HO 3 g>tu&p of tije Cousins anb Social Conbttiomi IN THE &vm Street ©fetrtct OF Hoa gtogelea, California, CORNELL UNIVSRSITV LIBRARIES ITHACA, N. Y. 148S3 Fine Am library Sibley Hall A STUDY OF THE HOUSING AND SOCIAL CONDITIONS IN THE ANN STREET DISTRICT OF LOS ANGELES CALIFORNIA UNDER THE DIRECTION OF THE DEPARTMENT OF SOCIOLOGY OF THE UNIVERSITY OF SOUTHERN CALIFORNIA BY GLADYS PATRIC, M. D. INSTRUCTOR IN TUBERCULOSIS PUBLISHED BY THE LOS ANGELES SOCIETY FOR THE STUDY AND PREVENTION OF TUBERCULOSIS 528 CHAMBER OF COMMERCE BUILDING Cornell University Library The original of this 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/cu31 92401 61 76020 INTRODUCTORY For several years I have been in close touch with the tubercu- losis situation in Los Angeles and particularly with the tuberculous poor, whom I have met and treated both at the Los Angeles County Hospital and the Los Angeles City Clinics. I have been impressed with the fact that treatment, at the best, is but palliative and that if the disease is to be controlled, a concerted effort must be made by the community to get at the causes and remove them. Early in the year of 1916 a municipal nurse, who was doing special tuberculosis nursing, invited me to spend a morning with her in home visiting. I found that house after house produced tuberculosis patients, and that one house gave a history in the past two years, of four families in each of which there had been an active case of tuberculosis and of two deaths of tuberculosis. At this time an opportunity presented itself to conduct a clinic at one of the neighborhood schools, for the diagnosis and treatment of tuberculous children. I accepted and spent a half day each week in the examination and treatment of those who had been reported by their teacher or the nurse, and devoted much time to district visiting. It was forcibly brought to my attention that the clinic treat- ments were relatively useless if the children lived under conditions which produced disease. To get adequate information, a survey of the district was made in the hope that the facts brought to the notice of the public would result in an effort to control and regu- late these conditions, which can be controlled and regulated by the community but not by the individual family. Trusting that the preventable causes of disease shown by this survey may be eliminated so far as possible, I respectfully submit the following data. I desire to express my grateful appreciation and thanks to all those whose help and co-operation have made this report possible, especially to Dr. Emory S. Bogardus of the Department of Sociology of the University of Southern California, for his personal interest and assistance, and for the work of his students whose house to house visitation was of inestimable value. GLADYS PATRIC, M.D. REPORT OF THE HOUSING AND SOCIAL CONDITIONS IN THE ANN STREET DISTRICT, LOS ANGELES, CAL. The district surveyed is situated in the northern part of the city and lies on both sides of the Los Angeles River. It is bounded almost entirely by railroad tracks upon which a large part of the' freight switching of the city is done. It is occupied by large indus- tries and the homes of the poorer people, mainly Mexicans and Italians. These industries are railroad shops, iron works, assembling plants for automobile firms, fruit canneries, a winery and other minor firms. The iron works and assembling plants employ little or none of the local labor, hence do not materially influence the people of the district. Three hundred and thirty-one habitations were visited in securing data. The occupants numbered 1650 and of these, 855 or 51.8% were Mexicans; 495 or 30% were Italians, and 300 or 18.2% were Spanish, Austrian, German, French, English, Irish and American. The majority of the people were foreign born, and, as shown by the following figures, few of them have been in the United States very long: LENGTH OP TIME IN THE UNITED STATES Less Born in Over 20-29 10-19 5-9 1-4 than Not Total U. S. 30 yrs. years years years years 1 yrs. obtained per cent per cent per cent per cent per cent per cent per cent per cent per cent Mexicans 8.0 2.0 4.0 28.0 28.0 9.0 7.0 14.0 100.0 Italians 2.0 4.0 8.0 30.0 29.0 21.0 6.0 None 100.0 Others 48.0 13.0 7.0 16.0 10.0 None None 6.0 100.0 LENGTH OF TIME IN CALIFORNIA Less Born in Over 20-29 10-19 5-9 1-4 than Not Cal. 30 yrs. years years years years 1 yr. obtained Total per cent per cent per cent per cent per cent per cent per cent per cent per cent Mexicans 1.0 1.0 3.0 28.0 27.0 13.0 9.0 18.0 100.0 Italians None None 2.0 23.0 39.0 30.0 None 6.0 100.0 Others None 7.0 16.0 32.0 32.0 7.0 None 6.0 100.0 LENGTH OF TIME IN LOS ANGELES Born in Over 20-29 10-19 5-9 1-4 than Not L: A. 30 yrs. years years years years 1 yr. obtained Total per cent per cent per cent per cent per cent per cent per cent per cent per cent Mexicans .. 1.0 1.0 3.0 34.0 31.0 15.0 10.0 5.0 100.0 Italians .. None None 2.0 23.0 38.0 31.0 None 6.0 100.0 Others.! :.. None 7.0 13.0 22.0 42.0 10.0 None 6.0 100.0 These figures show that the immigrant has been in America a relatively short time and that the burden of Americanization falls directly upon Los Angeles. It should be borne in mind that the comparisons found throughout this report are in no way comparisons of Mexicans and Italians as races, for in such a case these figures would be most unfair. Furthermore in justice, it should be explained that the Mexicans, in this district, rank as peons or peasants, while the Italians are above the peasant class. COMPARATIVE CHART SHOWING LENGTH OE TIMB FAMILIES HAVE LIVED IN UNITED STATES (SEE CHART "Z CALIFORNIA, *3 LOS AJVCSLBS) NO.l. MEXICANS ITALIANS OTHERS •»•>.":•->.'.■ > w, ■>•- . '.n'; ■'/;-,.>,•" 30/7 Af /N US. A HEPS OVER 30 YfABS 20 -2 9 YEARS *1> /0-/9 yeahs zefo S-9 re/iai ZBf. 1-4- YEAKS 3"J„ L.ESS THAN I reA/e 7 1> NOT OBTAINED "7- '. .'■ vl/V m OOAIN /At U.S. A 27. HEKE OVER 30 YeAXS* *7- ZO-Z9 YEAKS ay. 10-19 re«» 30 f. E- 9 yeaks a 9 7. 1-4 YEAO.S Zlf. SSS THAN I YEAK. >; I. ' 20-29 VHAJ /0-/9 r«A«.s 5"- 9 YEAfBS 33 f. /-4- YEAKS 30^a AfOT OBTAINED 6 Jo HCIZC OVEB SO YBAKS 7 •'•'v'T'"''!- ^"-9 YEAKS 3Z"fo /-* YEAKS rf. *ro-r OBTA/A/ED PREPARED &Y GLADYS PAT&./C FOG THE LOS ANGELES SOC/STY FOR THE. S7UDY ANO PREVENTION Of TOOBK COi-OSt-S COMPARATIVE CHART SHOWING LENGTH OF TIME FAMILIES HAVE LIVED IN L OS ANGELES (SEE CHART "I UNITED STATES, Z CALIFORNIA) NO. 3. MEXICANS ITALIANS OTHERS ■\V..'.-' ' ao*n m LOS AN Q. /% HCRSOYEK 30 YCMS /jS 20-2 9 X.MffJ ^5& ZO-/9 YEARS 3* ^ 5"- 3 Y*AKS 3/ ft i-4 YEABS tESS THAN / YBAG lOje AOT OBTAINED s 7 . ; • '.' •:-••'.' 20-29 YEAIBS Zf. IO-I9 TEAKS 23 f» S-9 -TEAKS 33 7= /-* YEAKS 31 7« AMJ7- OBTAINED "7- V&ft ** He Km OVEK 30 Ye A Its 20-29 YEARS 10-19 YEAKS 22J& ^•-9 YEAKS *z jr. /V07 - OBTAINED «7« PKCPAR.EO BY GLADYS PATAZIC FOK THE LOS ANCELeS SOCIETY FOR THE STl'DY ANO PREVENTION OF TOBEKCCli-OSIS Housing and Social Conditions 11 Among the 853 Mexicans, there were 212 employed or 23.6% ; among the 495 Italians, there were 132 employed or 26.6% ; and among the 300 representatives of the other nationalities there were 72 employed or 23.3%. Employment was frequently irregu- lar. There were few skilled laborers as shown by the following table: CLASSES OF LABOR Mexicans Italians Others Cl 11 _, , ^ No - No - No - skilled laborers None 10 43 Unskilled laborers, regularly employed 140 85 25 Unskilled laborers, irregularly employed ... . 40 IS Mone "Widows and disabled men irregularly em- ployed (not included above) 32 24 4 Total 212 132 72 The unskilled regular laborers were found to be employed in the following industries: EMPLOYMENT BY INDUSTRIES Mexicans Italians Others No. No. No. Railroads 98 44 12 Food Production 5 19 5 Cement Establishments 3 1 None Laundries 2 2 None Barber and Tailor Shops None 3 2 Stone Cutting None 3 None Miscellaneous 32 13 6 Total 140 85 25 The average wage of the Mexican worker was $10.35 per week; the Italians $12.35, and the others $13.60. In the Mexican family the average number of children per family was three; in the Italian family, three; and among the others there were two children per family. When we consider the size of the family and the wages, we are appalled at the small sum on which these people exist. Occasionally roomers or board- ers were secured to help supplement the family income, but with large families and small houses this procedure was not always possible or desirable. The average rent paid by the Mexican family was $6.36 per month; the Italian, $9.82; and the others $11.00. Ownership of homes by the occupant was found in only 19 cases, four of which were by Italians and the remaining fifteen among the other nationalities. The Bureau of Labor for the State of Washington in a report under date of April, 1916, states that the average family of five needed for food and fuel alone $460.20 per year, or $7.67 per month for each member of the family. In the district investigated it was not possible to find the amount paid for food and fuel, but the income of each individual was determined and used in comparison with the above figures. Thus for example, it was found that the income of many families of eight members was $1.50 a day or $39 COMPARATIVE CHART SNOWING PER CENT OF FAMILIES LIVING ON SPECIFIED MONTHLY EARNINGS. AMOUNTS STATED BEING BALANCE TOR BACH INDIVIDUAL AFTER DEDUCTING RENT. (MBXICAUS, JTAZ.ZAU3AUD OTHBR.8) '/e-ea Hi 77. ■■■■ // 7* ■■ 77. ■i «* 7« \D ATG * *7. \ z mtasrflf/teo V6 ANBABOVm */e.i£ 0) ** to " a ■■7?. ■1 Sf. ■■i 771. "■"•/*■ m *j° ■■■■■ /J74 ■1 5/0 ■■■■■ /*?& ■■■■■■ /9f. 5 7 2 '* s '*■ ■■ 67° ■ 274 WtDOW&t* /f0T0B7WN£0 te *t6.*NBABWM g *7.£7 ■■■ 'of. ■ *?. mmmmmmmmm zey- A/BUMAl. mi. COAST OA/r VSAK, XOO $ ** #767/ /ttiB/J 5 MINIMUM A MOUNT REQUIRl ^DIVIDUAL FOR MONTHLY ZIYJ RISES EXCEPTING RENT PKePAaEO BY GLADYS PATKIC FOX. THE LOS ANCELES SOCIETY POK THE STUDY AND PREVENT/ON OF TUBERCULOSIS Housing and Sociai, Conditions 13 a month, and the rent was $5 a month. The rent was substracted leaving $34 to be divided among eight. This left $4.25 a month for each member of the family for food and fuel and all the other necessities. If $7.67 was needed in 1916 for food and fuel alone, how far below the average standard of living must the family go in 1917 when $4.25 must provide not only food and fuel but every- thing else? In the following table the number of families living on given amounts per individual is shown: COST OF LIVING Over $10- $9 $8 $7 $6 $5 $4 $3 Irreg. Widows Not Total $16 $15 obtained Families Mexicans. 12 19 12 8 12 8 12 14 7 33 26 9 172 Italians . . 14 19 6 12 20 6 5 4 2 18 10 4 99 Others 33 15 None None None 3 None None None 9 Kane None 60 With $7.67 as a norm, the chart printed above, compares the per cent of families whose income exceeds $7.67 per individual for one month, with those having less. It is clear that these people are living on a wage too small to secure the necessities of life, and that they are saving little, or nothing, for illness or old age.. Eventually the burden of their care must fall on the community. Therefore if we desire to de- crease the number of people who must be cared for by the public, we must have accurate information concerning their living con- ditions. We must remove the causes which produce sickness and its attendant expense and loss of wage. About one-half of the Mexicans were found living in courts built on the same general plan of the house-courts in other parts of California. In these courts each family has two rooms, with one window and outside door in each room. A toilet is provided for every six or eight families. In the court, common to all the houses, are the water faucets, one faucet must do for four or six families. The Italian seemed to have a preference for the cottage, but many families of both Mexicans and Italians were living in dwell- ings made over from old factories and stores. None of these houses were fully equipped with the modern conveniences for health and comfort as the following table shows : PLUMBING FACILITIES Houses having Houses having Houses having Total Bath Tubs Toilets Sinks Houses No. No. No. Mexicans 36 55 135 172 Italians 64 6 92 99 Others 48 43 60 60 This table shows a smaller number of toilets in the houses occupied by the Italians than in the other families. This is due to the fact that they had good out-of-door toilets — usually one for each family. Laundry facilities were fairly good in most of the houses ex- cept in those built on the house courts. As there was no running COMPARATIVE CHART SHOWING BA THS AND SINKS IN MOUSES OCCUPIED BY MEXICANS, ITALIANS AND OTHERS. MEXICANS ITALIANS OTHERS 1 * --;;.'; :'■$,**; V ****** ?&> 4 ■• "* \ ' : <.'"* 'V'--; ■:& H. I-"il- '"•* V* *\}' .* ■ - )'- A*j ^ ! h'i: 11 ■•'£:<• i !■'■•• '■"'. J' "J' if. ., X J V* jj }$ '.*' ■*"■ •••*: ■■: r' ■'' >■<■;■ Bj B*.- •■'. **• **s .' v '. '. *,, .*, ' >.'**£ 5 i'i^'' .;>;': t£'* ■&' I^Va *V" *'. ;:* *< t:;j:< .\& . . . ' ■ 1 «. ■ ■'•■* i i *,*''"** •s w 01 <0 ; *:!i:' N "-* ."" 41 . l -\-»? 5 "$? 0) ';'£ V'-;^" A "'•'".. 8 -*- .' ,l 5 *■.;.* )< V 1 V^V!* 1 V * ^ A" ,,/-, , s * *& ^ / -"-"" * v : . J '.- 55 f* V?" "• *.*■' in .'■•'■'; » ■"** ' «) h*£,*' * ^ft $? J l: i-P- m i'.* ( V/ ■■■ .i K ''■*•*. !„/. ■• K • • ■•*.! '■:<' tf. '\ r \' 1 ;-.'-K S *«i ';■"."*- :''•'. 0) .'V'/s .■■:<■; '•".' '•&'• K :3> \-"X 1% >:! I !'■'■'? i'-'.-V '«•■■ .'«?'-' k * '• * .* '.v"» "f'5 < "-I'-'V* %".£*£ • t s>'- * >'/*■"■; ID ;V.V'( H>\ '-":>* '.'/•:' > : ii o * ■■ to II ^ •'•• 5 V W"' 1 ■'>,'■ ■ ^ J '»•'' J C;. 5 .' ^■• o 1 ! V ";.'<■ ^ %o H i H" !-'«-' i -(it.* ■ k I s ■ s ^H 1 ?"••«.*: « 1 1 i!» 1 1 ? PKEPAR.EO BY GLADYS fA.rii.IC. PORTHE LOS ANGELES SOCIETY FOB THE STUOYANO PKEVENTIONOF TUBEK CULOSIS COMPARATIVE CHART SHOWING TOILETS IN HOUSES AND YARDS OCCUPIED BY MEXICANS, ITALIANS AND OTHERS MEXICANS ITALIANS OTHERS vCW. s //Ot/S£ 32 7i 8£S HOOSE C-'/r-"-'C : : i.V- s -'. • "■. .' HOUSE. 7/ Jo ^^^^| YAR.O i* * ?' '' 1 _- „ . . v> YAK.D ^^^H .?■'•■"''■ ^■"■; : .•■.T.<7''- : "' YA/ZO B9f. po c e>A& c n fly GLAOVS PAT/^/C FOIZTHELOS HNGBLBS SOCIETY FOK THE STUDY ANP MBVEHnoN Of TuaeacULOSlS 16 Housing and Social Conditions water in these houses the tubs were placed on the ground near the faucets. By arranging a tub on bricks and building -a small fire underneath, the water was slowly heated. The public school has provided a laundry room where the girls are taught proper laundry methods. On certain days this laundry is open to their mothers. Here and at Recreation Center opportu- nities for bathing have been provided not only for the children but for the adults. It is hoped that the day is not far distant when the schdolhouse or public building which provides these opportu- nities will be open the entire year. Small and irregular incomes result in irregularly paid rent and consequently the landlords do not feel encouraged to keep the houses in good condition. Moving was frequent. When a family moves, out, the house is not properly cleaned before another family moves into it. The screening of the doors and windows of these houses was imperfect and no provision was made for storing food — hence an appalling number of flies. The following table shows the length of time the given fam- ilies have occupied their present habitation : LENGTH OF RESIDENCE IN HABITATION Over 1-5 6-9 1-6 Less than Not Total Number of 5 years years months months 1 month obtained Mexican families 15 48 19 57 9 24 172 Italian families 20 43 16 11 None 9 90 Other families 13 24 3 8 3 9 60 When the frequent moving is considered it is not surprising to learn that there were few gardens, especially among the Mex- icans. The soil is very poor and the smoke from the factories is not conducive to gardening. Furthermore the garden space was meager and the family activities, such as laundry work, called for the use of much of it. The Italians had a small garden, if pos- sible, where they raised a few green vegetables. There were five in the average family and three rooms in the average house. It was not possible to find how many slept in one room although it was evident that the number was high. In the two-room court houses the family frequently numbered six or eight, which means that the kitchen was used for the double duty of kitchen and bedroom. It was not uncommon to find two or three children under the bed on a poor mattress. Some of the most desperate cases of tuberculosis were found in these two court houses. Under such crowded and unsanitary conditions, and without even the crudest conveniences, it is not surprising that personal cleanliness, as well as the necessary care of the home, is neglected. Such housing results in lowered vitality for the occupants, mak- ing them susceptible to every infection ranging from common cold to tuberculosis. Crowded sleeping conditions cause a. rapid spread of the disease from one member of the family to another until all are infected. The houses have not the facilities for the COMPARATIVE CHART SHOWING LENGTH OF TIME PRESENT OCCUPANTS HAVE LIVED IN HOUSES MEXICANS, ITALIANS AND OTHERS. MEXICANS ITALIANS PAFZ THE LOS 0Y GLADYS PATfZIC ANGELES SOCIETY FOK THE STUDY AMO PREVENTION Or TUOEKCULOSIS 18 Housing and Sociai, Conditions care of the sick and the income is not sufficient to pay for insti- tutional care. Finally the burden falls upon the public. How- ever, if we were to place these unfortunate people in a house with all the modern improvements they would not be immediately con- verted into hygienic citizens. While better houses are imperative, the desire, after all, must come from within the individual. Hence, the problem is one of education. In regard to the food of the families investigated the follow- ing conditions were found: As might be expected by the low wage received by the bread- winner, the quality of food was poor and became more so as the time from the last pay day lengthened. Breakfast usually con- sisted of bread and coffee, the remains of the previous evening meal, and perhaps some fruit. Lunch was often conspicuous by its absence. Where there was any at all, it was similar to break- fast. The main meal of the day was at night when the bread- winner came home, then meat and vegetables were served. As a whole these people appeared better fed than it would seem possible on their meager incomes. Perhaps this can be ex- plained by considering the food commonly eaten. Both the Mex- icans and Italians subsist largely on dishes that have developed with the history of their people and unconsciously are well pro- portioned in their ratio of fat, starch and protein. Examples of this may be seen when the Italian adds cheese which is rich in fat to their spaghetti with starch and protein. The tamale of the Mexican contains fat and protein in the meat and starch in the cornmeal. Cornmeal is used a Teat deal by the Mexicans, and when we remember that the American Indian often lived entirely upon narched corn, we realize its value as a food and the imoor- tant part it plays in the diet of these people. Another nourishing food found to be commonlv used was the bean. Few of these people have fresh milk delivered at their homes but purchase it at the grocery store, and by so doing receive a poorer grade. In order that the grocer may make his commission this milk is only 3.8% fat, while that delivered direct to the con- sumer is 4.2% fat. The penny lunch served at the school has done much for the child. It consisted of soup in which was meat stock, vegetables and rice. With it was served a sweetened bun. Sometimes cocoa or beans took the place of soup. Many a child lacked the neces- sary penny but in all cases he was given his lunch. As an addi- tion to the diet the penny lunch is excellent, but after all a cup of soup and a bun do not go very far in meeting the needs of a grow- ing child and is a very meager meal for underfed children. The medical care of these people falls mainly on the corps of city physicians and nurses. A few individuals employ private doctors but with the majority there was nothing left after the daily necessities were paid for, to provide for sickness. There is always COMPARATIVE CHART SHOWING HOUSES FROM WHICH CASES OF TUBERCULOSIS HA V£ BEEN REPORTED ©0000 00 00 0®O0 =©Q 03 0v DEATHS REPRESENTED BLACK a DIAGNOSED TUBERCULOSIS (ADULT) o DIAGNOSED TUBERCULOSIS (CHILD) LARGE CIRCLES REJPRESEHT HOUSES DIVISIONS MCIGCLES REPRESENT BltEEREHT FA/rtli-IES THAT HAVE LIVEO /Al THE HOUSE PBEPAEEB BtT BI.I'ZA.BB-riJ ~r. MV/M FOR THE £03 ANGBJLBS SOCIETY FOR. TUB STUDY AND PREVENTION or rOBBRCl/zoals 20 Housing and Social Conditions a city physician who is on call for urgent cases, but as his duties also cover other districts, his time in this section is limited. The city provides a nurse upon whom the health burden really falls. Her duties include the teaching of methods of prevention as well as caring for the sick. She investigates all cases of reported illness and at the same time finds others which she reports to the health department. She sees that the needy sick have a city phy- sician or is directed to the various clinics of the city. Patients requiring hospital care are sent to the Los Angeles County Hospital, but unfortunately, the people of the district hav- ing tuberculosis are only willing to go to the County Hospital as a last resort. This seems to be due to the crowded condition of the tuberculosis wards which prevents desirable surroundings being provided for the ambulatory cases. The Supervisors of Los Angeles county have recently appropriated $75,000.00 for the erec- tion of a sanatorium in the neighboring hills. This will provide sur- roundings that will appeal to the patients. At the same time the crowded condition at the main hospital will be relieved, permitting constructive plans to be made for the rearrangement of the wards. In order to find out what diseases caused the majority of deaths in this district the Los Angeles Health Department kindly permitted a study of the death certificates for the past five years. It was found that during this time there had been 227 deaths. Of these, tuberculosis may be called their captain, for it had caused eighty-nine deaths. Of the remaining 138, there were sixty of infantile diseases of the digestive tract; thirty of still-birth; twen- ty-nine of pneumonia; five of cancer; four of meningitis; three of infantile paralysis ; two of complications of maternity ; two of syphilis and one of typhoid. Of the sixty deaths in infancy, thirty-nine were in the years 1912 and 1913, while but twenty-one were found in the remaining three years. This fact is no doubt due to the development of infant feeding stations and the education of the mothers. Of the thirty cases of still-birth, twenty cases were during the year 1912 and 1913, and but ten cases in the remaining three years. Here again we see the effect of the work of the Health Department in the organization of the maternity division. There was no decline in the death rate of tuberculosis. While tuberculosis caused 17.4% of the total deaths of the entire city for the given period, it caused 39.2% of the deaths of this district. A chart has been prepared showing the location of the houses in which death from tuberculosis has occurred during the past five years and of the cases of tuberculosis reported during the last year. In this chart each circle represented a house. Deaths are shown by solid black squares, diagnosed cases in the adult by plain squares, and diagnosed cases in the child by small circles: It is to be noticed that some of the circles representing houses are divided, showing that during this period more than one family having the disease had occupied the given house. How many other families Housing and Social Conditions 21 had lived in these infected places is not known, nor is it assumed that the cases reported are all that occurred. But finding 105 in- fected houses among 331 is a striking fact and deserves considera- tion. So poorly have these houses been constructed that the most thorough fumigation would not render them safe. Dust (in which may be found the germs of tuberculosis) lodges in cracks and under wall paper where the most powerful disinfectant cannot penetrate sufficiently to kill the germ. A clinic for the diagnosis and treatment of the children of tuberculous tendency living in this district was maintained for eight months by the Los Angeles Society for the Study and Pre- vention of Tuberculosis and the Health Department in the clinic room of the Ann Street School. To' this clinic children were re- ferred by the teachers or by the visiting nurses, and only children who showed a definite tendency to the disease or who had been exposed to open cases were considered. Careful record of their physical examinations and home conditions was recorded. There were seventy-five children examined, of which number sixty showed a definite infection with the tubercle bacilli, but as Dr. William Palmer Lucas, of the University of California, has stated: "This must mean tuberculosis infection and not tuber- culous disease." However in a large per cent of the cases it was difficult to say whether the bacilli were dormant or whether there was the beginning of the active disease. After the examination and subsequent observation, twenty-nine of the children were classed as definitely suffering from the disease. Eight of the chil- dren examined have since died, seven of which died of tuberculosis. Arrestment of the tuberculous activity has been found in five cases, two of which responded after the removal of adenoids and infected tonsils. On the whole treatment was not satisfactory. The following chart shows the result of the examination and home observation: Ser Age Nationality Bom Test Physical Condition Home and Living Conditions F. 10 Mexican Mexico None Suppuration Cerv. Glands Dirty. No Cooperation. M. 9 Mexican Texaa Poa. Cerv. and brooch, glands Oper. for Tbc. Lumbar vert. Mother a widow Irreg. income M. 9 Mexican Texas Pos. Cervical glands Dirty M. 8 Mexican Cal. POB. Tonsil and Adenoids Cervical Glands Mother died of Tbc. Fair home M. 7 Italian Italy Neg. Bad Tonsils and. adenoids Mental Defective Pair income. Dirty F. 6 Italian Italy Neg. Cervical Glands No cooperation M. 12 Mexican Cal. Pos. Active Tbc. Both lungs Father advanced Tbc. F. 8 Mexican Cal. Poa. Cerv. glands Act. both lungs Clean, but very poor F. 13 Italian Cal. Neg. Adenoids Cerv. glands Act. Tbc. Good home F. 9 Italian Cal. Pos. Cervical glands Good cooperation F. 9 Mexican Arizona Pos. Poorly nourished Cerv. glands Very dirty. Irreg. income No cooperation 22 Housing and Social Conditions Sex Age Nationality Born Skin Test Physical Condition Home and Living Conditions F. 5 Mexican Mexico Neg. Poorly nourished. Cerv. glands F. 6 Mexican Mexico Neg. Poorly nourished, si. act-tbc. Six in family F. 4 Mexican Mexico Neg. Poorly nourished Frequent colds Irreg. income Mother incipient Tbc. F. 2 Mexican Cal. None Act. Tbc. Glands F. 8 Mexican Texas Neg. Poorly nourished. Bad teeth Cerv. Glands Irreg. income. Dirty F. 8 Italian Cal. Pos. Cerv. Glands, si. act. Tbc. Good home. Clean F. 11 Mexican Mexico Poa. Cerv. Glands. Act. both lungs Poor home. Irreg. income F. 13 Mexican Arizona Pos. Cerv. and Bronch. glands Act. Tbc. Irreg. income Mother' brother and F. 16 Mexican Arizona None Advanced case Baby died of Tbc. F. 8 Mexican Mexico Pos. Poorly nourished. Cerv. glands 'f. 7 Mexican Mexico Neg. Poorly nourished. Cerv. glands. Heart complications Fair home M. 12 Mexican Cal. Pos. Very poorly nourished Cerv. Glands Eleven in family Irreg. income M. 10 Italian Cal. Neg. Atrophic Rhinitis Cerv. Glands Poor home. Bad ventila- tion. Irreg. income M. 12 Mexican Mexico Pos. Ch. Otitis Media Cerv. Glands Active Poor home Family Syphilitic No cooperation M. 12 Mexican Mexico Neg. Poorly nourished. Enlarged Tonsils. Cerv. Glands Fair home M. 9 Mexican Mexico Pos. Poorly nourished. Enlarged Tonsils. Cerv. Glands Two children died in infancy. M. 6 Mexican Texas Pos. Poorly nourished. Enlarged Tonsils. Act. both lungs Two were stillborn F. 17 Mexican Mexico None Advanced case sent to hospital Better class Mexican home F. 11 Mexican Cal. Pos. Poorly nourished Act. both lungs Dirty home' Irreg. income F. 9 Mexican Cal. Poa. Poorly nourished Infection both lungs Two sisters dead Tbc. M. 12 Mexican Mexico Neg. Very bad teeth. Cerv. glands Mother a widow with advanced tbc. Depend on charity F. 11 Mexican Mexico Neg. Cerv. Glands Infection rt. lung F. 6 Mexican Mexico Neg. Cerv. Glands Clean. Good cooperation M. 14 Mexican Mexico Pos. Cerv. Glands Infection both lungs Poor home Irreg. income F. 8 Mexican Cal. Neg. Cerv. Glands No Cooperation F. 9 Mexican Texas Neg. Poorly nourished Cerv. Glands. Tbc. knee Mother has advanced tbc. 5 chil. alive, 5 chil. dead F. 10 Mexican Mexico Neg. Teeth bad condition Bronch. glands. Act. Tbc. Fair home conditions F. 9 Mexican Mexico POB. SI. act. left lung Clean home, small F. 12 Mexican Mexico Neg. Poorly nourished Cerv. glands Irreg. income 4 chin, living, 2 dead. Tbc. F. 8 Mexican Mexico None Poorly nourished Cerv. glands Home very poor and dirty Irreg. income F. 8 Mexican Mexico Pos. Poorly nourished Cerv. glands. Act. Tbc. Poor home Irreg. income Housing and Social Conditions 23 Sex Age Nationality Born Skin Test Physical Condition Home and Living Conditions F. 9 Mexican Arizona Neg. Poorly nourished Sister died Tbc. Good home M. 15 Mexican Mexico Pos. Cerv. glands. Act. both lungs Mother and sister died . of Tbc. Girl 13 years keeps house F. 13 Mexican Mexico Pos. Cerv. glands. Infected lungs M. 9 Mexican Cal. Pos. Cerv. glands. Infected lung Two rooms F- 6 Mexican Cal. Pos. Cerv. and Bronch. glands Father regular laborer M. 4 Mexican Cal. Neg. . Poorly nourished. Act. Tbc. ' M. 7 Mexican Mexico Neg. Poorly nourished Cerv. glands Fair home. 4 other cod . died in infancy M. 10 Mexican Cal. None Poorly nourished Dirty home F. 6 Mexican Cal. Neg. Poorly nourished. Cerv. glands Irreg. income F. 11 Mexican Cal. Neg. Cerv. glands. Act. Tbc. Good Home F. 7 Mexican Cal. Pos. Cerv. glands. Act. both lungs Good cooperation M. 14 Mexican Cal. Neg. Well nourished. Cold Good Home M. 12 American Utah Neg. Poorly nourished. Cerv .glands Fair home M. 17 Italian Cal. Neg. Acne face and chest Fibiosis lungs Good home M. 12 Italian Cal. None Endocarditis Good home F. 10 Mexican Mexico Pos. SI. infected lung Irreg. income. Fair home M. 10 Austrian Austria Pos. Adenoids. Cerv. glands Rt. lung Good home Good cooperation F. 11 Italian Cal. Neg. Very poor teeth Fairly good home F. 16- Mexican N. Mex. Pos. Cerv. glands Good home. 3 children living, 11 died in infancy F. 12 Mexican N. Mex. Pos. Cerv. glands. Act. lungs 3 children living M. 9 Mexican N. Mex. Pos. Had Mastoid Oper. Cerv. glands. Act. lungs 11 died in infancy F. 9 I Mexican Cal. Neg. Cerv. glands Father died Tbc. Mother died Tbc. 3 days after birth of child. F. 6 Mexican Arizona Neg. Cerv. Glands Clean. Irreg. income F. 9 Mexican Cal. Neg. Poorly nourished Bad teeth and tonsils Widow poor health Irreg. Income M. 14 Mexican Mexico Pos. Bad tonsils. Act. both lungs 6 in family 2 rooms. Dirty Irreg. income M. 13 Mexican Mexico Neg. Act. Tbc. both lungs following La Grippe Good home F. 15 Mexican Mexico Pos. Cerv. glands Fair home M. 10 Italian Cal. Neg. Tbc. glands removed Act. both lungs Only child. Clean home Good cooperation M. 13 Italian Italy Pos. Cerv. glands Good home F. 14 Mexican Cal. Pos. Poorly nourished Act. both lungs 2rooms - F. 10 Mexican Cal. Pos. Poorly nourished Infection left lung 9 in family M. 8 Mexican Cal. Pos. Poorly nourished Act. both lungs Mother died Tbc. M. e Mexican Cal. Pos. Poorly nourished. Bad tonsils Irreg. income 24 Housing and Social Conditions The question may well be asked: "Why was treatment not satisfactory among these children and was it necessary for them to go to an early death?" In the first place no medicine on earth can cure a tuberculous child when he does not have proper food and air. If the child has tuberculosis of the lungs and is sent to the County Hospital, because of crowded conditions the child, over ten years is put in the ward with the adult cases. This has long been unsatisfactory to all concerned. At the Sanitarium being planned by the County Supervisors special quarters for these chil- dren will be provided. At present there is no place for the child but his over-crowded home. Another question arises as to what will become of the children infected with the tubercle bacilli but do not show active symptoms of the disease. If they were in good surroundings the probability is that the majority would not develop the disease. But if these children continue in their present surroundings, their resistance will be so lowered that the majority will develop tuberculosis. Tuberculosis may not appear in childhood, but in adult life, par- ticularly early adult life. This fact makes the economic loss to the state great, for after immense cost in education, the victim is in- capacitated at the beginning of his productive life. SUMMARY OF CONDITIONS. Tuberculosis, as everyone knows, is caused by a bacillus. If this is present in the human body, and the conditions are favorable, it will cause the disease. But the soil must be ready for its growth. Physicians speak frequently of a lowered resistance by which they mean that the fighting power of the body against disease is so low that the soil (or body tissues) is in favorable condition for the growth of the germs. By raising the resistance we restore the functions of the cells of the body so that they furnish a poor soil (or resist the growth of bacteria). The factors which lower the resistance and thereby prepare the soil for disease are called pre- disposing causes, while the germ is the exciting cause. In considering tuberculosis in the Ann Street District, the patients were divided into two classes, inactive and active or open. The following factors were found to be pre-disposing causes which lowered bodily resistence and made ready the soil for the ever-present germ. 1. The low wage. 2. Poor and insufficient food. 3. Overcrowding and lack of ventilation. 4. Lack of facilities for cleanliness. 5. Ignorance in regard to personal hygiene. 6. Prevalence of flies. By considering these factors and their bearing on the disease some conclusions may be reached as to what must be done in order to combat the disease. The following measures are recommended : Housing and Social Conditions 25 Correction of Environment. The Health Department, through its Bureau of House Commission, should have authority to execute the new Dwelling House Law which particularly controls the maintenance of all one-family places. The Housing Commission has not had the authority to enter the one-family dwelling, hence many unsanitary conditions have been ignored. The necessary measures have been passed by the recent legislature, but in order for these to be effective in Los Angeles the existing city ordinance must be changed from "two dwellings or habitations" to "one dwelling or habitation." If this were done and the Housing Com- mission given a sufficient number of workers to carry out the law there would be a lowered tuberculosis and other death rate. Care of Open Cases of Tuberculosis. In order that the open cases (or those giving off the germ) may not spread the disease, we should enforce laws already in existence such as compulsory registration of all cases and the anti-spitting ordinances. Blanks for reporting cases should be mailed to every licensed physician accompanied by a letter explaining the data required by the city and state and making a plea for co-operation. The Sanitorium being planned by Los Angeles County should be but a beginning in the public control of tuberculosis. They should have every facility for conducting this institution along social as well as medical lines. A system should be installed sO that patients may be followed up after they leave and conditions so arranged that patients do not again break down in health. Much of the money spent under our present system is wasted because discharged patients leaving hospitals return to bad surroundings amidst an economic stress which destroys the work just accom- plished. Open Air Schools. The public schools of Los Angeles should recognize the fact that tuberculosis occurs among school children and should plan for the care of such and of those predisposed to the disease. It is unfortunate that in a climate like ours, there should be so few open air schools. In this respect we are far behind other American cities, some of which have severe winter climates. Not only Ann Street but other similar districts should have up-to-date open air rooms and should furnish special nourish- ment for those who need it. A Preventorium in the country should be provided for children whose home conditions are such that adequate measures for pre- vention cannot be carried out. This should be a social as well as a medical institution. The homes of the children should be cor- rected in regard to these unsanitary conditions while the children are in the Preventorium in order that the good work may not be undone on their return. Municipal Dental Clinics should be provided. The relation of teeth to disease has been given much attention during the past few vears. We know that the care of the teeth is imperative if 26 Housing and Sociai, Conditions Front View of House Made Over Front Building Formerly a Part of Iron Works. In This House We Have Had During the Time Covered: 1 Family 3 Reported Cases — Children. 1 Family 2 Reported Cases — Children. 1 Family 1 Adult Death and 1 Re- ported Adult. Another View of Same House. Housing and Social Conditions 27 House Court, Front View. Showing an Out-of-door Toilet. 28 Housing and Sociai, Conditions we wish to preserve health, yet we have no place in Los Angeles where an adult can have free dental care. Some children are well cared for in the Parent-Teachers' Clinic but the number is limited. No type of clinic is more greatly needed in Los Angeles today. An Urgent and Immediate War-time Need. We are "enter- ing into the most terrible and disastrous of all wars in order that the world may be made safe for democracy." This war, we are assured, is to be decided by the efficiency of the industrial classes. We are pitted against a nation, one of whose greatest elements of strength is the physical efficiency of her people. This efficiency has been made possible through the elimination of the slums and the granting of every opportunity for the maintenance of a high standard of living for all her subjects. We are seeing today the result of the lack of preventive measures in time of peace in the sufferings of France whose prob- lem of tuberculosis, today, is parallelled by a similar problem in the case of each of the allies. If in normal times our people must live below standard, how much lower must they go when the price of food continues to advance? If they have managed to exist on a diet in which grain plays an important part, what will they do when these become prohibitive in price? Even if the government regulates the price the cost of living will continue to increase and the number of indi- viduals living below the normal standard of nourishment will also increase. On their small wage these people must substitute food with less nourishment and at a higher price for present conditions. Clothing which has never been adequate, must be less so, and "colds" will be more common and of longer duration. Unless we care for such people, as in this district, in times of economic stress, we must plan for a harvest of tuberculosis the like of which we have never known. Barn to Left, House to Right. Cornell University Library 1 HD7304.L7P31 A study of the housing and I social condit 3 1924 016 176 020