The effect of alcohol upon ability to do mental work.
Attention—that is, the power of the mind to grasp and consider impressions obtained through the senses—is weakened by drink. The ability of the mind to associate or combine ideas, the faculty involved in sound judgment, showed that when the persons had taken the amounts of alcohol mentioned, the combinations of ideas or judgments expressed by them were confused, foggy, sentimental, and general. When the persons had taken no alcohol, their judgments were rational, specific, keen, showing closer observation.
"The words of Professor Helmholtz at the celebration of his seventieth birthday are very interesting in this connection. He spoke of the ideas flashing up from the depths of the unknown soul, that lies at the foundation of every truly creative intellectual production, and closed his account of their origin with these words: 'The smallest quantity of an alcoholic beverage seemed to frighten these ideas away.'"—Dr. G. Sims Woodhead, Professor of Pathology, Cambridge University, England.
Professor Von Bunge (Textbook of Physiological and Pathological Chemistry) of Switzerland says that:
"The stimulating action which alcohol appears to exert on the brain functions is only a paralytic action. The cerebral functions which are first interfered with are the power of clear judgment and reason. No man ever became witty by aid of spirituous drinks. The lively gesticulations and useless exertions of intoxicated people are due to paralysis,—the restraining influences, which prevent a sober man from uselessly expending his strength, being removed."
The Drink Habit.—The harmful effects of alcohol (aside from the purely physiological effect upon the tissues and organs of the body) are most terribly seen in the formation of the alcohol habit. The first effect of drinking alcoholic liquors is that of exhilaration. After the feeling of exhilaration is gone, for this is a temporary state, the subject feels depressed and less able to work than before he took the drink. To overcome this feeling, he takes another drink. The result is that before long he finds a habit formed from which he cannot escape. With body and mind weakened, he attempts to break off the habit. But meanwhile his will, too, has suffered from overindulgence. He has become a victim of the drink habit!
"The capital argument against alcohol, that which must eventually condemn its use, is this, that it takes away all the reserved control, the power of mastership, and therefore offends against the splendid pride in himself or herself, which is fundamental in every man or woman worth anything."—Dr. John Johnson, quoting Walt Whitman.
Self-indulgence, be it in gratification of such a simple desire as that for candy or the more harmful indulgence in tobacco or alcoholic beverages, is dangerous—not only in its immediate effects on the tissues and organs, but in its more far-reaching effects on habit formation. Each one of us is a bundle of appetites. If we gratify appetites of the wrong kind, we are surely laying the foundation for the habit of excess. Self-denial is a good thing for each of us to practice at one time or another, if for no other purpose than to be ready to fight temptation when it comes.
The Economic Effect of Alcoholic Poisoning.—In the struggle for existence, it is evident that the man whose intellect is the quickest and keenest, whose judgment is most sound, is the man who is most likely to succeed. The paralyzing effect of alcohol upon the nerve centers must place the drinker at a disadvantage. In a hundred ways, the drinker sooner or later feels the handicap that the habit of drink has imposed upon him. Many corporations, notably several of our greatest railroads (the Pennsylvania and the New York Central Railroad among them), refuse to employ any but abstainers in positions of trust. Few persons know the number of railway accidents due to the uncertain eye of some engineer who mistook his signal, or the hazy inactivity of the brain of some train dispatcher who, because of drink, forgot to send the telegram that was to hold the train from wreck. In business and in the professions, the story is the same. The abstainer wins out over the drinking man.
Effect of Alcohol on Ability to do Work.—In Physiological Aspects of the Liquor Problem, Professor Hodge, formerly of Clark University, describes many of his own experiments showing the effect of alcohol on animals. He trained four selected puppies to recover a ball thrown across a gymnasium. To two of the dogs he gave food mixed with doses of alcohol, while the others were fed normally. The ball was thrown 100 feet as rapidly as recovered. This was repeated 100 times each day for fourteen successive days. Out of 1400 times the dogs to which alcohol had been given brought back the ball only 478 times, while the others secured it 922 times.
Dr. Parkes experimented with two gangs of men, selected to be as nearly similar as possible, in mowing. He found that with one gang abstaining from alcoholic drinks and the other not, the abstaining gang could accomplish more. On transposing the gangs, the same results were repeatedly obtained. Similar results were obtained by Professor Aschaffenburg of Heidelberg University, who found experimentally that men "were able to do 15 per cent less work after taking alcohol."
Recently many experiments along the same lines have been made. In typewriting, in typesetting, in bricklaying, or in the highest type of mental work the result is the same. The quality and quantity of work done on days when alcohol is taken is less than on days when no alcohol is taken.
The Relation of Alcohol to Efficiency.—We have already seen that work is neither so well done nor is as much accomplished by drinkers as by non-drinkers.
A Massachusetts shoe manufacturer told a recent writer on temperance that in one year his firm lost over $5000 in shoes spoiled by drinking men, and that he had himself traced these spoiled shoes to the workmen who, through their use of alcoholic liquors, had thus rendered themselves incapable. This is a serious handicap to our modern factory system, and explains why so many factory towns and cities are strongly favoring a policy of "No license" in opposition to the saloons.
"It is believed that the largest number of accidents in shops and mills takes place on Monday, because the alcohol that is drunk on Sunday takes away the skill and attentive care of the workman. To prove the truth of this opinion, the accidents of the building trades in Zurich were studied during a period of six years, with the result shown by this table":—
Shaded, non-alcoholic; black, alcoholic, accidents. (From Tolman, Hygiene for the Worker.)
Another relation to efficiency is shown by the following chart. During the week the curve of working efficiency is highest on Friday and lowest on Monday. The number of accidents were also least on Friday and greatest on Monday. Lastly the assaults were fewest in number on Friday and greatest on Sunday and Monday. The moral is plain. Workingmen are apt to spend their week's wages freely on Saturday. Much of this goes into drink, and as a result comes crime on Sunday because of the deadened moral and mental condition of the drinker, and loss of efficiency on Monday, because of the poisonous effects of the drug.
Notice that the curve of efficiency is lowest on Monday and that crimes and accidents are most frequent on Sunday and Monday. Account for this.
Effect of Alcohol upon Duration of Life.—Still more serious is the relation of alcohol as a direct cause of disease (see table).
It is as yet quite impossible, in the United States at least, to tell just how many deaths are brought about, directly or indirectly, by alcohol. Especially is this true in trying to determine the number of cases of deaths from disease promoted by alcohol. In Switzerland provision is made for learning these facts, and the records of that country throw some light on the subject.
Dr. Rudolph Pfister made a study of the records of the city of Basle for the years 1892-1906, finding the percentage of deaths in which alcohol had been reported by the attending physician as one cause of death. He found that 18.1 per cent of all deaths of men between 40 and 50 years of age were caused, in part at least, by alcohol, and this at what should be the most active period in a man's life, the time when he is most needed by his family and community. Taking all ages between 20 and 80, he found that alcohol was one cause of death in one man in every ten who died.
Another study was made by a certain doctor in Sweden, from records of 1082 deaths occurring in his own practice and the local hospital. No case was counted as alcoholic of which there was the slightest doubt. Of deaths of adult men, 18 in every 100 were due, directly or indirectly, to alcoholism. In middle life, between the ages of 40 and 50, 29; and between 50 and 60 years of age, 25.6 out of every 100 deaths had alcohol as one cause, thus agreeing with other statistics we have been quoting.—From the Metropolitan, Vol. XXV, Number 11.
The proportion of crime due to alcohol is shown in black.
The Relation of Alcohol to Crime.—A recent study of more than 2500 habitual users of alcohol showed that over 66 per cent had committed crime. Usually the crimes had been done in saloons or as a result of quarrels after drinking. Of another lot of 23,581 criminals questioned, 20,070 said that alcohol had led them to commit crime.
The Relation of Alcohol to Pauperism.—We have already spoken of the Jukes family. These and many other families of a similar sort are more or less directly a burden upon the state. Alcohol is in part at least responsible for the condition of such families. Alcohol weakens the efficiency and moral courage, and thus leads to begging, pauperism, petty stealing or worse, and ultimately to life in some public institution. In Massachusetts, of 3230 inmates of such institutions, 66 per cent were alcoholics.
The Relation of Alcohol to Heredity.—Perhaps the gravest side of the alcohol question lies here. If each one of us had only himself to think of, the question of alcohol might not be so serious. But drinkers may hand down to their unfortunate children tendencies toward drink as well as nervous diseases of various sorts; an alcoholic parent may beget children who are epileptic, neurotic, or even insane.
In the State of New York there are at the present time some 30,000 insane persons in public and private hospitals. It is believed that about one fifth of them, or 6000 patients, owe their insanity to alcohol used either by themselves or by their parents. In the asylums of the United States there are 150,000 insane people. Taking the same proportions as before, there are 30,000 persons in this country whom alcohol has made or has helped to make insane. This is the most terrible side of the alcohol problem.
Reference Reading
elementary
Hunter, Laboratory Problems in Civic Biology. American Book Company.
Overton, General Hygiene. American Book Company.
The Gulick Hygiene Series, Emergencies, Good Health, The Body at Work, Control of Body and Mind. Ginn and Company.
Ritchie, Human Physiology. World Book Company.
Hough and Sedgwick, The Human Mechanism. Ginn and Company.
Problems.—How may we improve our home conditions of living?
How may we help improve our conditions at school?
How does the city care for the improvement of our environment?
(a) In inspection of buildings, etc.
(b) In inspection of food supplies.
(c) In inspection of milk.
(d) In care of water supplies.
(e) In disposal of wastes.
(f) In care of public health.
Laboratory Suggestions
Home exercise.—How to ventilate my bedroom.
Demonstration.—Effect of use of duster and damp cloth upon bacteria in schoolroom.
Home exercise.—Luncheon dietaries.
Home exercise.—Sanitary map of my own block.
Demonstration.—The bacterial content of milk of various grades and from different sources.
Demonstration.—Bacterial content of distilled water, rain water, tap water, dilute sewage.
Laboratory exercise.—Study of board of health tables to plot curves of mortality from certain diseases during certain times of year.
The Purpose of this Chapter.—In the preceding chapters we have traced the lives of both plants and animals within their own environment. We have seen that man, as well as plants and other animals, needs a favorable environment in order to live in comfort and health. It will be the purpose of the following pages first to show how we as individuals may better our home environment, and secondly, to see how we may aid the civic authorities in the betterment of conditions in the city in which we live.
How I should ventilate my bedroom.
Home Conditions.—The Bedroom.—We spend about one third of our total time in our bedroom. This room, therefore, deserves more than passing attention. First of all, it should have good ventilation. Two windows make an ideal condition, especially if the windows receive some sun. Such a condition as this is manifestly impossible in a crowded city, where too often the apartment bedrooms open upon narrow and ill-ventilated courts. Until comparatively recent time, tenement houses were built so that the bedrooms had practically no light or air; now, thanks to good tenement-house laws, wide airshafts and larger windows are required by statute.
Care of the Bedroom.—Since sunlight cannot always be obtained for a bedroom, we must so care for and furnish the room that it will be difficult for germs to grow there. Bedroom furniture should be light and easy to clean, the bedstead of iron, the floors painted or of hardwood. No hangings should be allowed at the windows to collect dust, nor should carpets be allowed for the same reason. Rugs on the floor may easily be removed when cleaning is done. The furniture and woodwork should be wiped with a damp cloth every day. Why a damp cloth? In certain tenements in New York City, tuberculosis is believed to have been spread by people occupying rooms in which a previous tenant has had tuberculosis. A new tenant should insist on a thorough cleaning of the bedrooms and removal of old wall paper before occupancy.
Sunlight Important.—In choosing a house in the country we would take a location in which the sunlight was abundant. A shaded location might be too damp for health. Sunlight should enter at least some of the rooms. In choosing an apartment we should have this matter in mind, for, as we know, germs cannot long exist in sunlight.
This map shows how cases of tuberculosis are found recurring in the same locality and in the same houses year after year. Each black dot is one case of tuberculosis.
Heating.—Houses in the country are often heated by open fires, stoves or hot-air furnaces, all of which make use of heated currents of air to warm the rooms. But in the city apartments, usually pipes conduct steam or hot water from a central plant to our rooms. The difficulty with this system is that it does not give us fresh air, but warms over the stale air in a room. Steam causes our rooms to be too warm part of the time, and not warm enough part of the time. Thus we become overheated and then take cold by becoming chilled. Steam heat is thus responsible for much sickness.
Lighting.—Lighting our rooms is a matter of much importance. A student lamp, or shaded incandescent light, should be used for reading. Shades must be provided so that the eyes are protected from direct light. Gas is a dangerous servant, because it contains a very poisonous substance, carbon monoxide. "It is estimated that 14 per cent of the total product of the gas plant leaks into the streets and houses of the cities supplied." This forms an unseen menace to the health in cities. Gas pipes, and especially gas cocks, should be watched carefully for escaping gas. Rubber tubing should not be used to conduct gas to movable gas lamps, because it becomes worn and allows gas to escape.
During the summer all food should be protected from flies. Why?
Insects and Foods.—In the summer our houses should be provided with screens. All food should be carefully protected from flies. Dirty dishes, scraps of food, and such garbage should be quickly cleaned up and disposed of after a meal. Insect powder (pyrethrum) will help keep out "croton bugs" and other undesirable household pests, but cleanliness will do far more. Most kitchen pests, as the roach, simply stay with us because they find dirt and food abundant.
Use of Ice.—Food should be properly cared for at all times, but especially during the summer. Iceboxes are a necessity, especially where children live, in order to keep milk fresh. A dirty icebox is almost as bad as none at all, because food will decay or take on unpleasant odors from other foods.
The wrong and the right kind of garbage cans.
Disposal of Wastes.—In city houses the disposal of human wastes is provided for by a city system of sewers. The wastes from the kitchen, the garbage, should be disposed of each day. The garbage pail should be frequently sterilized by rinsing it with boiling water. Plenty of lye or soap should be used. Remember that flies frequent the uncovered garbage pail, and that they may next walk on your food. Collection and disposal of garbage is the work of the municipality.
School Surroundings.—How to Improve Them.—From five to six hours a day for forty weeks is spent by the average boy or girl in the schoolroom. It is part of our environment and should therefore be considered as worthy of our care. Not only should a schoolroom be attractive, but it should be clean and sanitary. City schools, because of their locations, of the sometimes poor janitorial service, and especially because of the selfishness and carelessness of children who use them, may be very dirty and unsanitary. Dirt and dust breed and carry bacteria. Plate cultures show greatly increased numbers of bacteria to be in the air when pupils are moving about, for then dust, bearing bacteria, is stirred up and circulated through the air. Sweeping and dusting with dry brooms or feather dusters only stirs up the dust, leaving it to settle in some other place with its load of bacteria. Professor Hodge tells of an experience in a school in Worcester, Mass. A health brigade was formed among the children, whose duty was to clean the rooms every morning by wiping all exposed surface with a damp cloth. In a school of 425 pupils not a single case of contagious diseases appeared during the entire year. Why not try this in your own school?
The culture (A) was exposed to the air of a dirty street in the crowded part of Manhattan. (B) was exposed to the air of a well-cleaned and watered street in the uptown residence portion. Which culture has the more colonies of bacteria? How do you account for this?
Unselfishness the Motto.—Pupils should be unselfish in the care of a school building. Papers and scraps dropped by some careless boy or girl make unpleasant the surroundings for hundreds of others. Chalk thrown by some mischievous boy and then tramped underfoot may irritate the lungs of a hundred innocent schoolmates. Colds or worse diseases may be spread through the filthy habits of some boys who spit in the halls or on the stairways.
Lunch Time and Lunches.—If you bring your own lunch to school, it should be clean, tasty, and well balanced as a ration. In most large schools well-managed lunch rooms are part of the school equipment, and balanced lunches can be obtained at low cost. Do not make a lunch entirely from cold food, if hot can be obtained. Do not eat only sweets. Ice cream is a good food, if taken with something else, but be sure of your ice cream. "Hokey pokey" cream, tested in a New York school laboratory, showed the presence of many more colonies of bacteria than good milk would show. Above all, be sure the food you buy is clean. Stands on the street, exposed to dust and germs, often sell food far from fit for human consumption.
A sensible lunch box, sanitary and compact.
If you eat your lunch on the street near your school, remember not to scatter refuse. Paper, bits of lunch, and the like scattered on the streets around your school show lack of school spirit and lack of civic pride. Let us learn above all other things to be good citizens.
Dust exhausts on grinding wheels protect lungs of the workmen.
Inspection of Factories, Public Buildings, etc.—It is the duty of a city to inspect the condition of all public buildings and especially of factories. Inspection should include, first, the supervision of the work undertaken. Certain trades where grit, dirt, or poison fumes are given off are dangerous to human health, hence care for the workers becomes a necessity. Factories should also be inspected as to cleanliness, the amount of air space per person employed, ventilation, toilet facilities, and proper fire protection. Tenement inspection should be thorough and should aim to provide safe and sanitary homes.
Inspection of Food Supplies.—In a city certain regulations for the care of public supplies are necessary. Foods, both fresh and preserved, must be inspected and rendered safe for the thousands of people who are to use them. All raw foods exposed on stands should be covered so as to prevent insects or dust laden with bacteria from coming in contact with them. Meats must be inspected for diseases, such as tuberculosis in beef, or trichinosis in pork. Cold storage plants must be inspected to prevent the keeping of food until it becomes unfit for use. Inspection of sanitary conditions of factories where products are canned, or bakeries where foods are prepared, must be part of the work of a city in caring for its citizens.
Care of Raw Foods.—Each one of us may coöperate with the city government by remembering that fruits and vegetables can be carriers of disease, especially if they are sold from exposed stalls or carts and handled by the passers-by. All vegetables, fruits, or raw foods should be carefully washed before using. Spoiled or overripe fruit, as well as meat which is decayed, is swarming with bacteria and should not be used.
An interesting exercise would be the inspection of conditions in your own home block. Make a map showing the houses on the block. Locate all stores, saloons, factories, etc. Notice any cases of contagious disease, marking this fact on the map. Mark all heaps of refuse in the street, all uncovered garbage pails, any street stands that sell uncovered fruit, and any stores with an excessive number of flies.
In addition to food inspection, two very important supplies must be rendered safe by a city for its citizens. These are milk and water.
Clean cows in clean barns with clean milkers and clean milk pails means clean milk in the city.
Care in Production of Milk.—Milk when drawn from a healthy cow should be free from bacteria. But immediately on reaching the air it may receive bacteria from the air, from the hands of the person who milks the cows, from the pail, or from the cow herself. Cows should, therefore, be milked in surroundings that are sanitary, the milkers should wear clean garments, put on over their ordinary clothes at milking time, while pails and all utensils used should be kept clean. Especially the surface exposed on the udder from which the milk is drawn should be cleansed before milking.
Most large cities now send inspectors to the farms from which milk is supplied. Farms that do not accept certain standards of cleanliness are not allowed to have their milk become part of the city supply.
Tuberculosis and Milk.—It is recognized that in some European countries from 30 to 40 per cent of all cattle have tuberculosis. Many dairy herds in this country are also infected. It is also known that the tubercle bacillus of cattle and man are much alike in form and action and that probably the germ from cattle would cause tuberculosis in man. Fortunately, the tuberculosis germ does not grow in milk, so that even if milk from tubercular cattle should get into our supply, it would be diluted with the milk of healthy cattle. In order to protect our milk supply from these germs it would be necessary to kill all tubercular cattle (almost an impossibility) or to pasteurize our milk so as to kill the germs in it.
Other Disease Germs in Milk.—We have already shown how typhoid may be spread through milk. Usually such outbreaks may be traced to a single case of typhoid, often a person who is a "typhoid carrier," i.e. one who may not suffer from the effects of the disease, but who carries the germs in his body, spreading them by contact. A recent epidemic of typhoid in New York City was traced to a single typhoid carrier on a farm far from the city. Sometimes the milk cans may be washed in contaminated water or the cows may even get the germs on their udders by wading in a polluted stream. Diphtheria, scarlet fever, and Asiatic cholera are also undoubtedly spread through milk supplies. Milk also plays a very important part in the high death rate from diarrhœal diseases among young children in warm weather. Why?
A diagram to show how typhoid may be spread in a city through an infected milk supply. The black spots in the blocks mean cases of typhoid. A, a farm where typhoid exists; the dashes in the streets represent the milk route. B is a second farm which sends part of its milk to A; the milk cans from B are washed at farm A and sent back to B. A few cases of typhoid appear along B's milk route. How do you account for that?
Grades of Milk in a City Supply.—Milk which comes to a city may be roughly placed in three different classes. The best milk, coming from farms where the highest sanitary standards exist, where the cows are all tubercular tested, where modern appliances for handling and cooling the milk exist, is known as certified or, in New York City, grade A milk. Most of the milk sold, however, is not so pure nor is so much care taken in handling it. Such milk, known in New York as grade B milk, is pasteurized before delivery, and is sold only in bottles. A still lower grade of milk (dipped milk) is sold direct from cans. It is evident that such milk, often exposed to dust and other dirt, is unfit for any purpose except for cooking. It should under no circumstances be used for children. A regulation recently made by the New York City Department of Health states that milk sold "loose" in restaurants, lunch-rooms, soda fountains, and hotels must be pasteurized.
Care of a City Milk Supply.—Besides caring for milk in its production on the farm, proper transportation facilities must be provided. Much of the milk used in New York City is forty-eight hours old before it reaches the consumer. During shipment it must be kept in refrigerator cars, and during transit to customers it should be iced. Why? All but the highest grade milk should be pasteurized. Why? Milk should be bottled by machinery if possible so as to insure no personal contact; it should be kept in clean, cool places; and no milk should be sold by dipping from cans. Why is this a method of dispensing impure milk?
Care of Milk in the Home.—Finally, milk at home should receive the best of care. It should be kept on ice and in covered bottles, because it readily takes up the odors of other foods. If we are not certain of its purity or keeping qualities, it should be pasteurized at home. Why?
New York City is spending $350,000,000 to have a pure and abundant water supply. This is the tunnel which will bring the water from the Catskill Mountains to New York City.
Water Supplies.—One of the greatest assets to the health of a large city is pure water. By pure water we mean water free from all organic impurities, including germs. Water from springs and deep driven wells is the safest water, that from large reservoirs next best, while water that has drainage in it, river water for example, is very unsafe.
The waters from deep wells or springs if properly protected will contain no bacteria. Water taken from protected streams into which no sewage flows will have but few bacteria, and these will be destroyed if exposed to the action of the sun and the constant aëration (mixing with oxygen) which the surface water receives in a large lake or reservoir. But water taken from a river into which the sewage of other towns and cities flows must be filtered before it is fit for use.
The city of Lowell in 1891 took its water without filtering, i.e. from the Merrimack River at the point shown on the map.
Typhoid fever broke out in North Chelmsford and about two weeks later cases began to appear in Lowell until a great epidemic occurred. Explain this outbreak. Each black dot is a case of typhoid.
Typhoid fever germs live in the food tube, hence the excreta of a typhoid patient will contain large numbers of germs. In a city with a system of sewage such germs might eventually pass from the sewers into a river. Many cities take their water supply directly from rivers, sometimes not far below another large town. Such cities must take many germs into their water supply. Many cities, as Cleveland and Buffalo, take their water from lakes into which their sewage flows. Others, as Albany, Pittsburgh, and Philadelphia, take their drinking water directly from rivers into which sewage from cities above them on the river has flowed. Filtering such water by means of passing the water through settling basins and sand filters removes about 98 per cent of the germs. The result of drinking unfiltered and filtered water in certain large cities is shown graphically at right. In cities which drain their sewage into rivers and lakes, the question of sewage disposal is a large one, and many cities now have means of disposing of their sewage in some manner as to render it harmless to their neighbors.
Filter beds at Albany, N. Y.
Cases of typhoid per 100,000 inhabitants before filtering water supply (solid) and after (shaded) in A, Watertown, N. Y.; B, Albany, N. Y.; C, Lawrence, Mass.; D, Cincinnati, Ohio. What is the effect of filtering the water supply?
Railroads are often responsible for carrying typhoid and spreading it. It is said that a recent outbreak of typhoid in Scranton, Pa., was due to the fact that the excreta from a typhoid patient traveling in a sleeping car was washed by rain into a reservoir near which the train was passing. Railroads are thus seen to be great open sewers. A sanitary car toilet is the only remedy.
This chart shows that during a cholera epidemic in 1892 there were hundreds of cases of cholera in Hamburg, which used unfiltered water from the Elbe, but in adjoining Altona, where filtered water was used, the cases were very few.
Stone filter beds in a sewage disposal plant.
Sewage Disposal.—Sewage disposal is an important sanitary problem for any city. Some cities, like New York, pour their sewage directly into rivers which flow into the ocean. Consequently much of the liquid which bathes the shores of Manhattan Island is dilute sewage. Other cities, like Buffalo or Cleveland, send their sewage into the lakes from which they obtain their supply of drinking water. Still other cities which are on rivers are forced to dispose of their sewage in various ways. Some have a system of filter beds in which the solid wastes are acted upon by the bacteria of decay, so that they can be collected and used as fertilizer. Others precipitate or condense the solid materials in the sewage and then dispose of it. Another method is to flow the sewage over large areas of land, later using this land for the cultivation of crops. This method is used by many small European cities.
Collecting ashes.
The Work of the Department of Street Cleaning.—In any city a menace to the health of its citizens exists in the refuse and garbage. The city streets, when dirty, contain countless millions of germs which have come from decaying material, or from people ill with disease. In most large cities a department of street cleaning not only cares for the removal of dust from the streets, but also has the removal of garbage, ashes, and other waste as a part of its work. The disposal of solid wastes is a tremendous task. In Manhattan the dry wastes are estimated to be 1,000,000 tons a year in addition to about 175,000 tons of garbage. Prior to 1895 in the city of New York garbage was not separated from ashes; now the law requires that garbage be placed in separate receptacles from ashes. Do you see why? The street-cleaning department should be aided by every citizen; rules for the separation of garbage, papers, and ashes should be kept. Garbage and ash cans should be covered. The practice of upsetting ash or garbage cans is one which no young citizen should allow in his neighborhood, for sanitary reasons. The best results in summer street cleaning are obtained by washing or flushing the streets, for thus the dirt containing germs is prevented from getting into the air. The garbage is removed in carts, and part of it is burned in huge furnaces. The animal and plant refuse is cooked in great tanks; from this material the fats are extracted, and the solid matter is sold for fertilizer. Ashes are used for filling marsh land. Thus the removal of waste matter may pay for itself in a large city.
The upper picture shows the stables where millions of flies were bred; the lower picture, the disinfection of manure so as to prevent the breeding of flies.
An Experiment in Civic Hygiene.—During the summer of 1913 an interesting experiment on the relation of flies and filth to disease was carried on in New York City by the Bureau of Public Health and Hygiene of the New York Association for improving the condition of the poor. Two adjoining blocks were chosen in a thickly populated part of the Bronx near a number of stables which were the sources of great numbers of flies. In one block all houses were screened, garbage pails were furnished with covers, refuse was removed and the surroundings made as sanitary as possible. In the adjoining block conditions were left unchanged. During the summer as flies began to breed in the manure heaps near the stables all manure was disinfected. Thus the breeding of flies was checked. The campaign of education was continued during the summer by means of moving pictures, nurses, boy scouts, and school children who became interested.
At the end of the summer it was found that there had been a considerable decrease in the number of cases of fly-carried diseases and a still greater decrease in the total days of sickness (especially of children) in the screened and sanitary block. The table and pictures speak for themselves. If such a small experiment shows results like this, then what might a general clean-up of a city show?
In the upper picture a little girl can be seen dumping garbage from the fire escape. She was a foreigner and knew no better. The picture below shows the result of such garbage disposal.
Public Hygiene.—Although it is absolutely necessary for each individual to obey the laws of health if he or she wishes to keep well, it has also become necessary, especially in large cities, to have general supervision over the health of people living in a community. This is done by means of a department or board of health. It is the function of this department to care for public health. In addition to such a body in cities, supervision over the health of its citizens is also exercised by state boards of health. But as yet the government of the United States has not established a Bureau of Health, important as such a bureau would be.
The Functions of a City Board of Health.—The administration of the Board of Health in New York City includes a number of divisions, each of which has a different work to do. Each is in itself important, and, working together, the entire machine provides ways and means for making the great city a safe and sanitary place in which to live. Let us take up the work of each division of the health board in order to find out how we may coöperate with them.
Comparison of cases of illness during the summer of 1913 in two city blocks, one clean and the other dirty. What are your conclusions?
The Division of Infectious Diseases.—Infectious diseases are chiefly spread through personal contact. It is the duty of a government to prevent a person having such a disease from spreading it broadcast among his neighbors. This can be done by quarantine or isolation of the person having the disease. So the board of health at once isolates any case of disease which may be communicated from one person to another. No one save the doctor or nurse should enter the room of the person quarantined. After the disease has run its course, the clothing, bedding, etc., in the sick room is fumigated. This is usually done by the board of health. Formaldehyde in the form of candles for burning or in a liquid form is a good disinfectant. In disinfecting the room should be tightly closed to prevent the escape of the gas used, as the object of the disinfection is to kill all the disease germs left in the room. In some cases of infectious disease, as scarlet fever, it is found best to isolate the patients in a hospital used for that purpose. Examples of the most infectious diseases are measles, scarlet fever, whooping cough, and diphtheria.
Immunity.—In the prevention of germ diseases we must fight the germ by attacking the parasites directly with poisons that will kill them (such poisons are called germicides or disinfectants), and we must strive to make the persons coming in contact with the disease unlikely to take it. This insusceptibility or immunity may be either natural or acquired. Natural immunity seems to be in the constitution of a person, and may be inherited. Immunity may be acquired by means of such treatment as the antitoxin treatment for diphtheria. This treatment, as the name denotes, is a method of neutralizing the poison (toxin) caused by the bacteria in the system. It was discovered a few years ago by a German, Von Behring, that the serum of the blood of an animal immune to diphtheria is capable of neutralizing the poison produced by the diphtheria-causing bacteria. Horses are rendered immune by giving them the diphtheria toxin in gradually increasing doses. The serum of the blood of these horses is then used to inoculate the patient suffering from or exposed to diphtheria, and thus the disease is checked or prevented altogether by the antitoxin injected into the blood. The laboratories of the board of health prepare this antitoxin and supply it fresh for public use.
Antitoxin for diphtheria prepared by the New York Board of Health.
It has been found from experience in hospitals that deaths from diphtheria are largely preventable by early use of antitoxin. When antitoxin was used on the first day of the disease no deaths took place. If not used until the second day, 5 deaths occurred in every hundred cases, on the third day 11 deaths, on the 4th day 19 deaths, and on the 5th day 20 deaths out of every hundred cases. It is therefore advisable, in a suspected case of diphtheria, to have antitoxin used at once to prevent serious results.
Vaccination.—Smallpox was once the most feared disease in this country; 95 per cent of all people suffered from it. As late as 1898, over 50,000 persons lost their lives annually in Russia from this disease. It is probably not caused by bacteria, but by a tiny animal parasite. Smallpox has been brought under absolute control by vaccination,—the inoculation of man with the substance (called virus) which causes cowpox in a cow. Cowpox is like a mild form of smallpox, and the introduction of this virus gives complete immunity to smallpox for several years after vaccination. This immunity is caused by the formation of a germicidal substance in the blood, due to the introduction of the virus. Another function of the board of health is the preparation and distribution of vaccine (material containing the virus of cowpox).
Rabies (Hydrophobia).—This disease, which is believed to be caused by a protozoan parasite, is communicated from one dog to another in the saliva by biting. In a similar manner it is transferred to man. The great French bacteriologist, Louis Pasteur, discovered a method of treating this disease so that when taken early at the time of the entry of the germ into the body of man, the disease can be prevented. In some large cities (among them New York) the board of health has established a laboratory where free treatment is given to all persons bitten by dogs suspected of having rabies.
Vaccination against Typhoid.—Typhoid fever has within the past five years received a new check from vaccination which has been introduced into our army and which is being used with good effect by the health departments of several large cities.
The following figures show the differences between number of cases and mortality in the army in 1898 during the war with Spain and in 1911 during the concentration of certain of our troops at San Antonio, Texas.
1898—2nd Division, 7th Army Corps, Jacksonville, Florida. June-October, 1898
Manœuver Division, San Antonio, Texas. March 10-July 11, 1911.