COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD .., I HX64077330 "I RA35.N45 F53 The health of New Ha RECAP Rfi3.^:/^^s £S3 ColutnWa (HnttJer^ftp CoDege of ^i)j>gician£f anti burgeons: Hibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/healthofnewhavenOOfish DOCUMENTS OF The Civic Federation of New Haven No. 13 The Health of New Haven By PROF. IRVING FISHER of Yale University NEW HAVEN November, 1913 DOCUMENTS OF THE Civic Federation of New Haven No. 1 Building Lines in New Haven September, 1909 No. 2 The New Haven Post-Office Building Problem January, 1910 No. 3 A Communication from tbe New Haven Civic Federation's Council of One Hundred and the New Haven Pas- tors' Union Concerning the Government of New Haven County June, 1910 No. 4 First Annual Report of the Civic Federation of New Haven, Connecticut September, 1910 No. 5 Report on County Affairs by the Special Committee of the Council of One Hundred November, 1910 No. 6 Improved Housing for Wage-Earners January, 1911 No. 7 Constitution of the Civic Federation of New Haven, Con- necticut March, 1911 No. 8 The Planting and Care of Street and Highway Trees April, 1912 No. 9 Third Annual Report of the Civic Federation of New Ha- ven, Connecticut November, 1912 No. 10 Mosquito Control March, 1913 No. 11 A Survey of a New Haven District April, 1913 No. 12 Housing Conditions in New Haven October, 1913 No. 13 The Health of New Haven November, 1913 Copies of the above documents are for distribution, and can be had of Robert A. Crosby, Executive Secretary of the Civic Federa- tion, by addressing him at Room 709, Chamber of Commerce Build- ing, New Haven, Conn. Materials printed under authority of the Executive Committee of the Civic Federation. THE HEALTH OF NEW HAVEN i THE HEALTH of NEW HAVEN BY IRVING FISHER YALE UNIVERSITY New Haven, in spite of many shortcomings, has in recent years made so much progress in hygiene that she compares not unfavora- bly with most American cities. The Department of Health and the Health Officer, Dr. Wright, have acomplished much when we con- sider the total inadequacy of their appropriations. We have for years had anti-spitting ordinances. These have never 'been properly enforced. Yet they have gradually developed something of a senti- ment against the filthy and un-hygienic habit of spitting indiscrim- inately. We are beginning to see the effects of the Gaylord Farm Sanatorium, both in restoring tuberculous invalids to health and in educating their families, friends and neighbors in the prevention of tuberculosis. We have an active and efficient Visiting Nurse Association which is financially aided by the Metropolitan Life Insurance Company for the benefit of its policy holders. We have a Day Camp for tubercu- lous invalids conducted by the Visiting Nurse Association. We have an active Consumers' League interested in pure foods and the esta- blishment of Pure Milk Stations. We have the Lowell House Settle- ment. The Water Company has installed, for some of its supply, water filters of the most approved type. The milk inspection, though far from adequate, has greatly improved. The milk producers and the milk dealers have been somewhat "educated" by the Department of Health, so that now the chief milk contamination is probably in the homes of consumers. These now need more "educating" than the milk producers or dealers. This could best be done by visiting nurses, milk depots, and public lectures, under the auspices of the Department of Health. We have now a State law forbidding the importation of tuberculous meat. The city tenements are somewhat influenced for the better by the Tenement Law of a few years ago, and by its more recent amend- ments. Privy vaults on sewered streets are fast disappearing, over several hundred having been abolished in the last year and only about four hundred being now left. We have established a fresh air school. After many years of waiting and struggle, we are to remove the reproach that a city of our size and standing should be without an isolation hospital. A beginning campaign has been waged to rid ourselves of the malarial swamps through the activity of the Civic Federation under the leadership of Dr. Bartlett, Dr. Gompertz and Dr. Britton, the State Entomologist. This follows a mosquito survey of the Con- necticut coast made some years ago by Dr. Britton, showing the importance of draining the marshes about New Haven and of cover- 2 THE CIVIC FEDERATION ing with oil, every ten days during the mosquito season, such por- tions as cannot be drained. We have already reaped some returns from these various improve- ments by a reduction in mortality especially among infants. And yet these improvements touch only the outer fringes of the health problem. New Haven has still much to 'be ashamed of in compari- son with some American cities, and almost all American cities have much to be ashamed of in comparison with London and other up-to- date municipalities abroad, as well as some of our "colonial" terri- tory, especially Panama. This will always be so until two condi- tions are remedied : public apathy and inefficiency in American boards of health. Until recently, Connecticut was the dumping ground for tuberculous meat which neighboring states would not take. It is still true that the meat slaughtered locally is under no government in- spection. Some of this meat is wholly unfit for food. To improve the quality of the local supply of meat, we need a municipal slaughter house, for which, under the leadership of Dr. Wright, a movement is now in progress. To insure ourselves against typhoid, we need to pay attention (1) to our stables, (2) our privies, (3) our garbage, (4) our sewerage, (5) our milk, and (6) our water. With these improvements, New Haven should be practically free from typhoid. It is now known that typhoid is carried largely by the common house fly or, as it is coming to be called, the "typhoid fly." To exterminate the flies, we must at- tack their breeding places, which are mostly in horse manure. Our stables should, during the fly season, be cleaned of manure every five days and at other times the manure heaps should be kept cov- ered. Flies carry typhoid on their feet from privy vaults to the food in our kitchens. There are probably in New Haven over 400 privy vaults — a. disgraceful condition for any city. A large number of these are on sewered streets and could be connected with the sew- ers if the owners were compelled to make the connections. We have ordinances requiring such connections. The Board of Health is clos- ing many of these vaults every year but special appropriation should be made, if necessary, for closing them all, liens being put upon the property when the owners are unable to pay at once. The fight against the fly must be largely waged in our garbage cans and no stu- dent of the garbage question will claim that it has yet been settled. The removal of ashes is unsatisfactory, especially in tenement dis- tricts, where the asbes often accumulate filth. Our clam and oyster beds have been polluted by our sewers. The Board of Health de- serves much credit for its courageous order forbidding the taking of oysters and clams from the inner harbor, especially in view of the strong opposition of the oyster interests and the surprising indiffer- ence of the public, the beneficiaries. Milk has always been a com- mon source of typhoid. The milk supply of New Haven comes from some 120 different milk men. The inspection of the farms, dealers and bottling stations is inadequate. We need a law against selling dipped milk. Another method, which has been found effective in Montclair, N. J., is for the Health Board to publicly post a bacterial count of the various milk men. I believe the Board of Health owes it to the THE HEALTH OF NEW HAVEN 3 consumer of milk to let him know just what sort of milk he is buying. Typhoid in New Haven has in the past been traceable also to in- fected water supply. We need to extend the filter system to include our whole supply. We need more thorough medical inspection of school children. This not only prevents infection among school children and the con- sequent carrying disease from one home to others, and also prevents the progressive development in the individual child of dental decay, bad eyesig'ht, hearing or other disabilities, but it also affords a means of educating the child and through the child 'its parents, in some of the elementary facts of hygiene. The matters which have been mentioned all relate to the preven- tion of infection. Hygienic progress during the last few decades has consisted almost exclusively in the prevention of infection. This is a natural and proper result of the discovery of the germ character of many diseases. They constitute for the most part the acute dis- eases — typhoid, smallpox, scarlet fever, etc. But there is another class of diseases equally important — most diseases of the kidney, liver, stomach, heart, blood vessels and nerves. These may be called the chronic diseases, the control of which depends on the personal habits of the individual. The two classes of diseases should be care- fully distinguished. Acute diseases are usually given from one per- son to another by germs. Chronic diseases are given by a man to himself by over-eating, the use of alcohol, tobacco and drugs, lack of sleep or recreation, over-work and worry, and last but not least by bad housing conditions. The prevention of infectious diseases is accomplished by stopping their communication through isolation and destruction of their car- riers such as mosquitoes and flies, by vaccination, disinfection, street cleaning, school inspection. Chronic diseases, on the other hand, are to be prevented by changing wrong habits of living of the individual. This is accomplished partly by pure food laws, partly by tenement laws, partly by playgrounds, clean streets and good housing, but chiefly by the education of the public. Few people yet appreciate the fact that while acute and infectious diseases on the one hand have beeti decreasing rapidly through the intelligent application of public hygiene, yet chronic and degenera- tive diseases, on the other hand, have been steadily increasing. This fact has at last attracted the attention of life insurance companies, leading to a campaign of education of their policy holders. We need such a campaign in New Haven. Until recently it has not been re- cognized as a function of Boards of Health to educate the people and in New Haven little or no thought has been given to this subject. Such health education as the people can get comes from the New Haven County Anti-Tuberculosis Association, the New Haven Dis- pensary, the Consumers' League, the District Nurses' Association, the Civic Federation, the United Workers and other similar organiza- tions ; but it is now being recognized that the most effective means of such education must be through the Boards of Health, in co-opera- tion with newspapers and moving picture shows and the public schools. The moving pictures display vividly the life history of the typhoid fly, the "trail of the germs" in tuberculosis and the story of 4 THE CIVIC FEDERATION dental decay and prevention. Chicago has led in this matter through the energy' of its former health officer, Commissioner Evans. It maintains a low death rate and saves thousands of lives. New York is beginning to follow Chicago's example. In Chicago, the newspapers printed Dr. Evans' "healthgrams' and the people read them with avidity. Latterly Dr. Wright has published popular comments in the Month- ly Report of the Board of Health and recently attracted some atten- tion as well as provided some entertainment by pointing out the hy- gienic evils of kissing. As this educational work expands, the Board of Health will find itself in closer touch with the public. In this work of popular education the newspapers must play an important part. ]vlany of them are beginning to feel a sense of re- sponsibility on this score, especially to note the incongruity of preach- ing health in their news and editorial columns while spreading dis- ease through their advertising columns. At least one of our local papers has awakened to a sense of public responsibility on this score. The movement toward cleaner advertising in newspapers and other periodicals is making rapid strides elsewhere. Some magazines like Collier's and the Ladies' Home Journal have not only eliminated im- moral and unhygienic advertising, especially of "patent medicines", but have entered on a crusade against nostrums and appliances which undermine the stamina of our people. Some newspapers, like the North American of Philadelphia, have adopted stringent rules as to its advertising, such as the following: (1) To exclude obscene announcements. (2) To exclude matter palpably fraudulent. (3) To exclude children's remedies containing large quantities of opiates. ' (4) To exclude preparations for adult use which contain drugs or alcohol in habit-forming quantities. (5) To exclude all advertisements of remedies in which state- ments of the word "cure" were made. One reason assigned for such rules was that the paper was not free to preach clean living until it practiced it. Evidently any newspaper which advertises immoraUty and quackery ties its hands for any service in a health campaign. But when through an en- lightened following of public sentiment all decent newspapers fol- low the examples which some are now setting, we shall not only be rid of a powerful publicity force for evil but shall acquire in its place a powerful publicity force for good. One great need to which our city is gradually awakening, and for which it has already made partial provision, is for playgrounds and healthful amusements. These are useful in many important though subtle ways. They induce physical exercise, the use of more fresh air, mental relaxation and enjoyment and a taste for those natural and simple modes of spending time to the exclusion of unhygienic and immoral methods, such as drinking, gambling and other unmentionable practices. I have grouped the health problems of New Havea under two classes, one relating to the prevention of acute and infectious dis- THE HEALTH OF NEW HAVEN 5 eases and the other to the prevention of chronic or personal diseases. But the two cannot be altogether separated and there is one problem in which they are inextricably interwoven. I refer to the tenement problem. It is in the bad tenements that we find the worst evils — over- crowding, neglect of garbage and sanitation, accumulation of filth in air-shafts, carrying of diseases by flies, and contagion; but these conditions also mean to the individual lack of fresh air and sunlight as well as lack of opportunity to practice decent hygienic, personal habits. For these reasons tenements are the homes of tuberculosis which is at once an infectious and a degenerative disease. During the year 1911, seventy-three tenements, accommodating from six to sixteen families each, were erected in New Haven. These menace the health and morals of the city. Many of these large tenements are frame and without adequate fire protection. If the working people in Washington, Baltimore and Philadelphia can be accommodated in one or two-family houses, surely this ought to be possible in New Haven. On Hill Street a first-floor, three-room apartment in a tenement house for six families was occupied by an Italian, his wife and three children; five lodgers were kept, who have beds in the front room, the family occupying the middle room and the kitchen. No tenement house census has ever been made for the whole city of New Haven. The only careful studies of tene- ment house conditions in New Haven have been made by the initiative of public-spirited citizens or associations, one in 1903 cover- ing one section of the city, by Lowell House, and another in 1912 by the Civic Federation. There is practically no tenement inspection. Only night inspection will reveal how much overcrowding exists. On State Street where a woman died recently, it was found that the husband, wife and two daughters slept in one bed. There has been started in New Haven a movement for the erec- tion of better tenements on a semi-commercial basis after the model of the Homes Companies of New York and other cities. The first model tenement is now being erected. It is to be hoped that this movement, combined with education in household economics or good housekeeping, together with better and stricter laws, may arrest the tendency toward overcrowding. The use of the public schools as a center and medium for disseminating health education should not go unmentioned. In some respects this is the most promising of all means of building up healthy citizens in the next generation. In order to secure our health reforms, we certainly need (1) to educate public sentiment, and (2) to supply the sinews of war to the Health Department. It would, in my opinion, also be an advantage to modify our present multiple board of health by making it frankly advisory and not dividing responsibility with the health officer. The experience of the Philippines, of Panama, of the State of Pennsylvania, of New York City and of other places indicates that boards constituted as ours is, however capable its members may be individually, are seldom very efficient. This inefficiency is due to division of responsibility rather than to individual incapacity. 6 THE CIVIC FEDERATION The health officer should be held strictly accountable for his work and should have a long term of service subject only to dismissal for cause. The returns which could be reaped from a better health ad- ministration and better health laws are incalculable. Even on a purely commercial basis hygiene pays. Dr. Britton and others have shown that the cost of exterminating malaria by draining and oiling the marshes is repaid in actual cash many times over by better crops, better land values, and better earning power of the population. When Gaylord Farm Sanatorium was established eight years ago,. a local, hard-headed, cynical business man, in refusing to contribute money, asked the late Dr. J. P. C. Foster if he really thought that this attempt to fight tuberculosis would "pay." We are now pre- pared to answer his question in the same hard, cold-cash terms. The treatment of patients, including interest on plant, has cost thus far $278,000, and the patients whose lives were thus saved as bread winners for their families have earned $706,000, besides having still left a potential earning capacity conservatively appraised at $2,- 500,000. Even this does not exhaust the commercial value of the benefits derived from the expenditure of the $278,000. In fact, the chief benefit has not been included; this is the spread of the gospel of health. Tuberculosis is one of the slowest and most expensive of diseases, and if a calculable return of nine-fold on the investment can be obtained within a few years in the fight against tuberculosis, a far larger return can be obtained in fighting other diseases. In fact, equally definite and convincing data for other diseases could be given. These data are not in the realm of speculation, but represent the actual, practical achievements in other places. Consider, for in- stance, that wonder of the world, the cutting in two of the death rate in London in a quarter of a century. London, the seat of the worst visitations of epidemics in Europe, the awful sufferers from the Black Death, the type in former times of bad sanitation, has now a death rate of thirteen per thousand, one of the very lowest of the cities of the world and very considerably lozver than New Haven. It is easily within our power, with a population incom- parably smaller and sparcer to reduce our own mortality until it is again where it ought to be, below that of London or any other city larger and more crowded than itself. We owe it to ourselves, to our children and our children's children to do this ; and not to do it is, in fact, if not in law, criminal negligence. Dr. Park, Health Commissioner of Rockford, 111., after an extensive comparative study of expenditures by city health departments, assigns 85 cents per capita as the very least for which adequate results can be ob- tained for cities of the size of New Haven. Our actual expenditures amount only to about 20 cents per capita.* In the light of these facts, how trivial seem the objections to making more generous health appropriations on the plea of saving the taxpayers' money or avoiding the hardship or expense to the house owner or the collector of garbage. Such a view is "penny THE HEALTH OF NEW HAVEN 7 wise and pound foolish" ; it is saving the penny to the taxpayer, the property owner or the contractor and losing the pound to the city of New Haven. It is sometimes said that the greatest enemy of hygiene is commercialism, but this is a misleading statement. The truth is that the greatest friend of commercialism is hygiene. The real conflict is between the special interests of the few and the general interests of the many. In a broad way, better health is not a means of spending money, but a means of saving money. The courageous administration of a public health office will not hurt, but help, the commercial interests of the community. It is better to advertise by showing good health conditions than by concealing the existence of bad health conditions. In Springfield, Illinois, the health officer has had the courage to publish a map showing the location of the privy vaults throughout the city. Doubtless he has temporarily injured the value of property of these streets, or, rather, revealed its truer value, but real estate men have also used his map to enhance the value of property on other streets. Life insurance com- panies are now trying to make money by lengthening human life and some municipalities are trying to make money by advertising better health conditions. The enterprising town of Winfield, Kansas, boasts of having more bath tubs and sleeping porches than any other town in Kansas. Some day it will pay New Haven to boast not only of a pure water supply, but also a pure milk supply, a pure meat supply, a pure air supply and a low death rate. SPECIAL HEALTH NEEDS IN NEW HAVEN 1. The reorganization of the existing Health Department, in order to make it more efficient and up-to-date. This could be done in various ways, one of which might be by converting the Board of Health into a purely advisory body and having only one Health Offi.cer or Commissioner, who should be held strictly responsible to the Mayor for the conduct of his office. 2. More funds for the Health Department, to be used for more inspectors, officers, milk depots, visiting nurses, lectures on health, etc. An immediate increase of 50 per cent, is needed to accomplish what the Board of Health has in view. This would make 30 cents per capita.* Dr. Wright has found by actual inquiry that all Ameri- can cities with a population of from 75,000 to 200,000 have larger appropriations than New Haven. 3. More funds for the Building Inspector^ to be used for the employment of deputy inspectors, etc., in order that he may prevent violations of the Connecticut Tenement House Law prescribing sizes of courts, etc. 4. All garbage to be removed at least every five days during the summer. In fact, twice or three times a week in hot weather would be none too often. The method of garbage collection and disposal should be improved. The municipal collection under the depart- ment of public works has, for some reason, proved a great dis- appointment. 5. The abolition of all vaults on sewered streets and their periodi- cal disinfection on unsewered streets, an appropriation being made for these purposes.* * 8 THE CIVIC FEDERATION 6. The passage of the proposed ordinance requiring all horse manure to 'be removed at short intervals.*** 7. An investigation aiming to discover a better method of dis- posing of city sewage so as not to contaminate the oyster and clam beds of the harbor. 8. The draining and oiling of malarial swamps. The city of New Haven has only a small area of swamp land. This could be easily drained and utilized for parks and playground purposes. ^ 9. The establishment of a municipal slaughter house where local cattle can be butchered under an inspector. This could be made self-supporting by the imposition of a small fee. The cost of such a slaughter house, I am told, would probably be about $2,000.1^ 10. The prohibition of the sale of dipped milk.^ The passage of a law requiring approval by the Board of Health of the pro- cedure employed in sterilizing milk. The adoption of the proposed ordinance requiring milk to 'be cooled soon after milking, kept cold and delivered cold. 11. Further improvements in the Tenement House Act. The Board of Health should keep a continuous life history of each tenement, the occurrence of diseases, disinfection, etc. 12. The extension and more generous support of the work of the Visiting Nurse Association and the United Workers (in the work of their visiting housekeepers). These organizations at present are our chief hope for educating the masses in sanitary housekeeping and personal hygiene. 13. The establishment of more fresh air schools such as those in use in Providence, Chicago and other cities, including South Manchester in this State. We have, however, as above stated, made a beginning. ^ 14. The better use of our schools for teaching and demonstrating hygiene to the pupils during school hours and to the public at evening meetings. 15. We should have a carefully-guarded law making it possible to remove children from families in which there is tuberculosis or other menace to health. We can remove morally-imperilled children and should be able to remove physically-imperilled children. 16. More playgrounds. 17. The complete elimination of unhygienic advertising by our newspapers. 18. Last but not least, an enlightened public spirit appreciative of the overwhelming importance of maintaining public health. * Since this was written, most of the increase suggested has been granted. ** Since this was written, provision has been made to abolish all vaults on sewered streets by April 1, 1914. *** Since this was written, such an ordinance has been passed. + Since this was written, an appropriation of $3,000 has been made for draining swamp-lands in City Parks. X Since this was written, the Board of Aldermen has recommended such a slaughter house and the matter will be considered by the Board of Finance. H Since this was written, a committee of the Board of Aldermen has recom- mended such an ordinance, and it will undoubtedly soon be passed. § Since this was written, a new open-air school has been provided for. DO IT FOR NEW HAVEN That city is well fortified which hath a wall of men instead of brick. — Lycurgus. ARE YOU INTERESTED IN NEW HAVEN? If your answer is "no/' you waste your time reading this page. If it is "yes," what is written will help you and your city. ARE YOU WORKING FOR NEW HAVEN? Are you doing your best to make New Haven a city in which you are proud to live and work ; a city you are proud to say is your home, or are you letting the "other fellow" do the work wliile you enjoy the benefits of his labor? DO YOU KNOW THE NEEDS OF NEW HAVEN? Have you accurate information as to Schools, Playgrounds, Housing, Streets, Parks, Public Health, our Dependents and Defectives, our Industrial Situation, etc., and w'hat is needed to improve conditions? HOW YOU CAN HELP NEW HAVEN First, you must know New Haven's needs, and second, you must co-operate with others to meet these needs. ENROLL AS AN ACTIVE CITIZEN by sending the following letter : Victor Af. Tyler, Treas,, Civic Federation of New Haven: Enclosed please find $1.00 as my membership fee for one year in the Civic Federation of New Haven. I wish to enroll as an active citizen and receive the monthly documents and notices of meetings of the organization. Signed Address COLUMBIA UNIVERSITY This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE C28(63e)MS0 KA35.K45 Fisher F53