, Jackson Miss Bell Woods Montgomery, Columbus Maj. R. W. Millsaps, Jackson Dr. Thos. K. Magee, Fernwood Mrs. J. E. Negus, Greenville Miss Ruth Ragsdale, Meridian W. B. Rogers, Laurel John Rundle, Louisville Prof. A. H. Shannon, Agricul- tural College Alfred H. Stone, Dunleith A. T. Stovall, Okolona Supt. Wm. H. Smith, Jackson Prof. W. I. Thames, Hattiesburg J. M. Thomas, Tupelo Louis Threefoot, Meridian John L. Webb, Yazoo City Frank G. Wisner, Laurel Dr. J. W. Young, Grenada 544 THE NEW CHIVALRY — HEALTH MISSOURI— Continued J. Silas Gravelle, Joplin Delbert J. Haff, Kansas City L. A. Halbert, Kansas City Mrs. Virigdnia Holland, Spring- field Dr. C. H. Hughes, St. Louis Rev. John W. Kuhlman, St. Louis Central College Library, Fayette Missouri Library Commission, Jefferson City Library University Missouri, Columbia St. Louis Mercantile Library As- sociation Public Library of St. Joseph Public Library, Kansas City St. Louis Public Library Dr. George B. Mangold, St. Louis Calvin B. Moody, Kansas City Dr. Paul Paquin, Kansas City Rev. John A. Rice, St. Louis Scarritt Bible and Training School, Kansas City Dr. C. B. Spencer, Kansas City Mrs. C. R. Springer, St. Louis D. W. Steidley, St. Louis E. H. Sutherland, Liberty James A. Waterworth, St. Louis Percy Werner, St. Louis MONTANA University of Montana Library, Missoula NEW JERSEY Alexander Johnson, Vineland Free Public Library, East Orange Hoboken Public Library, Hoboken NEW YORK Miss Margaret M. Armstrong, Poughkeepsie Orin C. Baker, New York City Dr. Arthur R. Burnet, New York City Lee K. Frankel, New York City Miss L. Drake Gill, New York City John M. Glenn, New York City Dr. Hastings H. Hart, New York City Dr. Wm. I. Haven, New York City Dr. John Ihlder, New York City Miss Abegil Jackson, New York City Brooklyn Public Library, New York City Rochester Theological Seminary New York Public Library, New York City- Buffalo Public Library Colgate University Library, Ham- ilton National Child Labor Committee, New York Syracuse Public Library Rev. Chas. S. Macfarland, New York City Miss A. B. Nutt, New York City Geo. Foster Peabody, Lake George James B. Reynolds, New York City Dr. C. J. Ryder, New York City Maurice Willows, New York City Y. W. C. A. International Com- mittee, New York City NORTH CAROLINA Dr. K. G. Averitt, Cedar Creek J. B. Blades, Newbem Rev. H. K. Boyer, Winston-Salem John C. Campbell, Asheville Rev. C. D. Chapman, Brevard Bishop Geo. W. Clinton, Charlotte Miss Clara Cox, High Point J. S. Cox, Greensboro *Gen. Julian S. Carr, Durham Mr. Roger A. Derby, Jackson Springs R. L. Doggett, Pilot Mountain James B. Dudley, Greensboro Miss C. B. Elliott, Highlands Mrs. J. P, Fearrington, Winston- Salem MEMBERSHIP LIST 545 NORTH CAROLINA-Contlnued Miss Frances L. Goodrich, Allan- stand Miss Fannie E. S. Heck, Raleigh C. H. Hobbs, Asheville Mrs. H. C. Houston, Waxhaw Rev. A. B. Hunter, Raleigh M. L. Kesler, Thomasville Dr. Chas. O'H. Laughinghouse, Greenville Col. J. L. Ludlow, Winston-Salem State Normal & Industrial Col- lege, Greensboro Carnegie Library, Charlotte University of North Carolina Li- brary, Chapel Hill State Library, Raleigh Shaw University Library, Raleigh Miss Elizabeth March, Winston- Salem Dr. L. B. McBrayer, Sanatorium *Dr. Chas. L. Minor, Asheville A. W. McAlister, Greensboro Dr. H. L. McCrorey, Charlotte N. C. Newbold, Raleigh Clarence Poe, Raleigh Pres. Wm. Louis Poteat, Wake Forest Dr. Joseph Hyde Pratt, Chapel Hill Dr. Frank M. Register, Tillery Mrs. J. L. Rodman, Waxhaw B. Winton Rogers, Mt. Airy R. E. Sentelle, Lumberton Norman C. Sehlichter, Charlotte John H. Small, Washington * State Board of Health, Raleigh Miss F. Stephenson, Asheville G. T. Stephenson, Winston-Salem Dr. M. L. Stevens, Asheville John Thames, Wilmington F. C. Toepleman, Henderson C. H. Trowbridge, Brevard *Geo. W. Watts, Durham M. S. Willard, Wilmington Wm. H. Williamson, Raleigh Rev. J. S. Williams, Asheville V. S. Woodward, Charlotte Robert H. Wright, Greenville OHIO Miss Elenor Blocher, Wooster Cleveland Public Library Richard Ernst, Cincinnati Ohio State Library, Columbus Library of Cincinnati Library of Lane Seminary, Cin- cinnati Irving W. Metcalf, Oberlin OKLAHOMA Mrs. G. A. Brown, Oklahoma City Mrs. M. Heard Carleton, Okla- homa City Dr. Fred H. Clark, El Reno Prof. Jerome Dowd, Norman Dr. John W. Duke, Guthrie Rev. Geo. W. Griner, Claremore Mrs. G. B. Hester, Muskogee W. A. Logan, Lehigh S. H. Mayes, Pryor Rev. Wm. D. Matthews, Oklahoma City Rev. Wm. Walter Park, Yukon Dr. A. J. Snelson, Checotah OREGON Library Portland Association PENNSYLVANIA Dr. S. Z. Batten, Philadelphia Dr. L. G. Jordan, Philadelphia Maurice Scharflf, Pittsburg Rev. A. C. Thompson, Tamaqua Dr. R. R. Wright, Jr., Philadel- phia RHODE ISLAND Brown University Library, Providence 35 546 THE NEW CHIVALRY — HEALTH SOUTH CAROLINA Mrs. J. W. Allen, Spartanburg W. T. Andrews, Sumter Lient.-Gov. Andrew J. Bethea, Columbia Mrs. J. L. Barringer, Florence Dr. Chas. W. Bimie, Sumter Eev. D. E. Camak, Spartanburg Richard Carroll, Columbia Eev. M. L. Carlisle, Greenville Dr. L. P. Chamberlayne, Colum- bia Clemson College Library, Clemson College Miss Rosa B. Cooley, St. Helena Island George B. Cromer, Newberry Mrs. Rufus Fant, Anderson Eev. K. G. Finlay, Columbia Mrs. T. H. Fisher, Columbia A. C. Flora, Columbia J. H. Harms, Newberry Miss Grace Biglow House, St. Helena Island Wm. Keyserling, St. Helena Island A. T. Jamison, Greenwood E. H. King, Charleston Dr. A. T. King, Johnston Library Wofford College, Spar- tanburg Library University of South Carolina, Columbia Judge Paul M. MacMillan, Charleston *Judge J. A. McCuUoch, Green- ville Miss E. E. McClintock, Columbia Dr. Josiah Morse, Columbia Jas. C. Otts, Spartanburg Mrs. A. E. Sands, Graniteville John Stevens, Charleston A. W. Summers, Orangeburg Dr. Geo. W. Quick, Greenville Gustaf Sylvan, Columbia Prof. B. W. Valentine, Columbia Prof. P. P. Watson, Orangeburg Ransom W. Westberry, Sumter Walter B. Wilbur, Charleston R. S. Wilkinson, Orangeburg TENNESSEE Rev. W. W. Alexander, Nashville Mrs. Max B. Amstein, Knoxville Dr. J. W. Bachman, Chattanooga Mrs. B. W. Barnwell, Sewanee Col. O. C. Barton, Paris Lewis T. Baxter, Nashville Claude J. Bell, Nashville Rev. B. R. Bell, Memphis Rev. C. K. Benedict, Sewanee John T. Benson, Nashville Miss Sarah Berry, Henderson- ville W. K. Boardman, Nashville Duke C. Bowers, Dresden J. E. Brading, Johnson City Dr. Perry Bromberg, Nashville Mrs. V. W. Broughton, Memphis Dr. W. A. Bryan, Nashville Dr. M. G. Buckner, Nashville Mrs. Helen C. Buffet, Knoxville Prof. H. B. Carre, Nashville John A. Chambliss, Chattanooga A. L. Chavaness, Knoxville Mrs. Mary E. Chevvis, Alton Park Rev. W. S. Claiborne, Chatta- nooiga Dr. Jas. E. Clarke, Nashville Rev. A. E. Clement, Nashville M. S. Cockrill, Nashville **Mrs. Anna Russell Cole, Nash- ville W. R. Cole, Nashville W. C. Collier, Nashville B. F. Cornelius, Nashville Rev. J. M. Culbreth, Nashville J. F. Davief Nashville Mrs. Dan Denny, Harriman Rev. C. E. Diehl, Clarksville *J. H. Dillard, Nashville Rev. D. A. Dobbs, Johnson City Finley M. Dorris, Nashville Dr. A. EJ. Douglas, Nashville Mrs. N. B. Dozier, Franklin Dr. F. B. Dresslar, Nashville Albert Dreyfus, Memphis Miss Emily H. Dutton, Murfrees- boro Chas. H. Eastman, Nashville Miss Grace M. Eaton, Nashville Mrs. M. G. Elliott, Murfreesboro Mrs. Joseph Fall, Nashville F. L. Fisher, Knoxville G. T. Fitzhugh, Memphis Dr. D. L. Flanary, Dyersburg Wilbur F. Foster, Nashville Rev. W. H. Franklin, Rogersville MEMBERSHIP LIST 547 TENNESSEE— Continued Rev. W. A. Freeman, Dyersburg Bishop Thos. F. Gailor, Memphis J. A. Goodman, Memphis Rev. Chas. O. Gray, Greeneville Clifton H. Green, Nashville *Dr. J. H. Hale, Nashville Curtis B. Haley, Nashville W. M. Hard, Nashville Dr. J. E. Harris, Nashville Miss Effie Heiskell, Memphis Miss Lena B. Henderson, Knox- ville Mrs. Ben Hermon, Nashville Prof. H. H. Hibbs, Jr., Nashville Mrs. S. M. Holman, Fayetteville Hon. Ben W. Hooper, Newport Dr. K. S. Howlett, Franklin Dr. Geo. A. Hubbell, Cumberland Gap Dr. G. W. Hubbard, Nashville R. F. Hudson, Chattanooga Leland Hume, Nashville J. W. Hunter, Jr., Nashville George B. Hinmon, Sewanee Mrs. G. H. Jarnagin, Chatta- liooga Miss Cora Jarrell, Eagleville Mrs. K. P. Jones, Maryville Rev. J. Q. Johnson, Shelbyville Mrs. W. C. Johnson, Memphis Mrs. L. H. Jones, LaVergne N. S. Jonte, Nashville C. H. Joyner, Pocahontas Rev. J. F. F. Kayhoe, Nashville Miss Margaret Kercheval, Nash- ville Rev. Paul B. Kern, Murfreesboro Prof. W. C. Kilvington, Nash- ville ♦Thomas B. King, Memphis Dr. J. H. Kirkland, Nashville Rev. Ryland Knight, Clarksville Senator Luke Lea, Nashville Charles Lee, Bemis Carnegie Public Library, Nash- ville Cossitt Library, Memphis Maryville College Library, Mary- ville Vanderbilt University Library, Nashville Wesley Hall Library, Nashville Tusculum College Library, Greeneville University of Tennessee Library, Knoxville Goodwyh Institute Library, Mem- phis Dr. Wm. Litterer, Nashville Lee J. Loventhal, Nashville Mrs. Adolph Loveman, Nashville Rev. Hubert S. Lyle, Maryville Mrs. R. W. MacDonell, Nashville P. D. Maddin, Nashville F. M. Massey, Pulaski Mrs. T. H. McCallie, Chattanooga *C. M. McClung, Knoxville Rev. Hugh S. McCord, Dyersburg Dr. R. W. McGranahan, Knox- ville Rev. J. H. Miller, Nashville Mrs. Reuben M. Mills, Nashville Chas. Mitchell, Nashville Mrs. Harriett Marshall, Nash- ville Rev. J. A. Molloy, Mt. Pleasant Mrs. D. P. Montague, Chatta- nooga Dr. John M. Moore, Nashville Dr. Henry W. Morgan, Nashville W. H. Morgan, Nashville *E. W. Ogden, Knoxville Mrs. Adele C. Ogden, Knoxville Dr. F. S. Parker, Nashville Albert Parlett, Bristol John A. Patten, Chattanooga Dr. Bruce R. Payne, Nashville T. W. Peace, Madisonville Judge John A. Pitts, Nashville Mrs. J. H. Pitts, Knoxville George H. Price, Nashville James J. Pryor, Nashville Rev. Wm. F. Quillian, Nashville * Gaston C. Raoul, Chattanooga T. E. Ranck, Pulaski Rev. B. G. Regen, Nashville Dr. Stanley L. Rich, Nashville *Dr. W. D. Richmond, Knoxville J. A. Riechman, Memphis E. H. Rolston, Chattanooga *Dr. C. V. Roman, Nashville C. E. Rose, Nashville *Mrs. Wm. C. Ross, Knoxville Robert Sharp, Nashville Mrs. R. M. Kirby-Smith, Sewanee * Bolton Smith, Memphis *J. H. Smith, Nashville Maj. E. B. Stahlman, Nashville Dr. Lee A. Stone, Memphis Mrs. P. M. Tamble, Nashville A. B. Tarpley, Nashville Prof. W. K. Tate, Nashville 548 THE NEW CHIVALRY — HEALTH TENNESSEE— Continued Dr. W. F. Tillett, Nashville *W. O. Tirrell, Nashville Dr. J. J. Totten, Memphis Mrs. R. H. Vance, Memphis Frank S. Washburn, Nashville Rev. C. A. Waterfield, Paris Mrs. Robert Weakley, Nashville Dr. W. D. Weatherford, Nashville Dr. Gordon White, Nashville Mrs. Chas. Whiteside, Gallatin W. I. Williams, Graysville S. T. Wilson, Maryville Rev. Thos. D. Windiate, Nashville Dr. G. B. Winton, Nashville Dr. J. A. Witherspoon, Nashville Dr. W. H. Witt, Nashville George T. Woflford, Johnson City TEXAS Mrs. O. M. Abbott, Dallas Mrs. C. E. Adams, Beaumont Mrs. J. D. Alexander, Cisco Mrs. Sam Allen, Houston Dr. B. L. Arms, Galveston B. W. Armstrong, Houston Miss Jennie Austin, Houston I. H. Ayres, Houston Dr. Ralph Bailey, Gatesville Dr. E. M. Bailey, Houston *Geo. E. Barstow, Barstow Dr. A. J. Barton, Waco Rabbi Henry Bamstein, Houston Dr. T. B. Bass, Abilene Mrs. W. P. Baugh, San Antonio J. B. Bell, Houston Rev. Geo. W. Benn, Dallas Pres. C. M. Bishop, Georgetown Prof. Wm. B. Bizzell, College Sta- tion P. E. Bledsoe, Prairie View Dr. J. T. Bernard, Dallas Dr. M. J. Bliem, San Antonio Dr. H. A. Boaz, Ft. Worth Wm. A. Bowen, Arlington Dr. Frank D. Boyd, Ft. Worth J. L. Boyd, Port Arthur Mr. Harris Brin, Terrell Dr. S. P. Brooks, Waco M. D. Brown, Newcastle W. H. Bruce, Denton Dr. Wm. M. Brumby, Waco Mrs. M. E. Bryan, Houston Mr. E. P. Buie, Tehuacana Rev. I. M. Buiigan, Houston Guy Burnett, Houston H. C. Burt, Houston R. E. Burt, Houston Mrs. J. F. Burton, Houston Mrs. Elliott Cage, Houston Rufus Cage, Houston Prof. Robert C. Caldwell, Houston Ennis Cargill, Houston M. F. Carpenter, Houston E. A. Carter, Prairie View Mrs. W. B. Chew, Houston Miss Ethel A. Claxton, Bellaire E. A. Cochran, Houston Dr. W. V. Collins, Lovelady Mrs. John M. Conley, Beaumont Mrs. W. C. Corbett, Houston J. S. CuUinan, Houston Mrs. March Culmore, Houston Mrs. Nannie W. Curtis, Waco Mrs. F. E. Daniel, Austin H. J. Dannenbaum, Houston Dr. John L. Davis, Waco Dr. Oscar Davis, Anderson W. B. Davis, Houston Arthur E. Dawes, Houston C. E. W. Day, Dallas J. V. Dealy, Houston Mrs. Belle Dilgarde, San Antonio Mrs. R. S. Dilworth, Gonzales Rev. J. I. Donaldson, Austin Mrs. Pat Dougherty, Houston Miss C. B. Drisdale, Prairie View Wm. H. Drummet, Houston J. D. Duckett, Houston D. M. Duller, Houston Miss Laura Edwards, Waco Prof. A. Caswell Ellis, Austin Dr. J. W. Embree, Dallas Mrs. Grace Engbald, Houston Dr. Belle C. Edkridge, Houston Mrs. P. W. Evans, George West Ira H. Evans, Austin J. W. Everman, Dallas Mrs. P. K. King, Houston Mrs. Henry B. Fall, Houston T. M. Fairchild, Houston Miss Annette Finnigan, Houston Judge T. W. Ford, Houston Ft. Worth Federation of Women's Clubs Rev. F. M. Foust, Houston Rabbi George Fox, Ft. Worth J. Marion Frierson, Houston E. J. Fry, Marshall W. H. Fuller, Austin MEMBERSHIP LIST 549 TEXAS-Continued Prof. O. A. Fuller, Marshall Dr. J. P. Gibbs, Houston Dr. H. R. Gilliam, Houston Rev. J. I. Gilmore, Houston Mrs. D. C. Glenn, Houston Dr. E. L. Goar, Houston Rev. O. E. Goddard, Galveston Rev. John C. Granbery, George- town Mrs. Fannie Green, Houston Isldor N. Greenburg, Houston Dr. William H. Greenburig, Dallas Rev. A. R. Griggs, Dallas Rev. E. M. Griggs, Palestine Dr. F. W. Gross, Houston Prof. A. L. Guerard, Houston Mrs. Sadia Haley, San Antonio R. W. Hall, Amarillo E. P. Hamblen, Houston Dr. A. L. Hamilton, Angleton J. J. Hardeway, Houston Claude S. Harkey, Alvin Joe Harrell, Austin Dr. R. H. Harrison, Houston Mrs. M. V. Harrison, Houston Mrs. J. H. Harrison, Dallas Dr. Henry Hartman, Galveston Rev. Russell A. Harty, Houston Rev. W. E. Hathom, Mt. Pleasant C. C. Hayden, Grandview Nat Q. Henderson, Houston J. M. Henshaw, Waco C. J. Hill, Houston Miss Clara Ida Hill, San Antonio Chas. Heimsath, Austin Maurice Hirsch, Houston James T. Hodge, Prairie View Rev. B. A. Hodges, Temple Miss Frances Hogan, Houston Miss Ima Hogg, Houston W. H. Hogue, HQUSton Mrs. Helena Holley, Houston Mrs. C. A. Hooper, El Paso D. C. Homan, Oglesby Prof. P. W. Horn, Houston Rev. W. W. Homer, Wallis Houston Settlement Association Rev. C. G. Howard, Marlin Rev. E. J. Howard, Houston Noyce Clement Hoyt, Houston John L. Hunter, Dallas \ Rev. A. H. Isbell, Lamesa Dr. Sidney Israel, Houston Dr. Chas. A. Jackson, Houston Miss Ethel Jackson, Waco Mrs. J. J. Jarvis, Ft. Worth Dr. J. W. Jent, Henrietta Mrs. L. B. Jones, Ft. Worth Mrs. W. R. Jones, Brownsville Wm. A. Johnson, Conroe C. D. Kennard, Houston W. R. Keeble, Abilene Dr. J. L. Kesler, Waco Mrs. L. A. Kidd-Key, .Sherman E. W. Kirkpatrick, McKinney Dr. R. H. Knolle, LaGrange Judge Ed. R. Kone, Austin Kenneth Krahl, Houston Texas State Library, Austin Carneigie Library, San Antonio Dallas Public Library Ft. Worth Relief Association Houston Lyceum and Carnegie Library Southwestern University. Library, Georgetown Baylor University Library, Waco Waco Public Library Peacock Military College, San Antonio Ft. Worth Public Library Associ- ation Univ. of Texas Library, Austin Mrs. N. J. Lacy, Waco Dr. C. W. LaGrand, Hempstead Wm. Lambdin, Waco Mrs. T. W. Lanier, El Paso Miss Dorothy B. Lanthrip, Hous- ton Miss Harriet Levy, Houston Rev. F. L. Lights, Houston Hon. J. W. Lockett, Houston Dr. W. S. Lockhart, Houston C. Lombardi, Dallas Mrs. G. W. Love, Houston Mrs. J. C. Love, Houston Prof. E. O. Lovett, Houston Prof. R. S. Lovinggood, Austin Dr. IBell P. Lowry, Ennis H. E. Luck, Gatesville Dr. O. M. Marchman, Dallas Dr. W. H. Martin, Houston Prof. C. H. Maxson, Marshall Capt. C. L. McAbee, San Antonio Mrs. F. W. McAllister, San An- tonio A. R. McCollum, Waco Mrs. A. R. McCollum, Waco H. E. McCoy, Houston Julius F. McDonald, Abilene Mrs. E. A. McDowell, Beaumont Mrs. C. E. McDuffie, Ennis 550 THE NEW CHIVALRY — HEALTH TEXAS— Continued Dr. Jas. D. McLean, Itasca Mrs. J. L. McReynolds, Houston Dr. M. S. Merchant, Houston Mrs. V. C. Middlebrook, Nacog- doches Mrs. W. D. Mihills, Houston H. L. Mills, Houston Rev. J. W. Mills, Houston M. V. Morris, Houston Dr. R. T. Morris, Houston Dr. Joseph Mullen, Houston J. W. Neal, Houston Dr. J. Mark O'Parrell, Richmond Miss Mary I. Orvis, San Antonio M. P. Ostrow, Houston T. V. Overton, Houston W. C. Paige, Houston J. J. Pastoriza, Houston Frank C. Patten, Galveston Mrs. R. G. Patton, Waco Rev. W. F. Perry, Houston Rev. J. A. Phillips, San Antonio Mrs. L. A. Pinkney, Galveston Judge S. P. Pounders, Mt. Pleas- ant Horace Pope, Houston Mrs. Florence Porter, Houston *Prof. C. S. Potts, Austin Mrs. H. S. Renck, Houston Mrs. F. A. Reichardt, Houston Karl M. Roberts, Houston Wade C. Rollins, Waco Rev. J. Elliot Ross, Austin Miss Mary W. Roper, Houston Miss Emma J. Ross, Dallas *Mrs. Edward Rotan, Waco Mrs. John F. Rowe, Waco Dr. J. D. Sandefer, Abilene R. J. Sanders, Frost Mrs. Joseph D. Sayers, Austin Chas. Schreiner, Kerrville Jacob H. Schultz, Houston Elmer Scott, Dallas ' Rev. J. D. Scott, San Antonio Mrs. O. A. Seward, Independence *Mrs. W. B. Sharp, Houston Mrs. C. B. Shepard, Brenham Rev. P. G. Sears, Houston Prof. J. W. Shepherd, Austin Miss Mary J. Sims, Prairie View Mrs. C. R. Slauter, Waco Dr. Carrie Weaver Smith, Dallas Mrs. Paris Smith, Bay City Mrs. J. B. Smith, Sagerton Dr. M. M. Smith, Dallas Mrs. J. G. Smith, Ft. Worth Major John C. Smith, Dallas Dr. J. Frank Smith, Dallas Ernest Daily Smith, Port Arthur R. L. Smith, Waco Rev. Glen L. Sneed, Dallas North Texas Conference M. E. Church, Greenville Prof. Walter Stairs, Houston Prof. J. E. Stamps, Prairie View G. E. Stock, Houston G. H. Stubblefleld, Houston Dean Wm. S. Sutton, Austin Mrs. Rosser Thomas, Bonham Mrs. J. Lewis Thompson, Houston Mrs. D. M. Thurston, Beeville Prof. J. B. Tidwell, Waco Edward Titche, Dallas Dr. J. W. Torbett, Marlin Rev. E. G. Townsend, Belton Miss Gerdie Trichelle, Houston Mrs. John S. Turner, Dallas Prof. R. A. Tsanoff, Houston Miss Mamie Wall, Waco Prof. S. R. Warner, Huntsville A. G. Webb, Abilene Capt. Frank M. Wells, Houston Mrs. Jas. B. Wells, Brownsville Miss E. H. West, San Antonio Natalie L. Wetzel, Houston Mrs. C. K. Wilbanks, Houston John W. Wilkinson, Houston Mrs. J. W. Wilkinson, Houston John H. Wilkinson, Houston John E. Wilkins, Greenville Rev. L. K. Williams, Ft. Worth Wm. A. Wilson, Houston Rev. Jas. Wilson, Jr., Temple W. T. Wilson, Nacogdoches Miss Helen Winston, Brownwood Henry B. Woods, Laredo John W. Woods, Rotan Dr. Martha A. Wood, Houston Rev. Comer M. Woodward, Ft. Worth Mrs. Edith D. Wright, Houston Mrs. C. S. Wright, Houston Dr. Eva A. Wright, Houston Prof. C. S. Yocum, Austin Dr. Willis Youens, Houston MEMBERSHIP LIST 551 VIRGINIA S. A. Ackley, Richmond Wm. Anthony Aery, Hampton Miss Ella G. Agnew, Burkeville John M. Arnold, Norfolk Dr. Wm. E. Atkins, Hampton Decatur Axtell, Richmond Mrs. W. B. Baldwin, Norfolk Miss Ella V. Ball, Waynesboro Dr. Robert S. Bosher, Jr., Rich- mond Jno. Steward Bryan, Richmond Dr. James Cannon, Blackstone J. J. Carter, Richmond Judge F. P. Christian, Lynchburg Miss M. L. Cocke, Hollins Miss Lucy L. Davis, Lynchburg Jackson Davis, Richmond Dr. Jas. H. Dillard, Charlottes- ville Prof. Thos. D. Eason, Farmville T. C. Edwin, Petersburg Dr. H. B. Frissell, Hampton Dr. C. R. Grandy, Norfolk Miss Mattie P. Harris, Roanoke Miss Hattie E. Hylton, Schove- field Mrs. S. W. Jamison, Roanoke Chas. P. Kelly, Attoway Dr. Norman Lassiter, Newport News Henry H. Kratzig, Norfolk Prof. J. M. Lear, Farmville Virginia State Library, Richmond Library of University of Vir- ginia, Charlottesville Virginia Union University Li- brary, Richmond A. R. Long, Lynchburg Hon. Wm. H. Mann, Richmond Dr. J. T. Mastin, Richmond H. B. McDonald, Cambria Wilton E. Mingea, Abingdon Maj. Robt. R. Moton, Hampton Barton Myers, Norfolk J. C. Parker, Franklin Mrs. J. S. Parrish, Richmond *John P. Pettyjohn, Lynchburg Miss M. G. Phillpotts, Norfolk F. M. Purser, Richmond Miss Rosabel Rider, Richmond *John L. Roper, Norfolk Dr. L. T. Royster, Norfolk Mrs. Henry L. Schmelz, Hampton T. S. Southgate, Norfolk Robert E. Steed, Norfolk R. C. Stearnes, Richmond Dr. E, G, Williams, Richmond W. T. B. Williams, Hampton Y. M. C. A., Richmond WEST VIRGINIA Miss Elizabeth Cummins, Wheel- G. M. McCuUoch, Bluefield ing *Rev. B. M. Spurr, Moundsville Mrs. Marguerite S. Hall, Mor- Joseph W. Stayman, Keyser gantown Prof. E. H. Vickers, Morgantown WISCONSIN Milwaukee Public Library Wisconsin Historical Society Li- brary, Madison University of Washington Li- brary, Seattle Seattle Public Library FOREIGN CANADA Rev. W. L. Clark, Leamington, Rev. R. J. Mclntyre, Nelson Ont. Rev. T. A. Moore, Toronto Rev. Asher P. Latter, Toronto Rev. Harvey D. Moyer, Petrolia, Ont. CUBA Rev. H. B. Bardwell, Havana MEXICO Prof. Andres Osuna, Saltillo, Coahuila 552 THE NEW CHIVALRY — HEALTH INDEX OF SPEAKERS, AUTHORS, OFFICERS A PAGE Alexander, Rev. W. W 528 Arms, Dr. B. L 358 Atkinson, Rev. Henry A 314 Austin, Judge Geonge F..233, 528 B Baker, Orin C 534 Baldwin, Roger N 528 Ballingall, Dr. George 96 Bamstein, Rabbi Henry 14 Barstow, Hon. George Eames. 87 Batten, Dr. Samuel Z 14, 460 Bennett, Miss Belle H 528 Bernard, Dr. L. L 349, 528 Bethea, Lieut.-Gov. Andrew J . 528 Booker, Dr. J. A 421 Boos, Dr. William P 108 Bowman, J. G 531 Briggs, Goerge Waverly.299, 531 Brooks, Dr. Samuel P. 14, 249, 528 Brough, Prof. C. H 528 Brown, B. Warren 290 Brownlee, Dr. C. H 50 Brumby, Dr. William M 46 Buxton, Noah 97 C Caldwell, Prof. B. C 528 Caldwell, Prof. Robert G 223 Call, Arthur Deerin 93 Carey, Judge Robert 118 Carre, Prof. Henry Beach 503, 533 Carrick, Dr. M. M 167 Clarke, William Lund 200 Claxton, Miss Ethel A 209 Cocks, Orrin G 327 Cohen, Dr. Solomon S 109 Cole, Mrs. Anna Russell.. 14, 528 Cole, Whitef oord R 528 Comer, Ex.-Gov. B. B....119, 529 Cope, Dr. Henry F 486 Cree, Dr. Arch C 528 D Davy, Dr. John 96 DeWitt, John H 534 Dillard, J. H 528, 532 Dinwiddle, Edwin C 114, 528 Dowd, Dr. Jerome 528 PAGE Dowling, Dr. Oscar 29, 528 Dresslar, Dr. F. B 216 Dublin, Dr. L. 1 32, 35 K Ellis, Prof. A. Caswell 41 Ellis, W. T 532 Emerson, Dr. Robert L 110 Evans, Dr. W. A 44 F Fagg, Marcus C 528 Fletcher, Prof. John M 77 Foster, Warren Dunham 322 Fox, Rabbi Geonge 159 G Gardner, Dr. C. S 528 Gearing, Miss Mary 340 Gilbert, Prof. J. W 405 Gilman, Miss Elizabeth 528 Granbery, Prof. John C 489 Graves, John Temple 532 H Harris, Dr. Seale..528, 529, 534 Harris, William J 235 Henderson, Prof. C. R 290 Hibbs, Prof. Henry H 176 Holley, Mrs. Helena 307 Holley, Dr. Lincoln 528 Holmes, Oliver Wendell 167 Hooper, Ex-Gov. Ben. W 528 Horn, Prof. P. W 529 I Ihlder, Dr. John 137, 529 J Johnson, Alexander 530 K Kenney, Prof. T. G. 204 Kern, Dr. A. A 528 Kesler, Dean J. L. 14, 449, 494, 529, 534 Kipplinger, O. L 118 L Lambuth, Bishop W. R 533 Lane, Dr. M. P 100 Leroy, Dr. Louis 108 Loeber, Miss Maud 244 INDEX OP SPEAKERS, AUTHORS, OFFICERS 553 M PAGE McBrayer, Dr. L. B 55, 530 McCulloch, J. E 14, 528 McCuUough, Judge J. A 528 Macfarland, Dr. Charles S 510 McKinney, Miss Nola 528 Magruder, J. W 528 Mallet, Dr. John W 110 Mann, Gov. William H...15, 528 Mastin, Dr. J. T 528 Matthews, Dr. W. D 528 Menzler, C. C 628 Musser, Dr. J. H 108 N Newton, Robert J 60, 528 Nietzsche, Friedrich 175 O Osborne, Dr. Oliver T 109 Osuna, Prof. Andres 20 P Phelps, Miss Caroline Berry.. 534 Phillips, W. J 532 Pdteat, Dr. W. L 14 Potts, Prof. C. S 528 Pratt, Dr. Joseph Hyde. .274, 528 B Rankin, Dr. W. S 274, 530 Riley, Dr. B. F 385 Roman, Dr. C. N 392 Rosenau, Dr. Milton J 130 Rutherford, Mrs. Minnie U. 153, 528 S PAGE Satterthwaite, Dr. Thomas E. . 112 Scroggs, Prof. W. 528 Searcy, Dr. J. T 107 Sears, Rev. Peter Gray 14 Steele, 0. L 634 Stephenson, Gilbert T 257, 528 Stoddard, Miss Cora Frances. 124 T Thomas, Judge W. H 528 Tilley, John S ...263, 529 U Ufford, Walter S 528 Vickers, Prof. E. H 528 Von Ezdorf, Dr. R. H.. .65, 70, 88 W Waterfield, Mrs. C. A 190 Waterfield, Rev. C. A. 14, 476, 528, 531, 534 Watkins, Dr. F. L 528 Weatherford, Dr. W. D. 14, 375, 528, 532, 634 Wilcox, Dr. R. W Ill Wiley, Dr. Harvey W 103 Williams, Dr. L. K 427 Wlnslow. C. E. A 90 Witherspoon, Dr. John A 107 Wood, Dr. H. C, Jr Ill Work, Prof. Monroe N 412 Wright, Dr. R. R 436 Y Yoakum, Prof. C. S 364 554 THE NEW CHIVALRY — HEALTH INDEX OF SUBJECTS A PAGE Address to the Churches 13 Alcohol Question and Social Justice, The 124 B Battle Hymn ( Sung at Houston) 12 C Causes of Society's Lack of Health, The 87 Causes of Unusual Mortality among Negroes 385 Challenge to the Church to Keep Children Out of Heaven, Th6. . 476 City Housing of Negroes in Relation to Health 405 Conservation of the Health of Children — A State Privilege and Asset 190 Conservation of the Health of Mothers, A Primary Responsi- bility of the State 153 Constitution and By-Laws of the Congress 525 Cost of Preventable Disease in the South, The 29 Creed and a Crusade, A 11 D District County Health Problems 46 E Effects of Caffeine upon the Human Organism, The 103 P Financial Cost of Preventable Disease, The 41 H Health Problems of the Negro Church 427 Health Teaching in Schools 216 Health the Basis of Racial Prosperity 436 Health — The New Attitude, the New Knowledge, the New Re- sponsibility 449 Housing and Health 137 Houston Plan 536 How Mexico and the United States Can Cooperate in the Pre- vention of Diseases 20 I Influence of Prenatal Conditions on Infant Mortality, The 176 Insane Asylums as Destroyers and Restorers of Health 364 Is the Negro Dying Out? Who Cares? 76 M Mental Health Safeguarded by Physical Health 249 Mental Hygiene 244 Mental Laboratory in the Juvenile Court, The 233 Modem Miracles of the Church in Health Conservation 460 INDEX OP SUBJECTS 555 N PAGE Neglected Problem in the Conservation of Health, A 77 Negro Woman and the Health Problem, The 392 O Old and New Attitude of the State toward Its Prisoners, The 274 Organized Play and Public Health 314 P Physical Health Championed by the Church 494 Physical 111 Health as a Cause of Crime 257 Poor State and the Tuberculosis Problem, The 55 Prena,tal Responsibility of Parents for Children 167 President's Address, The 15 Press and the Fight for National Health, The 299 Prevention of Malaria 70 Prevention of Typhoid Fever 65 Price Paid by the South to the Hookworm Disease, The 50 Primary Function of the Church — To Save Life 489 Problem of Health in Connection with Prisons, The 290 Program of the Church as the Conserver of Social Health, The. . 503 Public Amusements Safeguarded for Moral Health 327 B Recreation as Related to the Health of Negroes in Rural Com- munities 421 Relation of Alcoholism to Poverty and Crime, The 114 Relation of Nutrition to Public Health 340 Relation of the School to the Public Health, The 223 Resolutions on National Department of Health 538 S Safeguarding the Health of Boys 200 Social Program of the Congress, The 537 Sociologist's Health Program for the Rural Community, A 349 South and the Health of Negroes, The 412 Sunday School as a Health School, The 476 T Treatment of Delinquent Boys, The 204 Treatment of the Delinquent Girl 209 Treatment or Punishment for the Prisoner 263 V Value of State Laboratories of Hygiene, The 358 W War as a Destroyer of Public Health 93 War on Disease — A Worthy Objective for a Religious Crusade. . 510 What Woman Suffrage Will Do toward the Conservation of Pub- lic Health 307 Working Program for Rural Recreation, A 322 Wlhy the Federal Government Should Establish Hospitals for Consumptives in the Southwest 60 Why the State and the Church Should Require Health Certifi- cates before Marriage 159 PUBLICATIONS OF THE SOUTHERN SOCIOLOGICAL CONGRESS The investigations and programs of the Congress vary from year to year. The work is constructive, and each volume so fits into a progressive plan of study that it is decidedly to the advantage of mem- bers to have the complete set of publications. They are: 1. The Call op the New South. The proceed- ings of the first Congress, held in Nashville in 1912. It contains forty-one addresses on "Child Welfare," "Courts and Prisons," "Public Health," "Negro Problems," "Enemies of the Home," "Education and Cooperation," "The Church and Social Service," and "The Qualifications of Social Workers." 387 pages. Price, $2. 2. The South Mobilizing foe Social Service. The proceedings of the Atlanta Congress, 1913. It is the w^ork of sixty-eight specialists. The 704 pages are brimful of facts and inspiring messages on the vital social and economic questions of our day. A prominent educator says of this Volume: "It is, in my judgment, the most useful book published in the South in ten years." It is a library in itself on up-to- date studies of sociological questions. Price, $2. 3. Battling for Social Betterment. The pro- ceedings of the Memphis Congress, 1914. Devoted exclusively to the study of "The Church and Social Service" and "Race Relations." 228 pages. Price, $2. 4. The Human Way. This contains all the ad- dresses on race problems delivered at the Atlanta Congress in 1913. 148 pages. Paper binding, 40 cents per copy ; cloth binding, 75 cents. Especially adapted to study classes and for distribution in con- ferences and schools. Address: Southern Sociological Congress, Nashville, Tenn.