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(<:C C c ccc c t'C C C" ccc ^ ^rcc ccc ((CC C C CC c I: m cc C Iff; CO-' ^r cc c .c c< ^c c c cc ccc . ^ CT> «: cc cc ^ <:c ccc -^ CC CCc cf«- CC ccc ^ €C cc c c <: • «t V CC oardman. H. C. Macatee, Assistant Secretary. GusTAvus A. Weber, Statistician, TABLE OF CONTENTS. ^^ , Letter of transmittal ^tlH^i vii The President's Homes Commission 1 Report of the committee on improvement of existing houses and elimination of insanitary and alley houses 3 Elimination of insanitary houses 6 Elimination of alley houses 7 Report of the committee on building regulations 17 Resolutions and recommendations of the commission 19 Industrial hygiene and social betterment 25 Report of the committee on social betterment 27 Part I. — Industeial Hygienp:. Chapter I. — Introduction 29 Occupations and mortality 30 Morbidity and mortality of wage-earners 32 Indoor occupations 35 II. — Occupations involving exposure to irritating dust 36 Metallic and mineral dust 37 Vegetable dust 40 Textile industries 41 Animal dust - 45 III. — Occupations involving exposure to infective matter in dust 46 Rag, paper, wool, and hair industry 46 IV. — Occupations involving exposure to poisonous dust — Lead dust.. 48 The lead industry in Massachusetts 49 Printers, type founders, and typesetters 51 Arsenical dust 54 V. — Occupations involving exposure to irritating or poisonous gases or vapors 55 Sulphur dioxide 55 Hydrochloric acid 56 Sulphuric and nitric acid 56 Ammonia 57 Chlorine gas 57 Bleaching establishments 57 Iodine and bromine vapors 58 Turpentine 58 Petroleum 58 Benzine vapors 58 Carbon monoxide 58 Carbonic acid gas 59 Carbon disulphide 59 Naphtha 59 Nitrobenzol 60 Dyeing and cleaning 60 Rubber industry 60 Patent-leather industry 61 Aniline vapor 61 Wood alcohol 62 Chrome pigments 62 Quinine 62 Manganese 62 Brass founders 62 Arsenical fumes 63 Mercury 63 Phosphorus 64 Beet-sugar industry 64 m6^S»3 III IV TABLE OF CONTENTS. Page. Chapter VI. — Occupations involving the inhalation of organic gases and vapors 65 VII. — Occupations involving exposure to extremes of heat, sudden changes, and abnormal atmospheric pressure 65 Caisson disease 66 VIII. — Occupations involving constrained attitudes 67 IX. — Occupations involving over exercise of parts of the body 67 X. — Occupations involving exposure to machinery, etc 67 Coal mining 68 Railway service 71 Railway accidents 71 Accidents and injuries 73 XI. — Employment of women and children 74 XII. — Special measures for the prevention of tuberculosis among wage-earners 80 XIII. — Measures for the protection of wage-earners 81 Sanitation of workshops and quarters for employees 82 Cubic air space and amount of fresh air per hour 83 Ventilation 84 Temperature 86 Humidity of the air 87 Lighting 88 Artificial light 88 Prevention of accidents 89 Miscellaneous sanitary provisions 91 Lodging houses and sleeping quarters 93 Permanent expositions devoted to industrial and social betterment of wage-earners 93 XIV. — What the Federal Government may do for the promotion of the welfare of its employees 94 German workingmen's insurance system 95 XV. — What the employer may do for the welfare of employees 100 XVI. — What the general public may do 102 XVII. — What the employee may do to contribute to his own welfare. . 107 Part II. — Social Betterment. Chapter I. — How to keep well and capacitated for work 109 H ouse and home 109 House cleaning 110 Temperature Ill Insects Ill Care of the skin 113 Ablutions and baths _ 113 • Clothing 114 Bed and bedding 117 Sleep 117 Importance of good teeth 119 Habit and regularity of the bowels 120 Care of the eyes 120 Care of the ear and nose 121 IL — Alimentation and foods 121 Animal food 127 Vegetable food 132 Combination of food 135 Storerooms 136 Preparation of food for cooking 137 Cooking and eating utensils 137 Volume of food 138 Meal hours 138 Good food at reasonable cost 139 Approximate weight and nutritive value of an average por- tion of some common food 142 Food value of breakfast 143 Food value of lunch 1 44 Food value of dinner 144 Food value of day's ration 144 TABLE OF CONTENTS. V Chapter II. — Alimentation and foods — Continued. Page. Food and home betterment 150 Menus for winter months 151 Menus for summer months 152 Cooking recipes for winter menus 152 Cooking recipes for summer menus 1.54 Market price of foods 156 Quantities of material to be used 156 III. — The causes and prevention of infectious diseases 157 Danger periods in hfe. 157 Sick room, care and disinfection 162 Consumption 165 Pneumonia 173 Influenza (*'la grippe") 174 Typhoid fever 175 Causes of typhoid fever 177 Typhoid fever in the rural districts 179 Why is there more typhoid fever in Washington than in northern cities 180 Diarrhea and dysentery 182 IV. — Infantile mortality 18 3 Maternal nursing 188 The anatomical and physiological characteristics of infants. 189 Care of the breasts 190 Frequency of nursing 190 Weaning of infants 191 Cow's milk as a cause of disease 193 Milk sediments or dirty milk 193 Production of pure milk 195 Certified milk 195 Pasteurized milk 11)6 Pasteurizing plants — milk depots 1 96 Advantages and disadvantages of pasteurized milk 196 Home treatment of nursery milk 198 Quantity of food for each feeding 199 Care of the nursery refrigerator, nursing bottles, nipples, utensils, etc 199 V. — The prevention of permanent disabilities in children 200 VI.— The health of the city of Washington 204 Relations of water supply and sewers to health 206 Filtration of the Potomac water 207 Influence of sewers upon the health of the community 207 Decrease in death rates since 1875 ._- 209 Causes of large death rates among the colored race 210 Regeneration of housing conditions 212 The present situation 212 Congress and the health of the District 213 VII. — Sexual and moral prophylaxis 213 Vice diseases 215 Syphilis 220 Gonorrhea 221 Crusade against the social evil 222 Educational methods 225 State methods 227 VIII.— The tobacco habit 229 IX.— The alcohol question 230 Fermented liquors 280 Wines and fruit wines 231 Beers 232 Brandv 233 Rum ; 233 Whisky 234 The nation's drink bill 234 Alcohol as a foodstuff 337 Physiological effects of alcohol 237 Pathological effects of alcohol 238 Alcohol increases the susceptibility to disease 238 Effects of alcohol upon longevity 239 VI TABLE OF CONTENTS. Chapter IX. — The alcohol question — Continued. Pflge. Effects of alcohol upon mental and moral faculties 239 Alcohol as a cause of accidents 240 Causes of intemperance 241 Poverty and drink 242 Remedial measures. .'. 244 List of alcoholic proprietary medicines 246 Recreations and inexpensive amusements 249 X. —The drug habit 251 Danger of soft drinks containing habit-forming drugs 256 Remedial measures for the victims of the alcohol and drug habit 257 Advertised habit cures 259 The harmful effects of so-called "ethical pro])rietary medi- cines, acetanilid, antipyrin, and phenacetin" 260 Thyroid extracts in obesity or antifat cures 261 The nostrum evil in general 202 Prevention of conception and feticide — Regulation of families 264 Infanticide by systematic drugging of childi en 266 Diphtheria cures 267 Injury and death to the adolescent 268 Consumption cures 268 Asthma and hay fever cures 269 Catarrh cures 270 Skin cures 271 Rheumatism cures . .- 272 Kidney and bladder cures 273 Cancer cures 274 Epilepsy cures 274 The miracle workers 277 Other forms of quackery 278 Topical remedies 278 Prescription nostrums 279 Efficient work of the Post-Office Department and of the Department of Agriculture in enforcing the law arouses opposition 281 Conclusions and recommendations 283 XI. — Sociological study of 1,251 families 284 Living conditions 286 Income and expenditures 287 Occupations 290 Employment 292 Wage-earners' lunches 293 Sickness 293 Insurance 294 Installment payments 295 Illiteracy 295 School attendance 296 XII. — The business relations of wage-earnersN 297 XIII. — The scale of wages and the cost of living 300 Compensation of government employees 303 XIV. — Suppression of usury.'. 305 The money borrower 307 The money lenders and their methods 308 Remedy proposed 310 XV. — How to benefit the poor in the slums 318 Appendix A. Healthof employees in the Government Print- ing Office, Washington, D. C, Wm. J. Manning, M. D.. 323 Appendix B. Regulation of dangerous trades in England. . . 328 Appendix C. Letters from Professor H. W. Wiley and Dr. L. T. Kebler, Bureau of Chemistry U. S. Department of Agriculture 371 Judge de Lacy 's letter 380 LETFER OF TRANSMIITAL. To THE Senate and House of Eepresentatives : I transmit herewith reports by the President's Homes Commission on improvement of existing houses and elimination of insanitary and alley houses, on social betterment, and on building regulations, to- gether with resolutions and recommendations adopted by the com- mission, and ask that they receive the careful consideration of the Congress. Theodore Roosevelt. The White House, January 5, 1909. THE PRESIDENT'S HOMES COMMISSION. REPORT OF THE COMMITTEE ON IMPROVEMENT OF EXISTING HOUSES AND ELIMINATION OF INSANITARY AND ALLEY HOUSES. BY WILLIAM H. BALDWIN, Chairman of the Committee. COMMITTEE. WILLIAM H. BALDWIN. T. C. PARSONS. F. L. SIDDONS. WILLIAM F. DOWNEY. S. W. WOODWARD. PROF. GEO. W. COOK. EMMETT L. ADAMS. S. Doc. 644, 60-i REPORT OF THE COMMITTEE ON IMPROVEMENT OF EXISTING HOUSES AND ELIMINATION OF INSANITARY AND ALLEY HOUSES. The report of the committee on the improvement of existing houses and the elimination of insanitary and alley houses naturally relates to the improvement of houses which are in any way unsafe or detri- mental to the health or morals of their occupants, or in case the owners do not think it worth while, or are unwilling to put them into proper condition, to their demolition, in order that the health of the people may not be injured by reason of them. Closely connected with the latter part of the subject is the question of alley houses, which may be structurally fit for habitation but which are so located as to make it practically impossible to supply them with proper sanitary conveniences, or to make the moral and social surroundings what they ought to be. IMPROVEMENT OP EXISTING HOUSES. At the time the committee made its preliminary report it was stated that the work of improving existing houses was being wisely and effectively carried on by the board for the condemnation of insanitary buildings, under the law of May 1, 1906. The evils due to the condi- tion into which a large number of ihe temporary and cheap structures, rendered necessary by circumstances succeeding the war, had fallen was long ago recognized, and in 1872 the board of health, which had been created by an act of Congress in the previous year, formulated a specific ordinance covering the condemnation of insanitary dwell- ings, under which in 1874, S89 were condemned, followed by 198 in 1875 and 371 in 1876 ; but the work was stopped not long afterwards by the reorganization of the health department, in which the power to condemn buildings unfit for habitation was not provided for." The necessity for further action continued, and as early as 1897 definite steps were taken toward the passage of a bill providing for the condemnation of buildings dangerous to the health or their occupants. These efforts were continued during successive years and in March, 1902, the Associated Charities formed a subcommittee on the improve- ment of housing conditions, of which the first purpose was stated to be the passage of a law which would enable the District Commission- ers, through the health department, to require the adequate repair or removal of dwellings unfit for human habitation ; but each year some objection to the proposed bill was made and it was not until May 1, 1906, after nine years of effort, that it was passed in its present form. The necessity of the bill, and the care with which it had been drawn, are shown by the excellence of the results obtained under it. <» Housing Movement in City of Washington, Dr. G. M. Kober, p. 6. 4 EEPOETS OF THE PBESIDENT's HOMES COMMISSION. The board to whom the enforcement of the law is by the act itself committed consists of the assistant to the Engineer Commissioner in charge of buildings, the health officer, and the inspector of buildings of the District, but the immediate execution of its requirements is in the hands of an inspector who is thoroughly interested in his work, and who has helped to administer the law in such a way as to secure the necessary results with the least possible hardship to the people who have been compelled by the destruction of the houses in which they were living to seek shelter elsewhere. Active work under the law was begun on July 1, 1906, and during the two years ending on June 30, 1908, the results had been as follows : Examined. Demol- ished. Repaired. Pending. Allevs 331 628 213 332 97 127 21 Streets 169 Total 959 545 224 190 Of the 769 buildings acted on 204 had been demolished and 94 repaired in the first year, and 341 were demolished and 130 repaired in the second year. It will be noticed that in the year 1907 the houses demolished amounted to 68.4 per cent of the cases disposed of and 72.5 per cent in the second year. It is probable that the proportion of houses demolished will be smaller in future, as the accumulation of dilapidated buildings ac- counts for a considerable portion of those which have been removed, and the tendency as to those which remain is to make repairs. This has been done in a large number of cases, and in addition many buildings, equal, as far as can be determined by permits issued, to three-quarters of those repaired by order of the board, have been voluntarily repaired and put into proper condition by their owners because they have known that if this was not done the board could, and would, take action in regard to them. The benefit which has resulted to those of the community most in need of help through the salutary provisions of this law is apparent, and it is a matter of congratulation that in accomplishing these satis- factory results there has been so little friction or complaint of arbi- trary or unjust action. During the last year 6 cases were referred to the corporation coun- sel for appropriate action in the police court. In one case the owner was fined $10 for failure to demolish, and in another the party was sent to the workhouse for five days for contempt of court, while the remaining cases ended in proper action by the defendants. These instances emphasize the sincerity with which the law has been exe- cuted. The law contains a provision for appeal to the supreme court of the District from the orders of the board, and two such appeals were made during the last year ; but in one case it was shown that the time for appeal had expired, and the other case was abandoned, so that the 9 houses involved in both were demolished without further delay or any cost to the board. BEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. 5 For the 94 houses repaired in 1907 no record of the number of occupants was kept. The 130 repaired in 1908 contained 609 people who were benefited by the improvement, an average of 4.7 per house. The number of people whose lives have been made more comfort- able by repairs voluntarily made by the owners of the houses on ac- count of this law can not, of course, be determined, but it is evident that a most gratifying advance in the standard of living has been made and that the reproach of Washington in this respect is being taken away. This does not mean that these homes are as yet all that could be desired, or that other improvQments in these and other houses might not well be made ; but to interfere with the independence of citizens, so long as the conditions in which they live are not dangerous to the health or morals of themselves or others, would be doing an indirect injury to our political and social status, and it is far better that the further improvement should be worked out by other influences than the strong arm of the compelling law. In its last report the board for the condemnation of insanitary buildings says: Bad housekeeping and general neglect are responsible for a great many houses being brought to the attention of the board, where, by proper attention to the ordinary household duties, there would be no occasion for complaint. The throwing of ashes and rubbish in the back yard, instead of placing it in cans for authorized collectors, results in the yard being elevated above the door in such a manner that ventilation under the floor is prevented, and it is possible for water to flow in during rain and snow storms, causing the floors to be damp. The habits of different tenants can be better noted in rows of houses where they are occupied under the same general conditions and the character of the houses is practically the same. One will be found in a clean and sanitary condition; others will be found filled with a general ac- cumulation of trash, with no attempt whatever to keep even within a semblance of cleanliness. In the annual report for 1907 the board called attention to the fact that some provision should be made for a school wherein good housekeeping could be taught, in order to teach the ignorant how to properly take care of themselves and their homes, which is an absolute benefit both to the occupants and the adjoining residents. Conditions have not materially changed since the above suggestion was made and the board, therefore, reiterates the statement. The inspector said that in one case where the board had required a sewer connection to be made, the trench which was dug showed a geological formation of 4 feet 2 inches of ashes, which had been thrown into the back yard, instead of being put into the hands of the collector of rubbish for removal. This field, however, appertains rather to the work of the committee on social betterment, which has a firmer foundation on which to build now that the experience of two years has demonstrated that a line has at last been drawn in Washington below which the con- ditions of any habitation can not fall without its being torn down and removed by constituted authority. There are still many houses which need repairs, and others, through the neglect of the owners, or perhaps as often through the carelessness of tenants, are getting into a condition which requires attention. Some, where notices are now being served by the inspector, have become unfit since the law was passed, showing the need of constant watchfulness ; but the present method promises to secure satisfactory results. 6 EEPOETS OF THE PKESIDEKT S HOMES COMMISSION. During the last two years a special inspector has been working under the authority given to require connections, where the street is provided with water and sewers, so that there are now comparatively few brick houses, even in alleys, which do not have both; and ex- tensions of water pipes are being steadily made. Residents who fail to comply with the order to connect are taken into the police court, and in case of nonresident owners the District government now makes the needed improvements, under the compulsory drainage act, and charges the cost up against the property. The building regulations require 8-foot ceilings as a minimum and all new houses or additions must conform to this, though repairs are sometimes permitted when ceilings are 7 feet 6 inches or even not higher than 6 feet 5 inches, but where they are lower than this the owner must either raise the ceiling or demolish the building, so that such cramped sleeping rooms are being done away with. ELIMINATION OF INSANITARY HOUSES. As has been intimated, the demolition of houses unfit for human habitation has gone on steadily since July 1, 1906, and in addition to the 545 up to June 30, last, 127 were torn down in the next five months, maJking 672 demolished in all, of which 245 were in alleys and 427 in streets. The proportion is due partly to the fact that the streets contain more houses, and partly to the fact that, because no more dwellings can be built in alleys, owners repair alley houses which they would destroy if they could substitute new ones for them. Up to this time the houses acted on have been mostly one or two story buildings, but there are larger ones which need attention, some of them residences converted into flats which accommodate several families. These are being taken up and one of them in Georgetown, a three-story brick, built in 1834 and known as Foxhall Mansions, is now being torn down. The committee has kept in touch with this work and there has seemed to be no occasion, in view of all the circumstances, to criticise the rate at which it is being carried on. In certain cases the in- spector has been obliged to extend the time for the vacation of build- ings to be demolished on account of the inability of the tenants to find other dwellings within their means, and while there should be no cessation of the activity of the board the absorption of displaced tenants can not be effected with much greater rapidity. The persons compelled to vacate the dwellings removed were as follows : Year ending- Houses demol- ished. Persona displaced. Average per house. Adults. Children. Total. Adults. Children. Total. June 30 1907 204 341 355 629 203 427 558 1,056 1.7 1.9 10 1.2 2 7 June 30, 1908 3 1 Total ... 645 984 630 1,614 1.8 1.2 3.0 The small average is due to the fact that many of the houses were vacant, especially in the first year. Counting only those actually REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 7 occupied, the average number in the families turned out would prob- ably be five. Some effort was made to determine definitely what became of these people, but it has been difficult to do this because they quit the premises at any time after notice is served, leaving the house vacant, and no record is made of them. Of the 1,056 persons displaced in the last year 13 were white, 1 was a Chinaman, and 1,042 were colored. The report for the year says4 A small portion of these tenants is going to the suburbs and rentyig or purchasing cheap houses, but the large majority are remaining within the city. A great many are renting the ordinary two-story brick and subletting rooms, or two families rent one house between them, one taking the upstairs and the other the downstairs, converting it practically into a two-family flat, but with none of the accommodations usually found in a building of that character. There is, at the present time, an unquestionable demand for the cheaper class of houses to take the place of those being destroyed. A further analysis of the facts shows that the houses removed during the year ending June 30, 1908, were assessed for taxation at $40,800 and that they had a rental value of $16,502.40. The average of property in an alley which was investigated as to its assessed value recently showed the land to be 35 per cent of the total, and assuming that it was 40 per cent for that from which the above houses were removed, and that the actual value of the property is 50 per cent more than the assessed valuation, the rentals indicate a gross return of 16 per cent on the investment. The rental value figures out $4.03 per month per house; but the report of the committee on building of model houses (p. 63) says that not one dwelling has been erected in Washington in the last five years which could be rented as low as $12 per month, and not more than 15 which could be rented as low as from $14 to $16.50 per month. The demolition of the houses in question, therefore, was not offset, so far as these people were concerned, by any new provision of which they could avail themselves, and sharing with others houses too expensive for one such family, with all the disadvantageslsuch an arrangement in houses not built for the purpose involves, afforded about the only means of shelter in the city. There are a few vacant houses in alleys which rent for from $8 per month up; but even one of these requires a considerable readjust- ment of the family budget for a tenant who has been paying but $4, and most of the cheapest houses which are vacant, even in alleys, rent for $10 per month or more. It is evident that such conditions, in connection with the incli- nation to demand more rent from colored people who desire to occupy decent houses, tend to keep rents high and render living properly on the wages of a day laborer still more difficult. THE ELIMINATION OF ALLEY HOUSES. By far the best way to do away with alley houses is to do away with the alleys by converting them into minor streets. So much has been said and written about the disadvantages of the alleys of Wash- ington and the evils of having scattered through the heart of the city a population discredited by the very location of their dwellings, and the difficulty of caring for and supervising them although really 8 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. in very close contact with the best residences of the city, that the problem seemed to be one requiring action rather than argument; and as " the rearrangement of the building space within the larger squares of the District of Columbia " was stated by Mr. Reynolds to be one of the purposes of the commission recommended in his report and as the work of improving existing houses and eliminating other insanitary houses has been progressing satisfactorily, as de- scribed above, this committee has devoted its chief energy to assist- ing in the conversion of the undesirable alleys into minor streets. Under the law of July 22, 1892, as amended on August 24, 1894, the Cominissioners at the time of the appointment of the conmiission had taken action in 12 cases upon the advice of a board consisting of the chief of police, the secretary of the board of charities, and the surveyor of the District, which had been appointed by the Commis- sioners for the purpose of investigating and advising them in regard to the alleys which most needed to be opened up because the conditions in them were detrimental to the general welfare of the city. As was stated in the preliminary report the progress of this work had been interrupted by the decision of the Supreme Court of the United States in the Brandenburg case on March 11, 1907, which declared it illegal to assess all the damages on certain property as provided by the existing law unless the property was found to be benefited to that extent. The Commissioners at the time expressed the intention of having the law amended at the coming session of Congress so as to remove this obstacle and anticipated no difficulty in doing this ; and as noth- ing further could be done in such cases without this further authority, the committee kept in touch with the situation and waited for the necessary action to be taken. In the first days of January last, before Congress convened after the holiday recess, it was stated in one of the papers that the Engineer Commissioner, who had succeeded to the office after the proceSiings had been begun, had recommended that the cases in three of the alleys be dropped because he had inspected them and was of the opinion that the expenditure of the sums necessary to pay the damages which would be incurred in opening them up as proposed would not be justified. One of these cases is Blagden's alley, square 368, concerning which the chief of police and his associates on the board stated in the recom- mendation for its conversion into a minor street that — Blagden's alley, located between Ninth and Tenth and M and N streets, con- tains 54 houses inhabited by a negro element who live in poverty and are a source of constant trouble. The dwellings are insanitary and dilapidated and afford shelter to ten or twelve persons each. Another is square 620, as to which the board reported : Logan's place contains 35 insanitary dwellings, which are very much over- crowded, and the Inhabitants, being of a vicious character, give the police more or less trouble. Everyone familiar with these and other such labyrinths realizes the security from police supervision which they afford, to say nothing of other disadvantages which fully justified the recomimendation of the board. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 9 There was no suggestion of any other plan, and the only reason given was that it was not worth while to spend the money required to do away with the wretched conditions by which the city has been for so long disgraced, and as this objection, if sustained, would make permanent such conditions in these three alleys, which are among the worst in the city, and put the whole matter upon a different basis, the committee took the subject up with the Commissioners and strongly urged that no effort be spared to pursue the original plan of the Commissioners, and to provide some way by which they could proceed to open up such alleys as they might, after investigation, think it worth while to convert into minor streets. These suggestions were cordially received by the other two Commissioners, and it was understood that the subject would be discussed with the corporation counsel with a view to arriving at the best way of accomplishing this object, and that any assistance which the committee could give would be wel- comed. The committe therefore consulted with the corporation counsel and looked up the law in other places, but as one of the Commissioners was compelled to go to the hospital for a considerable stay, not long after this, further action was delayed. The situation, which was fully reported to the commission at a meeting held January 17, 1908, seemed so serious that the commission adopted a resolution urging that the District Commissioners " take all possible steps toward opening alleys into minor streets in each case recommended by the committee ap- pointed for the purpose, and that such changes in the present law be recommended by the Commissioners as will permit the conversion of these alleys or any others into minor streets, to the end that all such alleys may within a reasonable time be done away with;" and the report of the committee, with this resolution, was submitted to the Commissioners by the chairman of the President's Homes Com- mission. The principal difficulty with the present law seemed to be that it required that an amount equal to the damages found should be as- sessed as benefits and that this should be assessed within a limited area. It was found tliat the law of 1906 in relation to the opening, extension, widening, or straightening of streets, provided that the jury should assess benefits not only upon adjoining and abutting prop- erty, but upon any and all other lots, pieces, or parcels of land which the jury might find to be benefited by the improvement. This ap- parently indicated a plan by which the amounts required could be raised in a more equitable manner, but as it seemed probable that in many case? the damages awarded would even then exceed the benefits which the jury might find, it seemed desirable to include also a pro- vision by which a certain proportion of the awards could, if necessary, be paid out of some general fund. One of the Commissioners had suggested, when the Engineer Com- missioner recommended that the work be stopped on account of the expense, that legislation might be urged providing that the alleys be opened and a certain proportion of the expense be paid by the United States Government, another portion by the District govern- ment, and the remainder be assessed upon the property owners in the neighborhood of the improvement Inasmuch as the deplorable con- ditions of the alleys have grown up under the administration of the 10 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. District government, it seems proper that a considerable portion of the expense of removing them should be borne in this way by those responsible for them; but, as any payment for District purposes by the Federal Government would be contrary to the definite policy adopted by Congress, it did not seem advisable to the committee to advocate such a provision. In order, however, to expedite the passage of any bill recommended and to profit by the advice of the District Committee in each House of Congress, as well as to secure their cooperation in any plan which might be proposed, the committee consulted with the chairman of each of the District Committees as to what fair provision would be most effective. The chairman of the Senate Subcommittee on Streets and Avenues declared that conditions which he had himself recently witnessed in the alleys of the city ought nowhere to exist, and that he would be glad to do all he consistently could to remove them. After full discussion he stated that if the amount to be paid from the general funds of the District could be limited to 25 per cent of the total damages awarded in any case, and the remainder be assessed upon any property benefited, he would earnestly recommend such a provision, with the full expectation that such a bill might be promptly passed by Congress. The chairman of the House committee, when consulted, concurred in this view and promised similar cooperation. A meeting of the commission, at which this plan was unanimously indorsed, was promptly held and the recommendation for such a bill was imme- diately put before the Commissioners by the committee, with every reason to expect that it would be promptly acted upon, so that the measure might be passed before Congress adjourned. Notwithstanding the fact that two of the Commissioners were heartily in favor of the general plan, the matter was delayed, and upon inquiry it was found that the Engineer Commissioner strongly objected to the plan proposed, on the ground that no jury would be apt to assess in any case more than 75 per cent of the damages found, and that in this way the District would be made to pay for 25 per cent of the cost of opening many alleys and minor streets in property where the expense should all be borne by the property owners who requested it. As further investigation developed the fact that there are numerous cases of this kind to which it was not intended to have this provision apply, the matter was again taken up with the corpora- tion counsel and a modification adopted limiting the operation of this provision in each case to the conversion of alleys into minor streets running through the block. When, however, this reached the Engineer Commissioner he still objected to the bill on the ground that it was likely to do injustice to the District, declaring that juries would not assess greater damages in any case than they were compelled to and that the only way to meet the situation was to introduce a special bill in Congress for each alley. As the special bills introduced for this purpose in reference to squares 1020, 878, and 801 had received no attention and the amount of effort needed to secure the passage of any bill is very great, and as it would be necessary in the case of each special bill to take up the attention of Congress with the objections of interested parties which could better be considered and attended to by the Commissioners, who EEPOBTS OF THE PRESIDBlirT's HOMES COMMISSIOK. 11 have m Infant Mortality, Newman, p. 137. 80 REPOKTS OF THE PRESIDENT'S HOMES COMMISSION. weaver's wages will not allow of the wife's remaining at home, considering the high rents and rates, and so both go — which is the rule — and a hand-to-mouth existence results even for themselves, let alone the little ones, who are left in the intervals to the mercies of the nurse, who, as a rule, takes in the babies to eke out her own husband's wages. Much good may be done by hygienic tuition, but I am certain that the root of the whole matter with us is, as I have said, comparatively low wages and high rents and rates. In the discussion of infant mortality it would be unfair not to em- phasize other facts, such as impure and dirty milk and 1-room tene- ments. Of 54,047 infantile deaths which were investigated both in the Old and the New World as to the character of feeding, it was found that 86 per cent had been artificially fed. Neumann," in inves- tigating 2,711 infantile deaths in Berlin, found that 1,792 occurred in 1-room apartments, 754 in 2-room apartments, 122 in 3-room apart- ments, and 43 in apartments of 4 rooms and over. It is hoped that Doctor Newman's study of the subject will result everywhere in the amelioration of existing conditions, for, as pointed out by the author and Sir John Simon, a high death rate of infants suggests racial degeneracy and is at least " an indication of the exist- ence of evil conditions in the homes of the people — which are, after all, the vitals of the nation." Doctor Daniels, in speaking of the female labor question in New York, says : That in no case in over 515 families examined by her was any woman work- ing other than from dire necessity. The average weekly income from the man's work was $3.81. The average rent was $9 per month. The average family to be supported was 4i persons. As it requires more than two weeks' wages to pay one month's rent, it is evident that the women and children must work or the family go hungry. (Charities, April 1, 1905.) Those interested in female labor as carried on in the " sweat shops " of New York at the rate of $3 to $4 a week should not fail to read ''The Long Day: The True Story of a New York Working Girl as Told by Herself." Chap'iier XII. SPECIAL MEASURES FOR THE PREVENTION OF TUBERCULOSIS AMONG WAGE-EARNERS. There is abundant statistical evidence to show that industrial workers pay a very heavy tribute to the so-called " white plague ; " nor is it cause of wonder when the many unfavorable factors to which they are subjected are considered, such as crowded and insanitary workshops, deficient light, overwork, long hours in a bad air, damp- ness, exposure to extremes of heat and cold, sudden changes in tem- perature, and the inhalation of irritating dust, vapors, etc. All of these factors are calculated to lower the power of resistance and favor the spread of disease, especially when some of the workmen themselves are already afflicted and are careless in the disposition of their expectoration. On the other hand, it would be unfair not to consider the influence of home environment, such as unclean and crowded or otherwise insanitary dwellings, insufficient or improper food, and last, but not • Deutsche med. Wochenschrift, Leipzig, 1904, p. 1723, KEPORTS OF THE PKESIDENT's HOMES COMMISSIOK. 81 least, the bad effects of the abuse of alcohol. It has been shown that alcohol not only affects the digestive and nervous functions, in con- sequence of which the general nutrition of the bod^ is markedly reduced, but the habit of visiting and remaining m saloons for hours, sometimes till midnight, deprives the individual of proper rest and exposes him to the poisonous fumes of tobacco, coal and carbonic- acid gases, and other injurious agents. The preventive measures are partly the duty of the State, which should regulate the air space and ventilation of the workshops and dwellings and improve the working conditions by forced ventilation and "wet processes" in order to diminish dust production and exposure to irritating gases. On the other hand, it is clearly the duty of the worlanen themselves and the community at large to improve social and housing conditions. In view of the undue prevalence of consumption among file cutters, metal grinders, stone cutters, and cotton, flax, and tobacco operatives, persons predisposed to this disease should be cautioned against engaging in such occupations. Simple printed instructions should be given as to the part expectoration plays in the spread of consump- tion. Cuspidors in sufficient number and properly disinfected should be provided, preferably one for each workman, and promiscuous expectoration should be forbidden. Chapter XIII. MEASURES FOR THE PROTECTION OF WAGE-EARNERS. From what has been said it is evident that the laboring classes need special protection against the many dangers referred to, and this should emanate from the State, the employers, the community, and the employees themselves. One of the important predisposing causes to disease is overwork or fatigue, because the accumulation of waste products in the blood, from muscular wear and tear, together with the expended nervous energy, combine to render the system more susceptible to disease. Excessive work is inimical to health, and long hours and hard work are calculated to diminish the general power of resistance, and thus bring about physical deterioration. Hence the necessity of laws regu- lating the hours of labor and the enforcement of a day of rest as contemplated by the Sunday laws. Professor Roth's conclusions on this subject are as follows :« (1) In order to prevent a state of chronic fatigue it is essential that the amount of work be regulated by the capacity of the individual; (2) the more intensive the work and the shorter the intervals of rest for the elimination of waste products the earlier we may expect mani- festations of fatigue, and the working hours must be regulated ac- cordingly ; (3) other industrial dangers, like excessive heat, humidity, violent concussions, constrained attitude, overexercise of certain groups of muscle, exposure to vitiated air and toxic agents favor premature fatigue, and should be controlled by rational measures; « Ermuedimg dnrcli Berufsarbeit Intern. Kongress fuer Hygiene und Demo- gaphie, Berlin, 1907, Band, ii, p. 620. S. Doc. 644, 60-2 1 82 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. (4) insufficient and improper food, vicious habits, long walks to place of work, and abuse of alcoholic drinks lower the vital powers and produce premature fatigue; (5) monotonous work or any employ- ment involving responsibility and intense mental application are con- ducive to fatigue. All of these factors should be considered and controlled by suitable preventive measures, so as to avoid the chronic effects of fatigue, which are generally evinced by anaemia, digestive derangements, neurasthenia, respiratory and cardiac difficulties. No child should be permitted to work in factories and wage-earning occupations under the age of 14, and then only upon presentation of a medical certificate that it is free from physical defects. Such children should not be obliged to work longer than six hours, with a two-hour interval of rest after the first three hours, so that they may be able to enjoy their noon dinner. Under no circumstances should they be permitted to perform night work or engage in the so-called danger- ous occupations. The same may be said of indi\dduals between the age of 16 and 18 years, who, however, may be permitted to work eight hours a day, with proper intervals for meals and rest. Women, even from a moral standpoint, should not be permitted to work in factories or shops after sundown. The laws of some coun- tries prescribe one hour for nooning, if they have their own house- holds, and their exclusion from factories six weeks before and after confinement, while in other countries hard labor for women is strictly forbidden. SANITATION OF WORKSHOPS AND QUARTERS FOR EMPLOYEES. The protection of wage-earners should extend to the work and workshops, and, in case the employees are housed by the employer, also to the living and sleeping quarters. A sanitary workshop demands sufficient air space for each inmate, a suitable temperature, proper ventilation and illumination, general cleanliness, and suitable opportunities for personal cleanliness. The necessity for abundant ventilation is apparent when it is recalled that men at work eliminate more carbonic-acid gas than individuals at rest, and that in the majority of occupations the air is further vitiated by the presence of dust and gases. The question of illumination is not only important for the preven- tion of defective vision and accidents, but when recourse is had to arti- ficial illumination the additional vitiation of the air must be con- sidered. Such matters, which, after all, are largely questions of public health, should not be left to the individual employer, but the principles of industrial hygiene which ought to be adopted should be embodied in suitable laws and enforced by competent inspectors. Among the most dangerous forms of workshops is one class whicli most state laws entirely ignore. For example, under the law of tlie State of New York relating to manufacturing in tenement houses, 33 distinct industries may be carried on in the living rooms of the workers, because they involve hand work or simple machinery. There are over 23,000 licensed " home factories " in the city of New York alone. Dr. Annie S. Daniels, who made a special investigation of manufacturing in tenements, says <» " that every garment worn by a • Charities, April 1, 1905. / REPORTS OP THE PRESIDENT'S HOMES COMMISSION. 83 woman is found being manufactured in tenement rooms; the same is true of clothing worn by infants and young children. In addition to wearing apparel for men, women, and children, including adorn- ments of woman's dress, the flowers and feathers for her hats, the hats themselves, and neckwear of every description, she found the manu- facture of paper boxes, cigars, pocketbooks, jewelry, clocks, watches, wigs, fur garments, paper bags, etc., and the articles frequently handled and stored in infected rooms." According to Doctor Daniels, among the 150 families tabulated by her, 66 continued at work during the entire course of the contagious disease for which she was attending the family, and the question naturally arises. How many germs of tuberculosis, measles, scarlet fever, diphtheria, and other infectious diseases may be sewed in the garments made in the tenement " sweat shops ? " "And last, but not least, the greatest danger falls upon the workers — ^it means the loss of health, physically and morally, the loss of home, because home life is impossible in a tenement workroom." Apart from the occupations referred to, numerous bakeries, candy, ice-cream, and milk shops ; butcher shops and sausage factories ; bot- tling establishments; tailor, cobbler, and other repair shops are carried on in basements under the most insanitary surroundings as regards workrooms and sleeping quarters. CUBIC AIR SPACE AND AMOUNT OF FRESH AIR PER HOUR. Reference has been made to the baneful effects of vitiated air, which are of course intensified when the occupation is attended with the pro- duction of dust and irritating fumes or gases. It is known that car- bonic acid is not itself a toxic agent, but an excess of this gas in the air of rooms leads to a deficiency of oxygen and also to defective elimina- tion of carbonic acid from the system, which can not be excreted whenever the tension of carbonic acid in the air exceeds that of the carbonic acid in the blood. In order that the respiratory impurities may not exceed certain limits (6 volumes of carbonic acid per 10,000), it has been found that an average adult requires 3,000 cubic feet of fresh air per hour, and this amount should be supplied without dis- comfort to the occupants. Experience has shown that the air of a room can not be changed oftener than three times in one hour in winter without causing a disagreeable draft; hence every occupant should have a cubic air space of 1,000 feet. This is the ideal standard, and section 100 of the factory laws of New York of 1901 (as amended by chapter 129, acts of 1906), relating to certain manufactures in tene- ments, provides " that the whole number of persons therein shall not exceed one to each 1,000 cubic feet of air space." Such an ideal standard, however, is not alwaj^s attainable in workshops, and it is believed that for practical purposes an air space of from 400 to 500 cubic feet per capita will suffice. The States of New York, Indiana, Michigan, New Jersey, Ohio, Pennsylvania, and Wisconsin appear to be the only States which make a definite provision on this point, and they require an air space of 250 cubic feet for each employee between the hours of 6 a. m. and 6 p. m., and, unless by written consent of the factory inspector, not less than 400 cubic feet for each employee between the hours of 6 p. m. and 6 a. m., provided such room is lighted by electricity, etc. This is a step in the right direction, but it would be extremely desirable to 84 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. place the minimum amount of cubic air space at 400 feet for day work and 500 feet for night work, unless electricity is used, in which case a uniform standard of 400 feet might be prescribed. At all events the question of sufficiency ought not to be left to the discretion of the factory inspector. Either the cubic air space should be speci- fied or the carbonic acid limited to 12 volumes per 10,000. VENTILATION. Ventilation, which means the removal and dispersion of bad air and the introduction of fresh air, is accomplished either by natural or artificial means. Natural ventilation is usually sufficient when each occupant has 1,000 feet of cubic air space, the walls of the building are porous or contain numerous crevices near the doors and windows, the difference betwen the indoor and outdoor temperature is consider- able, and the winds strike the walls directly or pass with great veloc- ity over chimney flues or other openings. But as the direction and force of the winds and the other factors referred to can not be con- trolled, other means should be provided for ventilation. For this purpose, open windows, doors, and revolving fans answer very well in summer. The objection to this method are the cold drafts in winter. In rooms heated with direct radiation the fresh air should therefore be admitted above the heads of the occupants, either by fresh-air reg- ister inlets in the walls or by the insertion of louvered or swinging windows, thus an upward direction being given to the air, so that it rnay impinge on the ceiling, mix with and be warmed by the heated air in this situation, falling gently into all parts of the room, and being gradually removed by means of the foul-air outlets, aided by exhaust fans. Another simple plan is to bore slanting holes in the bottom rail of the window sash, or to employ a Pullman or Bury ventilator, or to insert a piece of board 4 inches wide across the window sill. The separation of the sashes thus caused will provide for indirect fresh-air inlets. Artificial ventilation, which may be secured by providing (1) suit- able inlets and outlets; (2) by extraction by heat, or the creation of a decided difference between the inner and outer temperature; and, (3) by propulsion and aspiration. Space will not permit to enter into details except to say that besides the contrivances already men- tioned, any of the ordinary registers in which the air passes through the walls by means of a perforated iron plate and is then directed upward by a valved plate with side checks will prove of service. McKinnel's ventilator consists of two cylinders, one inside the other and of different lengths, the longer tube, projecting above and below, serves to conduct the impure air, while the outer cylinder, having a larger sectional area, serves as an inlet. The outlet is protected on the top with a cowl, and both tubes can be regulated by valves. They are especially useful in the ventilation of one-story buildings or the upper story of any building. If gas is used as an illuminant, the burners may be placed immediately under the extracting tube. As the warm air escapes through the inner tube a corresponding volume is admitted through the interspace between the two cylinders. The Ridge ventilators consist of openings through the ceiling and roof with louvered sides and ends, protected with a small roof, the opening of the air shaft in the ceiling usually being provided with REPORTS OF THE PRESIDENT S HOMES COMMISSION. 85 suitable registers. The fresh air is admitted by the means ah-eady referred to, or by registers placed behind radiators. If the building is heated by stoves, the fresh air may be admitted by inlets running underneath the floor between the joists and discharging through a register near the stove. Extraction of foul air by heat is usually accomplished by placing a separate flue next to the chimney flue ; the latter, if in use for firing purposes, creates an upward current. If this is not sufficient it may be promoted by gas jets or a steam coil placed in the flue. The propulsion and aspiration system is especially adapted for all large buildings and factories, and consists of mechanical devices by which the fresh air is forced into and distributed throughout the building by the use of fans or air propellers, the foul or objectionable air being removed by so-called exhaust fans. A number of States have made statutory provisions for the ventilation of workshops, and quite a number, including California, Connecticut, Illinois, Indiana, Iowa, Maryland, Massachusetts, Ohio, Oregon, Pennsylvania, Michigan, Minnesota, Mississippi, New Jersey, New York, South Dakota, Washington, and Wisconsin, require mechanical devices for the re- moval of injurious dust or gases. Of these States several lay down specific rules concerning the construction of workbenches and hoods. The latter empty into air shafts connected with exhaust fans, and thus extract all dust and fumes without material injury from drafts to the operatives. The provisions apply especially to operations in which emery wheels or belts or other buffing processes are employed. The laws of the State of Michigan, acts of 1899, furnish a good ex- ample of regulations of this character. ACT NO. 202. — Factories and workshops — Blowers for emery wheels, etc. Section 1. All persons, companies or corporations, operating any factory or workshop, where wheels or emery belts of any description are in general use, either leather, leather covered, felt, canvas paper, cotton or wheels or belts rolled or coated with emery or corundum, or cotton, wheels used as buffs, shall provide the same with fans or blowers, or similar apparatus, when ordered by the commissioner of labor, which shall be placed in such a position or manner as to protest [protect] the person or persons using the same from the particles of the dust produced and caused thereby, and to carry away the dust arising from, or thrown off by such wheels, or belts, while in operation, directly to the outside of the building or to some other receptacle placed so as to receive and confine such dust, and the same shall be placed in such factory or workshop within three months after this act shall take effect, in the manner and accord- ing to the directions and specifications as herein, in this act set forth : Pro- vided, That grinding machines upon which water is used at the point of grind- ing contract shall be exempt from the conditions of this act: And provided further, That this act shall not apply to solid emery wheels used in sawmills or planing mills or other woodworking establishments. Sec. 2. It shall be the duty of any person, company, or corporation operating any such factory or workshop to provide or construct such appliances, appa- ratus, machinery or other things necessary to carry out the purpose of this act, as set forth in the preceding section, as follows: Each and every such wheel shall be fitted with a sheet or cast-iron hood or hopper of such form and so applied to such wheel or wheels that the dust or refuse therefrom will fall from such wheels or will be thrown in such hood or hopper by centrifugal force and be carried off" by the current of air into a suction pipe attached to same hood or hopper. Sec. 3. Each and every sueh wheel six inches or less in diameter shall be provided with a three-inch suction pipe; wheels six inches to twenty-four inches in diameter with four-inch suction pipe; wheels from twenty-four inches to thirty-six inches in diameter with a five-inch suction pipe; and all 86 - REPORTS OF THE PRESIDENT'S HOMES COMMISSION. wheels larger in diameter than those stated above shall be provided each with a suction pipe, not less than six inches in diameter. The suction pipe from each wheel, so specified, must be full sized to the main trunk suction pipe, and the said main suction pipe to which smaller pipes are attached shall, in its diameter and capacity, be equal to the combined area of such smaller pipes attached to the same; and the discharge pipe from the exhaust fan, connected with such suction pipe or pipes, shall be as large or larger than the suction pipe. Sec. 4. It shall be the duty of any person, company or corporation operating tiny such factory or workshop, to provide the necessary fans or blowers to be c'ormected with such pipe or pipes, as above set forth, which shall be run at such a rate of speed as will produce a velocity of air in such suction or dis- charge pipes of at least nine thousand feet per minute or an equivalent suction or pressure of air equal to raising a column of water not less than five inches high in a U-shaped tube. All branch pipes must enter the main trunk pipe at an angle of forty-five degrees or less. The main suction, or trunk pipe, shall be below the polishing or bufling wheels and as close to the same as possible and to be either upon the floor or beneath the floor on which the machines are placed to which such wheels are attached. All bends, turns or elbows in such pipes must be made with easy smooth surfaces having a radius in the throat of not less than two diameters of the pipe on which they are connected. Sec 5. It shall be the duty of any factory inspector, sheriff, constable or prosecuting attorney of any county in this State, in which any such factory or workshop is situated, upon receiving notice in writing, signed by any person or persons, having knowledge of such facts, that such factory or workshop, is not provided with such appliances as herein provided for, to visit any such factory or workshop and inspect the same and for such purpose they are hereby author- ized to enter any factory or workshop in this State during working hours, and upon ascertaining the facts that the proprietors or managers of such factory or workshop have failed to comply with the provisions of this act, to make com- plaint of the same in writing before a justice of the peace, or police magistrate having jurisdiction, who shall thereupon issue his warrant directed to the owner, manager, or director in such factory or workshop, who shall be there- upon proceeded against for the violation of this act as hereinafter mentioned, and it is made the duty of the prosecuting attorney to prosecute all cases under this act. TEMPERATURE. It is a well-known fact that the welfare and capacity for work of individuals are to a great extent influenced by the surrounding tem- perature. Reference has been made to occupations involving ex- posure to extremes of heat and cold, dampness, and sudden changes. The human organism possesses the faculty of maintaining a uniform temperature, i. e., it so regulates and harmonizes the production and the loss of animal heat that the normal temperature of the blood, 98.2° F. is not materially affected, and in this the skin doubtless plays the most important role. Whenever cold acts upon the skin the irritation is primarily exerted upon the nerves, which transmit it to the central organs of the nervous system (the heat-regulating center) , and from there it is reflected to the nerves of tlie cutaneous vessels and muscular fibers, which promptly contracts, and in con- sequence of a diminished blood supply there is less loss of heat. If, on the other hand, heat instead of cold plays upon the skin, we have dilatation instead of contraction of the vessels, with an increased sur- face blood supply and corresponding loss of heat by radiation and conduction. At the same time the perspiratory glands are stimulated to greater activity, more sweat is excreted and evaporated, and still more heat is dissipated. One of the bad effects of profuse perspira- tion is that the blood is deprived of some of its constituents. The blood is taken away too long from the internal organs ; the proper dis- tribution of the blood supply is interfered with, and in consequence REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 87 tone and nutrition of the stomach, lungs, heart, and other internal organs is lowered. We lose our appetite and suffer from indigestion ; the tone and nutrition of the stomach, lungs, heart, and other internal enervation, and the system in consequence is rendered more suscep- tible to disease. While the human organism endeavors to adapt itself to extremes of heat and cold, the faculty of the body to maintain the equilibrium is by no means unlimited, and the heat-regulating center is liable to fail or become paralyzed if imposed upon too long or too frequently. This is especially the case during sudden changes of temperature. It is the abruptness which offends the peripheral nerves, and the ^eater the abruptness the more intensive will be the irritation which IS transmitted by reflex action to other parts of the body, usually the weakest parts, and may result in driving the blood to internal organs, causing congestion and other mischief. Then again a cold draft playing on the cheek may cause neuralgia, paralysis, sore throat, bronchitis, or pneumonia, showing that cold applied locally may excite disease in the neighborhood of its application or in distant organs, and finally it may produce disease by checking the secretions of the skin. The most agreeable temperature for average healthy adults prop- erly clothed and performing light work is between 65° and 70° F., and every effort should be made to avoid extremes of heat and cold. Much may be done to reduce the temperature of workshops by forced ventilation and a supply of cool, fresh air. The windows should be kept open during the summer nights, so that the rooms may be thor- oughly flushed with fresh and cool air. HUMIDITY OF THE AIR. The atmosphere always contains a certain amount of water in the state of vapor, which varies from 30 per cent to complete saturation, or, according to temperature, from 1 to 12 grains in a cubic foot of air. The degree of atmospheric humidity is of special hygienic importance, as it influences to a great extent the cutaneous and pul- monary exhalation of vapor and in consequence also affects the ani- mal temperature. The average daily amount of water eliminated by the skin is 2J pounds, and about 10 ounces by the lungs. It is evident that when the air is damp it lessens evaporation, as it pos- sesses little drying power, and the water from the skin and lungs is with difficulty evaporated. The evaporation of perspiration, by which much heat is rendered latent, is one of the chief sources of cooling of the body. Consequently when the air is hot and moist the humidity tends to increase the effects of the heat, the blood is with difficulty kept at its proper temperature, and all the disagree- able effects of a high temperature are intensified. This condition may be so aggravated that the temperature of the body exceeds the normal degree and causes our cases of so-called heat stroke or heat exhaustion, which occurs especially on hot, sultry days. A damp, cold, or chilly air also produces mischief, as it abstracts an undue amount of animal heat, lowers the general vitality of the system, and favors the development of diseases of the respiratory passages, neuralgic and rheumatic affections, and aggravates the severity of such attacks. We may conclude, therefore, that excessive 88 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. humidity tends to intensify the effects of both heat and cold. On the other hand, excessive dryness of the air is also harmful; it increases evaporation, the skin becomes dry and chapped, and the mucous membranes of the mouth, eyes, and respiratory passages are irritated, causing so-called catarrhal conditions. For all these reasons an aver- age relative humidity between 65 and 75 per cent has been found most healthful, and efforts should be made to maintain such a standard whenever practicable. Apart from methods calculated to accomplish these results, reliable thermometers and hygrometers are required to secure efficient control. State legislators would do well, instead of making a general provision for sufficient heat, moisture, etc., to pre- scribe a standard, at least in industries w^here such standards are practicable and can be reasonably enforced. LIGHTING. The natural light in workshops should be sufficient so that the eyes need not be strained even on cloudy days. When the light is defect- ive the objects have to be brought too near. The eyes in consequence converge, and the muscular strain thus induced causes a gradual elongation of the anterior-posterior axis of the eyeball, and near- sightedness results. In addition it is believed by specialists that 80 to 90 per cent of the headaches are caused by eye strain. It has been found by Putzeys* that the natural lighting in temperate climates will usually come up to hygienic requirements when the area of win- dows, exclusive of sash frames, equals one-sixth of the floor space. In order that the light may penetrate the deeper portions of the room, the windows should reach almost to the ceiling and the glass should be either pure white ribbed or prismatic and kept clean. Wis- consin is apparently the only State which has undertaken to legislate specifically upon this point, as section 3 of chapter 79, acts of 1899, provides : Every window shall have not less than 12 square feet in superficial area, and the entire area of window surface shall not be less than 12 per cent of the floor space of such room. The difficulty of securing a sufficient amount of daylight in build- ings located on narrow streets surrounded by tall buildings has been partly overcome by glass building blocks 8 bjr 6 by 2^ inches, with an air chamber in the center, used instead of brick or stone, in connec- tion with steel-frame construction, but more particularly by the intro- duction of prismatic glass, which refracts and diffuses the light. ARTIFICIAL LIGHT. No matter how obtained, artificial li^ht differs from daylight in this, that it does not furnish a pure white light, the prevailing rays being red, yellow, or violet. Whatever difference or opinion there may be as to the color best suited to our eyes, we know that our vision is most perfect under the influence of a white light, and this ought to be a good criterion. One of the disadvantages of all low- power illuminants is that the light is never as bright as daylight, in- volving, therefore, closer application of the eyes and consequent strain « Cited by Munson, Military Hygiene, 1901, p. 521. EEPORTS OP THE PKESIDENT S HOMES COMMISSION. 89 of the muscles of the eyeball. These remarks are hardly applicable to the electric arc light and the Welsbach gas burner, the rays of which, like the direct solar rays, may indeed be so glaring as to cause undue irritation of the retina. Another harmful effect of artificial illumination is the unsteady or flickering character, especially seen in the electric arc light, and which on account of the abrupt changes is likely to irritate the retina. Another disadvantage is that the ordinary illuminants, except the electric light, tend to vitiate the air by the products of combustion, and also affect the temperature and humidity of the air by the heat evolved. The requirements of a hygienic light are that it should be as near as possible the color of the sunlight, sufficiently ample but not too glaring; it should be steady, and instead of deteriorating the air it should as far as practicable be utilized to promote ventilation; nor should the heat evolved be sufficiently intense to be a source of dis- comfort to the inmates in warm weather. The most common methods of lighting now employed are the electric incandescent lamps, arc lights, mercury-vapor lights and electric bulbs, gaslight, and kero- sene lamps. Of these, the electric lights, especially the mercury-vapor lights, are superior to gas or other illuminants because there is little or no danger from fire, there are no products of combustion, hence no pollution of the air, nor are the temperature and humidity of the room affected to any perceptible extent. These advantages over gas or kerosene are of special importance to the inmates of the buildings where the question of fresh air and temperature plays an important role; hence many industrial plants find it profitable to install the very best type of electric lighting, and thereby save time and money by the prevention of sickness and accidents among their employees. Next to the electric light, gas, especially in connection with a Wels- bach or Siemen's burner, or the acetylene gas, offers the next best choice. In the absence of either electric or gas light, kerosene with a high flashing point should be preferred over other illuminants. In all such instances suitable outlets for tlie products of combustion should be provided. White, clean ceilings and walls will be of great service not only in solving the question of light, but also in general sanitation, and a number of States, notably Indiana, Kentucky, Missouri, New Jersey, and New York, require the walls to be limewashed or painted. The sufficiency of artificial lighting may be approximately deter- mined by observation, and quite accurately by the employment of Bunsen's method and his photometer. In this country and England, according to Munson, " the unit adopted for the measurement and comparison of lights is a No. 6 sperm candle burning 8 grams per hour and giving out a light known as ' 1 candlepower.' " Such a candle contains on analysis carbon 80 per cent, hydrogen 13 per cent, oxygen 6 per cent, and in combustion yields equal volumes of car- bonic acid and watery vapor to the air, namely, 0.41 cubic foot. PREVENTION OF ACCIDENTS. About 22 States have taken steps to reduce accidents to a mini- mum. For this purpose they have enacted laws concerning employers' liability if they fail to provide safety devices for the movable and 90 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. dangerous parts of machinery. Apart from proper screening, belting, etc., the use of respirators, wire masks, and goggles are absolutely essential for the prevention of accidents or injuries in many employ- ments. At least 27 States require some form of protection in case of fire, by means of fire escapes and doors swinging outwardly, while a respectable number also insist upon inspection and registration of steam boilers. A careful inspection of steam boilers and examination of engineers have materially lessened the dangers from boiler explosions, so that in England there is only about 1 explosion in 6,200 registered boilers. It has been suggested that employees who come in contact with moving machinery should provide themselves with suitable clothing, so fitted and arranged as to reduce the dangers to a minimum. There is an endless variety of suitable patterns in the market, of which the snug-fitting duck union suits properly buttoned and adjusted are the best. Asbestos clothing has been recommended for firemen and fur- nace operators; but as it is rather heavy, light leather suits or aprons are preferable, while even ordinary clothing may be rendered practi- cally noninflammable by chemical treatment. The following views of Mr. Frederick Hoffman <» in his excellent article on industrial accidents are reproduced : The present state of American industrial accident statistics does not warrant final conclusions regarding the true rate of the risk in different employments nor of the approximate determination of the occupation hazard, by degree of injury, for the more important industrial employments. Most of the present information is limited to the facts of accidental death or injuries generally, and while such data have their value they require to be made more specific to throw light upon the larger problem of accident prevention and working- men's compensation for industrial casualties. The importance of such infor- mation has been clearly brought out in an address on " Valuation, in Actions for Damages for Negligence, of Human Life, Destroyed or Impaired," by Miles M. Dawson, before the International Actuarial Congress in 1903.* For insurance and other purposes, however, the data presented in this article will prove useful and emphasize the more dangerous trades and the present ten- dency toward an increase or decrease in the risk of accidental injury in the more important dangerous occupations.'' To the workingman himself there is no more important problem than the most effective protection of his life and health against the accident risk inherent in, or incidental to, the occupation in which he is employed. Much that could be done for his protection is still neglected, though many important and far-reaching improvements have been introduced in factory practice during the last decade. Accurate statistics alone can furnish a reasonable basis for reform. The possibilities for successful accident prevention have been clearly demonstrated in the experience of foreign countries and the exhibition of safety devices of the American Institute for Social Service. SOCIAL ASPECTS OF THE ACCmENT PROBLEM. " The facts presented in this article warrant the conclusion that the casualty risk in American industries is a most serious one, toward the reduction of which every effort should be made. At least a more « Bulletin of the Bureau of Labor No. 78. Washington, D. C, September, 1908. * Proceedings Fourth International Congress of Actuaries, 1904, Vol. I, p. 929. "A useful and suggestive work on the prevention of accidents in industry has been published by the German Association of Trade Unions entitled : Un- fallverhiitungsvorschriften, herausgegeben vom Verbande Deutscher Berufs- genossenschaften, Berlin, 1900. Mention may also be made of a valuable treatise on definition of invalidity under the title : Der Begrifif der Erwerbsun- fahigkeit auf dem Gebiete des Versicherungswesens, by H. Siefart, Berlin. 1906. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 91 earnest effort should be made to profit by the industrial methods of European countries. Granting that the underlying conditions are often quite different, and that many of our industrial accidents are the result of ignorance, reckless indifference, or carelessness, the fact remains that an immense amount of human life is wasted and a vast amount of injury is done to health and strength, with resulting phys- ical impairment, which has a very considerable economic value to the nation as a whole. If, for illustration, the accident liability of em- ployees in coal mines in the United States were reduced from 3.10 per 1,000, which was the average annual rate for the period 1897-1906,* to 1.29 per 1,000, the average rate in the United Kingdom for the same period,^ the annual saving in human life would be 915. If the rate of casualties of railway employees in this country were re- duced from 2.50 per 1,000, which was the average annual rate for 1897-1906," to 0.98 per 1,000, the average for the German Empire for the same period,^ the annual saving would be 1,735 valuable human lives. As stated at the outset, upon a conservative estimate, the total mortality from accidents in the United States among adult male wage-earners is between 30,000 and 35,000, of which it should not be impossible to save at least one-third and perhaps one-half by intelligent and rational methods of factory inspection, legislation, and control. In addition there were approximately not much less than two million nonfatal accidents, that not only involve a vast amount of human suffering and sorrow, but materially curtail the normal longevity among those exposed to the often needless risk of industrial casualties." (Hoffman.) MISCELLANEOUS SANITARY PROVISIONS. A number of States have enacted laws concerning general cleanli- ness of factories and workshops. Most of the factory laws make pro- visions for the necessary sanitary conveniences, such as privies, water- closets, and urinals, and where men and women are employed separate dressing rooms and water-closets are called for. Some of the States, like Wisconsin, for example, specify " that when the number employed is more than 25 of either sex there shall be provided an additional water-closet for such sex up to the number of 50 persons, and above that number in the same ratio." The author believes that there should be at least one water-closet or privy for every 20 employees. A large number of States make seats for female employees, wash rooins, and dressing rooms obligator}'-, and not a few insist upon sepa- rate provisions for the sexes. The importance of personal cleanliness has been pointed out. In certain occupations the washing of the hands before eating is important, and in occupations involving exposure to poisonous dust or agents the employment of a general bath should be encouraged by insisting upon the introduction of suitable shower baths. * Computed from the mine inspectors' reports of the various States. ^ Computed from statistics included in the annual reports of the Home Office entitled "Mines and Quarries: General Reports and Statistics, London." ^ Computed from statistics shown in the Report of the Interstate Commerce Commission, Statistics of Railways, 1906, pp. 42, 109. '^Computed from Statistisches Jahrbuch fiir das Deutsche Reich, 1908, pp. 85-88. 92 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. A few States, notably Massachusetts and Rhode Island, make pro- visions for " fresh drinking water of good quality." The former also regulates the spitting habit by insisting upon suitable spittoons. These and other questions, like clothes lockers and lunch rooms, and the time allowed for the noonday meals, which is already regulated in a number of States, should receive universal attention. Much industrial legislation has been enacted by state legislatures during the past ten years. Commendable progress has been made in the pro- vision of ventilation, heating, lighting, removal of dust, and general sanitation of workshops. The need for additional improvement is shown by the Massachusetts board of health's survey of the work in that State, which has generally been in the lead in factory laws. The report of the state board of health, on page 4, reads : In many [industries] the conditions were found to be satisfactory. In the emery and corundum, sandpaper, and certain other industries more attention should be given to keeping the dust away from the mouth and nostrils of the workmen. In the rag dusting, sorting, and cutting rooms of some paper mills very objectionable amounts of dust were found, with some pale and sickly ap- pearing operatives ; but there are mills using the same kind of stock where the dust is kept away from the employees in a satisfactory manner, and much im- provement is practicable in the former class. The same remarks are applicable to the textile industries, and the hope is expressed that the unsatisfactory conditions found in the minority of establishments will be raised to" those which are now found to be good. Reference Kas already been made in these pages to the conditions found in machine shops, the cutlery and tool industry, cigar, rubber, boot and shoe, and other industries examined. In the boot and shoe industry comment is made upon " four conditions which can be and ought to be remedied." These are poor ventilation, inadequate re- moval of dust from machines, the conditions of water-closets, and spit upon the floors. In the majority of factories visited the ventilation was found to be poor, and in many of them distinctly bad. Of the rooms not especially dusty, 102 were badly ventilated and 26 were overcrowded. * * * Of 84 of the many dusty rooms reported, 40 were also overcrowded, 35 were dark, 21 were overheated, and 18 were over- crowded, dark, and overheated. " In more than one-third of the factories visited the conditions of water-closets were not commendable; most of them were dark and dirty to very dirty. In 50 establishments no spitting was noticed, in 173 there was some, in 115 considerable, and in 35 much." " In some establishments lunch rooms are provided, where employ- ees may eat the luncheon they have brought or may buy one ; in much the larger number the employees eat in the workrooms. * * * In 85 factories, or 23 per cent of those visited, a considerable proportion of the employees are noticeably pale and unhealthy." In discussing the following provision in the Massachusetts laws, "All factories shall be kept clean," the state board of health very properly points out that " what is clean in an ax-grinding factory would not be clean in a silk mill ; but the law makes no distinction, and the judgment of the officer can not be received as law." The board considers it impossible to specify in any law a standard of cleanliness applicable to all industries, and advises " that the officer should be authorized to hold all factories in any industry up to the REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 93 standard of cleanliness which he finds maintained in the factories in the same industry and using the same grade of stock which are the cleanest." The same method is recommended for the enforcement of standards in other directions, subject to an appeal to the state board of health. LODGING HOUSES AND SLEEPING QUARTERS. It not infrequently happens that large industrial plants and con- tractors provide board and lodging for their unmarried employees. Again, in a number of the smaller industries the employees not infre- quently board with the family and are obliged to sleep in objection- able rooms. All such provisions should come up to a reasonable standard as regards salubrity, air space, light, heat, and ventilation, and separate provisions should be required for males and females and youthful employees. Lodging houses should come up to a certain standard, and wash and bath rooms and suitable tiolet facilities should be provided. Special attention should be paid to general cleanliness within and without quarters for working parties, and to the character and preparation of food. PERMANENT EXPOSITIONS DEVOTED TO INDUSTRIAL AND SOCIAL BETTER- MENT or WAGE-EARNERS. It will require time and patience to bring employers and workers to a full realization of the dangers incident to the various occupations and to a thorough appreciation of the methods which have been pro- posed in the way of factory sanitation, safety devices, ete. Good re- sults abroad have been accomplished by a permanent exposition de- voted to social and industrial betterm'ent for wage-earners. Such an exposition was provided for by the German Parliament a few years ago, and a similar effort is now being made in the city of New York. The German exposition occupies a building specially erected for the purpose at Charlottenburg, a suburb of Berlin, and here every safety appliance which inventive genius has devised can be seen in practical operation. The different labor unions appear to profit immensely by the special lectures and demonstrations which are given on Sundays, or, upon request, at any convenient time, by men formerly employed in " dangerous occupations." Apart from safety devices for ma- chinery and appliances for removal of dust and injurious gases, all improved methods calculated to diminish danger, as, for example, in the manufacture of white lead, etc., are illustrated by models and de- scriptive text, printed leaflets being distributed free of charge. Here, too, may be seen the best and most recent types of respirators, wire masks, goggles, illuminating appliances, and safety working suits. Inventors and designers esteem it a great honor to have their prod- ucts admitted for exposition. Only meritorious objects are displayed, and they are replaced by the newer and more satisfactory types. One of the most interesting collections consists of a series of bottles containing different varieties of dust, a series of photographs show- ing the microscopical character of this dust, and, last but not least, anatomical specimens and microscopical slides showing the effects of dust upon the air-passages and lungs of the human subject. Models, plans, and photographs of tenements and model homes for wage- 94 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. earners, exterior and interior decorations, literature, and charts con- cerning industrial betterment, all find a prominent place in the ex- hibit. The display of foodstuffs, their nutritive and economic value, together with instructive leaflets, form part of this interesting expo- sition. A popular pamphlet seen at the exposition in September, 1907 was compiled by Professor Kalle and Doctor Schellenberg, entitled " How to keep well and capacitated for work," which is sold by the Society for Popular Education at 2^ cents a copy, over 470,000 so far having been sold. Chapter XIV. WHAT THE FEDERAL GOVERNMENT MAY DO FOR THE PROMOTION OF THE WELFARE OF ITS EMPLOYEES, ETC. Much excellent work has been and is being done by the United States Bureau of Labor in the collection and publication of facts con- cerning every phase of industrial and social betterment. These bul- letins are issued bimonthly, and if carefully read can not fail to exert a tremendous educational influence upon those for whom they are pri- marily intended, viz, the wage-earners and employers. But while much has been achieved more remains to be accomplished. It seems to the writer that apart from establishing, in connection with the Na- tional Museum, a permanent exposition relating to industrial and social betterment of wage-earners, it is clearly the duty of the Fed- eral Government to establish and adopt a standard of industrial hygiene for all the government workshops. President Roosevelt, in a message to Congress December, 1907, has said : The National Government should be a model employer. It should demand the highest quality of service from each of its employees and it should care for all of them properly in return. Congress should adopt legislation providing for limited but definite compensation for accidents to all vi'orkmen within the scope of the federal power, including employees of navy-yards and arsenals. We regret to say that with the possible exception of the extraor- dinary efforts and special precautions exercised to protect the health and general welfare of the employees in the operations connected with the construction of the canal on the Isthmus of Panama, the sanita- tion of offices and workshops in this country proper, for government employees, is not even on a par with some of the best private indus- trial concerns. There can be no question that model government workshops and efforts for the promotion of the general welfare of the employees would prove a salutary precept and example. The General Government is not in a position to legislate for the States, but it can at least enact a model labor and factory law for the Dis- trict of Columbia, and all of the workshops connected witli the army and navy arsenals, gun factories, powder depots, clothing depots, and the immense army of labor employed on the Isthmus of Panama. Apart from strictly sanitary measures for the promotion and pres- ervation of health, the Government, as a model employer, should provide some adequate relief in case of sickness, accidents, or disa- bility from disease or injuries contracted in the line of duty. As it is now, the Government merely grants one month's sick leave to oflfi- KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 95 cials and office employees, none to workmen employed in government shops, and in case of accidents the employee or his dependents have no remedy except recourse to the courts of law. While it is true that government employees in many instances have banded together for the purpose of establishing sick benefit and relief associations, such organizations lack official control and do not always embody the most advanced principles of social and political economy. INDUSTRIAL INSURANCE. For reasons briefly stated, the Federal Government would do a wise act, by creating the so-called industrial insurance system, for the sick, for accidents, disability and old age, for its own employees and others in the District of Columbia, and thus initiating a system which has proved to be a veritable blessing in many of the European countries. Any one who desires to become familiar with the " German working- men's insurance " should not fail to read a digest in the Bulletin of the Bureau of Labor No. 53, July, 1904, page 941, and Professor Henderson's " Summary of European Laws on Industrial Insurance." (Charities, December 7, 1907, p. 1191.) « Under the operation of the German law, enacted in 1883, all work- men employed in commerce, industry and the handicraft trades, and whose wage is less than 2,000 marks (about $480) must be insured. By special regulations this requirement may be extended to agricul- tural and household employees. To secure the enrollment of indi- viduals " for sick benefits," the employers in the industries subject to the law are required to send to the proper insurance fund the names of each person who enters or leaves their service. The income of the sick funds is derived from the dues of members — the amount is fixed by each local association, but can not exceed 6 per cent of the members' wages. The employee, pays two-thirds of the dues and the employer one-third. The employee's share is de- ducted from his wages and paid direct to the insurance fund by the employei;, when he remits his own share. The benefits offered by the sick funds vary in amount, but all of them are required to provide the following as a minimum: (1) Free medicine, attendance, and treatment. (2) In case the sickness causes inability to work, the fund pays a sick benefit equal to one-half the wage rate which was used in calculating the member's dues. This benefit begins the third day after the disability sets in, and continues for 26 weeks. Instead of receiving medical treatment at home a member is entitled to treatment at a hospital, in which case an amount not exceeding one-half of his daily wage is paid to his dependents. Female members receive similar benefits for a period of six weeks fol- lowing confinement. (3) In case of death, a funeral benefit equal to twenty times the amount of his daily wage is paid to the heirs of a member. In 1904 there were 22,912 local sick and miners' provident associa- tions in the German Empire with 11,400,000 members, practically « The writer is indebted to these sources for much of the informatioa on this subject and gratefully acknowledges this indebtedness. 96 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. one-fifth of the population. The disbursements amounted to 237,- 107,000 marks (about $56,470,000). Of this amount 106,000,000 marks (about $25,238,000) was paid for sick benefits, and the remain- der for medical and hospital treatment, convalescence and funeral benefits. ACCIDENT INSUBANCE. Under the provisions of the laws of 1884, 1887, and 1900, all work- ingmen and technical experts engaged in industry, agriculture, for- estry, transportation, and coast fisheries earning less than 3,000 marks (or about $715) per annum, are required to be insured against acci- dent. By special enactment it may be extended to foremen and petty emplo3'ers with more than 3,000 marks income. This form of insur- ance is administered by associations of employers known as " mutual trades associations," subject to federal supervision. In 1904 there were 114 associations, including 5,300,000 establishments and 17,- 500,000 workmen. The workingman's share of the expense of the accident insurance consists of the benefits paid out of the sick insur- ance fund to the injured person during the first thirteen weeks of dis- ability. The share of the employer is determined from the amount of his pay roll and the danger rate of occupation. Beginning with the fourteenth week the trades association provides (1) free medical treatment; (2) a pension during the continuation of the disability, whether the disability is partial or complete. In case of complete disability the pension is equal to two-thirds of the earnings of the in- jured person; in case of partial disability the insured receives a frac- tion of the above pension, proportioned to the degree of disability. In case of a fatal accident, the law provides for (1) a funeral benefit of not less than $12; (2) a pension to the dependents of the deceased, including parents, beginning with the day of death. The widow and each child up to the age of 15 receives 20 per cent of the earnings of the deceased, though the sum of these pensions may not exceed 60 per cent of such earnings. Premiums paid in 1904 were $35,592,000; disbursements, $30,- 552,000, viz, to 758,392 injured members, to 65,503 widows, 97,246 children, and to 3,647 parents of those killed. INVALID AND OLD-AGE PENSIONS. Invalid and old-age pensions were made compulsory under the German law of 1889 (revised in 1899) for all wage-earners with an income of less than $480 per annum ; the provisions may also be ex- tended to include petty employers and persons in household industry. The invalid pension is paid without regard to age to those persons whose earning capacity has been permanently reduced to less than one-third. The pension is also paid to those who have been in a state of disability for twenty-six weeks and continues as long as the disability lasts. To be eligible for this pension, the insured person must have been a member of the " insurance institute " for two hundred weeks, during which time not less than 100 payments of weekly dues must have been made. If the disability has been incurred purposely the right to a pension ceases and the offender is liable to criminal prosecution. REPORTS OP THE PRESIDENT'S HOMES COMMISSION. 97 In addition to the pension from the " insurance institutes " the Empire grants a stipend of 50 marks (about $12) per annum to invalids, as well as persons over 70 years of age. Members are divided into five classes on the basis of wages received. Each class pays a different rate of dues and receives benefits in pro- portion. The lowest invalidity pension granted is $27.70, the highest IS $107.10 per annum. The dues range from 3J cents per week, according to the wage class in which the member is enrolled. One- half of the amount is paid by the employer and one-half by the employee. The old-age pension is paid without regard to earning capacity when the seventieth year of age is completed. Members must have paid dues for one thousand two hundred weeks before they become eligible for such a pension. In 1904 there were 40 inavlid pension organizations, with 13,800,000 insured members. Premiums paid in, $36,960,000 ; disbursements, $35,520,000. The average invalid pension is $37.20, and the old-age pension $37.68, varying in amount with the wage class. The financial soundness of the system is secured by making the employers, the guilds, and parishes eventually responsible for any deficit in the various sick insurance organizations. The national, state, and local governments guarantee the payment of claims against the accident and invalidity insurance organizations. SYNOPSIS OF PRACTICAL RESULTS. The financial status of the workingmen has been improved at least to the extent of the benefits received from the amounts contributed by the employers and the Government. Experience has shown that employers have not deducted their share of the dues from wages. The hygienic conditions of the workingmen have been improved, both on account of the safeguards which the accident insurance organ- izations require employers to use and because of the special efforts made by the " sick funds " to reduce the sick rate among the members to a minimum. The general knowledge in regard to the preservation and promotion of health, which the " sick fund organizations " have disseminated by means of circulars, monographs, popular lectures, etc., have exerted a tremendous educational influence in the promotion of health and morals. One of the most beneficent features of the entire system has been that parts of the funds of these organizations are invested in model houses, hospitals, and sanitoria for the use of members. The writer, during his visit to Berlin in the autumn of 1907, had occasion to inspect some of these workingmen's houses, as well as the most complete and elaborate sanatorium in the world, at Beelitz,near Berlin. The object of this is to provide the very best facili- ties for the speedy recovery and the restoration of earning power of the industrial wage-earner. Doctor Bielefeldt (Med. Keform, 15th Jahrg, 1907, p. 238) calculates that in the treatment of 159,802 tuber- culous patients between 1897 and 1906 the net gain, in spite of an expenditure of 56,000,000 marks, amounted to more than 4,500,000. It is interesting to note that the Prussian " insurance institutes and sick funds " in 1907 alone maintained 28 hospitals and sanatoria, the latter chiefly for consumptives and convalescents. One of the latest features was the establishment in 1902 of a special hospital for sexual diseases in the male, at Lichtenberg, near Berlin, and a sanitorium S. Doc. 644. 60-2 8 98 REPORTS OF THE PRESIDENT S HOMES COMMISSION. for nervous and anaemic female wage-earners in Pyrmont (Hann- over) ; all upon the principle that it is in the highest degree good economy to restore as speedily as possible the unproductive to the ranks of the producers. Some conception of the good work may be found by a brief description of the sanatorium at Beelitz, which was erected in 1902 by the " insurance institute " of Berlin at a cost, according to report of directors, June, 1907, of 15,287,994 marks. Average number of patients, 413 males and 203 females; number of cases treated in 1906, 4,192 ; number of hospital days, 212,457 ; expense for 1906, 1,470,062.25 marks, or at the rate per capita per day of 6.92 marks. One portion of the institution is devoted to the treatment of incipient cases of tuberculosis ; another, and entirely detached depart- ment, to cases of every description requiring high-grade sanatorium treatment in order to prevent premature invalidity. Each of the handsome and spacious pavilions accommodates 200 males or 100 females ; apart from these are 4 porters' lodges for the 4 departments under separate inclosures, 1 general administration building, 1 central power and heating plant, 1 central bathing establishment, 1 disinfect- ing plant, 3 pumping stations, kitchen, laundry, workshops, quarters for medical officers, employees, bowling alleys, hothouses, stables, etc. The hospital staff consists of 10 physicians and 128 employees. * The writer was informed in September, 1907, that since the estab- lishment of the " sick funds " and " insurance institutes " in Germany, poverty has decreased and the number of patients treated wholly at public expense has markedly diminished, as workingmen, even of the humbler classes, prefer to devote their sick benefits to hospital care, rather than be a charge upon the parish or country. Income, expenditures, and invested funds of the insurance system. Item. Sick insur- ance, 1901, Accident insurance, 1902. Old-age and invalidity insurance, 1902. Total of all insurance, 1835 to 1901. Dues of employers Dues of employees Subsidy of Imperial Government. Interest and other income .' $13,952,723 .1 31,126,584 $29,907,868 Totalincome. 2,604,130 3,743,936 $16,539,308 16,539,308 9, 008, 227 8,054,310 $508, 445, 565 487,147,059 51,049,907 93,588,044 47, 683, 437 33,651,804 60,141,153 1,140,230,575 Expenses for relief — Cost of administration Total expenditures Inrested funds 43, 595, 450 .| 2,590,837 46, 186, 287 44,421,557 25, 735, 679 29,701.662 "4^^0^,235 28, 658, 559 2,843,541 31,502,100 835,009,441 239,779,652 309,020,248 EFFECTS OF THE INSURANCE SYSTEM ON THE EMPLOYER AND CONSUMEB. The foregoing table shows that the system has materially added to the financial burdens of the employer, but it is believed that they have not been too heavy; at least they have not injured Germany's ability to compete in forei^ markets. One authority estimates that the amount paid by the employer for accident insurance is 3 per cent of the wages, for sick insurance IJ per cent of the wages, and for old-age and invalidity insurance, 1 per cent, or a total of 5^ per cent of the wages added to the cost of pro- duction. Doctor Lass, of the imperial insurance office, concludes. REPORTS OP THE PRESIDENT S HOMES COMMISSION. 99 however, that this burden has not been shifted to wages, nor has it resulted in higher prices to the consumer, but has been made up by improved methods of production. The writer has purposely devoted much space to the German in- dustrial insurance system, because he realizes that sickness and funerals are the most potent causes of poverty and distress ; he knows from personal knowledge that prior to 1883 Germany depended upon employers' liability laws, charitable organizations, and private com- panies for the protection of her wage-earners, with very questionable results. While much has been achieved in other directions for the prevention of disease, the most distinct gain in social-political en- deavors was made by the enactment of these laws, and especially the law of June, 1889, authorizing " insurance institutes " to invest part of their funds in hospitals and sanatoria, thus affording the best pos- sible facilities for the speedy recovery and the prevention as far as practicable of permanent disabilities. According to Zacher (Leitfaden zur Arbeiterversicherung des Deutschen Reiches, 1906) , quoted by Professor Henderson, " at the end of 1905 in all 70,000,000 pensioners (sick, injured, invalids, and their dependents) had received $1,200,000,000 in benefits. The work- men have contributed less than one-half of the premiums, and have received $480,000,000 more than they have paid out. Property is owned to the amount of $408,000,000, of which $120,000,000 have been invested in w^orkmen's dwellings, hospitals, and convalescent homes, sanatoria, baths, and similar institutions of welfare." There is no pauperization in a method where the beneficiary con- tributes such a large share to the undertaking. As a matter of fact, methods in vogue in our own country are calculated to shift all of the burden upon the taxpayer. For a more complete exhibit, the following tables are reproduced from Professor Henderson's article in Charities, December 7, 1907 : SICKNESS INSURANCE (SINCE 1885). Marks. United States equivalent. Sickness payments. Physicians Medicines, etc .Hospitals Death benefits Lying-in women . . . Various benefits — 1888-1904 1905 In round numbers ,114,629,489 514,803,920 402,757,651 303,061,148 83, 763, 839 36, 513, 672 38,414,074 2, 493, 973, 763 250, 000, COO 2,744,000,000 5267, 500, 077. 36 123, 552, 940. 80 96,661,836.24 72, 734, 675. 52 20,103,321.36 8, 770, 481. 28 9,219,377.76 598, 553, 710. 32 60,000,000.00 658, 560, 000. 00 ACCIDENT INSURANCE (SINCE ] 18S5). 759,172,928 191,777,559 34,275.716 55,010.333 6,927.990 7, 747, 570 2,846,489 $182,201,502.72 46,026,614.16 8, 226. 171. 84 13,202,479.92 1,662,717.60 1,859,416.80 683,157.36 Payments to dependents of deceased Medical care Death benefits Widows 1885-1904 1,057,758,586 136, 000, 000 253,862,060.40 32,640,000.00 1905 In round numbers 1,194, 000, OCO 286,560,000.00 100 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. INVALID AND OLD-AGE PENSIONS (SINCE 1891). Marks. United States equiyaleut. Invalid pensions Old-nge pensions Medical care Return of premiums At marriage At death At accident 1891-1904 1905 In round numbers . . 560, 486, 961 836,472,378 55,371,747 38,025,117 13,422,508 171,201 $134,516,870.64 80,753,370.72 13,389,219.28 9,126,028.08 3,221,401.92 41,088.24 1, 003, 949. 912 162, 000, 000 240, 947, 878. 88 38,880,000.00 1,166,000,000 279.840.000.00 It is sincerely hoped that the wage-earners of this country may profit by the experience elsewhere by the adoption of a similar system, and thus avoid the dangers and losses to which they are now so fre- quently subjected by unscrupulously managed insurance concerns. There appears to be no good reason why the National Government should not inaugurate such a system for its own employees. In this connection it may be well to refer to a most successful precedent in the establishment of the United States Soldiers' Home in Washington. This institution was founded in 1851 with $100,000 paid as indemnity by the City of Mexico. Every soldier is taxed at the rate of 12J cents per month, which is deducted from his pay. This together with the fines from courts-martial and forfeited pay from deserters is turned into the treasury of the home. The home now owns property costing over $2,500,000, accommodates 950 inmates, pays a commutation at the rate of $8 per month to soldiers having dependents and unable to avail themselves of the privileges of the home, amounting to about $20,000 a year, and still has a reserve fund of about $4,000,000. Chapter XV. WHAT THE EMPLOYER MAY DO FOR THE WELFARE OF EMPLOYEES. It has been stated at the outset that social betterment can not be disassociated from industrial betterment, and it is here that the em- ployer can do much for the welfare of his employees. Apart from a" cheerful compliance with the laws and ordinances which may, from time to time, be enacted for the protection of the working classes, it is clearly the duty of the employer to promote in every way the effi- ciency and earning power of the wage-earner and to pay such wages as are necessary to improve the standard of living among poorly paid employees. There is no dojbt that thoughtful employers generally realize that they are not only responsible for the proper technical training of ap- prentices, but also for their habits, and a gratifying number of estab- lishments have made every effort to surround them with all possible chances for improvement, mentally and morally. There is a class of youthful employees, both males and females, for whom the writer begs to enter a special plea ; they are entitled to every consideration, because, either as a result of inheritance or faulty environments, they REPORTS OP THE PRESIDENT'S HOMES COMMISSION. 101 have acquired a general inaptitude; they are perfectly willing to work, but awkward in all their movements — simply do not know how to work — and soon exhaust the patience of their instructors. Such persons are found seeking to make an honest living in nearly all occupations, and while they may be better adapted to some employ- ments than others, to discharge them without a fair trial means their utter ruin. Here appears to be a field for human sympathy, and special pains should be taken to teach them, by patient fellow-work- men, how to handle tools and work to better advantage, whether it is with the pick or shovel, at the ploughshare, the street or house broom, or in the diversified employments of artisans' workshops. INDUSTRIAL BETTERMENT. Space will not permit to enter into details concerning efforts which have been made at home and abroad in the promotion of the general welfare of the working classes. At a meeting of the American Social Science Association, held in Washington, April 18, 1901, Mr. J. H. Patterson, Dayton, Ohio, read a paper on factory sanitation and described a large manufacturing plant of which he is the head, and their close adherence to the principles of hygiene and the uplifting of mankind. The interior of the factory is painted in cheerful colors, extra windows were made to give light, forced ventilation to afford plenty of fresh air, and all dust and acid fumes are carried away by exhaust fans. Bathrooms and well-furnished toilet rooms are on all the floors. All seats have backs. Clean aprons are furnished by the company, and a dining room where hot meals are served and a course in domestic economy is conducted. The grounds around the factory and the houses of the employees are healthful and attractive. " We have demonstrated," said Mr. Patterson, " that this system pays the employee, the manufacturer, and the buyer, in the health of one, profit of the second, and the improved quality of the product pur- chased by the third." Bulletin No. 31, Department of Labor, Novem- ber, 1900, contains an article on betterment of industrial conditions, showing what has elsewhere been accomplished, every effort being in the right direction. Among the most important may be mentioned (1) the increasing of industrial efficiency through industrial schools and manual training classes; (2) the care for employees' health and comfort by means of bathing facilities, gymnasiums, calisthenics, baseball, bicycle clubs, dining and lunch rooms, the furnishing of hot lunches free, or at cost, improved sanitary conditions and appliances ; (3) the improvement of domestic conditions by means of improved dwellings, instruction in sewing, cooking and housekeeping, in land- scape and kitchen gardening, and the exterior and interior decora- tions of homes; (4) the care of sick and disabled employees and their families by means of free insurance, medical attendance and hospital facilities, and by the encouragement of beneficial organizations; (5) club organizations for social, recreative, and intellectual purposes by means of free lectures, libraries, kindergartens and educational classes, social gatherings, summer outings, meeting places, game rooms, banquets, dances, etc.; (6) the encouragement of musical and dramatic clubs and the promotion of spiritual life by means of Sun- day schools and general religious work; (7) the cultivation of thrift 102 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. through savings-bank facilities, building associations, or provident organizations, rewards for valuable suggestions of employees, for faithful service or the manifestation of zeal and interest in their employment; (8) the promotion of employees' personal interest in the successful co^iduct of the business by encouraging and assisting them to purchase shares, financial aid to employees in case of unusual hard- ships and distress, and the cultivation of cordial and even confidential relations between employer and employees. (For details consult Bul- letin of the Department^of Labor No. 31, pp. 1117-1156.) It is gratifying to note that, although Washington is not an indus- trial center, a large number of firms have taken steps for the promo- tion of the general welfare of employees. Chapter XVI. WHAT THE GENERAL PUBLIC MAY DO. There is a tendency at present among young men, the sons of par- ents who have accumulated some means, to expect to live and grow rich w^ithout manual labor. It is becoming fashionable to look upon the mechanic with disdain, to consider manual labor degrading, an evidence of low breeding, and all such nonsense. The young men want to be bookkeepers, bankers, lawyers, doctors, or office holders, anything which does not involve manual labor, and expect their fathers to furnish the means to- attain the goal of their ambition ; as a result the professions are overcrowded and men fail who might have been successful in the handicrafts. Let us teach our children to respect and perform honest labor, whether it is behind the plow- share, in the saddle, or in the workshops. It will teach them self- reliance, prudence, and perseverence. It will be conceded that the burdens of improving industrial and social conditions should not be carried by the employer and employees alone. There are many phases of vital importance from the stand- point of public health and humanity which should concern every thoughtful man and woman. Reference has already been made to the appalling and dangerous conditions under which many of the trades and occupations are carried on in tenement houses. While this is, in part, due to the greed of the manufacturer, because it means less factory space, less rent, light, fuel, and a decidedly smaller pay roll, the consumer is equally to blame, because of his constant demand for cheaper goods, quite oblivious to the fact that the garments may be a source of danger from infectious diseases, and are stained with the sweat and blood of helpless women and little children. During one of the presidential campaigns a clever orator referred to Glasgow, and told us that 41,000 of the 100,000 laboring families of that manufacturing center lived in 1-room tenements, and that this one room for a family of father, mother, daughters, and sons told what the wages in Scotland were and how they dragged humanity down into bestiality and misery. We need not go to Glasgow for such illustrations, for to our shame it must be confessed that similar conditions obtain in nearly every American industrial city. The effects of such conditions upon death rates will be presently referred to. In the meantime, it will be readily conceded tnat the people do BEPORTS OF THE PBESIDENT^S HOMES COMMISSION. 103 not live as a rule in such quarters from choice, but from sheer neces- sity. Low wages compel the working classes not only to find shelter in houses unfit for human occupation, but also affect their health and the health of their children by insufficient food and clothing, and last, but not least, it means the utilization of child and female labor in some of the most atrocious forms referred to on another page. Indeed, there is much reason for assuming that low standards of liv- ing, which insufficient wages tend to beget, play a very important role in physical, mental, and moral degeneracy. " Physical health is the basis of mental health." This aphorism of Aristotle has been proved to be true by the experience of every educator. Professor Dawson, in his study of youthful degeneracy (Pedagog- ical Seminary, Vol. IV, p. 2), found among the boys and girls m reform schools evidence of physical degeneracy as shown by lighter weights, shorter statures, and diminished muscular power, and de- clared that 16 per cent of those examined by him were " clearly suf- ferers from low nutrition." It is to be hoped that the public con- science may be sufficiently aroused to insist upon adequate wages for all classes, and that the producer and consumer alike will be willing to assume this responsibility, not as a matter of charity, but in justice to the laboring classes. In the whole range of social betterment and sanitation, especially in our efforts to combat tuberculosis, no field affords better oppor- tunity for philanthropic work than the erection of sanitary homes for wage-earners, at reasonable rentals, the encouragement of cooking schools, and the establishment of model lodging and eating houses. The new York City and Suburban Homes Company has now for divi- dend disbursements 4.5 per cent a year on an investment of $5,500,000. The Washington Housing Companies have an investment of over one million, have paid, respectively, 4 and 5 per cent from the very incep- tion of the companies, and have a surplus fund of over $100,000. London has more than $100,000,000 invested in model tenements. HOUSES FOR WAGE-EARNERS. The housing of the working classes has very properly been made the subject of legislation in many countries, and is a matter in which factory owners, labor unions, and the general public should be deeply and mutually interested. There are several systems of dwellings for artisans and laborers, viz, individual houses or cottages, a row of houses under one roof, and the so-called " flats." Preference should be given, when practicable, to the cottage system, but in large cities unfortunately the value of real estate frequently compels the erection of large tenements, and in such an event the State should insist upon hygienic requirements as regards air space, light, and ventilation. No home can be considered sanitary where one room has to answer the purposes of a living room, sleeping room, and kitchen or where the water-closet or privy is used by more than one family. EVIL EFFECTS OF INSANITARY HOUSES AND OVERCROWDING. The primary object of habitations is to secure protection from the influence of heat, cold, rain, sunshine, and storms, and thus promote the health and happiness and indirectly also the morals and culture of the human race. 104 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. The intluence of sanitary houses can not be overestimated. Doctor Villernie, in an investigation in France from 1821 to 1827, found that among the inhabitants of arrondissements containing 7 per cent of badly constructed dwellings, 1 person out of every 72 died ; of inhabit- ants of arrondissements containing 22 per cent of badly constructed dwellings, 1 out of 65 died, while of the inhabitants of arrondisse- ments containing 38 per cent of badly constructed dwellings, 1 out of every 15 died. With the present rapid transit facilities in every city, our voice should be clearly in favor of individual homes ; and when this is im- practicable, we should insist on broad streets and deep yards. No more than 68 per cent of the lot should be covered by the house, and the height of the building should never exceed the width of the street. The baneful effects of tenement houses should be avoided, as infec- tious diseases are more liable to spread in consequence of aerial infec- tion and the more intimate contact of the occupants. Apart from structural defects, there is no doubt that the death rate is largely determined by the number of occupants to a room. Russell has shown that in Glasgow, when the average number of per- sons to each room was only 1.31, the mortality was 21.7 per 1,000, and when the number of occupants amounted to 2.05 for each room, the mortality reached 28.6 per 1,000. According to Korosi, the mortality from infectious diseases at Budapest is only 20 when the number of occupants to each room does not exceed 2, but is 29 per 1,000 with 3.5 occupants, 32 per 1,000 with 6.10 occupants, and 79 per 1,000 when there are more than 10 occu- pants to each apartment. TJae death rate at Berlin, in 1885, among the 73,000 one-room ten- ements was 163.5 per 1,000, against 5.4 per 1,000 among 398,000 resi- dents occupying four or more room apartments.** The analysis of 2,701 infantile deaths in Berlin during 1903, investigated by Neumann, has been presented elsewhere in this work. Insanitary dwellings are to be found everywhere, and particularly in older cities, erected at a time when the principles of sanitation were comparatively unknown. One of the most important municipal problems is to correct existing evils by the enactment and enforce- ment of suitable laws. It requires, however, a strong public senti- ment to bring about a complete and satisfactory reformation, as evi- denced by the housing movement elsewhere, for in spite of the excel- lent tenement-house laws in New York, according to Homer Folks, of 370,000 dark rooms reported in existence by the De Forest tene- ment-house department in 1903, some 20,000 only have been opened to the light during the past three and a half years. The prohibition against the use of cellar and basement rooms partly underground can not be enforced, owing to the lack of a sufficient number of in- spectors. The notorious Lung Block " continues to contribute its horrifying quota to the annual mortality. (Charities, November 30, 1907.) The writer has no hesitation in declaring that the housing condi- tions of the least resourceful of people have been, and are even now, more potent than any other factor in helping to swell the frightful •Town and City, Jewett, p. 14. BEPOBTS OP THE PRESIDENT'S HOMES COMMISSION. 105 mortality from consumption and other so-called house diseases en- gendered by unwholesome environment. HOUSE DISEASES. It has long been known that rickets, scrofula, and other chronic forms of tuberculosis are especially prevalent in dark, damp, and insanitary houses. The children are anaemic and as puny as plants reared without the stimulating effects of sunlight. Add to this the fact that dampness abstracts an undue amount of animal heat, lowers the power of resistance, and favors the development of catarrhal con- ditions, which render the system more vulnerable to tuberculosis, and we have a reasonable explanation why these diseases prevail, espe- cially in basements or houses below grade and otherwise unfit for human habitation. The death rate is often double and treble that of other localities, and while there are doubtless other factors which determine the frightful mortality, none are more potent than deficient sunlight and ventilation. Diphtheria, cerebro-spinal meningitis, acute and chronic rheumatism, and bronchial affections are also more frequent in insanitary dwellings. That the same is true of infantile diarrhea is doubtless due to the fact that the construction of the buildings does not protect from the heat of summer, and the enervating effects of heat and the more speedy decomposition of food (especially of milk) in such an atmos- phere, combine to carry on the slaughter of the innocents. The existence of disease-breeding habitations is a reflection upon Christian civilization, and there should be sufficient human sympa- thy to provide decent, healthful homes for our wage-earners, who constitute, after all, the bone and sinew of the country; and this is one of the occasions when we may well act as our brother's keeper. The history of improved dwellings reveals everywhere a lessened death rate, and the experience of the Washington Sanitary Improve- ment Company is equally gratifying. During the year ending De- cember 31, 1906, the apartments were occupied by 778 adults and 380 children, total, 1,158; births, 39 and only 16 deaths, 10 adults and 6 infants, a death rate of about 13.7 per 1,000 — which, with all due allowance for the average age of the occupants, shows a remarkbly low mortality when compared with the general death rate among the white population of 15.16 per 1,000. This regeneration of the housing conditions for the least resource- ful people is the great sanitary and social problem of the twentieth century. Take away the hovels and filthy places, let sunshine and pure air circulate through their homes, and teach them habits of cleanliness and responsibility, and the first step toward the elevation of the de- graded and the education of the ignorant will be taken, not only in the warfare against tuberculosis and other diseases engendered by insanitary surroundings, but also in the battle for higher moral and social standards. LODGING HOUSES OR HOMES FOR WAGE-EARNERS. Those who have read " The Long Day " can not fail to be im- pressed with the just criticism of our present system of homes for 106 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. working girls. The author makes a strong plea for homes designed after the Mills hotels for workingmen ; no charity, but so built and con- ducted that they will pay a 4 per cent rate of interest upon the money invested. "A clean room and three wholesomely cooked meals a day can be furnished to working girls at a price such as would make it possible for them to live honestly on the small wages of the factory or store. We do not ask for luxuries or dainties. In the model lodg- ing house there should be perfect liberty of conduct and action on the part of the guests, who w411 not be ' inmates ' in any sense of the word so long as the conventions of ordinary social life are complied with." It is to be hoped that her simple but truthful story will be read and her appeal for industrial and social betterment answered. So long as the conditions described in the book exist, so long will it be wicked to rear magnificent and costly church edifices, and in this respect Christian civilization, which should be a strong factor in uplifting and regenerative influences, has been remiss in its sacred obligations. To supply the needs spoken of, together with the estab- lishment of cooking schools and kindergartens so that the children of toil may at least have an opportunity to learn to work intelligently, may be regarded as a suitable field for practical Christianity, and' would do much toward narrowing the breach which now exists be- tween the church and wage-earners and between capital and labor. FOOD FOR WORKING CLASSES. While the character and variety of food now served is very much better than it was fifty years ago, it is not what it should be, espe- cially in lodging houses. The chief faults consist in improper cooking and the widespread error of consuming a cold dinner from the lunch basket or dinner bucket. The art of cooking and how to supply good wholesome food and in proper quantities should be made the subject of popular instruction. The " Ladies Sanitary Association of England " deserves credit for having taken this matter in hand, especially since experience teaches that nothing prevents the abuse of alcohol so much as a sufficient and palatable supply of food. The establishment of public kitchens and eating houses for un- married laborers conducted upon practical sanitary and economic principles would prove a great blessing; the same may be said of lunch rooms where rolls, sandwiches, a cup of coffee, tea, milk, hot soups, etc., may be obtained at a nominal cost, and which would materially lessen the evils of intemperance. Since coffee and tea allay thirst and are stimulants, without the depressing effects of alcoholics, there is no reason why factories and workshops should not supply these beverages at noon to employees at actual cost. The subject of food and cooking will be discussed in a special paper. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 107 Chapter XVII. WHAT THE EMPLOYEE MAY DO TO CONTRIBUTE TO HIS OWN WELFARE. Sufficient has been said in the preceding pages to indicate the dangers to which the working classes are exposed in many industrial pursuits, and the methods proposed to alleviate the effects have also been pointed out. It must be 6onceded that all remedial efforts have been prompted by the true spirit of humanity and as a social duty; hence it is reasonable to expect that wage-earners should show a willingness to avail themselves of the various " safety devices " and not underrate their importance in the protection of life and limb. While it is criminal for employers not to provide suitable protection, it is equally culpable on the part of the operatives to disregard all such preventive measures. So, for example, it is not a pleasing reflec- tion to be told by Doctor Harrington, professor of hygiene at the Harvard Medical School, in speaking of respirators, that "Aside from the discomfort caused, the operatives have another and a sense- less objection to their use; women complaining that they are made to look ridiculous, and men being moved to discard them by the gibes of their more reckless fellows." In January, 1908, the writer visited Frankford Arsenal and found men working in high explo- sives without rubber gloves and respirators, although provided by the Government. (See p. 60). Doctor Farrand, Secretary of the National Association for the Study and Prevention of Tuberculosis, also spoke to me of the great difficulties he and others have encoun- tered in New York and New Jersey in inducing the operatives to give safety devices a fair trial. PART II.- SOCIAL BETTERMENT. Chapter I. HOW VO KEEP WELL AND CAPACITATED FOR WORK. It is a matter of constant observation that families, even with a modest income, get along very well until sickness and death enters the once happy home; and if these financial burdens and sorrow can be prevented it is clearly our duty to do so, even if the " chief bread winner " is not himself incapacitated for work. For these reasons the writer offers a few suggestions along the lines of general and personal hygiene, with the hope that they may serve to diminish human suffering and distress. In doing so, while utilizing his own lecture material, he is indebted for the inspiration and popular pres- entation, as well as some of the subject-matter, to the valuable brochure by Prof. Fritz Kalle and Dr. Gustav Schellenberg " Wie erhalt man sich gesund und erwerbsf ahig, Berlin, 1907." HOUSE AND HOME. Special pains should be taken in the selection of living quarters, no matter how humble they may be, as they constitute our abode for the greater part of our life. With the excellent motor facilities, there is no reason why crowded tenements should be chosen, and prefer- ence should always be given to individual homes, or apartments, in not exceeding two-story tenements. The Germans have an old but true proverb : " Where the sun does not enter the doctor surely will ;" hence dark, gloomy and damp houses should be avoided; moldy spots on the walls or ceilings and a close musty odor indicate damp- ness, and cheap rents should prove no inducement to occupy such quarters. Leaky roofs and down spouts, or a pile of ashes against a brick wall, may keep the house damp, and the causes should be promptly removed. In all such instances, as well as in the occupancy of a recently constructed house, it is very desirable to dry out the house by heat and open windows. Since we know that the mortality from contagious diseases in- creases in proportion to the number of inmates of the rooms, hygiene requires that even the most modest dwellings should afford sufficient room to prevent overcrowding. Ventilation is always necessary, but open windows are especially indicated at night, as nothing can take the place of pure fresh air in small quarters. This may be effectively accomplished without the danger of drafts by opening the window in the bedrooms from the top, and those of the adjoining room at the bottom. Night air, contrary to popular opinion, is not unwholesome. The only danger is from mosquitoes, which should be excluded by proper screening of windows and doors. 109 110 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. There are many families who properly insist upon having a sit- ting room or parlor, which is most commendable, if the bedrooms are large enough to afford 500 cubic feet of air space for each occupant. If they do not, it is desirable after proper airing of the larger rooms to utilize them for sleeping purposes, for it must be remembered that the air of habitations is vitiated by the consumption of oxygen and the exhalation of carbonic acid. The airing of rooms is even more essential in cold weather, because of the additional pollution by carbonic acid from light and fires. There are a number of families, unfortunately, who for various reasons are obliged to live, cook, and sleep in one room, and for whom the question of fresh air is therefore of vital importance. Such families should not hesitate to avail them- selves of the benefit of fresh air, especially when medical science has demonstrated the advantages of fresh and even cold air in the treat- ment of consumption and pneumonia, provided the body is kept warm by sufficient bedclothes. The household dust is as objectionable in many respects as the dust of workshops, because dust and germs always go hand in hand. So, for example, Uffelmann found that while the outer air contained only 250 ^erms in 10 cubic feet the air of his library contained 2,900, of his sitting room 7,500, of his bedroom 12,500 and the air of a living room of a workingman's family as many as 31,000 germs. He also demonstrated that they increased after disturbing the dust of the rooms by feather dusters or by slamming the doors, showing that they actually cling to the household dust. If the dust should happen to contain the germs of tuberculosis, from carelessly expectorated spu- tum, or which may have been carried into the house upon the soles of footwear, bottom of skirts, etc., such dust may prove a source of danger, especially to children. HOUSE CLEANING. For reasons just given, there should be no accumulation of dust in any part of the premises. Hygiene, therefore condemns all carpets and interior finishes which serve as dust and germ traps, such as heavy cornices, elaborate moldings of door and window frames, wardrobes, cumbersome draperies, and unnecessary furniture. Hy- giene, on the other hand, approves of neatly polished floors with small rugs, which can be easily taken up and cleaned outside of the house, curves instead of cornices and angles, smooth and nonabsorbent walls, instead of embossed wall papers, simplicity of furniture, closets instead of bureaus and wardrobes. In brief, everything which will prevent the collection of dust and germs and facilitate their removal may be regarded as hygienic. So, for example, a plain, tinted, smooth wall, or the varnished wall papers, which can be cleaned with a damp cloth, or any smooth wall paper guaranteed to be free from arsenic, are in point of health superior to the embossed silk hangings and tapestries of the rich man's home. The object of house cleaning is primarily to get rid of the dust and germs. In sweeping it is desirable, therefore, to open the upper windows, but to keep the door leading into the hall closed, so that the dust may not be wafted back into the house. The dusting should always be done with a soft, damp cloth, frequently changed. Under REPORTS OP THE PRESIDENT'S HOMES COMMISSION. Ill no circumstances should the feather duster be used inside of the house, as it does not remove, but simply displaces the dust. If the cracks in floors have been neatly filled up, and the floors oiled or waxed, they can be cleaned with a damp cloth much more effectively than by the tiresome process of scrubbing, a drudgery to every neat housekeeper. The kitchen, cooking, and eating utensils need special care, as un- clean food and utensils are often the cause of cholera-morbus and diarrheal diseases. Captain Sanderson, in the Cook's Creed, pub- lished for the United States Army, in 1862, showed his sanitary acu- men when he said : Better wear out your pans with scouring than your stomachs with purging, and it is less dangerous to worli your elbows than your comrades' bowels. Dirt and grease betray the poor cook and destroy the poor soldier. Every effort should be made to have clean and cool storage facilities for food, and all perishable food, especially milk for infant feeding, should be kept on ice whenever the temperature is above 60°, TEMPERATURE. The most healthful room temperature in cold weather is between 65° and 70°, as overheated rooms predispose to colds and should be avoided. When the house or apartment is heated by cast-iron stoves or other heaters, special care is necessary not to bring them to a red heat, as the very dangerous coal gas is liable to escape through invisible fis- sures in the plate and joints while the heaters are red hot. It is desirable to select a good-sized heater lined with fire clay, which will not have to be brought to a red heat, and at the same time furnishes sufficient volume of warm air. If the air is superheated it acquires a peculiar odor, probably due to charring of organic dust; it also becomes very dry and irritating, owing to the rapid evaporation of moisture from the skin and mucous surfaces of the inmates, and in consequence is apt to produce catarrhal affections, conditions which do not prevail when care is taken and provisions made for the evapora- tion of a certain amount of water. Coal oil or gas stoves can not be recommended, unless provisions are made to carry off the products of combustion. The danger from fire, which is always a great calamity, should be reduced to a minimum by preventing the accumulation of combustible material on the premises, proper care of matches, and instruction of the children. Coal oil, gasoline, etc., should never be used for kin- dling purposes ; there is always great danger from explosions, fire, and fatal burns by filling a burning lamp, or extinguishing the wick by blowing over the chimney, or using a lamp when the chimney is broken. INSECTS. Special attention should be paid to the exclusion and destruction of house flies, mosquitoes, and other insects, for apart from the dis- comfort produced, there is much reason ^or assuming that disease germs may be conveyed by flies and mosquitoes, fleas, bedbugs, and roaches. Celli,° of Rome, in 1888, demonstrated that the germs of «A. Celli Boll. dell. Soc. Lancis, degli, ospedali di Roma, 1888. 112 REPORTS OP THE PRESIDENT'S HOMES COMMISSION". tuberculosis and other disease germs may retain their vitality after passing through the intestinal tract of flies. Spillmann ^ pointed out that flies caught while feeding upon the expectoration of a consump- tive invariably contained viable germs, and Hoffmann * not only con- firmed these observations, but also found the germs in the fly spots on the walls of a room occupied by a phthisical subject. The*^ writer has declared it his opinion for years that flies may carry the germs on their feet, from typhoid stools and infected sources, to the food and milk supply, and in 1895 ^ pointed out a number of house infec- tions in this city which could not be explained in any other way. The experience of the Spanish-American war appears to have fully con- firmed this conclusion. In like manner, the germs of cholera and of the oriental pest have been disseminated by the house fly. Professor Stiles, of the Public Health and Marine-Hospital Service, has shown that the eggs of the pork worm, whip worm, pin worm, and round worm may be carried by flies to the food and there is rea- son to believe that purulent affections of the eye and wound infections may be thus conveyed. The evidence that certain species of mosquitoes are the intermedi- ate host of the germs of malaria and yellow fever, and that man may be directly inoculated by the sting of these insects is absolutely con- clusive. The efficacy of measures for the extermination of mosqui- toes, and their exclusion from houses by proper screening, has been abundantly demonstrated both at home and abroad. It is gratifying to know that the mystery of yellow fever was solved by the work of Surgeons Reed, Carroll, Lazear, and Agra- monte of the United States Army, and Surgeons Gorgas and Keane have demonstrated the best methods for the prevention of yellow fever and malaria by waging an unceasing warfare against the mosquitoes. Poultry, pigeons, and household pets, like dogs, cats, and parrots, ought not to be kept in the rooms, as they contaminate the air, harbor insects, and may even convey disease germs. It is held by a number of authors that diphtheria as observed in chickens, pigeons, and cats is identical with the human disease. Parrots suffer at times from a pulmonary disease, which is transmissible to man, while certain forms of skin disease and itch may be conveyed by dogs and cats. There is some evidence to show that a certain tapeworm found in the dog and sometimes in children undergoes a larval stage in fleas and dog lice and when swallowed unconsciously by children may cause infection. What has been said of the desirability of general cleanliness applies with equal force to the basement, cellar, attic, 3^ard, outhouses, gar- bage cans, etc. There should be no accumulation of rubbish within or without the premises. Where no sewer connections exist, the out- houses should be kept in a clean condition, and the seats provided with lids so as to exclude flies. It is also a good plan to disinfect the vault or receptacle with chlorinated lime or fresh whitewash, etc. A good housewife can not only accomplish a great deal for the health, but also for the comfort and morals of the family. As indi- « Spillmann and Haushalter, Comptes rendus 105, p. 352. *' Hoffmann Deutsche Med. Zeitung, 188S, No. 57. ^' Iteport of tlie Health Officer, District of Columbia, 1895. BBPOBTS OP THE PBESIDENT's HOMES COMMISSION-. 113 cated by our German authors, general order and neatness, clean, white, washable curtains, some potted plants, and a few suitable pictures, avoiding the loud chromos, and a cheerful and refined at- mosphere will do much toward keeping the husband and sons from the saloons. As a matter of fact, much may be done to transform undesirable living quarters into healthful homes, while filth, neglect, and slovenly housekeeping often convert even structurally good houses into verita- ble hotbeds for disease germs. So, too, persons with delicate con- stitutions may, by attention to the laws of health, attain to a good old age, while the physical giant by a reckless life soon undermines his general health and goes to a premature grave. CARE OF THE SKIN. The skin is supplied with a network of blood vessels and nerves, and is a sensory, respiratory, execretory, and heat reflating organ. As a sensory organ, it combines with the tactile functions, the power of perceiving impressions of warmth and cold. The respiratory functions of the skin are limited, to be sure ; nevertheless, small quan- tities of oxygen are absorbed and carbonic acid is eliminated. Apart from this, the skin on an average adult eliminates through the sweat glands about 2^ pounds of water a day. Human sweat contains about 2 per cent of solid constituents, mostly in the form of waste matter or impurities, and the odor varies in different regions of the body and in different races. The skin also secrets a fatty substance through the sebaceous glands. As the water from the skin evapo- rates, the solid matter remains upon the surface, combines with dirt, harbors germs, and readily undergoes decomposition, which, apart from the disagreeable odors so characteristic of unclean j)ersons, also tends to mascerate the skin and is liable to produce " galling or chaf- ing," pimples, and boils. Last, but not least, the accumulation of this matter would natu- rally close the pores of the perspiratory and sebaceous glands and throw the work of eliminating the impurities upon other organs. A normal cutaneous function is doubtless of great hygienic im- portance, as shown by the occurrence of many diseases following its suppression, because in such an event, in addition to the retention of the waste matter in the blood, work is thrown upon the kidneys and other eliminating organs, and these, if already weakened, naturally break down. Since the functions of the skin depend not only upon its anatomical intactness, but also upon cleanliness and a proper tone of the cutaneous vessels and nerves, a rational culture of the skin demands: (1) that it should be freed regularly from the secretory products and particles of dirt; (2) that the cutaneous nerves retain their normal excitability or when impaired that they regain their tone; (3) that we assist the skin in its heat- regulating functions, so that it may not be overtaxed. All of which may be accomplished by ablutions, baths, and suitable clothing. ABLUTIONS AND BATHS. Regular and systematic ablutions with soap and water are requisite for reasons already given, and are especially necessary when engaged in dirty work or exposed to poisonous dust. In addition to the S. Doc. 644, 60-2 9 114 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. chemical effects of soap, vigorous friction with a brush may be em- ployed, not omitting the finger nails, as disease germs have been found in nail dirt. The water used should not be too warm for the body, as this would relax the skin and increase the susceptibility to catching cold. If the bathing is not done in the bath tub, it will be well to wash and dry part of the body at a time. In any event the surface should be wiped dry and hard, especially the hair, since wet hair is calculated to pro- duce colds. It is always a good plan to wash the neck and chest with cold water, so as to harden the skin. We will now brieiBiy refer to the different forms of baths. The cold bath is usually taken in a tub or by means of a shower or needle bath at a temperature of about 65° for adults. It should not last over three minutes. Cool baths vary from 65° to 80°. Tepid baths are taken at a temperature of between 80° to 90°, continued from ten to fifteen minutes. Warm baths vary from 90° to 100°, and are generally employed for their cleansing effect. In addition, there are steam or Russian baths, the Turkish or dry hot-air baths, river and ocean baths, swimming pools connected with public baths, medicated baths, etc. Swimming baths are particularly useful, as they also afford an opportunity for muscular exercise, and as the temperature of the water is rarely above 80°. Such baths are both cleansing and stimu- lating, and therefore an excellent tonic for the skin. All baths should be followed by a cool douche and friction with a rough towel should be employed until the skin is in a general glow. The value of bathing is so fully appreciated that the building regulations of this city com- pel a bathroom for every apartment offered for rent. No community should fail to make provisions for public baths, both in summer and winter. The beneficial effects upon the health and morals of the least resourceful people can not be too strongly emphasized. The old Roman baths were prominent features of the daily life of the Romans, and were counted among the choicest privileges. Eleven large and 826 smaller public institutions adorned the ancient capital during the Diocletian period, and the baths of Caracalla, the ruins of which can be seen to-day, could accommodate 1,600 bathers at one time. The following sensible rules on the subject of bathing have been issued by the English Humane Society, and are well worth observing by bathers : Avoid bathing within two hours after a meal. Avoid bathing when exhausted by fatigue or from any other cause. Avoid bathing when the body is cooling after perspiration. Avoid bathing altogether in the open air, if, after having been a short time in the water, there is a sense of chilliness, with numbness of the hands and feet, but bathe when the body is warm, provided no time is lost in getting into the water. Avoid chilling the body by sitting or standing un- dressed on the banks or in boats, after having been in the water. Avoid remain- ing too long in the water, but leave the water immediately if there is the slight- est feeling of chilliness. The vigorous and strong may bathe early in the morning on an empty stomach. The young, and those who are weak, had better bathe two or three hours after meals; the best time for such is from two to three hours after breakfast. Those who are subject to giddiness or faintness, or suffer from palpitation or other sense of discomfort at the heart, should not bathe without first consulting their medical adviser. CLOTHING. The object of clothing, apart from the moral and aesthetic aspect, is to aid the skin in its heat-regulating functions. It should, there- BEPOHTS OF THE PRESIDENT'S HOMES COMMISSION. 115 fore, afford protection against heat and cold, as well as rain and mechanical irritation. Clothing must be adapted to climate and sea- sons, and extremes should be avoided ; as a general rule warm woolen goods are best suited for winter wear, and cotton or linen for warm weather. It should be understood, however, that flannels absorb more dirt, odors, germs, and water than linen or silk, whilst cotton oc- cupies an intermediate position. The question of wet clothing, whether from perspiration or rain, is important, as the drying of clothing on the body involves an expenditure of animal heat, and it is not a matter of indifference whether this takes place rapidly or slowly. It is a fact that a wet cotton shirt or sweater feels more un- comfortable and colder than a wet woolen garment. The simple rea- son is that the cotton garment dries more rapidly, but it abstracts during the same time more animal heat than flannels. This fact is not without a practical bearing, as it teaches that persons who per- spire easily will do well to wear flannels next to the skin, and this is all the more important when they are liable to draughts or abrupt changes in temperature. As a protection against cold, wool is superior to either cotton or linen, and should be worn for all underclothing. In case of extreme cold, besides wool, leather, fur, or waterproof clothing, on account of their impermeability to air, are useful. As a protection against cold winds, for equal thickness, leather and India rubber take the first rank, wool the second. As a protection against rain, india rubber or oiled canvas clothing is the best, but it is an exceedingly hot dress, owing to its impermeability to air, which causes condensation and retention of the perspiration. To overcome this objection, Dumas suggests a material, which is waterproof and yet permeable, pre- pared as follows : The garment is placed in a 7 per cent solution of gelatine, heated to a temperature of 100° F. After immersion for a few minutes it is dried in the air and after drying it is soaked in a three-fourths of 1 per cent solution of alum and again dried. As a protection against heat in the shade, the thickness and con- ducting power of the material are the only factors to be considered. Texture has nothing to do with protection from the direct solar rays ; it depends entirely on color, and white is the best. As a protection against fire, leather clothing is generally worn. The fabric can be rendered noninflammable by the addition of 20 per cent of tungstate of soda and 3 per cent of phosphate of soda to ordinary starch sizing, while cotton or linen goods may be treated simply with starch and borax, in the proportion of a teaspoonful of borax to one-half pint of starch. CLOTHING AS A CAUSE OF DISEASE. Clothing may impair the functions of the body and cause disease (1) by improper fitting, which leads to compression of blood vessels and nerves and interferes with the normal position of organs and the movements of the body; (2) by improper selection of material afford- ing either insufficient protection or overheating a part or the whole of the body; improper material may also produce irritation or inter- fere with the vejntilation of the skin; (3) by wet clothing, which, in drying, may abstract sufficient animal heat to cause peripheral irrita- tion and reflex internal congestions; (4) by poisonous dyes, such as 116 EEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. compounds of arsenic and antimony, chrome yellow, zinc chloride, and some of the aniline colors. The toxic symptoms may manifest themselves by general impairment of health or m local affections of the skin; (5) clothing may harbor disease germs, and a number of instances are on record in which itch, smallpox, tuberculosis, and scarlet fever have been spread by second-hand clothing and bedding. This points to the necessity of thorough disinfectioi SPECIAL ABRANGEMENT OF DBESS. The head dress. — As long as the head is covered with hair, the head dress should be permeable and not too warm, lest headache may be induced ; on the other hand, insufficient covering may produce neural- gia and rheumatic affections. The head and eyes should always be protected from the direct rays of the sun, and for this purpose broad-brmimed, dark felt hats for cold weather and straw or some other light-colored material for summer use are the best. For the neck. — Nothing should be worn around the neck which would overheat the parts, dilate the blood vessels, and render the skin sensitive. The collars should be loose fitting, so as not to compress the blood vessels. The neck ought to be bared as much as possible and hardened by frequent ablutions with cold water. For the hody. — For undergarments, the union suits are the best. They should secure a normal amount of warmth and be so arranged as not to interfere with the free movements of the chest, or compress or displace the abdominal and pelvic organs. For these reasons, cor- sets and waistbands are wholly inadmissible. Suspenders should be worn by both sexes, or women may wear a bodice arranged for the attachment of skirts, so as to suspend their weight from the shoulders. Steel corset stays and tight lacing can not be too strongly condemned, because there is ample evidence that they have caused displacement and disease of the abdominal and pelvic organs. The stockings should be made of some warm, permeable material, such as wool or merino, as the circulation is rather feeble in the lower extremities, and the feet are more liable to perspire. They should be long enough to reach above the knees and there fastened with some loosely-fitting band. Tight elastic bands and other constricting gar- ters are liable to produce varicose veins. The trousers must be sufficiently loose around the waist and else- where to permit of free circulation of blood. FOOTWEAR. Boots and shoes are intended to protect the feet from the uneven and rough surfaces of the ground, from cold, wet, and even heat, and must be constructed so as to meet these requirements. It is needless to insist that they should be patterned after the foot. The sole of a shoe should be so constructed that the great toe touches it in such a way that a line projected posteriorly through the middle of this toe will strike the middle of the heel. The heel should be broad and low, so as not to throw the weight on the toes. Across the tread and toes the sole should be sufficiently broad to permit of lateral expansion. The uppers should be soft and flexible, but not too roomy, and should fit EEPOETS OF THE PRESIDENT'S HOMES COMMISSION. 117 snugly around the ankles and insteps. Elastic gaiters are preferablf^ to laced shoes. It is perhaps needless to insist that cleanliness in body and cloth- ing is next to godliness. This may be secured by frequent bathing and change of underwear. It is also a good plan to use nightshirts or pajamas, so as to afford an opportunity for a thorough airing of the underwear worn during the day. If in spite of the general clean- liness there should be indications of excessive sweatmg and dis- agreeable odors, especially of the feet, a physician should be consulted. BED AND BEDDING. Since about one-third of our life is spent in bed, something should be said of this article of comfort and necessity. As the object of the bed is to promote a refreshing sleep, it should be long and broad enough to permit of the necessary extension of the body; it should be elastic, so as not to compress the soft parts unnecessarily, and it should be warm, but not too warm. Metallic bedsteads are preferable to wood, because less liable to be infected with insects; they should be provided with a woven-wire mattress which admits of free cir- culation of air. Upon this may be placed a mattress of hair, felt, cotton, or excelsior, and pillows preferably made of horsehair. Feather pillows are too heating for the head, unless a layer of paper has been interposed, and high pillows are objectionable, as the posi- tion of the sleeper would impede the movement of the diaphragm. Sheets and pillowcases of cotton for winter and of linen for summer are necessaiy to prevent irritation of the skin and soiling of the mat- tress, pillows, and blankets. The most suitable coverings for a bed are woolen blankets; they are warm and their permeability admits of the escape of gases. For warm w^eather a cotton quilt or comforter or even a linen sheet is preferable. The bedding should be aired every morning and exposed, whenever practicable, to sunlight, which is nature's purifier and destroys all forms of germs. " Feather beds " and " down quilts " are warmer than blankets, as the air contained in the feathers is a bad conductor of heat, but they are only suitable in very cold climates, or for anaemic and delicate individuals, because they overheat the body, cause dilation of the cutaneous vessels, and consequently relax and impair the tone of the skin. The sleeper should lie with his head slightly raised, preferably with the body inclined to the right side. He should rise rather slowly from the recumbent position, since a sudden change to the erect position not only accelerates the heart's action, but also changes the blood distribution too abruptly. The bed should be so placed that the occupant is not disturbed by the influence of light. A sound, refreshing sleep can only be had when the senses are no longer stimu- lated, and light is a stimulus which acts even through the closed eyelids. SLEEP. We are still in ignorance of the exact nature of sleep or the sus- pension of automatic activity of the brain. Some authors maintain 118 BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. that it is due to an accumulation of waste products in the blood and central nervous sj^stem, and that it ceases with the elimination of these products. Others believe that sleep results from the exhaustion of the supply of intra-molecular oxygen, while still others attribute it to a temporary anaemia of the brain. On the whole, there is much reason for assuming that the refreshing effects of sleep are due to the elimination of waste products from the system and the absorption of a fresh store of oxygen. At all events, Pettenkoffer and Voit found that of the 954.5 grams of oxygen absorbed by a healthy adult in the course of twenty-four hours, 659.7 grams are absorbed between 6 o'clock in the evening and 6 o'clock in tne morning. AMOUNT OF SLEEP BEQUIEED. It is well known that healthy, new-bom infants sleep all day, except while nursing. About the third or fourth week of their life they may remain awake for one-quarter of an hour, in addition to their nursing; in the seventh or eighth week they remain awake one-half hour, and in the fifth month about one hour ; but even when a year old a child sleeps more than half of the twenty-four hours. During the second and third year it sleeps from ten to twelve hours at night and from two to two and one-half hours in the daytime. After the completion of the third year the necessity for sleep in day- time ceases. Uffelmann has made a series of careful observations and believes that " healthy, well-cared-for children between 4 and 6 years of age require eleven hours of sleep ; at 7 years of age, ten to ten and one- half hours of sleep ; at 10 j^ears of age, nine and one-half to ten hours of sleep; at 12 years of age, nine hours of sleep; at 14 years of age, eight and one-half hours of sleep; youths between 16 and 20, eight and one-half hours of sleep; adults, seven and one-half to eight hours of sleep ; while the aged require a larger amount of sleep." No hard and fast lines, however, can be drawn ; some children and adults can get along with less, and others require more sleep. On the whole, we may conclude that the average adult requires about eight hours of sleep, and if the amount is materially lessened languor, pallor, nervous irritability, and general peevishness may be observed. Excessive sleep is harmful, as it tends to produce sluggishness of the bodily functions, especially of the digestive organs. It lessens tis- sue metamorphosis and favors the deposition of fat — not to mention the bad effects of the prolonged presence in a polluted atmosphere. We are also beginning to understand that the reason why an excess of sleep instead of being restful to intellectual energy is rather ex- haustive is: After a certain amount of sleep, even though the body continues to be somnolent, the mind awakes and, in the midst of the undirected, rapidly varying mental excursions which follow, as much nerve force and mental energy is expended as would be necessary for the more continuous thinking of regular intellectual work. Irregularity in sleep is always objectionable. The human body resents irregular habits of all kinds. Many infants sicken because of irregular nursing, and we all experience unpleasant symptoms when from any cause our regular meal hours are interrupted, and it is per- fectly natural that such an important organ as the brain should demand regularity in action and rest. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 119 Irregular bed hours are not calculated to promote a sound and refreshing sleep. Since we enjoy the best sleep before midnight, the hours between 10 o'clock p. m. and 6 a. m. or 11 p. m. to 7 a. m. are the most suitable. Opinions differ as to the admissibility of a nap after dinner, and the question must be decided by individual circumstances. It is quite certain, however, that there is no physiological necessity for such a sleep in healthy children above the age of 4, nor for men and women in their best years, unless they have taken an inordinate amount of food. Persons in advanced age may profit by a short rest, which seems often demanded by an overwhelming drowsiness; the same may be said of delicate and anaemic individuals and those suffering from diseases of the digestive system. DREAMS. In spite of considerable research the occult character of dreams has not been entirely cleared up, although psychologists are agreed that they constitute a manifestation of intellectual life involving the expenditure of a certain amount of brain force or mental energy. Practical experience also teaches that a dreamless sleep is in every way recuperative, while a dreamful night produces a tired feeling in the morning; hence dreams should be avoided, if possible. There is much reason for believing that the old custom of relating dreams, and the attempt to interpret them, has a bad effect on the minds of all, and especially of children, as it tends to bring about a similar mental rambling during sleep of subsequent nights. Atten- tion has recently been called in an editorial -(Journal A. M. A., July 28, 1907), to the fact that children suffer more frequently from night terrors, which are really overvivid dreams, on Sunday and Monday nights. This is partly attributed to the fact that the children have indulged in the '' imagination-intoxicating " colored supplement to the Sunday newspaper with its horrors and its dream suggestions. Those of us who have been brought up in rural districts and have listened to dream tales and folklore and perused exciting literature have learned that all of this is productive of dreams and night terrors, and should be avoided. IMPORTANCE OF GOOD TEETH. When we recall the physiology of digestion it is scarcely necessary to point out the importance of a good set of teeth in order to secure thorough mastication and insalivation of the food. The temperature of food and drink exerts a special influence on our teeth. It has been shown that a sudden change from hot to cold in the mouth causes the enamel to crack, and leads to premature decay of the teeth, because the microbes in the mouth will find these fissures a suitable lurking place for their destructive work. The teeth should never be used for the purpose of cracking nuts. Microbes of every description abound in the mouth, and find in the presence of lodged and decaying particles of food a suitable medium for their multiplication. In order to prevent their destructive effects, cleanliness of the mouth is absolutely essential. This can be secured by brushing the teeth with water and castile soap after each meal 120 REPOKTS OF THE PRESIDENT'S HOMES COMMISSION. and before retiring. In case particles of food can not be thus dis- lodged, a soft silk thread drawn between the teeth will accomplish the purpose more effectively and wisely than a toothpick. If the teeth are already painful, or show evidence of decay or of accumula- tion of tartar, a dentist should be consulted. It is a wise plan to have the teeth examined once a year, and as there are free dental infirm- aries, the question of cost should not deter even the least resourceful people. HABIT AND REGULARITY OF THE BOWELS. As i)ointed out by Hammond,^ when we perform an act under the operation of certain impressions, there is a tendency toward the per- formance of a similar act, if like influences are brought to bear upon the organism. " This disposition to repetition prevails in nearly every function of the body and mind until some powerful force inter- venes." It is shown by the sensation of hunger and thirst which occur at customary meal hours, the desire to evacuate the bowels at the same hour of the day, the desire for sleep, the hour of awakening, and the inexpressible feeling excited by the want of a smoke or a customary stimulant. CONSTIPATION. When regularity of the bowels is established, the desire to go to the stool returns at the same hour. If this tendency is resisted, it is not long before constipation becomes the rule, with all its attending consequences of ill health. The most natural remedy to correct this morbid habit will be persistent effort to secure an evacuation every day at a fixed hour, aided by the use of succulent vegetables and fruits, and if necessary by' small doses of olive oil, cotton-seed oil, or Epsom salts and water. One of the most baneful effects of constipation is hypochondry — a nervous and mental condition brought about by absorption of poison- ous products in the intestinal tract, and the continued action of the mind upon some one organ or function supposed to be disordered, notably the heart, liver, and stomach. The disease appears most commonly in irritable individuals and in those exhausted from a variety of causes. Such persons are of sound judgment in other respects, but reason erroneously on whatever concerns their own health. In these cases, apart from correcting the digestive derange- ments, it is often necessary to act upon the mind by keeping it occu- pied with matters which will divert the thoughts of the patient from himself. This is often readily accomplished on the golf links in persons who require exercise. CARE OF THE EYES. It is well known that exposure of the eyes to the direct rays of the sun may cause inflammation of the retina and even total blindness, and similar effects may be produced by the reflected rays of the sun from mirrors, sheets of water, white walls, and snow (snow blind- ness) . On the other hand, defective lighting, as pointed out on page 88, also produces mischief, and must, therefore, be avoided in the • Treatise on Hygiene, Wm. A. Hammond, 1863, p. 122. EEPORTS OF THE PKESIDENt's HOMES COMMISSION. 121 home as well as in the shop. Sudden transposition from light to dark or dark to light is also, injurious and may cause serious diseases of the eyes. Whenever there is any evidence of redness, inflamma- tion, pain, watering, or " mattering " of the eyes, a physician should be consulted. While free bathing of the eyes with cold water may exert a preventive and tonic effect, the value of good eyesight is too great to trust to domestic remedies, or even to the services of an optician. Whenever there is any diifficulty in reading, accompanied by pain or headache, an occulist should be chosen. When we recall the number of accidents which befall the eyes in many occupations, the importance of protective goggles must be apparent. EAR AND NOSE. These organs should be kept clean. There is danger from lodg- ment of foreign bodies, particularly in children, which may impair the hearing for life, especially when injudicious attempts at removal have been made. In such instances it is always best to consult a competent physician. The chief function of the nose evidently is to arrest more or less of the dust and germs upon its mucous surfaces, and in cold weather to warm the inspired air. Hence, the importance of cleanliness and of breathing through the nose instead of the mouth. In order to do this without discomfort, it is necessary that there be no obstruction in the nasal passages, and persons suffering from catarrh or other symptoms of difficult breathing will do well to undergo treatment. In this connection attention should be called to the advantages of so-called " deep breathing " in the open air or near an open window. This is best accomplished by taking 10 or 12 deep inspirations morning and evening, so as to inflate the lungs to their fullest expansive capacity. This practice is believed to secure a thor- ough ventilation of all the air vesicles and to increase the power of resistance to the invasion of the tubercle bacillus. Chapter II. ALIMENTATION AND FOODS. The fact that proper nutrition of the body is important for the enjoyment of health has long since been recognized, and we all agree that the character of food not only influences the growth and develop- ment of the child, but also the health, power of endurance and resist- ance in the adult, and often plays a most important, if not decisive, role in the treatment of disease. The human organism is made up of about 60 per cent of water, 19 per cent of protein compounds, 15 per cent of fats, and 6 per cent of mineral salts, all of which are sooner or later consumed, involving certain expenditures which must be covered if health and life are to be preserved. The process by which the repair of waste is supplied is called alimentation or nutrition, and the entire process involved in the waste and repair of tissues is called metabolism. The simple chemical compounds which are appropriated by the system are called alimen- tary principles or nutrients, and the simple or artificial combinations of several nutrients are called nutriment or food. 122 REPOETS OF THE PBESIDENt's HOMES COMMISSION. The cause of the constant consumption of the proximate principals of the body must be looked for in the functional activity of the cells. We know that they take up, utilize, disintegrate, and eliminate matter ; this gives rise to the generation of heat and the evolution of force or mechanical power, both of which are the result of latent energy contained in the substances introduced into the system as food. The heat and vital force of the heart and other muscles of the body have their source clearly in the process of oxidation of carbon and oxygen, which primarily takes place in the cells; and all nutrients containing carbon and hydrogen contribute to the generation of heat and the evolution of muscular force. The chief objects of food are, according to Atwater, to form the material of the body and repair its waste, and to yield heat to keep the body warm and muscular and other power for the work it has to do. The amount of energy contained in different foodstuffs has been measured in the laboratory by the amount of heat evolved during their combustion by means of an apparatus called the calorimeter. The unit commonly used is the calorie, by which we understand the amount of heat required to raise the temperature of a pound of water 1® F., or if transformed into mechanical power, such as the muscles use to do their work, a calorie represents force which would be suffi- cient to lift one ton 1.54 feet. Atwater gives the following general estimate for the average amount of heat and energy in one pound of each of the classes of nutrients : Calories. 1 pound of protein 1, 860 1 pound of fat 4, 220 1 pound of carbohydrates 1, 860 Since the supply of foodstuff or income must be regulated by the consumption or outgo, it is essential that the consumption should be determined. Experiments of this kind are made in an apparatus called the " respiration calorimeter," and include not only a quantita- tive analysis of the food, drink, and air consumed by the man and of all the excretory products, which make up the income and outgo of the system, but also a careful estimate of the energy represented by ingested material, as well as the energy liberated from the body in the various excreta, in heat and mechanical energy. The balance of income and expenditure is thus made, and the gain or loss of material of the body, with different kinds and amounts of food, and under different conditions of muscular exercise and rest, is determined. By means of these experiments Professor Atwater has been able to verify the law of the conservation of energy as applied to the animal organism, and has shown that every unit of energy which enters the body as potential energy of the food will leave the body in potential energy as excreta, in heat radiated from the body, or in mechanical work done by the muscular system. The material income of the body must balance the material outgo, and the energy income of the body must balance the energy outgo. According to the classical experiments of Pettenkoffer and Voit, nearly forty years a^o, the waste products of a healthy adult weigh- ing 154 pounds, during twenty- four hours, at rest amounted to 16.8 grams of nitrogen in the urine, 275 grams of carbon, and 2,500 grams of water, while the wast« products of the same individual, performing moderately hard muscular work, amounted to 18.8 grams of nitrogen, REPORTS OF THE PRESIDENT S HOMES COMMISSION. 123 328 of carbon, and 2,190 grams of water, and from these experiments the authors named concluded that the following quantities of nutrients are required during twenty-four hours : Protein. Fata. Carbohy- drates. Man without muscular work QratM. 118 118 146 Oram*. 45 56 100 Orams. 450 Man with moderate muscular work 500 Man with hard muscular work 500 Professor Chittenden's experiments, conducted about three years ago, indicate that the nitrogen equilibrium is preserved on a daily intake of 8.5 to 9.5 grams of nitrogen, or about 55 grams of nitroge- nous food, so that the protein ration of Voit may be cut in two, pro- vided the fats and carbohydrates are introduced in sufficient quantities to bring the full value up to 2,500 or 2,600 calories. Other authorities, however, believe that it would be unwise to reduce the protein ration below 100 grains or 3.5 ounces a day. One of the difficulties in the way of setting up exact standards is, as pointed out by Professor Atwater, that " different individuals of the same class differ widely in their demands for food and in the use they make of it. Two men of like age, size, build, and occupation may live and work side by side. One will eat more and the other less, while both do the same amount of work, or both may eat the same food and do the same work, and one will be fat and the other lean, or both may have the same diet and yet one w ill be strong and vigorous and able to do a great deal of work, while the other will be weak and able to accomplish but little. Just why individuals differ in their ways of utilizing their food and how to measure the differences and make diet- ary rules to fit them exactly, are problems which the physiological chemist has not yet solved." Theie are also persons who, because of some peculiarity of the diges- tive system, can not use foods which for people in general are most wholesome and nutritious. Some persons can not eat eggs, others suffer if they take milk, others have to avoid certain kinds of meat or fruit and all these idiosyncracies indicate that the nutrition of man is not a mere matter of grams of protein, fats, and carbohydrates. In fact we live not upon what we eat, but upon what we digest and assimilate. The whole subject of dietary standards is still in its infancy and the best we can do is to make estimates which apply to averages rather than individual cases. In a general way we may conclude that the needs of the economy are influenced (1) by the height and weight of the individual, amounting to a difference of 40 to 50 calories for each kilogram in body weight; (2) by the temperament — nervous and excitable persons require more food than those of a phlegmatic tem- perament; (3) by muscular activity, which involves not only an in- creased expenditure of carbon, but also increased consumption of pro- tein ; (4) age, in so far as during active growth there is also a more active metabolism and children consume more for each kilogram of their weight than adults ; on the other hand, with advancing years tis- sue metamorphosis becomes less active; (5) sex influences me amount 124 KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. of tissue consumption only in so far as there is a difference in weight and muscular activity ; an exception should be noted in pregnant and nursing women, who doubtless should receive a more liberal supply of proteids; (6) by temperature and climate. The injfiuence of low temperatures results in increased oxidation of carbon; hence an instinctive craving for more fatty food and the carbohydrates, sugar and starches, during the winter months and in cold climates. In the summer months and in warm climates there is a repugnance for fat and a craving for refreshing food and drinks, and hence the mini- mum amount of fat, about 40 grams, and between 300 to 400 grams of carbohydrates with a normal protein ration will meet the require- ments. Foodstuffs are classified according to their proximate composition as follows: First. Organic, nitrogeneous, as proteids or albuminoids; non- nitrogenous (a) fats, (h) carbohydrates, (c) vegetable acids. Second. Inorganic — mineral salts and water. Third. Food accessories, as tea, coffee, and condiments. The first two classes of foodstuff are essential to life ; the third class is important as favoring palatability and digestibility. The true nutrients are protein, fats, and carbohydrates. The term " protein " includes most of the nitrogeneous food com- pounds, such as albuminoids, gelatinoids, and extractives. 1. The albuminoids include all substances allied in their chemical composition to egg albumin, and have an average composition of N 16 per cent, C 53 per cent, H 7 per cent, O 23 per cent, S 1 per cent. They are found in eggs, lean part of meat, milk, curds, and the gluten of wheat, the leguminous plants, etc. The principles of this group during digestion, with the exception of nuclein, are converted into soluble peptones or alkaline albuminates and readily absorbed as such ; they are the chief tissue formers of the muscles and tendons of the body, but apart from this purely plastic function they also play a role in oxidation and therefore in the generation of heat and energy. At all events they can take the place of fats and carbohydrates if the body has not enough of one or the other for fuel, but neither of the latter can take the place of albuminoids in building and repairing tissue. 2. The gelatinoids resemble the albuminoid group in their chemical composition; they are derived from ossein and chondrin (connective tissue) and are changed to gelatin on heating with water and during digestion into gelatin-peptones. They are not tissue formers, but serve as fuel, and thus protect the protein fats and carbohydrates from consumption. Indeed 100 grams of gelatin can take the place of 36 grams of albumin and 25 grams of fat, but unfortunately large quantities are liable to cause nausea and diarrhea, probably because the undigested particles undergo rapid decomposition. 3. The extractives, so called because they are extracted from flesh by water, are known in the laboratory as creatin, creatinin, carnin, etc., and are the chief constituents of beef tea and meat extracts. Neither the extractives or amids found in vegetables like asparagus, betain, etc., can replace or exert a sparing effect on the consumption oi albumin ; they are therefore alimentary aids and not true foods. Indeed Kemmerich, over twenty years ago, pointed out that they are not free from danger on account of the large percentage of potas- EEPORTS OF THE PBBSIDENt's HOMES COMMISSION. 125 slum salt; at all events, it has been shown that animals fed exclu- sively on meat extracts die more quickly from starvation than do those deprived entirely of food, and Fothergill, one of the most dis- tinguished English food experts, exj^ressed the opinion " that more lives have been lost by a mistaken belief in the food value of beef tea than by all the Napoleonic wars." Beef tea acts as a regulator and stimulant of digestion and assimilation and, like the meat broths, is useful in the dietary of sickness, provided we combine it with eggs, farinaceous food, and small quantities of gelatin. The meat peptones and fluid meat, containing, as they do, considerable proportions of true nutriments, are much to be preferred, but their nutritive value in the treatment of disease must not be overestimated. 4. The hydrocarbons of fats, whether derived from the animal or vegetable kingdom, are emulsified and saponified by the pancreatic juice and bile and finally reach the tissues, where they become an integral part of the cells. Apart from aiding in the reconstruction of fatty tissues, they undergo oxidation, and thus supply heat and energy. Since the cells without exception contain more or less fat, it being, in conjunction with albumin, the principal constituent of nerve tissue, a store of adipose tissue, especially during febrile conditions, hard work, or whenever the consumption exceeds the supply, is very desir- able. If the supply of fat exceeds the demand, the excess is eliminated in the feces, while other portions are stored up in the visceral cavities and subcutaneous tissues, where it serves as a nonconductor of heat, gives beauty and form to the body, and protects various important structures from injury, but most important of all, if the supply should be cut off, or the consumption be increased, as during febrile condi- tions and hard work, this reserve fuel can be drawn upon for the production of heat and energy, and thus protect the more important protein compounds from oxidation. 5. The carbohydrates are nonnitrogenized principles which, in ad- dition to carbon, contain hydrogen and oxygen in the proportion to form water. The formula for starch or dextrose is CgHioOg and that of sucrose or cane sugar C12H22O11. The carbohydrates, whatever their source, enter the blood as sugar; normal blood contains about 0.1 per cent and rarely more than 0.2 per cent of sugar. The liver prevents a large accumulation by stor- ing it up as glycogen, or liver-starch, which under the influence of a ])eculiar ferment is reconverted into sugar as the needs of the economy demand, and any further excess is removed by the kidneys. The sugar in the blood is carried to the tissues, where it undergoes oxidation, yielding heat and energy. It is generally held that carbohydrates when ingested in liberal amounts may be converted into fat. How this is accomplished is not yet understood, but it may partly be ac- counted for by the fact that the oxidation of sugar saves the fatty and protein tissues from destruction and allows the fat in the diet to form new fatty tissues. 6. The pectin substances, like pectose and pectin, found in fruit and tubers, form jellies with water, are related to the carbohydrates, and probably serve similar purposes in the economy. 7. The organic acids, like tartaric, mallic, citric, acetic, oxalic, and lactic acids existing in fresh vegetables and fruits, fresh meats and milk, are transformed in the system into carbonates and as such pre- serve the alkalinity of the blood and other fluids. In the absence of 126 EEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. these acids the blood becomes impoverished and scurvy is liable to develop. An excess is likely to interfere with digestion, especially with the conversion of starch into sugar, not to mention the laxative and diuretic properties. 8. The fact that 60 per cent of the body is composed of water clearly indicates that a sufficient amount must be introduced to make up the loss sustained by its excretion through the lungs, kidneys, skin, and feces. It is simply necessary to recall the physiological functions of water in the absorption and assimilation of food, the elimination of waste products, and its role as a heat regulator to appreciate that a deficiency is certain to be followed hj injurious effects. 9. The mineral salts, which furnish about 6 per cent of the body weight, are potassium, calcium, magnesium, sodium, and iron in com- bination with chlorine, phosphoric, sulphuric, and carbonic acid. The phosphates of lime, potash, and magnesia contribute largely to the formation of bone, and are also essential for the growth of the nervous system. Iron is required for the red blood corpuscles and coloring matters, the chlorides are the source of hydrochloric acid in the gas- tric juice and keep the globulins of the blood and other fluids of the body in solution. Potassium for the blood cells and solid tisues and sodium for the intercellular fluids are all essential for the growth and repair of the tissues; of these certain quantities are daily eliminated and must be replaced. Forster has shown that when the supply in animals is suspended, serious digestive derangements, depressions of the nervous system, muscular weakness, trembling, paralysis, stupor, and death ensue. Voit's experiments indicate that an insufficient supply of the salts of lime produced rickets in growing animals, and children fed largely upon farinaceous food are proverbially prone to this affection ; incom- plete absorption of these salts produces the same effect, as shown by the frequent development of rickets after prolonged diarrheal affections. An insufficient supply of iron or incomplete absorption may give rise to chlorosis and anaemia, and a deficiency of the potassium salts in consequence of an exclusive animal diet is believed to favor the development of scurvy, but as this disease has developed among prisoners who subsisted largely on a vegetable diet, I quite agree with Fluegge that the absence of fresh vegetables, more especially the organic acids contained therein, is the most important factor in the development of scuryy. An excess of chloride of sodium, as during a constant salt meat diet, doubtless predisposes to scurvy, probably because the chloride of sodium exerts a decomposing effect on the potassium combinations of the blood corpuscles. The question as to the exact requirements of the inorganic salts in the system has not yet been solved. According to Boussingault an adult requires from 60 to 90 mgrs. of iron daily, and according to Konig, persons upon a mixed diet require from 12 to 20 grams of sodium chloride. In reference to accessory foods, such as spices and condiments, extractives of meat, bitter principles contained in vegetables, tonics, and the alkaloidal beverages like coffee, tea, and cocoa, we can not stop to point out their physiological effects, except to say that, since .they act largely through the nervous system, every excess over and above the amount required will produce mischiei; indeed we may REPORTS OF THE PRESIDENT S HOMES COMMISSION. 127 safely conclude that, while the use of accessory foods in moderation increases temporarily the elasticity of mind and body and a desire and capacity for work, their abuse is fraught with danger. FOOD. The two broad divisions of food are animal and vegetable, although the mineral kingdom unites to furnish man with sustenance. Animal food is characterized by a predominance of the proteids and mineral salts, while vegetable food is rich in carbohydrates, which, however, like the vegetable albumin, are inclosed in cells composed of a fibrous frame-work known as cellulose, and therefore more difficult to be acted upon by the digestive fluids. An excess of this cellulose usually excites undue peristaltic action and consequently a more rapid transit of the intestinal contents, and thus interferes with the complete utilization of the nutritive material ; a certain amount of cellulose is necessary, however, to promote the action, because if the food was so nutritious as to be entirely absorbed, there would be very little solid to transmit and the action of the bow- els would become irregular and unsatisfactory. Hence the good effect of graham bread, vegetables, and fruit in habitual constipation. ANIMAL FOOD. MEAT. In a dietetic point of view we mean by meat the muscular substance with its connective tissues, the fat and various juices deposited therein. The nutritive value of meat depends upon the large percentage of protein. Dark meats, such as game and wild fowl and beef, contain from 18 to 25 per cent of albumin. The relative amount of nutritive matter is shown in the following table based upon analyses by Konig, Voit, and others : Proteids. Gelatin. Fat. Salts. Extract- ives. Beef Per cent. 18.4 16.3 17.5 15.5 15.3 19.8 21.7 23.3 21.5 19.3 21.1 Per cent. 1.6 4.5 Per cent. 0.9 1.0 1.5 6.5 28.9 20.8 2.5 1.1 2.5 16.3 22.9 Per cent. 1.3 1.0 1.2 1.2 .8 5.5 1.0 1.1 Per cent. 1 9 Veal .9 1 4 Pork fresh lean 1.5 1 3 Ham smoked lean Game ( rabbit) Broiler chicken .. 1.0 1.0 Turkey According to the foregoing table, game and fowl are richest in pro- teids, salts and extractives; veal and pork are poorest in proteids; veal richest in gelatin ; ham and pork richest in fat ; horse and veal poorest in fat ; beef richest in extractives ; veal poorest in extractives. All of which explains the superior nutritive value of game and wild fowl, in the so-called dark meats and also the superior flavor of beef and fowl over veal and pork, and also explains the rich amount of gelatin in veal broth and gravies. 128 BEPOETS OF THE PRESIDENT'S HOMES COMMISSION. The particular part from which the meat is derived also influences the percentage of proteids, as shown by Konig ; Per cent of proteids in beef from — A shoulder piece 14. 50 The loins 18. 80 The neck 19. 50 The hind quarter 20.81 The meat of young animals, on account of the excess of water, con- tains less nutriment, but because of the more delicate connective tissue is more readily digested. FISH. The meat of fish contains about the same foodstuffs, only in smaller proportions, due to the excess of water. Most of the fish meat con- tains from 15 to 20 per cent of proteids, but oysters, crabs, and lobsters contain only from 5 to 10 per cent. There is little or no difference in the digestibility of white and dark meats, as from 95 to 96 per cent are utilized. Fish meat, contrary to popular opinion, contains less phosphates than that of other animals. Carbo- hydrates. Oysters Canned oysters.. Clams Mussels Lobsters Crab Shrlmj)s, canned Terrapin Green turtle Proteids. Fats. Salts. Per cent. Per cent. Per cent. 9.78 2.05 1.98 7.41 2.07 2.15 14.55 1.79 2.76 12. 51 1.67 1.73 14.49 1.84 1.71 16.64 1.96 3.13 25.38 1.00 2.58 21.23 3.47 1.02 19.84 .53 1.20 Per cent. 5.89 3.95 2.94 5.42 According to J. Konig and the United States Commissioner of Fisheries the composition of fish meat is as follows : » Haddock Pike Carp Herring Eel Salmon Shad Spanish mackerel Mackerel Lake trout Brook trout Halibut Black bass Red bass White perch Yellow perch Red snapper Sturgeon Smelt Codfish meal Smoked haddock Smoked herring Proteids. Fats. Percent. Per cent. 16.71 0.20 18.34 .51 21.86 1.09 10.11 7.11 12.83 28.37 15.01 6.42 18.65 9.48 20.97 9.43 18.77 8.21 18.22 n.88 18.97 2.10 18.35 6.18 21.05 2.44 16.68 .53 19.03 4.07 18.49 .70 19.20 1.03 17.96 L90 17.36 1.80 74.46 LOO 33.68 .17 36.44 15.82 Salts. Per cent. L44 .93 1.33 2.07 .81 1.36 L36 1.60 L40 1.26 L21 1.06 1.24 1.23 1.19 1.29 L31 1.43 1.68 6.41 1.63 2.06 The consumption of raw meats should be discouraged on account of the danger of transmission of animal parasites which are only destroyed by a temperature of 1G0° F. In roast iig meat, certain chemical changes take place which not only improve the taste but its digestibility, largely because the ccn- EEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. 129 nective tissue is converted into gelatin and the liberated muscular fibers are more readily acted upon by the digestive fluids. Broiling produces very much the same changes, except perhaps a more complete retention of the juices, extractives, and salts. Fried meats are usually objectionable, unless they have been dropped into very hot fat, in which case coagulation of the albumin not only pre- vents excessive absorption of fat, but also the exudations of flavor and juices. BOILED MEATS AND BEOTHS. Boiling water coagulates the albumin, transforms the connective tissue into gelatin, and dissipates the coloring matter, but as the water penetrates, it abstracts some of the newly formed gelatin, ex- tractives, and salts ; also some of the fats and proteids. The loss thus sustained depends upon whether the meat has been placed in boiling or cold water. If we wish to retain the juices and flavor in the meat, it should be plunged in boiling water, as the rapid coagulation of the albumin will prevent excessive exudation. If, on the other hand, we desire a rich broth, the meat should be placed in cold water and kept at a temperature below 160°. The loss sustained in extractives, salts, and water renders boiled meat less palatable and also some- what tougher unless cooked at a temperature below 180°, and it is therefore not so easily digested; the nutritive value of boiled meat, however, is not impaired and the objections referred to can be over- come by chopping and the addition of spices. In stewing, the meat should be cut into small pieces, placed in cold water, and brought up gradually to a temperature of 180 degrees, and kept there for several hours. Gravies, on account of the large amount of fat and gelatin present, are liable to cause indigestion in feeble stomachs and are not suitable for the sick and invalids. The meat peptones and meat juices, because of the presence of pro- teids, are doubtless of value in the treatment of disease. SPECIAL CONCENTRATED MEAT PBODUCTS. Meat powder or meat flour is made of lean beef, cut into strips and dipped into very hot fat. After draining, it is dried slowly in an oven and ground into very fine powder, 1 pound representing about 4 pounds of flesh. The nutritive value of these products is very high. Carne pura contains 68 per cent of protein, and codfish meal Y9 per cent. Their digestibility is also very good, they keep well, and the price is moderate, but on account of their taste and odor they have not come into general use. Meat powder has been mixed with meal from the legumes, wheat flour, and other farinaceous food in the form of biscuits or compressed cakes for use as an army emergency ration. The nutritive value of ham, bacon, sausage, and other meat products is also very high. Meat may be preserved by cold storage, by heat as in the canning process, by drying as in the case of jerked beef or venison, by smoking and pickling either in brine or vinegar. Chemical preservatives other than salt or vinegar should not be tolerated, as we possess in cold storage and heat far more efficient and certainly less harmful preservatives. S. Doc. 644, 60-2 10 130 EEPORTS OP THE PRESIDENT'S HOMES COMMISSION. MEAT INSPECTION. In judging the quality and wholesomeness of meat, the color, con- sistency, and odor are valuable points to be observed. Good beef has a bright red color and marbled appearance due to the presence of fat; it is firm yet elastic to the touch, moderately moist, and has a characteristic beefy odor. Bull beef is usually of a darker color; mutton has more of a brownish red color; meat of immature animals is pale, watery, and friable. Meat which has gone beyond the first stage of decomposition is soft and liable to pit or crackle upon pres- sure, and emits an offensive tainted odor, especially when hot water is poured upon it. In pushing a knife to the hilt, the resistance in good meat is uniform, while in putrefying meat some parts are softer than others and the tainted odor clings to the knife. In temperate climates the marrow remains solid for twenty-four hours and is of a light pink color; when it is soft, looks brownish, and contains black points the animal has either been sick or putrefactive changes have begun. In connection with meat products the possibility of ptomaine poisoning, with symptoms of nauseau, vomiting, diarrhea, cramps, and depression should not be overlooked. Similar symptoms have been observed after the eating of oysters, mussels, crabs, lobsters, and milk. Oysters raised in sewage-polluted beds have been known to transmit the germs of typhoid fever. Diseases like anthrax, bovine tuberculosis, hydrophobia, foot-and-mouth disease, infectious en- teritis, actinomyces, trichina, and cystererci are transmissible to man through the meat supply. For all these reasons hygiene demands not only a proper control of the meat market, but also proper cook- ing, since nothing short of a temperature of 160° wdll destroy these organisms. MILK. Milk is an ideal food. The average composition of cow's milk is protein, 4.5 ; fat, 3 ; sugar, 4.5 ; salts, 0.75 ; water, 8T.25. In keeping milk at ordinary temperature it rapidly undergoes changes which are brought about by the agency of micro-organisms. One of the greatest dangers in milk is caused by impurities seen in the so-called milk sediments, which consist largely of excrementi- tious matter clinging to the teats and udder of the animal, and which, owing to the presence of fecal bacteria, bring about rapid souring of the milk, with the production of toxins such as tyrotoxicon, and these in turn give rise to cholera infantum and other gastro-enteric diseases. The reaction of milk should be neutral or amphoteric, the amount of cream should not be less than 10 per cent per volume, and the amount of total solids not less than 12 per cent, of which at least 3 per cent should be butter fat. Milk is not quite as digestible as meat; nevertheless, from 89 to 92 per cent is utilized. Boiled milk is not as digestible as raw or pasteurized milk. (See also milk as a cause of disease, p. 193. Skimmed milk is the residue after the cream has been removed. As it contains the other solids and is quite cheap, it should become a more popular article of food. The same may be said of cott^ige cheese. There are a number of brands of condensed milk in the market, all made by the evaporation of the water of the milk by moderate heat or REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 131 in vacuum pans with or without the addition of sugar. In the plain variety the milk is condensed to about one-third or one-fourth of its volume. As at present prepared, condensed milk is unsuitable for infant feeding, because it contains an excess of the proteids and sugar and is deficient in fats. These objections can be removed by modify- ing the milk previous to condensation, so that the composition is as nearly as possible that of human milk. It then can be condensed to about one-third of its original volume and the proportions restored by proper dilution just before using it for infant feeding. Whey is the serum or watery part of the milk which remains after the curds have been pressed out from the milk to make cheese. It is used in certain diseases and also as a food in very difficult cases of indigestion in infant feeding. Milk wines, like koumis and kefyr, are made from mares' or cows' milk, respectively, and are the products of a peculiar fermentation, combining alcoholic with lactic acid fermentations. These beverages, in addition to the normal constituents of milk, contain alcohol, car- bonic acid, and lactic acid, and are of value in the feeding of invalids. Buttermilk contains all of the constituents of milk except that the amount of fat and sugar is less. The presence of lactic acid imparts a pleasant taste, and as it contains most of the desirable nutrients and is, moreover, quite cheap, its use should be encouraged. CHEESE. Cheese varies in richness according to the amount of cream used in its manufacture. Cheeses contain from 26 to 40 per cent of fat and 17 to 29 per cent of protein, and possess, therefore, remarkable nutritive qualities. If taken in reasonable quantities, 96 per cent of the protein and 97 per cent of the fat is digested. Cheese should never be taken in the form of toasted cheese. The richer cheeses, unless eaten quite sparingly, are very apt to produce dyspepsia. BUTTEE AND BUTTEB SUBSTITUTES. Butter is formed by churning the cream of milk. The amount of butter in coavs' milk is about 3.75 or 4 per cent (i. e., about 4 pounds to the 100 pounds of milk). Butter contains about 84 per cent of fat, of which nearly 97 per cent is digested if taken in moderate quanti- ties. Eancid butter is very liable to cause indigestion. Process or renovated butter is the product of rancid or tainted but- ter which has been purified by melting and washing, and, since it is sold far below the market value of butter and possesses the same nutri- tive properties as fresh butter, its use should not be scorned. Oleomargarine is a mixture of oleo oil derived from the richest and choicest fat of the beef, neutral lard, butter, cream, or milk and salt, and in the cheaper grades cotton- seed oil is also used. Oleo and neutral lard are the chief ingredients. These, after melting, are churned with cream or milk, salted, and run through cold water, worked in a butter worker, and placed in suitable packages and labeled, according to the United States laws, " Oleomargarine." If colored to resemble June butter it is subject to a special tax of 10 cents per pound. If sold uncolored the revenue tax is only one-fourth cent per pound. There is practically no difference in the nutritive value 132 REPORTS OF THE PRESIDENT S HOMES COMMISSION. and the digestibility between butter and oleomargarine or butterine, and, as it is sold for half the cost of butter, the writer, as a teacher of hygiene, has urged upon his students for years to bring the nutri- tive value of this foodstuff to the attention of the public and, in the interest of the wage-earners, to correct, as far as possible, the preju- dice which has been created against its use, provided, of course, it is sold under its true name and at its real value. EGGS. Egg albumin has the following composition : Albumin 13 per cent, fat 0.2 per cent, salts 0.6 per cent, water 86 per cent ; yolk, vitellin 15.8 per cent, lecithin 8.7 per cent, nuclein 1.5 per cent, fat 20.3 per cent, salts 1 per cent, water 51.8 per cent. Eggs, raw or soft boiled or when stirred into hot soups, are readily digested ; about 97 per cent of the proteids and 95 per cent of the fats are utilized. Hard-boiled eggs are not readily digested, and for people with feeble digestion the yolk of the egg stirred in soup should be preferred. The nutritive value of a single egg is equal to 37 grams of fat beef or 165 c. cm. of rich milk. Fish eggs contain, on the whole, the same nutritive principles as chicken eggs, only in different proportions. VEGETABLE FOOD. CEEEALS. Of all the vegetables the cereals stand at the head of the list. While the legumes contain more vegetable albumin, they can not be prepared in so many suitable ways, and are more difficult of digestion. H. W. Wiley's analysis, based upon American grains, is as follows : Wheat Rye Barley Oata Indian corn... Buckwheat . . . Rice, polished Mois- ture. Per cent. 10.60 10.50 10. 85 10.00 10.75 12.00 12.40 Pro- teids. Per cent. 12.25 12.26 11.00 12.00 10.00 10.75 7.50 Fat and ether extracts. Per cent. 1.75 1.50 2.25 4.50 4.25 2.00 .40 Starch. Per cent. 71.25 71.75 69.55 58.00 71.75 62. 75 78.80 Cellu- lose. Per cent. 2.40 2.10 3.85 12.00 1.75 10.75 .40 Salts. Per cent. 1.75 1.90 2.50 3.50 1.50 1.75 .50 The following table (ITffelmann's) shows the average composition of different flours and cereals: Pro- tein. Cnrbo- | Cellu- hydratcs. lose. Fine wheat flour Per cent. 11.00 10.20 10.43 10.89 11. 25 14.29 10.00 10.71 7.80 Per cent. 74.90 7.'i.l0 75.95 71.85 70.64 65.73 71.00 70.12 79.40 Per cent. Pine rye flour Fine cracked wheat 22 Fine cracked barlev 47 Pealed barley 54 Oatmeal 2 24 Commeal 2 50 Buckwheat meul _ 1 04 Rice EEPORTS OF THE PKESIDENT S HOMES COMMISSION. 133 The cereals are eaten only after a series of careful manipulations producing different grades of flour, varieties of breakfast cereals, etc. In the finest grades of flour nearly all the outer membranes of the wheat grain (bran) is separated; while this removes much indigesti- ble matter it also removes some of the proteids and fats. On the other hand the nutritive material in bran is in a form quite difficult of digestion, and the experiments conducted by Professor Snyder in 1901 indicated that the available proteids in graham bread are not utilized to the same extent as in high-grade white bread. Wlieat and rye flour, on account of the gluten present, are especially suited for the preparation of bread; preference should be given to properly baked yeast bread, and next to the patent aerated bread, while the use of baking powders should be discouraged. Apart from the fact that yeast predigests in a degree the starchy matter, baking powders are often subject to shameful adulterations. Bread possesses decided nutritive qualities, the proportion of nitrogenous to non- nitrogenous matter being 1 in 7. Experience has shown that a male adult can not digest over 750 grams, and a female over 600 grams a day. This amount would supply about two-fifths of the protein and two-thirds of the carbohydrates required in twenty-four hours. When taken in proper quantities 95 to 96 per cent of a light, spongy bread are digested. Toasted bread contains less water and hence more nutriment pound for pound. Crackers can not take the place of bread. Gluten crackers are suitable for diabetic subjects, because they contain from 55 to 75 per cent of protein and only from 10 to 30 per cent of starch. The nutritive value of vermicelli, macaroni, and the various grits used in soups and in the preparation of mushes may be materially enhanced by the addition of milk and cream. Legumes are a most valuable class of foodstuff, on account of the great amount of vegetable albumin present, and have very aptly been called the poor man's meat.- The difference in nutritive value be- tween the immature peas and beans, which are used as green vegeta- bles, and the matured seeds is shown by the analysis of Konig, Atwater, and Bryant : Pro- teids. Fat. Starch and dextrin. Carbohy- drates. Cellu- lose. Salts. Soja beans Per cent. 33.41 24. 27 23.21 22.85 26.70 7.00 3.60 2.30 1.10 Per cent. 17.19 1.61 2.14 1.79 1.89 • .50 .20 .30 .10 Per cent. 29.99 49.01 53.67 52.46 53.46 Per cent. Per cent. 4.71 7.09 3.69 5.43 3.57 Per cent. 5.19 3.26 3.56 2.58 3.04 1 00 Kidney beans Peas Lentils Green peas (Atwater and Brvant) 16.90 9.80 7.40 3.80 Canned peas (Atwater and Bryant) 1 10 String beans: Fresh 80 Canned 1 30 The digestibility of these vegetables depends largely upon the rnode of cooking; they should not be cooked in hard water, as the lime salts form insoluble compounds with the legumin, and after cooking the outer membrane should be removed by straining, in which case about 88 per cent of the nutritives are utilized. If they are old they should first be soaked for twenty-four hours in cold water. 134 REPORTS OF THE PRESIDENT S HOMES COMMISSION. SUCCULENT VEGETABLES. Almost all of the fresh vegetables, except potatoes and green peas, contain a great amount of water, cellulose, and salts, and therefore very little nutriment. They are rich in amido-compounds, and their chief value consists in the fact that they supply the mineral salts in a very palatable and assimilable form. Potatoes contain proteids 2 per cent, fat 0.10 per cent, starch 20 per cent. The juice is a valuable antiscorbutic. If over 600 grams of potatoes are taken daily some of the starch is liable to undergo fer- mentation. In sprouting solanin, a toxic agent, is produced ; this is liable to cause nausea, vomiting, and diarrhea. The nutritive value of potatoes can be improved by cooking them in their jackets and the addition of butter and milk; fried potatoes, except in the form of Saratoga chips, can not be recommended. String beans and green peas possess greater nutritive value than potatoes, carrots, beets, oyster plant, parsnips, radishes, turnips, pumpkins, celery, lettuce, squash, asparagus, tomatoes, and cucum- bers on account of the greater amount of vegetable albumin present. With the exception of beans and peas most of the vegetables are deficient in proteids but fairly rich in carbohydrates and are chiefly valuable for their salts and for the variety which they give to our food. The different varieties of cabbage and spinach are antiscorbutic agents, while lettuce and endive owe their refreshing taste to the presence of organic acids in the form of citrates, malates, and oxa- lates. The efficacy of onions, wild artichoke, sorrel, scurvy grass, mustard, cress, and lambs' quarters as antiscorbutics should not be forgotten. The nutritive value of edible mushrooms is not greater than that of other fresh vegetables; they are not easily digested and have been greatly overrated as an article of diet. FRUITS. Fruits, apart from vegetable fiber and juice, contain some soluble proteids, sugar, dextrose, lavulose, pectins, free organic acids (citric, malic, and tartaric), and compounds of these with potassium, sodium, and lime. The quantitative composition of some of the fresh fruits, according to Konig, is as follows : Qrapes Cherries Peaches Pears Apples Apricots Plums Currants Strawberries. . Oranges Blackberries. . RaspbcrricH... Cranberries... Huckleberries Dried grapes . Dried apples.. Dried pears... " plozoB. . Proteids. Per cent. 0.59 .67 .65 .36 .78 .61 .54 .73 .51 .40 .12 .78 2.42 1.28 2.07 2.25 Free acids. Per cent. 0.79 .91 .92 .20 .82 1.16 .85 2.16 .93 2.44 1.19 1.42 2.34 L66 3.60 .84 2.75 Sugar and pectin. Per cent. 26. 32 12.00 11.65 11.90 13.03 11.04 11.07 7.28 7.74 5.54 4.44 3.86 1.53 5.02 62.00 59. 77 58.80 62.32 Cellu- lose. Per cent. 3.60 6.07 6.06 4.30 1.51 6.27 5.41 4.67 2.32 1.79 6.97 8.10 6.27 13.16 4.99 6.86 1.62 Salts. Per cent. 0.53 .73 .69 .31 49 82 .71 .72 .81 .49 .48 .48 .16 1.02 1.21 1.57 1.67 1.87 REPORTS OP THE PRESIDENT S HOMES COMMISSION. 135 Watermelons contain 92 per cent of water, 0.4 per cent of protein, 0.2 per cent fat, 6.7 per cent of carbohydrates and fiber, and 0.3 per cent of salts. There is nothing in their nutritive qualities to justify their popularity. Ripe bananas contain 20 per cent of sugar, 2 per cent of protein, 0.5 per cent of starch, and a little more of fat. Fresh figs are about equal in nutritive value to the banana. The dried fig contains 50 per cent of sugar, 4 per cent of protein, 3 per cent of salts, and about 13 per cent of seeds and indigestible fiber. Fruit contains very little protein, but the percentage of carbohy- drates is considerable, and on account of the organic salts and aro- matics they are very refreshing and promote the action of the bowels and kidneys. Hard and very acid fruits are liable to produce diar- rhea. Lemon and lime juice contain free organic acids, about 30 grains of citric acid to 1 ounce of the juice, and are excellent anti- scorbutic agents. Shell fruits contain a great amount of nutritive material in the form of protein, fat, and carbohydrates, as shown by the following table prepared by Uffelmann : Protein. Fat. Carbo- hydrate. Cellu- lose. Salts. Almonds Per cent. 24.18 16.37 5.48 3.99 Per cent. 53.68 62. 86 1.37 1.69 Per cent. 7.23 7.89 38.34 67.67 Per cent. 6.56 6.17 1.61 5.10 Per cent. 2 96 Walnuts 2 03 Chestnuts 1.72 Bread fruit 1 69 Hazelnuts have about the same composition as walnuts. The meat of cocoanuts contains about TO per cent of fat and the milk contains nearly 7 per cent of sugar. Peanuts contain about 30 per cent of pro- tein and 45 per cent of fat, and hence enjoy a very deserved reputa- tion. Chestnuts are quite indigestible in the raw state, and should be either roasted or cooked. Roasting also aids in the digestion of peanuts and almonds. Honey, sugar, and sirups are foodstuffs, as they supply heat and energy in the system and also improve the palatability of the food. The same is true of jams and jellies; the latter delicacies should always be homemade, as it is frequently the case that they are made from glucose, sirups, and gelatin artificially colored and flavored. Indeed it has been shown that the refuse of fruit-canning establish- ments and such tasteless articles as summer squash, boiled white tur- nips, and clover seed are transformed into commercial jams. COMBINATION OF FOOD. A question of considerable importance is whether the needs of the economy shall be supplied with an animal, vegetable, or mixed diet, and the answer is plainly in favor of a mixed course. In the first place, the structures of our teeth and digestive tract plainly indicate that we occupy an intermediate position between the carnivora and herbivora. In the second place, if we were to supply the needs of protein in the system exclusively from the vegetable kingdom, we would have to introduce an excess of carbohydrates, i. e., about 1,800 grams of bread or rice or 6,000 grams of potatoes. On the other hand, in order to supply the requirements of carbon from the animal kingdom, we woul^ have to eat about 7,000 grams of meat containing 136 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 5 per cent of fat or drink 6,000 grams of milk. Such quantities can not be taken for any length of time without creating intense disgust for food and causing serious systemic disorders. For these reasons alone a mixed diet should be preferred. Moreover, Uffelmann has shown that the recruits of a Prussian infantry company, between the ages of 21 and 22 years, made their best gains while subsisting on 39 grams of animal and 71 grams of vegetable proteids, and con- cludes that this proportion is, physiologically speaking, the proper one. Indeed an exclusive animal diet is liable to produce gout and diseases of the arteries, kidneys, and liver, and health suffers when- ever 75 per cent or more of the proteids are supplied in the form of meat or eggs, probably on account of the crystalline waste products in the blood. Food should be combined so as not to tax the digestive organs. Thus, for example, milk is not well borne with acid fruits, and the digestibility of eggs is impaired by large quantities of fluids. The condiments and relishes should not be wanting, and monotony in diet should be avoided. The foundation of a suitable diet will, however, be found in meat, milk, butter or fat, bread, rice, or potatoes. The amount of cooked meat should not be less than 160 grams and should not exceed 190 grams a day, or from 180 to 210 grams of fish. If the minimum amounts are taken, the deficiency should be supplied by 250 c. cm. of milk. The daily requirements of fat are at least 25 grams of butter, oleo- margarine or lard, or 30 grams of bacon, according to the taste and circumstances of the individual. Bread is an indispensable article of diet, and has long been called the staff of life; it furnishes a well-balanced ration of protein and hydrocarbons, but experience has shown that more than 750 grams Eer day can not be tolerated, nor can more than 600 grams of potatoes e profitably consumed per day. It is very desirable that legumes and rice should take the place of some of the potatoes. From our knowledge of the proximate constituents contained in the various foodstuffs, diet tables can be constructed which will meet the requirements of the body as well as the purse of the consumer. So, for example, a ration of bread, codfish, lard, bacon, potatoes, beans, milk, sugar, and tea may be purchased for 15 to 20 cents which in actual food value is equal to the best hotel fare. STOREROOMS AND PANTRIES. The different methods employed in food preservation — such as cold storage, drying, salting, pickling, and canning — have been briefly re- ferred to, and it remains to point out what may be done for the preser- vation of food of a perishable nature. When we realize that all fer- mentative and putrefactive processes are initiated by micro-organ- isms, we will appreciate the importance of absolute cleanliness and the creation of such environments as will preclude at least their rapid proliferation. For this purpose the food should be kept in dry, well- ventilated, and cool storerooms or pantries, located preferably in the basement, and away from contaminating influences, such as impure air, dust, and other sources of infection. In summer the use of ice boxes or cold storage is quite essential to inhibit bacteria 1 develop- ment, and food should be purchased in such quantities ns to insure speedy consumption. It is perhaps unnecessary to say that food REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 137 should never be kept in, or in close proximity to, living and sleeping rooms or soiled linen closets, and yet this is not infrequently the case. In order to prevent infection of the food by means of flies, the store- room should be properly screened, and it is also a good plan to use either filtered or boiled water for washing fruits and vegetables which are eaten raw. Persons suffering or recovering from communicable diseases should not be permitted to handle food for others. Food should never be placed in dirty pans or dishes, and great care should be exercised to prevent metallic contamination. For example, old milk pans may impart zinc, utensils made of tin, lead, or copper may contaminate fruit, lead or tinfoil may contaminate cheese; arsenical pigments have been knowm to contaminate the bread in green-painted bread boxes, or confectionery wrapped in colored papers. PREPARATION OF FOOD FOR COOKING, ETC. Prior to coolring, all raw materials should be thoroughly cleaned by soaking, rubbing, rinsing, and wiping. This will render the food not only more appetizing, but also more wholesome, by the removal of adherent particles of dirt and micro-organisms. The same may be said of the removal of decayed or indigestible portions — such as the husks of legumes, the peelings of fruits, potatoes, and other vege- tables — and the removal of tendons and fasciae from meat. Chopping, grinding, and pounding render meat and other articles more tender and accessible to the action of the digestive fluids. The addition of condiments improves the taste and digestibility, provided the food is not too highly seasoned. A high temperature secured by boiling, steaming, roasting, or baking not only influences the consistency, taste, flavor, chemical constitution, digestibility, and keeping qualities of food, but also destroys all parasites and micro-organisms which may be present. COOKING AND EATING UTENSILS. Hygiene demands that all such utensils must be kept scrupulously clean; apart from the hygienic and esthetic aspect, food served in clean and attractive dishes tastes better and stimulates the appetite and digestion. We have learned that, long before we knew of the existence of saprophytic germs and ptomaine intoxications, the Hebrews paid special attention to the subject of clean cooking, eating, and drinking utensils. We know from daily observation that unclean methods are a fruitful cause of disease. (Industrial Hygiene, p. 111.) The shape of cooking utensils is. of importance in the question of cleanliness ; for this reason a flat bottom, with a quarter-round termi- nation of the sides, should be chosen. Earthenware pots and pans glazed with lead, or iron pots enameled with lead or zinc containing lead, should not be used. Britannia ware occasionally contains lead and should be tested. Utensils made of nickel impart a peculiar bit- ter taste to the food and drink, but are not otherwise objectionable. Copper and brass utensils must be kept polished to prevent the forma- tion of copper salts. Food containing fat, chloride of sodium, and ammonia compounds should not be permitted to cool in copper uten- sils, as the copper oxidizes at the level of the food and becomes solu- ble. Iron utensils impart a peculiar inky taste and grayish appear- 138 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. ance to food, and should therefore be tinned or enameled. For all these reasons porcelain lined or granite ware and the various steam- cooking utensils should be preferred. The temperature of food and drink is not a matter of indifference ; this is especially seen in the artificial feeding of infants. Iced drinks hastily swallowed are liable to cause neuralgia of the stomach, dys- pepsia, and even acute gastric catarrh ; cold grapes and fruit are apt to produce colic and diarrhea. The bad effects of cold victuals have been frequently observed in persons obliged to eat cold lunches, and may be regarded as a frequent cause of intemperance. Apart from the bad effects of high and low temperature upon the teeth,'* we know that cold injesta also impair the action of pepsin and ptyalin, which are most efficient at about the body temperature. Hot food or drinks, apart from injuring the mucous membranes of the mouth and stomach, also interfere with the action of pepsin and ptyalin, which is completely arrested at a temperature of 140° F. On the whole, we may conclude that the temperature of food and drink should be as nearly as possible that of the body heat, and this should be the rule for infants. A temperature of 45° may be re- garded an extreme low and one of 120° an extreme high temperature for the introduction of food. The consistency of food exerts considerable influence upon our di- gestive organs; coarse and tough substances are less susceptible to the action of the digestive fluids, and consequently more difficult of diges- tion ; this is especially true of many fibrous vegetables, of hard-boiled eggs, and heavy, sodden bread. For infants, liquid food is the best form, but adults require a certain stimulus, not to be had in liquid food, and if taken for any length of time this is certain to disagree and create disgust. A semisolid food has also been objected to be- cause of the excess of water, which is believed to lower the tone of the digestive organs. These objections have been urged by physicians on behalf of prisoners, who, on account of insufficient exercise, can not very well get rid of the excess of water. This same objection does not apply to persons actively employed, and for whom a semisolid food has indeed been found by experience the best suited to their wants. VOLUME OF FOOD. It is not sufficient to supply the required quantity of food, but it should also be introduced in such a volume as to satisfy the feeling of the individual and the capacity of the stomach. From the results of experience and observation we may conclude that an adult of average weight and performing ordinary labor, in order to satisfy a feeling of contentment, requires from 1,600 to 2,000 grams (4 to 5 pounds of food) daily. Of this amount from 800 to 1,000 grams (2 to 2^ pounds) should be taken at dinner. These fig- ures are simply suggestive, and as individual habits play an impor- tant role it will be well to guard against a sudden increase or diminu- tion in the volume of food. MEAL HOURS. The daily allowance of food should be taken in divided meals. On account of the different habits and occupations it is difficult to formu- late a rule for all classes. In a general way we may say that a • Kober's Industrial Hy^ene, p. 119. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 139 healthy adult should eat at least three times and not oftener than five times a day. The most rational dinner hour for a man who begins his labors at 6 or 7 o'clock in the morning is between 12 and 1 o'clock, for he will then be in need of food, and if he defers his principal meal till evening he will be so tired that he can neither enjoy nor fully digest it. Such persons should eat a good breakfast, a full dinner about noon, and a supper between 5 and 6 o'clock. If their appetite for an early breakfast is poor, they should eat a light lunch about 9 o'clock a. m. and a similar lunch between 8 and 9 p. m. For persons not engaged in active muscular work it is desirable that they should eat a light breakfast, a hot lunch at noon, dinner at 5 o'clock, and some light lunch between 8 and 9 p. m. Unfortunately, we possess as yet no reliable data, as regards the re- quirements of food for men who, while leading a sedentary life, per- form a great amount of brain woi'k. Some authorities claim that mental, like physical, labor increases the amount of carbon consump- tion, but not of nitrogen. Others insist that since the brain and nerve tissues contain the elements of nitrogen and phosphorus which occur in the protein compounds, they should be especially concerned in building up brain and nerves and keeping them in repair. The general impression, however, is that people whose work is mental rather than physical eat too much, especially fat and carbohydrates, and that the ordinary subsistence diet composed of 100 grams of protein, 56 grams of fat, and 450 grams of carbohydrates is best suited for their wants. The food for all persons of leisure should be selected with a view of preventing overtaxing the digestive tract, and the production of constipation with its attending evils, such as pelvic congestion, enlargement of the liver, hemorrhoids, and chronic dyspepsia. The legumes, coarse vegetables, and clarets should be avoided, but the use of light dry wines, fruits, and coffee instead of tea may be encouraged. The importance of a good set of teeth for complete mastication and avoidance of bolting the food, in order to secure thorough in- salivation, has already been pointed out; nor should we underrate the influence of our frame of mind upon this important physiological function. Every meal should be a feast; the food should be tempt- ingly served and monotony avoided; relishes and flavors should not be wanting. Pawlow, in 1902, has shown that the primary secretion of true gastric juice is the result of a reflex starting in the mouth and that the relish of the food originates the reflex. In other words, he has experimentally demonstrated why certain tempting dishes, however inexpensive, "make our mouths water," and Hornborg, in 1904, has shown that distasteful food fails to cause gastric secretion. GOOD FOOD AT REASONABLE COST. [By C. F. Lang WORTHY, Ph. D., expert in nutrition. Office of Experiment Stations, United States Department of Agriculture.] The human body needs food, air, and water for its growth and maintenance just as do all living things. An engine can not run a machine or draw a train unless it has fuel, which is converted into energy or, as we say, which is used to generate power. In the same way the body must have fuel for the work of all sorts which it per- forms, for instance, for the work expended by a mason in laying stone, or by a carpenter in sawing or driving nails, by a woman who 140 BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. sweeps or does her housework, or by a child who runs or plays, and the body must also have fuel for the work which goes on inside it, such as the beating of the heart, or the movement of the chest when we breathe, a sort of work which is less often thought about and so less familiar to most of us. Everyone knows that a large engine requires more fuel than a small one, and that if the work is severe more fuel is needed than is the case when the engine is simply running and little or no work is done. It is the same way with the human body. A large, vigorous man needs more food than a small 'child or a woman who is not more than two-thirds his size, and if a man or woman is engaged in severe work each needs more food than when idle, the need being manifested by " a better appetite." Age also has a decided effect on the kind and amount of food needed, an aged man or woman naturally requiring less food than a man in youth or middle life, since the daily tasks and the amount of work done gradually decrease until in extreme old age most of the time is passed in quiet. Soft foods and simple dishes are more suited to old age, w^hen teeth are few and body vigor is much less than in the prime of life, than are the hearty foods which strong men and women need. The infant needs the mother's milk and later the simple foods — eggs, milk, bread, vegetables, cereals, fruits, etc., which are the best foods for childhood and are most certain to build up a vigorous body. As childhood passes, the mixed diet with which most of us are familiar is commonly followed and, all things con- sidered, is doubtless the most satisfactory for ordinary persons in health. Such a diet is made up of vegetables, fruits, flour and other products from cereal grains, meat, fish, dairy products, eggs, and so on. Many persons have an idea that there is some special food, some ideal diet suited to each kind of work and to every condition of life, and that if we possessed full knowledge of the subject it would be desirable to prescribe the daily fare with the same care and accuracy with which a physician prescribes his medicines, but this does not seem to be the case. We do not regulate with such exactness the work we do, the leisure we take, the amount of clothing we wear, and all other conditions of our daily lives, and so it is for our best interest simply to regulate our diet along general lines in accordance with good sense, economy, and the knowledge which has been gained from a scientific study of the subject, taking care that the different foods are so combined that all the needs of the body are provided for, that excessive waste is prevented, and that both undernourishment and excess or overeating are avoided. It is essential that foods should be of good quality, clean, and wholesome, and that they should be well cooked. The dishes that are most relished and the methods of preparing them will vary in different countries and in different regions of the same country, for each race, and, indeed, each region, has its favorite foods and its special methods of cookery. However, when the question of food is carefully studied, we find that value of the diet expressed in scientific terms is practi- cally the same the world over when we consider persons of like size and weight performing equal aCmounts of work. This means that just as an engine of a given size would require in China the same amount of fuel for a given work which would.be needed in the United Stales, so the human machine in anj part of the world requires the REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 141 same amount of fuel, that is, food, for a given task which would be required in any other region. With the engine it is immaterial whether the fuel be wood, coal, or anything else which is convenient, provided the quality is satisfactory and the engineer knows how to use it. With the human machine it is something the same. All ordinary foods are useful when rightly combined, and each country will naturally make use of the food supply which may be most easily and economically produced. A study of the various materials which are used as food shows that they are composed of comparatively few constituents, namely, water, mineral matter, starch, sugar, and other bodies which are called car- bohydrates, fat, and nitrogenous material commonly called protein, such as the white of egg and the lean of meat. The human body is made up of the same constituents. All of the body tissues contain the nitrogenous material, protein, which is similar to that found in the lean of meat, the white of egg, in gluten of wheat, etc., and so it is understandable that the body must be supplied with food containing nitrogenous material enough for forming this tissue and for replacing any which, like the skin, finger nails, etc., may be worn away by the various conditions of our daily life and also for other purposes for which the body requires protein. In the case of the infant the nitrog- enous material needed for body growth is supplied by the milk — a food comparatively rich in this constituent as well as in the other nutrients. Later in life the nitrogenous material is supplied largely by milk, cheese, eggs, meat, cereals, beans, and similar foods. As has been said, men, the world over, of like size and performing like amounts of work apparently eat practically the same amounts of food when considered from the standpoint of its composition, and students of nutrition questions are very generally of the opinion that this fact is more than a coincidence and that these average quantities eaten actually represent average needs. Values deduced from such observations are commonly referred to as dietary standards — that is, guides for food management. Expressed in its simplest terms, the dietary standard for a man of medium size, say 150 pounds in weight, in good health and perform- ing a moderate amount of work, calls for 100 grams (or 3.5 ounces) of nitrogenous material (protein), and fat and carbohydrates enough to supply with the protein 3,500 calories of energy in the amount of food provided per day. There is always some waste in cooking and serving food, and if we consider the food purchased the values are 115 grams protein (4 ounces) and 3,800 calories. These terms are un- familiar to most persons, and it is unfortunate that some terms which are more familiar can not be found, but it is true here as everywhere else that each subject requires its own terms. We can measure cloth by the yard or milk by the quart, but we must measure work by horsepower or electricity by terms which are even less familiar. For- tunately, in the case of food and diet the matter can be explained in other ways so that the results can be applied in home management without undue difficulty. The housekeeper who wishes to estimate the nutritive value of the food she prepares, in order that she may conform with the suggested dietary standards, can readily do so by the use of such a table as the one here given, which shows the protein and energy value of the por- 142 REPOBTS OF THE PRESIDENT S HOMES COMMISSION. tions ordinarily served of the more common food materials, the values given being approximately only, as it would be hardly desir- able to state absolute figures for such a purpose as that for which the table is designed. The weights of the food portions included in the table are given in both grams, the unit of weight commonly used in scientific work, and in ounces, the more common household unit. To avoid unusual frac- tions of an ounce the nearest half ounce or quarter ounce or some similar common fraction is used instead of more accurate equivalents. In such a table the protein content of the food gives an idea of its relative value for building body tissue. The value of the food as a source of power for carrying on work is expressed by the energy it supplies when utilized in the body as fuel is burned under a boiler, and is measured as calories. A calorie is equal very nearly to 1.54 foot-tons — that is, it represents force which would be sufficient to lift 1 ton 1.54 feet — and is a more convenient unit for such purposes than horsepower or other similar unit. Approximate weight and nutritive value of an average portion of some common foods. Kind of food. 1 slice of roast meat 1 portion of meat stew 1 Frankfurt sausage 1 pork chop 1 slice of boiled bacon 1 portion of fried bacon 1 portion of steak 1 portion of meat soup 1 portion of pea or bean soup 1 cup or glass of milk 1 cup or glass of skim milk or buttermilk 1 portion of cream .* legg 1 portion of butter 1 portion of cheese 1 baked or boiled potato 1 portion of turnip, beet.carrot, or similar vegetable. 1 ear of green corn or 1 portion of stewed corn. 1 tomato or 1 portion of stewed tomato. . 1 serving of cooked spinach, cabbage, or other green vegetable. 1 portion of baked beans or black-eyed peas. 1 slice of bread 1 portion of com bread 1 slice of cake 1 slice of apple or other fruit pie 1 cup of flour 1 teaspoonful of sugar 1 cup of sugar 1 portion of sirup or molasses 1 portion of cooked cereal 1 portion of dry ready to eat cereal M i Ik f or cereal 1 portion of boiled rice 1 portion of rice pudding, bread pudding, or similar cuitard pudding. 1 portion of cherry roll or similar pudding 1 apple or pear 1 banana 1 orange 1 peach or 2 plums 1 portion of stewed prunes 1 portion of preserves 1 portion of fresh berries Average weight of portion. Grams. Ounces 325 60 190 100 50 100 190 190 225 225 65 50 10 20 140 130 75 95 126 200 60 50 60 150 225 10 226 76 200 50 25 140 176 176 100 100 126 75 100 65 100 3 11 2 7 3i 2 3J 7 7 8 8 2 2 4J Average bulk of por- tion. Saucerful . Cupful do One-half pint. do One-half gill.. Protein, grams. 1-inch cube. Medium size, 3 inches long. Saucerful .do .do. .do. .do. 4 by 4 by 1 Inches. 3 by 3 by 1 inches. 4 by 2 by 1 inches. One-sixth of a pie. One-half pint One-half pint About one-half gill. Saucerful do One-half gill Saucerful do Slice. Saucerful . do.... do.... Energy, calories. 197 461 170 765 432 252 411 60 70 170 86 130 96 95 94 145 25 40 300 175 142 190 440 960 40 890 200 170 200 40 155 50 70 50 36 116 160 35 EEPORTS OF THE PRESIDENT S HOMES COMMISSION. 143 The table may be conveniently used by supposing that the food eaten by one member of the family will represent in character and amount the food for the entire family. To estimate by means of the table the food value of the diet, the portions of each article used at each meal should be set down in order, together Avith the protein and energy which each supplies, and the total sum of the protein and of the energy will represent the amount eaten in the whole day. Suppose, for instance, that breakfast for the man of the family, a mechanic, whose work calls for a medium expenditure of physical strength, consists of 2 slices of bread, 1 portion of butter, a potato, 2 cups of coffee, and 2 eggs. Each slice of bread, as the table shows, supplies 4 grams protein and 175 calories. Two slices would there- fore supply 8 grams protein and 350 calories. A portion of butter supplies 95 calories of energy. Butter, as will be noted, contains no protein. One potato would supply 4 grams of protein and 145 calories; 2 eggs 14 grams protein and 192 calories. Tea and coffee in themselves supply so little nutritive material that they may be neglected. The sugar and cream, however, which would be used should be taken into account. If in each cup of coffee a teaspoonful of sugar is used, the amount for two cups would of course be two teaspoonfuls, and the energy value 80 calories. As the table shows, sugar contains no protein. When one-quarter gill of cream is used for each cup of coffee one-half gill will be used for two cups, and according to the figures in the table would supply 2 grams protein and 130 calories. If these foods eaten at breakfast and the protein and energy which they supply are set down in order and the quan- tities added together, the total shows the amount eaten for breakfast, as follows: Food value of hreakfast. Protein. Energy. 2 slices bread 1 portion butter 1 potato 2eggs 2 cups coffee 2 teaspoonfuls sugar for coffee One-half gill cream for coffee. Total Grams. Calories. 8 350 95 4 145 14 192 80 2 130 28 992 In the day's ration which has been selected we will suppose that the man carries his lunch and that it consists of two sandwiches (made from four slices of bread, one portion of butter, and two portions of cheese) a slice of cake, and a banana, and that for dinner he has one portion of beefsteak, one potato, one serving of turnips, an ear of corn, one slice of bread, one portion of butter, a dish of rice pudding, and one cup of tea withl sugar and milk. Following the same method as was used in computing the value of breakfast, the lunch would supply the following. 144 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. Food value of lunch. Protein. Energy. 4 slices of bread for sandwiches. . 2 portions cheese for sandwiches 1 portion butter for sandwiches. . 1 slice cake 1 banana Total Grams. Calories. 16 700 10 198 95 8 19C 70 29 1,253 The protein and energy value of dinner computed in the same way would be as follows: Food value of dinner. Protein. Energy. 1 portion beefsteak 1 potato 1 portion turnips 1 ear corn 1 slice bread 1 portion butter 1 dish rice pudding 1 cup tea 1 teaspoonful sugar for 1 cup tea. . One-quarter gill milk for 1 cup tea Total Grams. Calories. 26 411 4 145 1 80 2 82 4 176 95 7 300 40 1 20 45 1,348 The total protein and energy of the food eaten by the man during the day would of course be the sums of the amounts for breakfast, lunch, and dinner, as follows: Food value of day's ration. Protein. Energy. Breakfast Orams. 28 29 45 Calories. 992 Lunch .... .... 1,253 1,348 Dinner Total . 102 3 593 As will be seen from the figures given above, the total protein for the day's ration is 102 grams, or 3f ounces, and the total energy value 3,593 calories — values which correspond very closely with those called for by the suggested dietary standard. If a little more or a little less food were eaten these figures would vary somewhat, though the agree- ment might still be reasonably close. Suppose, for instance, that another portion of cheese had been used in making the sandwiches. This would have added 5 grams of protein and 94 calories, making the total amount 107 grams protein and 3,687 calories. Such varia- tions are, of course, what might be expected and are of no particular moment. It is by no means necessary that the food eacli (\\\y should agree exactly with the suggested dietary standard, for any deficiency in protein or energy one day will very probably be offset by an excess REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 145 on some other day. It is believed, however, that the daily food will be most satisfactory when the average for long periods agrees with the suggested values. The calculated values obtained by the methods outlined above are designed simply to show in a general way whether the food corresponds to the dietary standard and to afford the house- wife some knowledge as to whether the meals which she provides are sufficient as to the kind and amount of nutritive material which they furnish. In the table on page 142 only the more common foods and staple dishes have been included. It will very often happen that other foods and dishes will be served. When this is done, and it is desired to calculate the relative value of the ration, no great error will ordi- narily be involved if the values of the food most like the article in question are used. For instance, griddlecakes or waffles, which are often served at breakfast, are not given in the table. A griddlecake or a waffle so closely resembles a slice of bread in food value that the protein and energy for a slice of bread may be used to represent the food value of each griddlecake or waffle served. In the same way an ordinary portion of boiled lamb may be assumed to have the same food value as a slice of roast beef, and a portion of pork sausage the same food value as a Frankfurt sausage. If a housekeeper desires to study the subject in greater detail she will find an abundance of data regarding the composition of foods, etc., in bulletins of the United States Department of Agriculture and elsewhere. In the calculations which have been described nothing has been said of the fact that women and children usually eat smaller amounts than men. Taking such factors into account would complicate the calcu- lations, and it is therefore easiest to take into account simply the amounts which the man of the family eats, and to assume that, as the same sort of food is provided for the family, each member will re- ceive the proper amount, and that if a diet for the man corresponds reasonably to the dietary standard the same may be supposed to be the case with that for the other members of the family. Young children, of course, would have milk or special foods, and so would be considered separately. The ways in which meat, fish, vegetables, and other common foods can be prepared for the table are endless, ranging all the way from the simple boiled potato or fried egg to the most elaborate dish of the highly trained cook. The ideal for family living is enough variety in food and method of preparation to make the daily fare attractive without excessive cost or undue labor, and it is possible to attain this ideal. It is just as possible to make a dinner pleasing and satisfactory in every way from simple materials simply cooked as it is to make ap- propriate and attractive clothing for a child or grown person from in- expensive yet suitable and well-chosen materials. It is the way in which it is done as much as the materials used. Anyone who works in a mill or factory with a complicated machine knows that many things must be learned before the machine can be intelligently man- aged and that much practice is required before he can become a skilled operator. The same is true of selection and preparation of food and other household tasks, but it is equally true that the skill and ability which comes from good training is just as valuable in the home as it is in the factory or workshop, and that the well-trained worker can S. Doc. 644, 60-2 11 146 REPORTS OF THE PRESIDENT'S HOMES COMMISSCON. accomplish better results with less trouble in a given time than the unskilled or poorly trained worker. If we look over the long list of foods which we use and the dishes we make from them, it becomes evident that they are of two general sorts — those which, like bread, rice, potatoes, and many other foods, have little distinctive taste, and those like cabbage, onions, cheese, sweet foods, and many other dishes, which possess a pronounced and characteristic flavor. It also becomes evident, when the subject is studied, that the foods which are used in greatest quantity belong to the. former class. A little butter and jam make a slice of bread something which a child will eat with relish. It is equally true that it is the foods and dishes of distinctive flavor which very largely at least make the daily fare appetizing and satisfactory and which insure the consumption of enough of the staple foods, many of them lacking in flavor, to make the diet well balanced and adequate. This distinctive flavor or pala- tability which is so desirable may, in general, be attained in two ways — namely, by the use of foods which are in themselves of dis- tinctive flavor, and by appetizing methods of cookery with proper seasoning. The art of housekeeping in its highest form consists in planning the meals so that the two classes of foods are well balanced and the cost kept within bounds, as related to the income, with the labor involved not excessive. Many housekeepers, since they have been well trained in youth by their mothers or in other ways have learned how to be good home- makers, instinctively provide tasty dishes in about the right propor- tion to the bread, potatoes, and other staple foods, and those who do not know how to do so should make the effort to learn. Such prob- lems can often be solved by care and attention, and by means of schools and classes for home economics and the like ways of good housekeeping are readily taught. For instance, if we assume that bread of some sort and coffee and some of the ordinary cereals are the usual breakfast dishes, and they doubtless are with the majority of families in this country, the needed variety is readily secured by bacon or creamed fish, fish balls, eggs, honey, sirup, or other foods. If work is light and a hearty breakfast is not needed, fried potatoes (perhaps seasoned with onions) , fried apples, or some similar dish is a palatable addition to creamed toast, cereal, or the bread and butter which makes up the principal part of the meal if that is not thought to be enough. Tea and coffee as a part of breakfast or other meal owe their food value mainly to the sugar and milk or cream commonly taken with them. Cocoa in itself contains rather more nutritive material than either tea or coffee, but also owes its food value for breakfast or any other meal largely to the milk and sugar which are used in making it. It is usually considered more satisfactory for children than either tea or coffee. The value of milk as a beverage, particularly for children, must never be overlooked. Skim milk is not usually fully appreciated for this purpose. It is, of course, " thinner " or " less hearty " than whole milk, as it has less fat (cream) — but is still a nutritious food — and though rather dilute, like all liquid foods, is well worth using in quantity. BEPORTS OF THE PEESIDENt's HOMES COMMISSION. 147 When the man of a family takes his lunch away to his work some- thing should be provided which is palatable as well as capable of satisfying hunger. Cold meat, a little smoked fish, or a chopped boiled egg will make a sandwich which is more palatable and more nutritious than plain bread and butter, and cheese of different kinds, cold bacon, and many other things may be used in the same way, while an apple, a banana, or a piece of cake or something similar will un- doubtedly be relished as much as the hearty food. If the children come home from school they and their mother should have something which is suited to their needs and yet which does not involve too much trouble. Bread and milk, or cereal and milk, with fruit, fresh or cooked, are all simple and easily prepared dishes which are suitable for the purpose, while bread and butter with a little cold meat, fruit, tomatoes, or any left-over foods which are relished will also answer the purpose. The evening meal under such circumstances would naturally be the heaviest meal of the day. If dinner is eaten in the middle of the day and supper at night, the suggestions made for lunch may be applied to supper, but some hot dish is an addition which most persons relish for supper. Creamed chipped beef, hash, meat croquettes, oysters in season, and similar dishes suggest themselves, but if so hearty foods are not wanted creamed potatoes, corn chowder, fried tomatoes, and others may be readily prepared. When roast beef, which is usually an expensive dish, is the princi- pal item of a dinner, the cost of the meal may be kept within reason- able limits by serving inexpensive vegetables and dessert. Any meat left over from the roast should be used for some other meal, either cold or made into a meat pie, meat croquettes, hash, or some other made dish, while any bones and scraps made into a well-seasoned thick soup may form the principal dish at still another meal. Hamburg steak, round steak, ham, and sausages are meats which may be readily cooked and which are appetizing, while pork chops have always been a favorite and are usually considerably less expen- sive than similar cuts of beef or lamb. Herring, mackerel, and other sorts of fish, when in season, make a pleasant variety and are as nutritious as meat. Perhaps fish is most commonly fried, but boiled fish with a well-made sauce, or fish stuffed and baked, is as easily prepared and adds variety. Custom has made it almost compulsory in this country to have some sweet dish at dinner, and the custom is reasonable, as such foods are palatable, and although badly made pastry and other desserts are frequent causes of digestive disturbances such dishes when well made and eaten at suitable times in reasonable quantity are generally con- ceded to be wholesome and are reasonably nutritious. A housekeeper who plans her meals rationally will serve a light dessert like stewed fruit with or without simple cakes or cookies, a simple rice pudding, or some similar dish with a hearty meat, and the heavy puddings, such as apple dumplings, suet pudding, etc., when the rest of the dinner is not so hearty. Beets, cabbage, onions, carrots, spinach, green com, tomatoes — in- deed, all the ordinary vegetables — are wholesome, valuable fcDds and should be used liberally. They contain a good deal of water and are bulky in proportion to their nutritive value, but this is in their favor. 148 By care and thought in selecting and by different methods of cooking vegetables and other foods it is easy to vary the dinner from day to day without too much labor. When most fresh vegetables are out of season or high in price, hominy, rice, fried corn-meal mush, and similar dishes are pleasant changes from canned corn, canned tomatoes, and other canned goods which are so much used to supplement potatoes, the standard vegeta- ble in most American homes, and which, when of good quality, are useful foods. Fresh fruits are always attractive additions to the diet and may be made to furnish a considerable amount of nutritive material. Canned fruits, jams, jellies, and the like are all valuable additions to the diet, useful for their nutritive value and for their palatable flavor. In earlier times in New England creamed salt codfish with baked potatoes, boiled salt salmon with drawn butter, boiled salt codfish with beets and boiled potatoes, and pork and beans were simple, inexpensive, and appetizing dinner dishes which were very commonly used. These foods are wholesome, nourishing, and have always been favorites in large numbers of families. Fried salt pork or bacon, well cooked, with cream gravy, and served with fried eggs and baked potatoes, is another old-fashioned dinner which retains its popular- ity, particularly in rural regions. Some such dish as this with hot corn bread, some vegetable which is in season, and a rice pudding or some other simple dessert makes a meal which is appetizing, ade- quate, easily prepared, and not expensive. In the Southern States hominy and rice, like corn breads of differ- ent sorts, have always been favorite dishes of reasonable cost. Corn bread and buttermilk is an old-fashioned combination which is well worth more extended use, for it is nutritious, wholesome, and to most people palatable. The dishes and food combinations which have been mentioned are only suggestions, for each housewife must of necessity suit her meals to the tastes of her family, and food customs differ decidedly with regions and with other circumstances. The southerner will relish bacon and greens, fried chicken, com bread, and many other dishes for which southern cooks are famous, while the northerner will per- haps prefer fish-balls, baked beans and brown bread, or " a boiled dinner " of corn beef with vegetables, or some similar dish with which he has always been familiar. Families of Italian origin or. descent naturally use macaroni, which they cook in such appetizing ways with tomatoes, cheese, or other seasoning, salads with an abun- dance of olive oil, and other dishes whi ;h are typical of Italy, while the Germans will more commonly select noodle soup, pork cutlet with cabbage or sauerkraut, apple cake, and many of the other char- acteristic and appetizing German dishes. Readiness to adopt new ideas is characteristic of American life and, as might be expected, many of the typical dishes of other coun- tries have become well known on most tables, and this may well be the case for, after all, the staple foods which are always in market and reasonable in price are not too numerous and new methods of cooking mean a pleasant variety. In general, it is true that to be reasonable in cost usually means that more time is required for the preparation of a monl or a dish than is the case when cost is not taken into account. A steak or chop REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 149 which can be quickly cooked is more costly than a stew, than beef or veal loaf, beef a la mode, pot roast, beef with horse radish, boiled mutton with white sauce, or any of the other appetizing dishes which can be made from the cheaper cuts of meat. The stew owes its palatabiltiy very largely to the onions or other seasoning, or to the fact that the meat was browned in a pan before it was stewed, and its pleasing texture to the long, slow cooking which makes tough meat tender. The steak or chop is in itself more tender and full of flavor than cheaper cuts, so it is reasonable that a simpler method of cooking is required for it. That such dishes as stews, etc., are very generally relished by people in all circumstances is shown by the fact that they so often appear on menus in expensive hotels and restaurants, as well as those where prices are cheaper, though more often as luncheon than dinner dishes, and find their way to most tables — no matter how large or how small the income. Granting that the foods are w^holesome and suitable, the final test with foods, after all, is skill in preparation. The simplest dish well cooked is always superior to an elaborate dish indifferently made and simple meals in the long run are more relished than those which are very elaborate. The housekeeper who manages her home with little or no help except that which other members of her family give has no time to waste on the entrees, elaborate cakes, and other sorts of " food fancy work " for which recipes are so frequently published and which many people seem to consider a mark of good living. It should be said that well-informed housekeepers long ago recognized that the majority of such dishes can not be satisfactorily prepared except by an unusually skillful cook and that, though entirely appropriate for special occasions and under many circumstances, they have little place in the everyday bill of fare. Furthermore, most persons tire of such dishes much more quickly than they do of foods prepared by simpler methods. As time has progressed very many household industries have become the subject of careful study with the result that they now rest on a sound scientific basis. The perfection which has been reached in spinning and weaving and other manufacturing enterprises, which have grown out of home industries, is a proof of what may be accomplished by a scien- tific study of domestic problems and an indication of what may be expected when careful consideration is given to food and nutrition as a part of home work by all housekeepers. In the development of labor-saving devices household work has not kept pace with farm work or with general manufacturing. How- ever, at the present time new interest seems to have been aroused in this question, and dishwashers, bread and cake mixers, and similar devices which are on the market, and hay boxes or fireless cookers are becoming fairly well known. When such devices are found to be fairly satisfactory they should find a place in the home with the washing machine and the carpet sweeper as a means of lessening the labors of the housekeeper. No carpenter can build a house or carry out even a simple enter- prise without a plan, and the better the plan the easier and more satisfactory will be the 'work, other things being equal. With the housbkeeper the same is true. Thought and system are important 150 REPOBTS OF THE PRESIDENT'S HOMES COMMISSION. time and strength savers. We do not need to live by rote, but simply to carry on the household tasks according to some definite plan which is flexible enough to permit of the variations made necessary by cir- cumstances. The housekeeper who will take advantage of opportunities to learn something regarding the relative nutritive value of different foods and their real worth as distinguished from their market value, and who understands good, sensible methods of cooking and serving food, and who will plan her meals and other household work so that un- necessary labor may be avoided, will be able to provide her family with a reasonable and palatable diet without undue labor or excessive cost. Thanks to its varied climate and soil, the United States pro- duces all staple foods in great variety, as well as the majority of those which are usually termed " luxuries," and for this and other reasons tlie food problem is a simpler one than is the case in many other countries where food materials are less plentifully grown and prices are higher. Good, substantial food, pleasing to the eye as well as satisfying the body, is within the reach of all, and w^ien wholesome, well-prepared meals are the rule in our homes and women's work in the household is carried on generally with the system and precision which were long ago introduced into the trades and manufacturing industries, then household work will be less a burden and the family will be healthier and better in every way. FOOD AND HOME BETTERMENT. [Introduction by Geo. M. Kober, M. D.] In our sociological study of families in this city we found that 476 families, with an income of $500 or less, expended 43.68 per cent of their annual income for food; 159 families, with an income of $500 to $600, 43.59 per cent ; 153 families, with an income of $600 to $700, 41.40 per cent; and 153 families, with an income of $700 to $800, 40.21 per cent for food. The question of food, while of importance to all classes in its relation to health and efficiency, is of special significance from an economic standpoint in families with limited means. It has been well said that " half the struggle for life is the struggle for food." Many of the problems tonnected with the nutri- tive value of farm products and other foods, the preparation of food for the table, the digestibility, palatability, and utilization of differ- ent foodstuffs, the hygienic and economic aspect of the question have received careful attention in the nutrition investigations conducted by the Office of Experiment Stations, United States Department of Agriculture. It may be truly said that these investigations have been a constant source of information and inspiration to teachers of domestic science in public schools and colleges, to settlement workers, persons in charge of charitable institutions, and others interested in the social betterment of their less resourceful neighbors. The work is of the utmost value, and, while much has been accomplished, it should be continued in the interest of home economics and home betterment. It has been found, over and over again, that persons of limited means purchase food containing little or no nutriment, or select needlessly expensive kinds of food, or prepare a diet altogether too one-sided, and last, but not least, know little or nothing about the art of cooking, and thus impair not only the nutritive value of the food. REPOKTS OF THE PRESIDENT S HOMES COMMISSIOTST. 151 but also the digestive functions and general health as well. In order to give housekeepers whose income is $1.50 a day an opportunity to prepare suitable dishes for a family of 6 — 2 adults and 4 children — Miss E. M. Cross, of the McKinley Manual Training School, has prepared suitable menus for winter and summer use which it is hoped will stimulate interest in the subject. Miss Cross assures me that she has verified the market prices personally and that the food can be purchased at the figures given. For reasons already stated butterine may very properly replace butter in families with small means, and for hygienic reasons bread twenty-four hours old is really superior to fresh bread. The writer desires to emphasize the fact that beans, peas, and lintels, containing, as they do, much protein, can replace from time to time the more expensive meat and egg ration. The nutritive value of skim milk, buttermilk, and cottage cheese, and the cheaper fish meats should also be more fully appreciated. To limit the expenditure for food, with an income of $1.50 to an average of 75 cents a day for a whole family, is no small under- taking and requires experience and judgment which are best obtained in our cooking schools. It is sincerely hoped that every girl will take a deep interest in matters of cooking and domestic economy. Every housewife should supply herself with scales and follow the general directions given in the cooking recipes with precision. All the quantities given are for a family of six, and reductions are made accordingly, rememboring always that hard-working men and nurs- ing or pregnant women, and convalescents from acute diseases, re- quire a more liberal diet. If, in spite of good cooking, there should be evidence in any member of the family of malnutrition and im- paired health it will be well to consult a physician. Miss Cross is entirely responsible for the following menus and cooking recipes, and is entitled to the credit for whatever merit they possess: MENUS FOR WINTER MONTHS." Protein. Energy. Cost. Monday: Breakfast— Hominv, skim milk, creamed hake, toast, butter, coffee.. Dinner— Irish stew' with dumplings, boiled rice, cold slaw, apple pie. . Grams. 28 54 13 Calories. 1,053 1,711 819 Cents. 18 31 23 Total 96 3,583 72 Tuesday: Breakfast— Rice cakes (left-over rice), kidney stew, entire wheat 44 28 29 1,176 842 1,196 16 Dinner— Corned beef, boiled potatoes, spinach, tapioca with milk 71 10 Total 101 8,214 97 Wednesday: Breakfast— Stewed prunes, meat cakes, com bread, butter, coffee — Dinner— Split pea soup, braised beef's heart, boiled cabbage (corn beef liquor), boiled onions, potatoes, apricot roll, vanilla sauce 23 56 29 771 1,572 1,002 27 44 18 Total ... 108 3,345 89 Thursday; Breakfast— Rolled wheat, skim milk, Potomac herring, corn bread, butter coffee . .................. . . .. . . 26 61 23 866 1,530 840 19 Dinner— Salt pork, potatoes, turnips, escarolle, apple butter, short cake . 29 Supper — Pigs' feet potato cakes bread, butter, coffee 26 Total 110 3,236 74 a For quantities of material to be used when not given in cooking recipes, see p. 156. 152 EEPORTS OF THE PRESIDENT'S HOMES COMMISSIOIT. MENUS FOR SUMMER MONTHS. Friday: Breakfastr— Oom flakes, skim milk, salt-water trout corn dodgers, coffee Dinner— Stewed tripe, boiled potatoes, stewed onions, raw tomatoes, bread, rice pudding Supper — Beef stew, corn cakes, butter, stewed apples, tea Total Saturday: Breakfast— Fried tomatoes, bacon, bread, butter, coffee Dinner—Boiled leg of mutton, boiled rice, green corn, summer squash, bread, gingerbread Supper— Cottage cheese, baked potatoes, raw onions, bread, butter, gingerbread, tea Total Sunday: Breakfast — Boiled eggs. Potomac herring, corn bread, butter, coffee. Dinner — Chartreuse of mutton, tomato sauce, boiled potatoes, string beans, blackberries, milk Supper— Rice muffins, baked tomatoes, apple butter, coffee Total Protein. Energy. Grama. 28 Calories. 1,175 1,035 35 120 3,106 1,054 1,014 1.048 Cost. Cents. .26 .35 .28 3,116 818 1,187 1,066 3,071 .13 .97 .23 1.33 23 56 COOKING KECIPES FOR WINTEB MENUS. Creamed hake. — ^After freeing 2 pounds of the fisli from bones and skin, flake it, then cover it with boiling water, put a cover on the pan and keep it on the back of the stove for ten minutes. Drain the water from it, then pour cream sauce over it and serve. Cream sauce. — Two tablespoonfuls butter, 2 tablespoonfuls flour, 1 cupful milk, one-half teaspoonful salt, one-eighth tea spoonful pepper. After melting the butter over steam, or on a cool part of the stove, add the flour and stir over the fire for one minute. Add the milk and the mixed salt and pepper, then stir the mixture until it thickens, after which cook over steam for ten minutes. Serve while hot. Irish stew with dumplings. — One pound beef (brisket), 1 slice salt pork, 1 onion, 4 potatoes. Cut the meat into 2-inch pieces, then dredge them with flour and brown them all over in the pork fat with the sliced onion. Cover the meat and onion with boiling water and let the mixture cook slowly on the back of the stove. In the meantime pare and dice the potatoes and boil them for ten minutes, then drain the water from them and add them to the stew when the meat is tender. When the potatoes are nearly done, put in the dumplings, pouring off the liquid, if necessary, so they will rest on the potatoes. Keep the pan closely covered and let the stew cook for ten minutes. Take out the dumplings, season the stew with salt and pepper, and put it in the center of a platter, then place the dumplings around the edge. Dumplings. — One pint flour, one-half teaspoonful salt, 1 cupful milk (scant), S teaspoonfuls baking powder. Make a soft dough and flatten it out half an inch thick, then cut into small rounds or mix softer and drop by the spoonful into the hot stew. Cold slaw. — One-fourth pound salt pork, 4 tablespoonfuls vinegar, 1 onion, 1 teaspoonful salt, one-third medium-sized head of cabbage. Put the pork into a pan with half a cup of water; let it boil until the water evaporates, then cook until the pork is brown and crisp. When the fat is cool, add it to the rest of the ingredients and pour the mixture over the thinly sliced cabbage. Apple pie. — One and one-half cupfuls flour, 1 teaspoonful salt, 8 tablespoon- fuls drippings, about three-fourths cupful ice water. After sifting the flour and salt together add the shortening and mix by cutting together with a knife, add the water slowly, still mixing with a knife, until a dry, crumbly paste is formed, but all of the flour is moistened. Turn this out on a board without flour, and after rolling it into a thin sheet turn the paste around and roll again. Con- tinue this process until the materials are well blended and the paste is smooth. Keep in a cool place until it is quite firm. It is better kept over night. Roll out one-half of the paste to fit the pie pan, cover this with a layer of apples, BEPOETS OF THE PRESIDENT'S HOMES COMMISSION. 153 which have been cored, pared, and cut into thin slices across the core. Sprinkle with sugar and a little cinnamon. Continue to put in these layers until the pan is full, having it higher in the center than on the sides. Put on a cover of pastry, fasten the edges down, then trim the pie, holding the knife well under the plate. Make several openings on the top for the escape of steam, then bake it in a moderately hot oven until it is brown, about thirty minutes. Remove it at once from the plate and serve either hot or cold. Corn Bread. — One pint meal, 1 teaspoonful salt, 1 tablespoonful fat from bacon, 1 teaspoonful soda, 1 pint sour buttermilk. Pour over the meal enough boiling water to scald it. The meal must be moist, not wet. Add the shorten- ing, salt, and the soda, which has been mixed with a little cold water. Stir this until it is thoroughly mixed, then put in the milk. Bake it in a quick oven in shallow pans for about forty-five minutes. Serve at once. Kidney stew. — Split the kidneys lengthwise in halves and trim off every bit of sinew and fat from the inside, then cut the kidneys into small pieces. Put them into a saucepan and cover them with cold water; then heat the water until it is nearly boiling. Drain this water off and cover the kidneys again with cold water; then heat the water as before. Repeat this, thus making three treat- ments. Be careful each time that the water does not boil at all, or the kidneys will be hard and tough. Discard all the water. Reheat the kidney in a brown sauce, season it with salt and pepper, and serve it. Brovm sauce. — Two tablespoonfuls butter, 2 tablespoonfuls flour, 1 cupful stock or w^ater, one-half teaspoonful salt, one-eighth teaspoonful pepper. After browning the butter add to it the flour and brown this mixture, then add the stock or water and stir until it is thick. Season and add the prepared kidney. Serve at once. To boil corn beef. — Wash the meat well and put it on in cold water. Bring slowly to simmering point and let it simmer thirty minutes for every pound of meat. If the meat is to be served cold allow it to cool in the liquor in which it was boiled. Tapioca with milk and sugar. — Cover 1 cup of flake tapioca with cold water and let stand over night. In the morning drain the water from it and add 1 quart of hot water. Cook over a slow fire until it is quite transparent, then add a pinch of salt and the rind and juice of 1 lemon. Pour this into molds which have been wet with water and keep in a cool place. When firm turn them out on a platter and serve with milk and sugar. Fried mush. — One pint water, 1 teaspoonful salt, one-half cupful yellow meal, 1 egg. Scatter the meal slowly into the boiling salted water, stirring constantly, then let the mixture bubble once or twice. Place the pan over hot water and let it cook for two hours, after which turn the mush into a square pan and keep in a cool place until it is firm. Cut it into slices half an inch thick and cover them with the beaten egg, which has been mixed with 1 table- spoonful of cold water. Cook these in smoking hot fat (enough to cover the pieces) until they are a golden brown. Serve at once. (Note. — Two saucepans may be used for cooking the mush, the smaller one resting on a piece of wire gauze in the bottom of the larger one, which contains water. The fat used is made from the small pieces of fat meat which may be purchased from the butcher at 2 cents per pound. The fat is strained and kept in a cool place for future use.) Stewed primes. — After v^ashing 1 pound of prunes, cover them with cold water and let them stand for several hours. Put them on the stove in the same water and let them cook slowly until a straw will go through them easily. Put the prunes in a dish, sweeten the liquid, let it boil for two minutes, then pour it over the prunes. (Note. — ^AU dried fruits should be soaked in the water before they are cooked.) Meat cakes. — One pound beef, 1 teaspoonful salt, one-eighth teaspoonful pepper. Use the lower part of the round, which may be purchased in some markets for 6 cents per pound. Grind the meat or have the butcher chop it with a cleaver until it is quite fine, then mix the seasoning with it, and shape it into small cakes, having the edge as thick as the center. Put enough fat in a hot spider to keep the meat from sticking to the pan, put in the cakes, and shake the pan over the fire until they are brown all over. Now let them cook more slowly, allowing seven minutes if they are an inch thick, turning them occasionally. After taking out the cakes, put into the pan 1 tablespoonful of drippings and the same amount of flour, stir well, then add half a cup of cold 164 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. water and cook until it thickens. Season with salt and p.epper and serve with meat cakes. Split pea soup. — One cupful split peas, 6 pints cold water, 1 onion, 2-inch cube salt pork, 2 tablespoonfuls drippings, 2 tablespoonfuls flour, 1^ teaspoonfuls salt, one-eighth tea spoonful pepper. After picking over the peas, wash them and let them soak in the cold water for five or six hours. Add the pork and onions, which have been cut into small pieces and cooked until they are a light brown. Let this mixture cook slowly for about four hours, after which strain it, mix the fat with the flour and add to the soup, stirring constantly until the mixture thickens, then let it cook for ten minutes. Season and serve at once. Braised beefs heart. — After soaking the heart in cold water for three hours, remove the muscles from the inside and the blood. Make a forcemeat of 1 cup of bread crumbs, 2 tablespoonfuls of drippings, 1 teaspoonful of thyme, 1 table- spoonful of chopped celery tops, 1 teaspoonful of onion juice, half a teaspoonful of salt, one-eighth of a teaspoonful of pepper. Mix and stuff the heart. Tie it together with twine, and put it into a pan which has a close-fitting cover. Add enough boiling water to half cover the heart, put on the lid, and cook in a mod- erately heated oven for three hours. Brown 2 tablespoonfuls of fat, add 2 tablespoonfuls of flour, and when well mixed, add the water in which the heart was cooked. Stir until it thickens, season with salt and pepper. Dish the heart and pour the sauce over it, then serve. Apricot roll. — Two cupfuls flour, one-half teaspoonful salt, one-third pound suet, 1 pint apricots. Free the suet from the fiber and skin, then chop it fine or press it through a wire basket. Mix this with the flour and salt and add gradu- ally enough cold water to make a soft dough. Roll it out on a floured board into a sheet about an inch thick, spread the apricots thickly over the dough, roll it up and tie it in a well-flouted cloth, leaving plenty of room for it to swell. Put it into a pot of boiling water and boil for two hours, or it may be steamed two hours and a half. Serve hot with vanilla sauce. Vanilla Sauce. — Two tablespoonfuls butter, 2 tablespoonfuls cornstarch, one- half cupful sugar, 1^ cupfuls water, 1 teaspoonful vanilla. After heating the butter and water to boiling point, stir in the mixed cornstarch and sugar. Cook the mixture for ten minutes, then flavor and serve. Comed-heef hash. — One pint finely chopped beef, 1 pint boiled potatoes, one- half teaspoonful salt, one-eighth teaspoonful pepper, 2 tablespoonfuls fat. Cut the potatoes into small pieces and mix them with the rest of the ingredi- ents. Put this into a heated spider, add enough hot water to moisten and stir until the mixture is well heated, then pack it closely in the pan, cover it, and let it cook until it is well browned on the bottom. Turn it out on a platter and serve. Apple butter short cake. — One pint flour, 1 teaspoonful salt, 3 tablespoonfuls drippings, 2 teaspoonfuls baking powder, milk or water (about three-fourths cup. Sift the flour with the salt and baking powder, then add the fat, and mix well. Pour in the water slowly, mixing with a knife until a soft dough is formed. Turn it out on a floured board and, after surrounding it with flour, roll it into a thin sheet about half an inch thick. Cut it into four-inch squares and bake them in a quick oven until they are a light brown, about twenty minutes. Split each square and put the apple butter between. Serve while hot. Pigs' feet. — After scraping a set of four of the feet soak them in cold water for several hours, then wash and scrub them. Split the feet and put them on in cold water and let them simmer until tender. Put them in an earthen jar, sea- son with salt and pepper, and pour over them hot spiced vinegar. They will be ready for use the next day. Spiced vinegar. — Boil for one minute a half-pint of cider vinegar, 12 whole cloves, 3 inches of cinnamon bark, and 2 bay leaves. Potato cakes. — Mash 1 pint boiled potatoes, then season them with salt and pepper, and moisten with hot milk. Make into cakes and brown in a pan with a small quantity of fat Serve hot. BECIPES FOB SUMMEB MENUS. Com dodgers.— Two cupfuls white meal, 6 tablespoonfuls skim milk, 2 table- spoonfuls shortening, 1 teaspoonful salt. After scalding the meal with boiling water, using just enough to moisten the meal, add the shortening and stir until it is well mixed, then put in the salt and milk. Put the mixture by spoonfuls in a large baking pan, flatten into small cakes, and keep them separate. Bake In a moderately heated oven until brown on both sides, then serve. REPOETS OF THE PRESIDENT'S HOMES COMMISSION. 155 Stewed tripe. — Two pounds boiled tripe, 2 ounces salt pork (ham may be used) one-balf medium sized onion, 1 tablespoonful chopped parsley, 1 bay leaf, 2 tablespoonfuls flour, 1 pint milk, 1 teaspoonful salt, one-eighth tea spoonful pepper. Cut the tripe into pieces about li inches long and a half inch wide. Dice the pork and put in a pan with the sliced onion and the bay leaf. Stir over the fire until quite brown, then add the flour, and when well mixed add the milk. Stir this until it is as thick as ordinary cream, after which put in the salt, pepper, and the tripe, and keep over a very moderate fire for five minutes. Add the parsley and serve at once. Rice pudding. — One-half cupful rice, one-half cupful sugar, 1 pinch of salt, 1 quart of milk. After washing the rice thoroughly, let it soak in the milk for half an hour, after which add the salt and sugar. Pour the mixture into a deep pan, cover it and let it bake about two hours, slowly at first, until the rice has softened and thickened the milk, then let it brown slightly. This may be served hot or cold. Beef stew. — One pound plate or brisket, 4 potatoes, 1 teaspoonful salt, 1 carrot, 1 tablespoonful fat, 1 tablespoonful flour, one eighth teaspoonful pepper. Cleanse the meat by wiping it with a damp cloth or by scraping it with the back of the knife. Cut it into pieces about 2 inches square, and put it into a saucepan with the bones and sliced carrot. Pour over this enough boiling water to cover well, about a pint and a half, and let it simmer until the meat is tender, then add the diced and parboiled potatoes. When the potatoes are done, thin the mixed fat and flour with a little of the hot liquor from the stew, and after pouring it into the stew stir it until it thickens slightly. Cook a few minutes longer, then remove the bones, season and serve. Corn eakes. — One pint meal, one-half cupful flour, 1 pint sour buttermilk, 1^ teaspoonful soda, 1 tablespoonful fat, 1 egg, 1 tablespoonful salt. Scald the meal with suflicient boiling water to moisten, then put in the fat and stir until well mixed. When this is cool add the salt, flour, and the buttermilk. Stir in the beaten egg and the soda, which is mixed with a little cold water. Bake in small cakes on a lightly greased hot griddle. Gingerbread. — One cupful molasses, one-third cupful drippings, 1 teaspoonful soda, one-half teaspoonful salt, 1 cupful sour buttermilk, 1 tablespoonful ginger, 3 cupfuls flour, 1 teaspoonful cinnamon, one-half teaspoonful allspice. After mixing the salt and spices with the molasses add the fat, after which add flour and buttermilk alternately, then beat until perfectly smooth. Stir in the soda, which is mixed with a little cold watef, and partly fill greased gem pans with the batter. Bake in a moderately hot oven about thirty minutes or until the cakes are a light brown. Chartreuse of mutton. — One cupful cooked chopped mutton, 1 teaspoonful chopped parsley, one-half teaspoonful onion juice, 1 teaspoonful lemon juice, one-fourth teaspoonful salt, 2 tablespoonfuls butter, 1 cupful stock or water, 2 tablespoonfuls flour, little cayenne. Make sauce as directed for cream sauce, then add the rest of the ingredients and mix thoroughly. Line a greased mold with hot boiled or steamed rice, having the layer about half an inch thick, then fill the center with the mutton mixture and cover the top evenly with rice. Steam forty-five minutes, then turn from the mold and serve with tomato sauce. The greased mold may be coated with bread crumbs, then lined with mashed potatoes and, after filling with the mutton, covered with potato. Bake. Tomato sauce. — Two tablespoonfuls drippings, 1 cupful strained tomatoes, 2 tablespoonfuls flour, one-half teaspoonful salt, one-eighth teaspoonful pepper. After melting the fat add the flour and cook for one minute, then add the strained tomatoes, the salt, and the pepper. Stir until it thickens, then serve. Scrapple. — Four pints water in which the lamb was cooked, 1 pound scrap meat, 3 teaspoonfuls salt, 1 teaspoonful thyme, 1 teaspoonful sweet marjoram, 1 pint meal, one-fourth teaspoonful pepper. After cleansing the meat, by wiping it with a damp cloth, cut it into small pieces and cook it slowly ih the mutton broth until it will easily separate. See that there is one quart of the liquid and that the meat is in very small pieces. Season the mixture of water and meat, put it on the stove and, when it reaches boiling point, stir in the meal. Cook over hot water for two hours, then add the thyme and mar- joram and, when well mixed, turn it into square pans and stand away to cool. When this is flrm cut it into slices and brown in a little fat. Rice muffins. — Two and one-fourth cupfuls flour, 1 cupful milk, three-fourths cupful hot rice, 1 egg, 5 teaspoonfuls baking powder, 2 tablespoonfuls butter or drippings, 1^ teaspoonfuls salt. After mixing the flour with the salt add the rice, which has been pressed through a strainer, and the milk which is 156 REPORTS OF THE PRESIDENT S HOMES COMMISSION. mixed with the beaten yolli of the egg. Beat until the batter is quite smooth, then add the melted fat, stir in carefully the baking powder and then fold in the stiffly beaten w^hite. Partly fill greased gem pans with the batter and bake in a moderately hot oven until a light brow^n, about thirty minutes. Serve hot. Market price of goods. Article. WINTER. Apples Apple butter Bacon (country) Beef: Part of the round. Brisket and plate . Corned Beef's heart Beans Broken rice Bread (stale) Butter Buttermilk Cabbage Coffee Com flakes Cottage clieese Escarolle Evaporated apricots. . . Flake tapioca Flour Hake Hominy Kidney Meal Mutton: Breast... Fore leg. Neck — Unit. Quarter peck Jar Pound do... do... do... do... Quart Pound... Loaf Pouixd.. . Que -t. . . . He^ i.... Pound... Package. Pint Head-... Pound... do... 6 pounds Pound... Quart Each Pound Quart Pound. ....do. ....do. Cost. Cents. 10 10 Article. Pigs' feet Potomac herring Potatoes Prunes Rolled wheat Salt pork Saltwater trout.. Sausage Skim milk Spinach. Split peas Sugar Tea Tripe Turnips Apples Beets Blackberries Butter Cabbage Corn Eggs Onions Potatoes Spinach String beans Summer squash . Tomatoes Unit. Set Dozen Feck Pound Package Pound do 3 pounds Quart Quarter peck . Pound do do 2 pounds Quarter peck . Quarter peck . 3 bunches Quart Pound Head Dozen -...do 3 bunches Bushel Quarter peck . do Dozen Quarter peck . Cost. Cents. Quantities of materials to he used for a family of six ichen not given in cooking recipes. BREAKFAST. Uncooked hominy cupful^_ 1 Skim milk gills__ 3 Toast loaf__ai Butter oimces__°3 Coffee tablespoonfuls— 4 Kidney 1 Stewed prunes pound__ 1 Rolled wheat , cupful__ 1 Potomac herring 3 Com flakes , cupfuls-_ 2 Fried tomatoes. . 8 Boiled eggs 12 DINNER. Uncooked rice . cupfuls__ 1^ Corned beef, for 3 meals pounds_- 8 Potatoes, 3 in. long 12 Spinach peck__ i Milk for tapioca gills__ 3 Sugar for tapioca tablespoonfuls.— 2 Beef's heart 1 Boiled cabbage head— \ Boiled onions 6 Potatoes 6 «Same quantity each time used. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 157 Salt pork _-POimd__ * Turnips (mashed) 8 Potatoes 6 Escarolle head— 1 Raw tomatoes 6 Leg of lamb, for 3 meals pounds__ 7 Rice cupful— 1 Corn ears— 12 Squash i-_ 4 String beans peck— i Blackberries quart— 1 Milk gills— 3 SUPPER. Cottage cheese pint— 1 Molasses gills__ 3 Pig's feet set— 1 Potatoes 8 Apples peck__ i Cottage cheese pint— 1 Potatoes 9 Onions (raw) 6 Tomatoes__— peck__ i Apple butter pint— i Chapter III. THE CAUSATION AND PREVENTION OF DISEASE. DANGER PERIODS IN LIFE.** According to a French medical journal the annual mortality of the entire human race is 33,000,000 persons. A fourth of the race die before completing their eighth year, and one-half before the end of the seventeenth year, but the average duration of life is about 38 to 40 years. Not more than one person in 100,000 lives to be 100 years old. ("Medical Eecord," February 27, 1892.) During life the fluids and tissues of the body are constantly under- going changes; new matter is formed and the old is removed with ceaseless activity. The body is indeed a complex machine in which the law that force is generated by decomposition is fully carried out. Every motion of the body, every pulsation of the heart, nay, even every thought, is accompanied by the destruction of a certain amount of tissue. As long as food is supplied in sufficient amount and the assimilative functions are not disordered, reparation proceeds as rapidly as decay, and so long as these two actions exactly counter- balance each other life and health, unless, of course, in case of acci- dent, continues. The human body has been aptly likened to a machine, and it is said that every machine has a natural life, capable of doing just so much work, but after all our machine differs from an inorganic machine in the fact that it possesses the power of self-repair, and also that for a given time, say between birth and the twenty-fifth year, our machine increases in growth and efficiency ; there is then another period, limited o Carpenter, "Cyclopedia of Anatomy and Physiology," Vol. I, article "Age," ** Hammond's Treatise on Hygiene." 158 BEPOBTS OF THE PRESIDENT'S HOMES COMMISSION". usually between the twenty-fifth and thirty-fifth year, during which the living machine maintains its fullest development and resistance, probably because regeneration and waste are exactly counterbalanced, and then comes the period of decline, reaching from the thirty-fifth year to the extreme limit of Imman life, when this natural resistance begins to fail and the tissues are not regenerated as fast as they are broken down. (Hammond.) The various periods in the life of man are marked by certain pecul- iarities, and exhibit susceptibility to some diseases and immunity to others. Statistics show that out of every 1,000 children born alive, 188, or over one-sixth, perish before the completion of the first year. Of the twelve months during the first year of life the first month furnishes the highest mortality. This is due to the fact that a great many children, imperfectly developed at birth, die within a few days; the first month is followed by the second, third, and fourth month, prob- ably, also, because of diminished vital resistance ; next by the twelfth month. This jump from the fourth to the twelfth month is quite suggestive, as it is the usual period of weaning, with its attending danger from digestive diseases incident to artificial feeding. During the second and subsequent years the mortality gradually decreases, and of children between the ages of 1 and 5 years there die annually about 37 out of 1,000, making a total loss during the first five years of 336 out of every 1,000 children bom. If we stop to inquire into the immediate cause of the excessive mortality during the first twelve months, we find that about 40 per cent perish from diseases of the digestive system ; about 21 per cent from affections of the respira- tory organs; next in frequency are the infectious diseases like diph- theria, scarlet fever, measles, whooping cough, mumps, tubercular affections. Rickets, diseases of the nervous systems, convulsions, and inflammation of the brain and its membranes are also of common occurrence. As the age of the child advances the body becomes more fully de- veloped and better fitted to resist disease. The diseases to which the race is especially liable during the period extending from puberty to maturity, or about the twentj^-fifth year, are those of the respiratory organs, tuberculosis, appendicitis, and typhoid fever. Thus of 500 cases of typhoid fever analyzed by me, 327 cases were between the ages of 10 and 25 years. It has been suggested that the undue prevalence of these diseases, as well as of mental and nervous affections during this period, may possibly be connected with a diminished power of resist- ance, the result of morbid sexual habits. The diseases which are most frequently met with during the period of maturity, which ordinarily extends from the twenty-fifth to the thirty-fifth year of life, are consumption, gastric affections, and rheumatism. The period of decline has been stated to embrace the thirty-fifth year to the extreme limit of human life. This is scarcely exact, as in the majority of instances we observe a period varying from five to ten years, during which the body remains at a nearly fixed point of development, before a disposition to degeneration is manifested. Indeed, during the first few years of actual decay the organism is so slowly affected that very little inconvenience results, and occasionally BEPOETS OF THE PRESIDENT'S HOMES COMMISSION. 159 Individuals may withstand the tendency to degeneration to a very advanced period of existence. The diseases to which the period of decline is especially liable are apoplexy and organic diseases of the heart and blood vessels, liver, and urinary organs. Gout and chronic rheumatism, pneumonia, bronchitis, and a variety of nervous affections are also very common ; while malignant diseases, especially in the female after the cessation of the menstrual functions, are not infrequent. We have not attempted to answer the question, quite often asked, why the body, after reaching a certain point of development, ceases to grow. A question equally interesting and difficult is, Why does the body, after reaching maturity, begin to degenerate ? It has been said by Hammond: If it were possible to so adjust the repair to the waste that neither would be in excess, there is no physiological reason why life, if protected against accidents, should not continue indefinitely. But as this, with our present knowledge, is impossible, we should at least direct our attention to the removal of the factors which here- tofore have interfered with the average span of life allotted to us. We know that with the advance of hygiene the average human life has been lengthened from eighteen to twenty years in the sixteenth century to thirty-eight to forty years and over at the present time, and there is reason to hope that we may still further prolong our existence. While much has been accomplished in the past, more remains to be done, and one of the pressing needs is an enlightened system of dietetics. A long series of investigations on tissue metamorphosis have been conducted by the Department of Agriculture — but are now inter- rupted for lack of funds — with a view of determining what substances are necessary to repair a certain amount of waste. We are extremely careful in other machines to use only those substances for the genera- tion of force Avhich are proper and no more than is absolutely neces- sary. In the human system little attention is paid to this question, and we eat without regard to the exact wants, and sooner or later disorganization results. Next, we want to be able to exercise all the organs of the body to that extent only which will insure their activity and the deposit of sufficient new material to keep them in a state of preservation, without leading to excess of the process of either re- gressive or progressive metamorphosis. THE CAUSES OF DISEASE. The direct and exciting causes of disease have been a source of much study. Thanks to the progress of medical science, the field is now limited to certain chemical, physical, mechanical, and vital agencies capable of producing definite alterations of the tissues and fluids of the body and manifestations of disease. Among the chemical causes we recognize: First. Those originating without the body of an or- ganic an dinorganic character, commonly known as irritants or poisons, many of which have been referred to in connection with in- dustrial pursuits. Second. Those originating within the body as a result of overeating, malnutrition, malfermentation, and other defects in the physiological functions of the body. Some of these, according 160 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. to Abbott,'* include the ordinary end products, or waste matter of tissue activity, that have accumulated within the system as a result of defective accretory and excretory organs; while still others are the toxic products of malfermentations, often in operation within the alimentary tract. There is much reason for believing that the pro- tein, when taken in excess in the food, undergoes putrefaction, and the absorption of these products gives rise to auto-intoxication by rendering the blood current impure. Herter, Comb, and others have shown that such a condition produces various maladies and milder forms of indisposition, and MetchnikofF considers auto-infection the chief cause of premature old age. Among the most frequent physical causes of disease are excessive heat, cold, and moisture.^ while the mechanical causes include, of course, accidents and injuries of every description. VITAL CAUSES. By the term " vital causes " we understand certain living animal and vegetable parasites capable of reproduction in the body, and under favorable conditions of producing manifestations of disease. " It matters little whether the living organism is large or small, or belongs to the vegetable or animal kingdom, or whether it produces its effect in the skin, muscle, lympathics, internal organs, intestines, or in the blood, its introduction and reproduction constitute infection." (Sternberg.) The writer does not pretend to differentiate between infectious and contagious diseases except to indicate that all contagious diseases are infectious, but not all the infectious diseases are contagious. Small- pox, measles, scarlet fever, German measles, mumps, and chicken pox are notable contagious diseases. Erysipelas, pneumonia, tuberculosis, glanders, and diphtheria, while not usually contagious, may become so under favorable conditions. Typhoid fever, cholera, yellow fever, and common suppuration are given by Abbott as examples of non- contagious infectious diseases. THE PREVENTION OF INFECTIOUS DISEASES. One great peculiarity of most of the infectious diseases is that they usually occur in groups, for it rarely happens that isolated cases of diphtheria, scarlet fever, measles, etc., develop unless special precau- tions have been taken to stamp out the first cases. Very generally a number of cases occur which can be traced to a common source of in- fection, and the disease may assume epidemic proportions. The ques- tion naturally arises. What constitutes an epidemic? In other wcft-ds, how many cases are necessary before an infectious disease in a com- munity with a given population can be said to be epidemic. Various answers have been given. The writer believes that a sudden and un- due prevMlcnce of any infectious disease may very properly be char- acterized as an epidemic. A disease is spoken of as pandemic when it spreads, like influenza for example, over a great extent of country — affects groups of several countries of the world generally. The term « " Hygiene of Transmissible Diseases," 1899, p. 52. » Kober's " Industrial Hygiene," p. 65. EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 161 " endemic " is applied to diseases that prevail in particular localities and are influenced by local conditions. It is in the field of infectious diseases that hygiene has achieved, and doubtless will continue to achieve, its greatest triumphs, and there is ample room when we contemplate the frightful mortality from these diseases. Think of the fact that consumption, during the census year 1900, claimed 111,059 victims in the United States alone. Pneu- monia caused 105,971 deaths, diarrheal diseases 46,907, typhoid fever 35,379, cholera infantum 25,576, influenza 16,645, diphtheria 16,475, croup 12,249, malarial fever 14,874, measles 12,866, whooping cough 9,958, septicemia 6,776, scarlet fever 6,333, cerebro-spinal meningitis 4,174. In order to appreciate the full significance of these figures we must consider not only the mortality, but also the number of cases treated. So, for example, the 35,379 deaths from typhoid fever in one year represent an annual prevalence of not less than 353,790 cases. The duration of a case of typhoid fever is not less than thirty days. If we calculate the average cost for care, treatment, and loss of work to be $300, and the average value of a human life at $5,000, we have a total loss of $283,032,000 per annum from one of the so-called pre- ventable diseases. We know that many of these diseases are preventable, and can at least, be checked, if not entirely stamped out. The decrease in the death rate from consumption in the United States since 1890 amounts to 54.9 per 100,000 of population. Diphtheria and croup, 52.5; cholera infantum, 31.9; diarrheal diseases, 19; typhoid fever, 12.5; malarial fever, 10.4; whooping cough, 3.1; scarlet fever, 2.7. Indeed, the average age at death in 1890 in the United States was 31.1; in 1900 it was 35.2 years. " IF CERTAIN DISEASES ARE PREVENTABLE, WHY ARE THEY NOT PREVENTED? " This very pertinent question was asked some years ago by the Prince of Wales, now King Edward, of England. Our answer is, while every scientific physician knows full well that if the methods of prevention recommended by sanitarians — including the prompt disinfection of the dejecta of typhoid fever patients, the expectora- tion and excretions of diphtheria, tuberculosis, and pneumonia pa- tients — were adopted, these diseases would be reduced to a minimum, and probably eradicated in the course of a few years. The facts are, these recommendations have not been generally adopted because the knowledge gained by experimental medicine is not sufficiently diffused. Nor is the medical profession responsible for the fact that so many States still permit every charlatan to practice one of the most difficult and responsible of all professions, without a rigid sys- tem of examination. So long as we recognize and employ irregular and incompetent practitioners, so long will infectious diseases be spread as the result of ignorance and neglect. The public should be made familiar with the nature and causes of infectious diseases, and be taught that many are a source of danger against which it is entitled to be warned. The health department should have competent medical inspectors and a clinical laboratory for the verification of the diagnosis. It should have the power, in S. Doc. 644, 60-2 12 162 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. certain of these diseases, to display warning signs, to enforce isola- tion and disinfection, and to take such other steps in the way of pre- vention as may be deemed necessary to limit their spread. Isolation to be effective should extend to all persons who have come in intimate contact with the patient. This is rarely enforced, except in smallpox, in the case of the wage-earners of the family, but it is clearly their duty to take special precautions in the way of clothing and personal disinfection. Since our knowledge of the nature of infectious diseases has been more and more defined, scientific methods for their prevention have been applied. We have learned, too, that in addition to the germ there must be a suitable soil for its proliferation and that sanita- tion should not only destroy the environment for its development without the body, but also place the system in the best possible con- dition to resist its poisonous action. In the way of individual efforts, all measures which will improve the tone, nutrition, and vital powers of the system, many of which have been alluded to in the preceding pages, can not fail to render us less susceptible to infection. Nor should we underrate the importance of preventive inoculations, for it must be remembered that smallpox, for example, would continue to carry off one-tenth of the population and disfigure another tenth if it were not for the protective influence of vaccination. The diseases which deserve special preventive efforts on account of their undue prevalence are consumption, pneumonia, scarlet fever, diphtheria, typhoid fever, diarrhea, and dysentery. . During the prev- alence of the last three diseases, and especially when the water is regarded with suspicion, the safest plan is to boil the drinking water and bring the milk to the boiling point. While the general rules of hygiene are necessary at all times, they are especially indicated during the prevalence of epidemics. A simple life, hope and courage, avoidance of excesses, of overwork, fear, and anxiety will serve to maintain a natural power of resistance to infection. If in spite of all precautions, including, of course, avoidance of sources of infection, contagious diseases should gain a foothold in the family, the advisability of hospital treatment ought to be seriously considered. The advantages from every point of view are in favor of such a course, especially when we consider the danger of infection to other members of the family. SICK ROOM, CARE AND DISINFECTION. If the patient is treated at home, a bright, quiet, and cheerful room should be chosen, and promptly stripped of carpets and unnecessary furniture. It is in just such instances, when the importance of simple furniture, oiled or waxed floors, avoidance of draperies, dust and germ traps gain special significance. It is needless to insist that the room must be kept properly ventilated. In the light of our knowledge it is certainly our duty to tell the family, in typhoid cases, that the infectious matter is contained in the excreta, and must be destroyed for the protection of others. In like manner we should not hesitate to inform a consumptive and his friends that the germs of the disease are contained in the expectora- tions; how they may be conveyed to others in coughing, kissing, and REPOKTS OF THE PRESIDENT'S HOMES COMMISSION. 163 dried sputum, and how they should be destroyed. And so we might go through the list of infectious diseases. Scientific disinfection had its inception with the labors of Koch and Sternberg in 1880. Although certain physical and chemical agents were used empirically for ages, now we know, from laboratory experiments, that they are effective, because they destroy the vitality of the germs. We also know that in most of the contagious diseases the infective matter is given off by the patient chiefly through the secretions and excretions, and it is evident that disinfection to be of value must be directed to these and all the media with which the patient has come in contact. A small gas stove near the sick room, and a 4-gallon wash boiler in which napkins, soiled linen, or clothing can be boiled, and thus disinfected before being laundered, will protect other inmates. The use of separate eating and drinking utensils, which can be boiled in a weak soda solution, is also a necessary precaution. The refuse of meals should be placed in a covered vessel containing a disinfectant solution (IJ tablespoonfuls of lysol to 1 quart of water). A similar solution may be used to wipe the floor, furniture, and door knobs. Clinical thermometers, tongue depressors, and other instruments should be kept in a disinfectant solution and rinsed off in warm water before using. The stools, vomited matter, expectorations, urine, blood and pus of infectious patients, especially those suffering from typhoid fever, dysentery, cholera, tuberculosis, pneumonia, influenza, diphtheria, and scarlet fever, should be placed in a covered vessel containing the germicidal solution to be hereafter described, the whole to be thor- oughly mixed and allowed to stand for one hour before throwing the contents into water closets or privy vaults. Disinfection is also indi- cated in diseases like typhus fever, cerebro-spinal meningitis, small- pox, anthrax, glanders, and j^ellow fever ; in the latter disease chiefly for the destruction of mosquitoes. It would also be well to resort to disinfection in all the early cases of measles, whooping cough, doubt- ful cases of fever, and diarrheal affections. In diseases like smallpox and scarlet fever, in which the infectious agent is given off most likely from the surface of the body, occasional sponging with dilute chlorinated soda solution, 1 part to 9 of water, has been recommended, or the body may be anointed with some harm- less antiseptic ointment ; while during convalescence, i. e., just before the patient mingles with others, a corrosive sublimate bath, 3 drachms to 30 gallons of water, is indicated. Infectious corpses should not be washed, but enveloped at once in a sheet saturated with a 5 per cent solutioa of carbolic acid or bichloride solution, 2 drachms to a gallon of water. All worthless articles should be burned. Metallic bodies may be sterilized b}^ exposure to red heat or boiling. A good solution for soiled body and bed clothing is made of carbolic acid 3 parts, com- mon soft soap 2 parts, and cold water 100 parts; they should soak for two hours, when they may be rinsed and sent to the laundry. Valuable clothing, mattresses, carpets, and draperies should be sub- jected to disinfection in a special apparatus furnished by the health department, and in the absence of such facilities they should be hung up loosely in the room and subjected to the influence of formaldehyde 164 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. gas, which has also been found the most effective agent for room and house disinfection after the recovery, death, or removal of pa- tients, and is usually conducted by agents of the health office. A cheerful compliance with the rules and regulations of this service can not fail to be a benefit to the family and public at large. If such a department does not exist, if becomes the duty of the attending physician to see that the premises are properly disinfected. For this purpose it is necessary to make the apartments as nearly air-tight as possible, and to generate either formaldehyde by the combustion of wood alcohol or liberate it from formalin. The room must be kept closed for six hours after fumigation and it should then be thor- oughly aired and exposed, when practicable, to sunlight, which is in itself a very efficient germicide. The report of the committee on public health of the Medical Society, District of Columbia (" Washington Medical Annals," January, 1908), shows that there has been a marked reduction in the mortality of diphtheria, measles, and scarlet fever during the past ten years in the American cities, coincident with the establishment of municipal quarantine and disinfection. The average reduction in the mortality from diphtheria in 10 cities amounted to 24.4 per cent. While in this disease the use of antitoxin has served to accom- plish the result, the reduction of 44 per cent in the mortality from measles and a reduction of 70.8 per cent in the mortality of scarlet fever must be largely attributed to preventive efforts, including, of course, higher standards of living. In this connection the early use of diphtheria anitoxin should be emphasized. The average diphtheria mortality, where antitoxin was used, in Chicago in 1902 was 6.48 per cent, and where not used it was 32.5 per cent ; the mortality in children when used upon the first day was only 1.45 per cent, but when used later than the fourth day it rose to 14.49 per cent. Space will not permit a detailed statement of other triumphs in preventive medicine, but the fact that, according to Surgeon-General Wyman of the Public Health and Marine-Hospital Service, there were during the last eight years 242,847 cases of smallpox with 6,067 deaths in the United States prompts the suggestion that every death from smallpox is a disgraceful reflection upon the intelligence of the age. This disease is entirely preventable by vaccination and proper re- vaccination. The statistics of England show that in the last half of the eighteenth century out of every 1,000 deaths from all causes 96, or nearly one-tenth, perished from smallpox. On the 14th of May, 1796, Edward Jenner introduced vaccination. During the period of optional vaccination the death rate fell from 200 to 41.-^ per 100,000 of population, and from 1850 to 1898, during a period of compulsory vaccination, it fell to 5.3. In August, 1898, the " conscientiously believes " clause was inserted in deference to the anti- vaccinationists ; 230,147 persons were exempted by the operation of the law, and in 1902 the rate rose in Scotland to 7.5, and in the United Kingdom to 6.1 per 100,000. The statistics of Prussia show that with the en- actment of the revaccination law in 1874 the mortality has fallen to less than one-tenth per 100,000 of population, while the rate in the registration area in the United States is just 34 times greater. Indeed, it is claimed that Prussia would be entirely free from the REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 165 disease were it not for the importations from Eussia and Austria. President Thomas Jeiferson was instrumental in introducing vacci- nation in 1801 in the South, and in 1806, according to Harrington, wrote the following letter to Doctor Jenner : You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived. Future nations will know by history alone that the loathsome smallpox has existed and by you has been extirpated. It is to be regretted that these prophetic words should not have been fulfilled in this country of progress and enlightenment. With the introduction of glycerinated animal lymph every vestige of prejudice against vaccination should cease, and compulsory laws should be enacted in every State, so that smallpox here, as in the German army, may become practically unknown. While quite a number of States have enacted laws requiring that un vaccinated children shall not be admitted to the public schools, the undue prevalence of the disease indicates that these laws are not rigidly enforced. TUBERCULOSIS OR CONSUMPTION. The total number of deaths reported as due to consumption in the United States during the census year of 1900 was 109,750, of which 53,626 were males and 56,124 were females. Statistics also show that the death rate from this disease in 1900 was highest in the District of Columbia. As a matter of fact, according. to the records of the health office during the past thirty years, 14.5 per cent of all the deaths occurring in the District of Columbia have been caused by pulmonary tuberculosis. The death rate, however, has gradually and constantly improved and has fallen from 4.5 per 1,000 inhabitants in 1878 to 2.3 in 1907. This decline, we believe, is almost entirely due to improved methods in general sanitation and higher standards of living, which have increased the natural power of resistance to the disease. The decline in the death rate of the white race during this period has been from 3.3 in 1878 to 1.3 in 1907, and for the colored race from 6.9 to 4.5 during the same period. An emphasis is given to the comparison of the death rates of the two races when we realize that the average colored population of the District during the past thirty years was about 31.8 per cent of the entire population. In other words, 31.8 per cent of the population has furnished over 54 per cent of deaths from pulmonary consumption since 1878. There were 9,534 deaths from this disease during the past twelve years in this city — 4,266 white and 6,268 colored. Consumption not only leads the list of diseases in order of frequency and mortality, but the pecuniary losses entailed by the long duration of the disease and the danger to others from infection renders the subject of importance from an economic as well as medical point of view. If we assume the average duration of the disease to be two hundred days, and that $2 per day is expended for treatment, care, and loss of work, the 9,534 deaths in twelve years involved a total financial loss to the community of $3,813,600, or an average of $317,800 per annum. The classical researches of Koch have established beyond a doubt that the disease is caused by the growth and multiplication in the 166 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. body of man or animal of a living microscopic organism or vegetable cell called the tubercle bacillus. The mere introduction does not necessarily cause disease, as the system possesses certain defensive forces, and if the tissue cell hap- pens to be stronger than the microbial invader no liarm results. If, on the other hand, the conditions of the system favor the growth and development of the germ, little tumor-like knots are formed, known as tubercles or tubercular deposits. These, if formed in the lungs, may soften and break down and are coughed up. Heller calculates that 7,200,000,000 of bacilli may be expectorated in twenty- four hours by a single patient. The disease most commonly affects the lungs, but may also affect the glands, intestinal and other internal organs ; also the skin, mucous membranes, bones, joints, and the membranes of the brain. The bacillus has been found in all tubercular deposits in man and animals, and the most frequent source of infection is conveyance from man to man, while the possibility of transmission from animals to man can not be ignored. The germs may enter the system by the respiratory and alimentary passages, and by the skin and mucous membranes if there is an abrasion. The tubercle bacilli have not yet been demonstrated in the soil, water, or atmosphere, except in the immediate vicinity of a con- sumptive. Cornet demonstrated their presence in the dust of rooms and hospitals inhabited by consumptives in 40 of the 147 samples examined. Since the brea.th of tuberculous patients does not con- tain the germs, we may assume that, when found in rooms, they originate from the material coughed up by persons and carelessly expectorated upon the floor, walls, or carpet, which material, after drying, becomes a constituent of the household dust. It has also been shown by the classical investigations conducted under Professor Fluegge that about 80 per cent of consumptives may in coughing, sneezing, and talking project into the air little droplets infected with tubercle bacilli, withm a distance of 2 to 3 feet from the patient ; and that these droplets constitute a source of danger, as they may be inhaled in a fresh and virulent state, especially if pa- tients fail to guard against this mode of spreading by the use of handkerchiefs held before their mouths. It is believed that this mode of spreading infection also operates to a great extent in in- fluenza and infectious catarrh of the respiratory passages, sore throats, diphtheria, etc. Fluegge, without wishing to exaggerate the danger from droplet infection, believes it to be greater than from the inhalation of infected dust. He very properly emphasizes the sources of infection from fresh dried sputum on floors, handkerchiefs, cloth- ing, towels, etc., and it is perfectly conceivable that the germs may likewise be conveyed by small particles of sputum in kissing, in in- strumental manipulations, or by adhering to eating and drinking utensils in common use. There is much reason to believe that the germs may be conveyed in clothing from carelessly expectorated sputum. Perlen tells us that of 4,177 tuberculosis subjects treated in the Munich Poliklinik, 709 were engaged in tailoring, cleaning, and shoe shops. Tubercle bacilli have been found in the milk of tuberculous mothers and cows, especially when the lacteal glands were the seat of the disease or the system was infected with general tuberculosis; they REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 167 have also been found, under certain conditions, in the flesh of animals, and in the blood, feces, and urine of affected persons. Milk, cream, butter, ice cream, and dairy products may contain tubercle bacilli if the product is derived from an infected cow. Professor Koch's views on this subject are in substance as follows: 1. The tubercle bacilli of bovine tuberculosis are different from those of human tuberculosis. 2. Human beings may be infected by bovine tubercle bacilli, but serious diseases from this cause occur very rarely. 3. Preventive measures against tuberculosis should, therefore, be directed primarily against the propagation of human tubercle bacilli. His opponents, on the other hand, believe that the danger from the transmission of bovine tuberculosis is considerable, and infection by the intestinal route may not only produce tuberculosis of the bowels, peritoneum, and lymphatic glands, but also of the lungs. Much re- mains to be done, however, to determine the real degree of danger from bovine tuberculosis. According to Doctor Salmon, during the year 1900, of 4,186,166 in- spected cattle in the United States, 5,279, or 1 in 921, were tubercu- lous, and of 23,336,884 hogs, 5,444 were sufficiently affected to cause contamination of some part of the carcass. The writer has tabulated 86 cases of milk-borne tuberculosis, 3 accidental inoculations in man by the topical application of cream and milk, and 12 tuberculosis wound infections in veterinarians and butchers. The possibility that the germs of tuberculosis may be carried by means of flies and dust suggests that greater precaution be exercised in the exposure of foodstuff's in show windows and markets. Other modes of infection, such as by the mucous membranes of the eye, geni- tals, wounds, and even through the unbroken skin, have been reported. There is little or no evidence to show that the disease is ever inherited, but we may assume that in children of consumptive parents we are dealing with the transmission of vulnerable anatomical elements, and this, together with the fact that they are constantly exposed to the germs, renders them peculiarly liable to the disease. From what has been said it is evident that the tubercle bacilli are widely scattered; the modes of invasion are also numerous; and yet there is a certain proportion of those exposed who do not contract the disease. This shows that in addition to the germ there must also be a suitable soil for its growth and development. Such a soil is usually found in persons of feeble physique, victims of malnutrition, whose bodies have been weakened from any one or more of numerous causes, whether it be a previous attack of sickness, loss of sleep, dissipation, morbid habits, insanitary houses, lack of pure air, cleanliness, sunlight and outdoor exercise or of proper food. Clinical experience indicates that faulty nutrition, debility, loss of blood, anemia, mental anxiety, diabetes, whooping cough, measles, and other diseases favor the development of tuberculosis. We also know that a predisposition may be mherited, as evidenced by a deli- cate physique, narrow chest, and general vulnerability of the tissues. A vulnerability of the tissues to the disease may also be acquired by dust- producing occupations, and here the amount of dust seems less important than the character of the particles which compose it. For this reason, no doubt, the hard, sharp, and angular particles of iron 168 REPORTS OF THE PRESIDENT'S HOMES COMMISSION, and slone dust are more liable to produce injuries of the respiratory passages, thus favoring the invasion of the bacilli. Uffelmann believes that what we call inherited or acquired predis- position to tuberculosis may amount, in many instances, only to a local susceptibility of the respiratory passages, a weakness of the membranes, and greater vulnerability, and refers to the fact that some individuals, otherwise healthy, show a greater liability to laryn- geal and bronchial catarrhs, and later to tuberculosis, whilst in others repeated attacks of tonsilitis predisposes to diphtheria. The observations of Doctor Bowditch, of Boston, and Doctor Buchanan, of England, indicate that damp soils and habitations are important predisposing causes to tuberculosis, and we know posi- tively that a decided reduction has been observed everywhere coinci- dent with the introduction of sewers. The only reasonable explanation is that sewers have helped to purify the air, and rendered otherwise damp soil and houses dry and more healthful. It is well known that a damp soil is liable to make a house damp by a capillary attraction, and the injurious effects of damp air have already been pointed out on page 104.* As in other infectious diseases, the question as to whether the germs are introduced directly, and in sufficient numbers, is of importance. The observations of Humphrey, Pollock, and Leudet conclusively show that in well-ventilated wards of chest and consumption hos- pitals the disease is not usually found to spread. In private practice the results are different. A French committee of investigation pre- sents 213 cases of tuberculosis in which the communicability of the disease was clearly established. In 64 of these cases the disease was conveyed from husband to wife ; in 43 from the wife to the husband ; in 38 it was transmitted to brothers or sisters ; in 19 from parents to the children; in 16 to distant relatives; and in 32 to outsiders. The communicability was most marked among the poorer classes. Another collective investigation, by a German medical society, revealed the fact that of 938 married persons who died of acquired tuberculosis, in 101 instances either the husband or the wife also contracted the disease. In 8.1 per cent of these cases the husband contracted the disease from his wife, and in 13.2 per cent the wife was infected from the husband. Other statistics might be adduced in favor of the communicability of the disease, but Zasetzlcy's observation is of spe- cial interest. He reports the case of a tuberculous woman who mar- ried, between 1872 and 1883, 3 husbands, all previously healthy; the first husband died in 1879 of tuberculosis ; the second in 1881, and the third husband, at the time of the report in 1884, was also a victim of the disease, the wife in the meantime having died of consumption. We can only explain the greater contagiousness in such cases by a more intimate contact, the occupation of the same room and bed, common use of eating and drinking utensils, mouth to mouth contact, and the vitiated and infected air of private rooms. KABLT SYMPTOMS OF CONSUMPTION. The early symptoms are by no means clearly defined; we have, however, a steady loss in weight, with a slight amount of fever, • Kober's Industrial Hygiene. BEPORTS OP THE PRESIDENT'S HOMES COMMISSION. 169 especially in the afternoon or evening ; the heart's action is quickened upon the slightest exertion, there is a general feeling of progressive weakness, with loss of appetite or disturbed digestion. There may- or may not be a cough in the early stage of the disease. The symptoms referred to are sufficiently serious to call for the advice of a physician, and should never be neglected. Every child should learn to know that prompt treatment in the incipient stage offers the best chances for recovery, and that by proper care 80 per cent may be permanently cured. Consumption is a curable disease, and the chief remedies, such as fresh air, wholesome food and living quarters, suitable clothing, systematic bathing and hardening of the skin, are also the best pre- ventive measures. Patients should not waste money on patent medi- cines or advertised cures for consumption. No reputable physician ever advertises his skill, and persons unable to pay for medical services will always find competent men at the dispensaries. PREVENTION OF TUBERCULOSIS. The facts presented in the foregoing pages justify the following conclusions : 1. Tuberculosis is an infectious disease caused by a microbe, trans- missible to healthy persons under certain favorable conditions. 2. Inherited and acquired predisposition play an important role in the invasion and multiplication oi the bacilli. 3. The germs may enter the system by the respiratory and alimen- tary passages, and by the skin and mucous membranes, if there be an abrasion. 4. 'V^^iile the bacillus may be transmitted through the milk, flesh, and blood of animals and man, the most common and effective way of distributing the disease is by the sputum and droplets of tuberculous patients. 5. The habitations of consumptives as well as their personal effects, clothing, etc., are infected and liable to convey the disease to others. Space will not permit me to consider in detail the measures for the prevention of this disease, but I desire to emphasize a few which may be resorted to in the control of the sources of infection and the diminution of the predisposing causes : 1. Compulsory notification of cases to the health authorities as soon as the disease is recognized. This is of vital importance for the location and control of the sources of infection, and for the protection of the family and others. It has been urged that the depressing effect of such information would be too great for the patient, but this will surely be counterbalanced when we inform him that it is a curable and preventable disease, and that his chances for recovery are especially favorable if he does not reinfect himself. The health authorities, apart from distributing proper printed directions for the use of the family and the patient, as regard the care, disinfection of sputum and avoidance of droplet infection, should also resort to disinfection of the home and personal effects, especially upon the death of the patient or vacation of the premises. It is a good plan to receive the expectoration into paper spitting cups, paper napkins, or moist saw dust, which should be burned. Cuspidors should contain a carbolic acid solution (6 ounces to a 170 BEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. gallon of water). The patient, when outdoors, should use pocket spitting flasks, and during coughing or sneezing hold a handkerchief over mouth or nose. Under no circumstances should patients spit into spaces where the expectoration may be dried, and as pulverized dust, gain access to the air. The same directions about disinfection apply to cases suffering from pneumonia, influenza, and diphtheria. The public should not cultivate an exaggerated fear of such cases, but has a right to insist upon clean and decent precautions. 2. The enactment and enforcement of laws against promiscuous expectoration and coughing into the faces of persons where the sputum is liable to infect, and provisions for suitable spittoons and their proper disinfection in all public places are called for. The streets should be sprinkled and swept at night so as to reduce the inhalation of germ-laden dust to a minimum. 3. The supervision of the sanitary condition of hotels, theaters, churches, schools, ambulance service, sleeping cars, etc., should like- wise be under the control of the health department, and house- cleaning should be accomplished as far as practicable by the vacuum system. 4. Marriage with a tuberculous person should not only be dis- couraged, but absolutely prohibited by law. A tuberculous mother should not nurse her infant, and in the selection of a wet nurse a certificate of health should be demanded. 5. Isolation of tuberculous patients should be insisted upon in hos- pitals, asylums, and public institutions. In private life the patient should occupy at least a separate bed, use separate eating and drink- ing utensils, and neither receive nor give kisses. 6. Government inspection of dairies and of dairy and meat prod- ucts, and the extermination of bovine tuberculosis, are called for. Until this is accomplished or as an additional precaution, milk should be heated to 150° for ten minutes, cooled quickly and kept cold, and all meats should be well cooked. Having considered the sources of infection and the indications for their control, it is well to refer to what may be done towards dimin- ishing the predisposing causes to consumption. Many of these ques- tions have been considered under personal hygiene, habitations, ven- tilation, food, alcohol, tobacco, clothing, bathing, etc., and it remains to sum up the duties of the state in this direction. Reference has already been made to the good effects of sewers in preventing air pollution, and in the removal of dampness by drain- age. When we recall the influence of sewers upon the prevalence of the disease, and remember that only about 30 per cent of the popu- lation in the United States live in sewered towns, and about 41 per cent live in towns having public water supplies, we see at once the necessity that a system of public sewerage should go hand in hand with the public water supply. The neglect on the part of the State not only mcreases the dampness of the soil, but compels recourse to the various makeshifts for the collection and removal of excreta, and leads to pollution of the air, soil, and water. INSANITARY DWELLINGS. The influence of insanitary dwellings on the prevalence of tuber- culosis has already been emphasized. In addition to what has been KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 171 said on page 104,** it should be remembered that the tubercle bacillus clinging to floors and walls in carelessly expectorated sputum or droplets would be destroyed by a few hours of sunlight, but finds in damp and gloomy rooms a suitable environment for its vitality and growth; and the other insanitary factors, alluded to vastly increase the susceptibility to the disease. For all these reasons I consider the condemnation of houses unfit for human habitation and substitution of sanitary homes only second in importance to the destruction of the germs. The State may not be in position to provide sanitary houses, but it can at least regulate and supervise the construction of all new houses with reference to the exclusion of dampness, sanitary plumbing, amount of air space, light, heating, and ventilation of dwellings, and clearly define what constitutes an insanitary tenement, offered for rent, and provide a suitable penalty. The State should also interdict the erection of tall buildings, and of all buildings covering over 66 per cent of the lot, since they shut out light and air, thus destroying the very object for which broad streets and avenues were created, and bringing us back to the insanitary era of the medieval towns with their narrow and winding streets. PHYSICAL CULTURE, PUBLIC PLAYGROUNDS, AND BATHS. The State should pay attention to the physical development of our youth, and this is best accomplished by proper training, preferably in the open air, in connection with the public schools and playgrounds. The children of consumptives require special attention because of the transmission of vulnerable anatomical elements which render them peculiarly liable to the disease ; this predisposition may certainly be overcome, in addition to proper food, by pure air, methodical gym- nastics, and systematic hardening of the skin secured by bathing, and no school should be without these hygienic advantages. If it be found that school children are starving for want of food it is clearly our duty to make suitable provisions to prevent permanent depend- ency. No effort should be spared to increase the resisting power of the individual. Indeed, we are altogether too apt to underrate the question of soil or predisposing factors in our crusade against the disease. There is abundant statistical material to indicate the influence of dust-producing occupations as a predisposing factor to tuberculosis and other pulmonary diseases, and it is clearly the duty of the State to formulate efficient laws in regard to factory sanitation and the occupations in general which are injurious to health. It is certainly the duty of the State to see that every patient who has no home, or whose environment offers less favorable conditions for his recovery, is provided with proper care and shelter. It may be truly said that hospital treatment of consumptives offers the best chances for recovery and the ultimate extermination of the disease, and the State, until a comprehensive system of industrial insurance has been adopted, must shoulder the responsibility in the case of patients unable to bear the financial burdens. Every city of any size should provide facilities for the isolation and proper treatment of •Kober's Industrial Hygiene. 172 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. the patients, supplemented by general state sanatoria. Since the identification of the disease is the first and most important step in its treatment and prevention, the establishment of dispensaries for the recognition of incipient cases among the dependent classes seems ur- gently called for. Such dispensaries should become the feeders for municipal and state sanatoria, and when properly conducted, with special reference to social service, will be a most important factor in the combat against tuberculosis. In all such cases it is desirable to sift charity from abuse ; and it devolves upon the State to determine the financial condition of the applicant and also prevent destitution of the family while the breadwinner is incapacitated for work. It is also the duty of the State to suppress quackery, for no class falls more readily a prey to unscrupulous mountebanks than our consumptives. The Federal Government is already performing an important duty by exercising a watchful care over the subject of tuberculosis among animals. The preventive measures urged by the Bureau of Animal Industry are of far-reaching significance, although primarily in- tended to protect the pocketbooks of our farmers and stock raisers. Large sums are annually, and very properly, expended to quarantine our seaports against cholera, yellow fever, and smallpox, because these diseases, if permitted to gain a foothold, occur in epidemics, are rapidly fatal, and hence strike terror into a community. It is to be hoped that similar opportunities will be afforded the public-health service to cope with tuberculosis, which claims more victims than all these diseases combined. In the actual care and treatment we also have a right to expect a more active participation on the part of the Federal Government. It is a notorious fact that thousands of helpless cases of consumption are annually dumped upon our States and Territories which have become famed as health resorts; and the hospitals, sanatoria, and almshouses of the Carolinas, California, Colorado, Arizona, and New Mexico are filled with indigent dying consumptives. It is claimed by Mr. Frank D. Witherbee, in " Charities," Novem- ber 6, 1904, that in Phoenix, Ariz., public and private charity is taxed to the uttermost, and that three-quarters of the money ex- pended on the inmates of the almshouses goes to alien consumptives. It is cruel and worse than useless to send a consumptive away from home without sufficient means to secure the ordinary comforts and advantages of climatic treatment, and the Federal Government should not tolerate it. But until this is prevented, the Public Health and Marine-Hospital Service should be authorized to study the problem, which studies may form the basis for a more permanent and en- lightened amelioration of the sufferings of this unfortunate class of victims. It is ver}^ evident that the great problem which confronts most of our sanatoria to-day is. What shall be done with the class of indigent patients whose disease has been arrested, but who need suitable em- ployment and surroundings for their permanent recovery? While it IS hoped that the opportunities of a cooperative system will broaden out in time in connection with the State sanatoria, it can not be denied that certain sections in the Far West offer suitable advantages for a permanent cure, and the question arises whether the Federal BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 173 Government would not be justified in engaging in extensive live- stock raising and employ young men of this class to do the work? The Government needs horses and mules, beef and mutton, butter and dairy products for the public service. It has many valuable reservations, susceptible of cultivation with or without reclamation, and there is no good reason why such government farms should not prove self-supporting. The results of the government sanatoria for consumptives at Fort Bayard, Fort Stanton, and Fort Lyons have been so gratifying that substantial and permanent results may be hoped for by an expansion of the system to at least the civilian employees of the Government, along the lines indicated, or by the establishment of colonies for arrested cases. PNEUMONIA. Pneumonia ranks next in frequency to consumption as a cause of death. During the census years of 1900 there were 105,971 deaths from pneumonia in the United States. The records of the health department show that during the past twelve years there were 5,947 deaths from this disease in the District of Columbia, 2,632 white and 3,315 colored. The undue prevalence of pneumonia and tuberculous diseases of the respiratory system is general. The colored population shows a peculiar susceptibility, which is, in all probability, caused by environ- ment and sociological factors rather than by racial differences. At all events, an attempt will be made, on page 210, to account for the undue mortality among our colored population. Pneumonia, like tuberculosis, is an infectious disease, and is caused by a microbe, first discovered by Gen. George M. Sternberg in 1880, and subsequently demonstrated to be the essential factor in the causation of the disease. This germ, known as a micrococcus, is found in a considerable number in the mouth and saliva of perfectly healthy subjects, and in very great numbers in the phlegm which fills the air cells of the affected part of the lung, and is coughed up during the disease in the form of rusty sputum. The rusty appear- ance is due to the presence of blood corpuscles issuing from highly inflamed lung tissue. The danger in pneumonia depends upon the extent of lung tissue involved, the amount of toxins generated and absorbed, the condition of the heart and kidneys, and the general power of resistance of the patient. In the causation of the disease we are evidently dealing with several factors, viz, the presence of the micrococcus, individual pre- disposition, and an exciting cause. Since the germ has been found in the mouths of perfectl}^ healthy persons, and was, in fact, discovered by General Sternberg in his own saliva, we may conclude that the invasion of the microbe alone is not sufficient to produce the disease. If, therefore, an attack of pneumonia results, the patient must have furnished a suitable soil for the rapid multiplication of the germs, and the structural changes which are brought about by their agency. As in tuberculosis, so in this disease debilitating factors and depress- ing influences, such- as malnutrition, alcoholism, and insanitary sur- roundings, are important predisposing causes. But, in addition to all this, there must be an exciting cause. A caref id study of the soa- 174 BBPORTS OF THE PBESIDENT's HOMES COMMISSION. sonal prevalence shows that pneumonia, like tuberculosis, bronchitis, and congestion of the lungs, is very much influenced by temperature, humidity, and prevailing winds. The following chart of the health department shows deaths from pneumonia during 1906, arranged by months, compared with the average monthly deaths for the past ten years. This chart shows that the disease is especially prevalent dur- ing the colder months of the year, and reaches a minimum in June, July, August, and Septen.ber. It is well known that cold, and espe- cially damp cold, winds, are often the cause of catching cold, prob- ably because they abstract bodily heat in proportion to their velocity, and if this takes place to an unusual degree, or with great abruptness, the capillaries of the skin contract, the blood is driven into the in- ternal organs, and congestion results, usually in the weakest spot. As an additional effect of sudden changes in temperature, we have the suppression of the cutaneous function and consequent retention of effete matter in the blood. We can readily appreciate how all this may be aggravated by the habitual presence of alcohol in the blood current, which diminishes oxidation of the waste products, and also by overcrowding, because the effect of deficient air supply is not only to reduce the quantity of carbonic acid by expiration, but also to diminish the normal oxidation of effete matter. In any event, the conditions referred to favor the accumulation of effete matter, render the blood current sufficiently impure to lose its germicidal properties, and thus constitute a suitable fluid for the rapid multiplication of the pneumococcus invader. It is also evident that other depressing influences, such as previous illness, especially an attack of measles or of influenza, vastly increase the vulnerability of the tissues and chances of infection. This disease is doubtless communicable from sick to well persons, as shown by the occurrence of epidemics in prisons, institutions, etc.; indeed, its infectiveness is no longer a matter of doubt, and calls for prompt disinfection of the sputum and avoidance of close contact, in the manner already described in the care of tuberculous patients. While precautionary measures for the destruction of the germs are of great importance in stamping out the sources of infection, our aim must also be directed toward the correction of predisposing and ex- citing causes. This we can do by clothing adapted to climate and sea- sons, proper housing conditions as regards heating and ventilation. proper food, and temperate habits. The disease, unfortunately, is mcreasing in this country, and the increase is doubtless influenced by the increased consumption of alcohol. We have already empha- sized the fact that pneumonia is vastly more fatal among the topers. We may also lessen the harmful effects of abrupt changes in tem- perature by systematic hardening of the skin, remembering always that a normal function of the skin depends largely upon .cleanliness, and a proper tone of the cutaneous vessels and nerves, secured by bathing. INFI.UENZA (la GRIPPE ) . Influenza or epidemic catarrh is also an infectious disease, caused by a very small bacillus, discovered by Pfeiffer in 1892. This organism is constantly found in the bronchial and nasal secretions of the af- fected persons, and, as in tuberculosis and diphtheria, is largely dis- MONTHLY DEATHS FROM PNEUMONIA DURING 1906, COMPARED WITH AVERAGE MONTHLY DEATHS FOR PAST TEN YEARS. CO -s: 1 S s CO ^ § ^ ^ 03 IS ^ to 00 jd CO SJ si §^ C3i i2 ^ 00 ?5 ^" CD ^ ?p\ ^ V^ ^ >; ^ ^ X, / 1 ^ ^ ^ 1 '^ ^ ^ ^ ^ ^ ^ ^ 'C' ^ ^ ..^ >; ^ X >; ^ X, f^ ^ 1 ^ 1 X ;/ 0- ^ x 1 ^ -< 1^^ "X ■ ^ ^ 1^ ■^ ^ X ^ ^ 1 O' ^ ■^ ^ 1^ X x 1 y 1 crrft ■ 1 <^ ^ ^ ^ ^^ ^. ^ :^ X. 1 1 1 ^ ^ 1 ^ ^ ^ f ^ X, 1 ^ 1 y 1 1 ^ ^ 1 Jan. "• ^arc/? > QctyioLC^e -Zot,-h/z^i^ joints' / jSzyopZu -jotjaC'. NNvS C~ ^V jj^ 5:^S75^??^ S S55? §^ ^ f^ogrooc p K^ l^uc. 5T? S'^VVSJ^ ^<5S55^55r Vl'M ^° ^ 5 c- Ml -14 11 ii i-t 11 ;;ov5s^? J^^;^y^.N^:»N■.^^.N•<<^s^ ^ .V>vN.>,SNS> ».>t»>-^<^»»N KN I ^^ ^. .-I S!^ "I ;=5^?^^I^ ^555=55?^ :ijjiiiiiii^i^iiiiais '5 i: 1^ t^ ^g— I ^£^£^ i'"ll"i rlillllll T _^, % diA ^^ s-v^N-^NS^;,-- inilnii Uiiii I iiiii.i.i itf'llMI LkmJ OtPO'oO/ 'f^<^ !>^'o^ iH^s/j- 10 20 30 40 SO 60 70 80 90 100 IIO BSaSBBBBBBSt ^Jl Vieniw Berlin ,^,ZurKJi SLC[*B(^dforrf Water bury Broiixborougli Mantia1tiiitt)urounti Pttwtutket ^ Newark Jersey Oru Baltimore Roctiesler ^racuse ^ River Brocton Tauoton HavertHU Portland Salem Mtlwautoe Detroit Chlcaod BuMc Ene Cleveland - Ill SiPaul Dulull Canton Brooklmborough ColuuflHis McKeesfXMTt Miu))eapolis Seattle New Orleans Toledo CvansviUe. priji^ficU' ovinolon . ranffRapids WJlniia^ioii RidinioiKl Cmcinital) Louisville Philodelplita Lancaster Atlanta Harristourg wneclinfl Alleglieiiu MEAN DEATH RATES FROM TYPHOID FEVER. T902 TO 1906, IN 66 AMERICAN CITIES AND 7 FOREIGN CITIES. GROUPED, AFTER FUERTES. ACCORDING TO THE QUALITY OF THEIR DRINKING WATER. THE RATES FOR FOREIGN CITIES ARE TAKEN FROM JAMES H. FUERTES. BEPOBTS OF THE PBESIDENT's HOMES COMMISSION. 177 from 50 to 100 cases appeared daily, and on one day it is said that 200 new cases were reported. Such instances might be multiplied by the hundreds ; we have sim- ply to recall the epidemic at. Ithaca, N. Y., during the months of January, February, and March, 1903, affecting 1,350 persons in a population of 13,000, with 78 deaths, among them 128 students at Cornell University, with 26 deaths. The epidemic at Butler, Pa., in the same year, affecting 1,348 persons with 111 deaths in a popula- tion of 18,000; the epidemic at Columbus, Ohio, in 1904, with 1,640 cases and 166 deaths in a population of 140,000 ; and the more recent epidemic of Scranton, in 1906-T, with 970 cases and 77 deaths, are other shocking examples of water-borne typhoid. INFLUENCE OF WATER SUPPLIES UPON TYPHOID FEVEB. Sanitarians are so convinced that a pure water supply is incom- patible with a high typhoid fever rate that they unhesitatingly declare, " Show me a city's statistics of the disease and I will tell you the character of its water supply." The writer, in a paper on "Conservation of life and health by improved water supply," pre- sented a number of diagrams showing the typhoid fever rate in a number of cities, classified according to their water supply, of which plate 7 is here reproduced. This diagram also conclusively shows that the European cities which do not only prevent pollution of rivers, but also filter their water, enjoy the lowest typhoid fever rates. In the same paper the writer has shown that in seven American cities the reduction in ty- phoid fever, after the introduction of pure water, amounted to 70.5 per cent, and that during the past twenty-five years the death rate from typhoid fever in 14 countries and cities, tabulated by him, has been reduced 54.3 per cent. The Bulletin for the month of April, 1908, of the New York State department of health shows that the death rate from typhoid fever in 10 cities of that State has been reduced 53.4 per cent by an improved water supply. CAUSES OF TYPHOID FEVEB. The writer has heretofore held that about 50 per cent of the cases are water borne (well, river, commercial, and ice), and has taught for years that wells in this city, on account of soil pollution, should not be tolerated, and that the only way to render a suspicious supply safe for drinking purposes was to boil the water. The danger from Potomac water since filtration, has been practically eliminated, but ice should not be mixed with it as it may be as impure as the water from which it is derived. Moreover, iced drinks and foods are also objectionable on account of the injury to the digestive functions, especially in the summer months, unless sipped very slowly, and, upon general principles, ice cream should be made with sterilized cream. In the writer's report on typhoid fever for 1895, he urged as a preventive measure the boiling of milk, and the systematic inspection of dairies. This, together with the fact that he has tabulated 195 of so-called milk-borne typhoid epidemics, clearly indicates that in his judgment milk is to a certain extent responsible for the dissemi- S. Doc. 644, 60-2 13 178 BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. nation of the disease, probably in about 15 per cent of the cases. In 148 of the 195 epidemics analyzed by him there is evidence of the disease having prevailed at the farm or dairy. In 67 instances it is probable that the infection reached the milk by soakage of the germs into the well water with which the utensils were washed, and in 16 instances the intentional dilution with polluted water is a matter of evidence. In 7 instances the infection is attributed to the cows wad- ing in sew age- polluted water and meadows, and it is quite conceiv- able that the germs clinging to the udder and teats found their w^ay into the milk. In 4 instances the infection was spread through cream prepared in infected premises. In 7 instances through cream- eries. In 1 instance the milk tins were washed with the same cloth used among the fever patients. In other instances the germs were probably carried into the milk by flies passing from the infected excreta. In 24 instances the people handling the milk also acted as nurses. In 10 instances patients while suffering from mild attacks, or during the first ten days of their illness, continued at work. From what has been said of the danger of soiled hands, we may assume that the germs in all such instances may be conveyed in the manner already explained. In like manner a " chronic bacillus carrier " may convey the germs by soiled fingers into the milk. This mode of infection was strongly suspected ever since Doctor Soper, of New York, traced a number of household epidemics to an infected cook,*^ and also by a very in- teresting instance reported by Dr. Henry Albert, occurring in the fall of 1907, at Cedar Falls, Iowa. The possibility of spreading the disease by such a carrier has been materially strengthened by a study of a milk-borne typhoid epidemic in this city in October, 1908. Surgeon-General Wyman's report says: Twenty-six cases of typhoid in Georgetown, occurring between October 8 and 15, were traced througli tlie milk to ttie dairy farm. On close inspection of this dairy farm no case of typhoid fever for years could be found to have occurred among any of the employees, nor was any other source of infection discovered until after a systematic examination of dejecta of all the em- ployees had been made in the hygienic laboratory. This examination developed large numbers of typhoid bacilli In the dejecta of one woman who had had typhoid fever eighteen years before, and was one of the milkers of the dairy. Persons thus affected are known to the medical profepfeion as typhoid bacilli carriers, but this is the first considerable outbreak of typhoid in the United States traced through milk to such a carrier, excepting the case reported by Dr. Henry Albert, of Iowa, in the " Hygienic Laboratory Bulletin," on "Milk and Its Relation to the Public Health," published last January. The case just discovered is deemed of special interest to health officers in their endeavors to trace the source of typhoid outbreaks when that source seems to be obscure. At least 2 per cent of all recovered cases of typhoid fever become bacilli carriers for a longer or shorter period, even while enjoying good health. Ten per cent of the cases of typhoid fever in Washington during the past three years have been definitely traced to infected milk. This instance is of extreme interest and certainly suggestive of dan- ger, but scientific critics may be tempted to ask: (1) If this woman was the only possible source of infection, why did she not infect the consumers of the milk before? unless, indeed, it can be shown that she had a recent reinfection; (2) were the typhoid fever germs actually found in the milk? (3) if not, why was there no effort made to <»" Journal American Medical Association," Vol. XLVIII, No. 24, p. 2019. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 179 demonstrate experimentally that this woman with the careless toilet habits could infect her hands and through it the milk? and (4) have all other local sources of infection in Georgetown been effectually eliminated ? The evidence on milk infections shows how important it is for us to bring our milk to the boiling point (scalding), which will kill the germs. In this connection it is interesting to note that, of the 330 milk epidemics (typhoid, scarlet fever, and diphtheria) collected by the writer, 243 have been recorded by English authors, 52 by Ameri- can, 14 by German, 11 by Scandinavian, and 5 each by French and Australian writers. This is probably due to the fact that the Eng- lish and Americans usually consume raw milk, while on the Conti- nent milk is rarely used without being first boiled. About 15 per cent of all typhoid cases are brought to the city from summer resorts and rural districts, and about 20 per cent may be spread through the agency of flies, personal contact, the consumption of raw oysters and shell fish raised in sewage-polluted waters, or the eating of strawberries, radishes, celery, lettuce, and other vegetables and fruits which have been contaminated with infected night soil. Hence the importance of carefully washing all uncooked articles of food. TYPHOID FEVEB IN THE EURAL DISTRICTS. There is much reason for assuming that the undue prevalence of typhoid in rural districts is a fruitful source of infection to the urban population, chiefly through the milk supply and summer boarders. When we consider the fact that over 70 per cent of our population resides in rural districts, that the " bone and sinew " of these are engaged in agricultural pursuits, and that they do not enjoy the benefits of enforced sanitation by local health boards, we see at once the desirability of the family physician extending useful suggestions on healthful building sites and homes, disposal of house wastes, the importance of a pure water supply, wholesome and properly cooked food, etc. As it is now, the diet is faulty, especially the hot biscuits and greasy fried dishes, while wells and privies are often dangerous neighbors, favoring the spread of filth diseases. The undue prev- alence of typhoid fever could be materially checked by chemical dis- infectants, or by adding to the discharges four or five times the quantity of boiling water kept in contact for at least ten minutes. While prompt disinfection of the excreta is of vital importance, we should also make an effort to get rid of the flies by prompt disposal of the horse manure in which they breed, the abandonment of open privies and surface pollution, substitution of the dry earth closet, or other rational methods for the collection and disposal of excreta, removal of garbage, etc PREDISPOSING CAUSES TO TYPHOID FEVEB. The writer, in his investigation of 500 cases in 1895, found that in a large number of cases, especially in the southwest and along the eastern branch of the Potomac, the system was very much debilitated by the malarial cachexia prior to the attack. What effect the James Creek Canal, the backing up of sewage and consequent flooding of 180 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. uncemented basements and cellars, or the emanations from the filth- reeking shores may have had, as a contributory factor, it is difficult to say. We know, however, that marshes breed mosquitoes, which are the carriers of malaria, and that, apart from the unwholesome emanations, the evaporation of water also increases the humidity of the air and thus intensifies the effects of both heat and cold, all of which can not fail to lower the power of resistance to disease. For these reasons his fifth recommendation, submitted in 1895, referred to sanitary measures looking to the reclamation of the stagnant and polluted marshes and the prompt disposal of sewage. In this connection let us remember, however, that while the Ana- costia flats are productive of disease, directly and indirectly, similar effects, differing only in degree, may be produced by filthy homes, back yards, and stagnant pools of water within the city limits. The same report, on page 261, says: In addition to the germ, there must also be a suitable soil for its proliferation in the system, and this individual predisposition or vulnerability, which renders the body more liable to be acted upon by the germs, may be the result of debility, faulty nutrition, fatigue^ excesses of all kinds, abrupt changes in temperature, impure air, mental depression, unwholesome food, and many other factors calculated to diminish the power of resistance of the individual. The factors of environment and other predisposing causes jye plainly revealed by the imdue fatality in the colored population. The average typhoid death rate among the colored during the past ten years was 76.4, as compared with 47.4 for the whites. Many of the factors concerned will be alluded to on page 210, and much may be done by uplifting influences and higher standards of living toward the removal of the predisposing causes of typhoid fever. WHY IS THEBE MORE TYPHOID FEVEB IN WASHINGTON THAN IN NORTHERN CITIES? Now that we have a pure-water supply this very pertinent question has been asked, and among the answers so far given may be mentioned the following: 1. Washington, like very many other southern cities, has a very large colored population, with their greater susceptibility to disease. This, however, accounts for only a certain percentage of the excess, as the rate for the white population is also abnormally high. 2. It is a well-known fact that all intestinal diseases are especially prevalent in hot climates and seasons. This is probably due to the fact that the blood is kept too long at the periphery on account of excessive perspiration, and the stomach and other internal organs suffer in tone and nutrition for want of adequate blood supply, and can not exert their normal defensive forces.** So, for example, typhoid-fever germs would be digested, like many other vegetable cells, as long as the digestive functions are normal, but if for any reason this function is impaired or arrested, this defensive force ceases, and the way for infection is open. Functional derangements of the stomach, together with the debilitating influences of heat, doubtless play an important role in increasing the general suscepti- bility to typhoid fever in all southern climes. 3. Doctor Woodward, our health officer, suggests that the greater intensity of heat in the South leads to the ingestion of larger quan- « See page 80, Kober's Industrial Hygiene, REPORTS OF THE PRESIDEKT^S UOMES COMMISSION. 181 titles of water than are consumed farther north, and, therefore, so far as water-borne typhoid fever is concerned, to increased chances of infection. He also suggests that " intensity of heat and the long dura- tion of the heated season probably lead to a more rapid and more extensive lowering of the water in the streams and wells than occurs in cooler regions, and thus lead to a greater concentration of infec- tivity, if the water in such streams and wells are infected. The temperature of the water in such streams and wells may be better suited to the lief of the typhoid-fever bacillus than is the temperature of northern waters. Moreover, owing to the greater duration of the summer season, the fly season is longer, and the period during which the diet of the people consists largely of uncooked articles is corre- spondingly extended. The chances of infection are therefore cor- respondingly increased in so far as relates to infection through foods. Still it would be but poor comfort to know that because Washington is a southern city it must continue forever to pay its death toll to the typhoid-fever Juggernaut; the problem must not be solved in that way. But the problem is not yet solved, nor is it likely ever to be solved until the investigation is taken up along broader lines than any that have yet been adopted; that is, until the investigation into the causes of the undue prevalence of typhoid fever in this District is made to include an investigation into the causes of the prevalence of typhoid fever elsewhere, so that by a process of comparison and exclusion the cause for the excessive typhoid fever rates in the District of Columbia can be ascertained." PBEVENTION OF TYPHOID FEVEE. The writer, in his report on typhoid fever in 1895, referred in his concluding recommendation to thorough disinfection of the excreta from all typhoid-fever patients, and greater care on the part of those connected with the sick. We have known for over twenty-five years that the typhoid germs are conveyed chiefly through the feces and urine of infected persons, that they are capable of reproduction within and without the body, unless killed by certain physical or chemical agents. We have already mentioned that even the addi- tion of four or five times the volume of boiling water to feces or urine will effectually destroy the vitality of the germs. If chemical agents are used the method must be thorough and exact. The at- tendant must prepare and use germicidal solutions of standard strength, and unless this is done the whole process is a snare and delusion. So, for example, all vessels containing stools should be filled with a double volume of a solution of chloride of lime (6 ounces to the gallon), or a 5 per cent solution of carbolic acid, 6 ounces to 1 gallon of boiling water, or a corrosive sublimate solu- tion, 60 grains of corrosive sublimate, 2 teaspoonfuls of table salt to 1 gallon of water, or any of the standard disinfectants ; and kept in a covered vessel for at least one hour before emptying. Disin- fection must also extend to the patient's soiled body, clothing, and bedding, and to the hands of the nurse. If this is not done there is danger from so-called contact infection. Infected fingers may contaminate the food, while a fly alighting upon a soiled part may carry the germs on its feet to the food and drink of the other inmates or even to some neighboring houses. Prompt and efficient disinfec- tion will destroy the principal sources of infection, and if carried 182 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. out universally, would go far toward removing typhoid fever from the face of the globe. That this is possible is shown by the fact that the typhoid rate in Berlin has been reduced from 142 per 100,000 of population in 1872 to 5 in 1906. The causes of typhoid fever in this city are perhaps more complex and varied than elsewhere ; no one factor can alone be held responsible for its undue prevalence, and in the prevention of the disease due attention must be paid to the removal of all the causes likely to influ- ence its spread. Among the sanitary measures which should be invoked are the following: The expenditure of $100,000 asked for by Major Cosby for the perfection of the quality of the filtered water. While the installation of the filtration plant has resulted in an improved water supply, it is found that during periods of great turbidity, especially during the months of December and January, the number of bacteria remaining in the effluent exceeds permissible limits. It has also been shown that the efficiency of the filters, as regards removal of bacteria, can not be increased without previous chemical treatment of the water at such periods. In view of the fact that the degree of danger varies with the number of bacteria left in the water, no effort should be spared to eliminate these high counts by the methods proposed by the engineer in charge. The prevention of river pollution involves problems which should be solved in the interest of this and other communities using a public water supply from interstate rivers, under which circumstances the inhabitants of one Commonwealth are powerless to protect themselves against the misdeeds of their neighbors. The abandonment of public and private wells and box privies, wherever found, the removal of slums, insistence upon clean homes, back yards, basements, cellars, alleys, streets, and vacant lots, and more stringent laws for the production and sale of milk and cream, together with the reclamation of the Anacostia Flats can not fail to diminish some of the contributory factors in the prevalence of the disease. Many of these measures have been urged by the commissioners and the health officer for years, and it is the duty of every good citizen to strengthen their hands in their well-directed efforts. In addition to all this, there is special need for more visiting nurses and social workers to instruct our neglected neighbors in higher standards of living, and finally, more attention should be paid in our schools to hygienic and sociological questions, so that the average child may learn the essentials for the preservation and promotion of health. DIARRHEA AND DYSENTERY. While diarrhea is a symptom of very many diseases, there is reason for believing that certain forms, occurring in infants as well as adults, toward the middle or close of a hot, dry summer, are caused by the consumption of tainted food, milk, impure water, etc., superinduced by putrefactive bacteria, and that the serious forms of summer com- plaints are due to specific germs. From what we know of the nature and cause of dysentery we are led to consider it an infectious disease, which is spread very much like typhoid fever. The tropical form of dysentery is caused by an ameboid organism, while the type most prevalent in this country is due to a bacillus. REPORTS OF THE PRESIDENT'S HOMES COMMISSION . 183 In our present state of knowledge we may conclude that the virus of dysentery, whether of the bacillary or amebic type, proceeds from the intestinal discharges of a previous case, and the most usual mode of transmission of the germs is through the water supply. This is the opinion of Virchow, based upon personal experience in Egypt, and Uffelmann has frequently observed that persons using boiled watet during a dysentery epidemic remained exempt, and that the simple closing of a suspicious well often checked the spread of the disease. It is also perfectly conceivable that the germs may be spread through soils strongly polluted and infected with excrementitious matter, and with particles of dust gain access to milk, fruit, fresh vegetables, etc., which are eaten raw. The agency of flies in carrying the germs from infected sources to the food supply can not be ignored. Temperature also plays an important role in the development of the disease. At all events, statistics show that in temperate climates the disease assumes epidemic proportions in July, August, and Sep- tember, and declines with the approach of cold weather ; it goes hand in hand, therefore, with a maximum temperature of the air and soil. It is also a clinical fact that badly nourished individuals, and those suffering from indigestion or intestinal catarrhs, are especially liable to be attacked. Prophylaxis: In the attempt to prevent epidemic extensions . of these diseases the water supply should be looked after, and every source of contamination of wells, springs, and public reservoirs must be avoided, and suspicious supplies closed. The public should be enlightened as to the nature of these diseases, and especially of the necessity for prompt disinfection of stools. It should also be informed that indigestion, the result of indiscretion in eating and drinking, and chilling of the body increase the suscep- tibility ; that it is desirable during the prevalence of these diseases to use only boiled water and milk, and to avoid the consumption of raw vegetables and fruit, unless they have been thoroughly washed with water previously boiled. Chapter IV. - ' INFANTILE MORTALITY. According to Oesterlein's statistics it is safe to assert that the average death rate during the first year of life is 188 out of 1,000 infants born. According to the census of 1900 the infantile mortality per 1,000 births in the so-called registration States was as follows : District of (Columbia 274. 5 Rhode Island 197. 9 Massachusetts 177. 8 New Hampshire 172. 6 New Jersey 167. 4 New York 159. 8 Connecticut 156.8 Maine 144. 1 Vermont 122.1 Michigan 121. 8 184 REPORTS OF THE PRESIDENT S HOMES COMMISSION. It will be seen that the rate of Vermont and Michigan is less than one half that of the District of Columbia. The rates in foreign countries likewise vary considerably. In France the average rate from 1874 to 1893 was 167 ; in 1903 it had fallen to 137, practically the same as that of New Jersey. According to Harrington* our highest rate about equals Russia, and it is not much greater than that of Austria. Ehode Island makes a better showing than Germany and Italy. The German rates for the five years 1901-1905 were 216, 184, 202, 204, 204. The Italian rates are 170. Maine stands with England and Wales, and better than Belgium and the Netherlands. The rates for England and Wales are 150; Belgium, 156; the Netherlands, 147. The rate of Vermont is lower than Scotland (126), Denmark (127), Finland (134), or Switzerland (144). Michigan is also lower than Scotland (126). The following countries have lower rates: New South Wales, 108; Victoria, 105; Ireland, 105; South Australia, 102; Queensland, 101; Sweden, 98 ; Norway, 90 ; New Zealand, 79. These are mean rates for rural and urban districts. In towns and cities the mortality is always higher, amounting to 33.6 per cent, as compared with the rural mortality of 27.8 per cent. The District of Columbia in 1900 had the unenviable reputation o:^ leading the list of the registration States in infant mortality, but the rate of Washington as a city compares favorably with other cities. The census of 1900 gives a list of 106 cities and towns with infantile death rates in excess of 175. In 9 cases the rate exceeded 300; in 38 it was between 200 and 280, and in 49 it was between 175 and 200. The following is a partial list of these cities : Charleston, S. C 419. 5 Savannah, Ga 387.5 Mobile, Ala 344. 5 Key West, Fla 311.8 Biddeford, Me. 811.6 Atlanta, Ga 306.0 Fall River, Mass 304.7 Lynchburg, Va 301. 7 Richmond, Vji 300.7 Laconia, N. H 294. 6 Shreveport, La 293. 5 Jacksonville, Fla 287.6 Norfolk, Va 284.6 Lowell, Mass 275. 5 Washington, D. C 274. 5 Baltimore, Md 235.1 New Orleans, La 1229.2 Detroit, Mich 201.2 Philadelphia, Pa 201.9 Newport, Ky 189.8 Indianapolis, Ind 173.5 Kansas City, Mo 168.8 Springfield, 111 167,4 New York, N. Y 189.4 •Harrington, Infantile Mortality, "Am. Jour. Med. Sc," December, 1906. REPORTS OF THE PRESIDENT S HOMES COMMISSION. 185 The following is a list of 24 German cities with excessive infantile death rates: Chemnitz .. Stettin Posen Nuremberg. Breslau Dantzig Halle Magdeburg. Konigsberg Leipzig Rixdorf Munich Cologne Plauen Stuttgart . . . Mannheim . Berlin Brunswick . Aachen Dresden .... Strassburg.. Diisseldorf . Karlsruhe . . Dortmund.. Infantile death rate. Diarrheal infantile death rate. 270.99 135.67 260.54 112.28 i 248.29 92.62 247. 63 113.80 244.39 98.62 243. 19 109. 87 235. 71 124. 77 233.52 100.73 233. 25 113.47 222. 14 121.49 218. 49 103.66 217. 39 95.33 212.45 93.60 208.01 36.25 205.63 74.80 203.67 86.46 199.83 87.99 196.64 81.22 195. 12 78.60 191.29 83.23 190.45 92.82 187. 97 82.43 185.12 86.17 184.96 61.76 Percentage of infan- tile deaths due to diar- rheal dis- 60.07 43.09 37.27 45.97 40.36 45.18 52.94 43.14 48.65 54.69 47.44 44.14 44.06 16.05 44.03 41.32 40.28 43.61 48.74 43.85 46.55 33.38 In 1904, in the 323 German cities and towns having populations ex- ceeding 15,000 the rate was 202. In the twelve months ended June 30, 1906, in 32 German cities with a population of over 100,000, the rate was 198. (Harrington.) From the foregoing figures it appears that in many cities, out of every 1,000 children born alive, over one-third perish before the com- pletion of the first year ; but fortunately for the perpetuation of the human race the average infant mortality all over the world is only about one-sixth of those born. Of the twelve months during the first year of life the first month furnishes the highest mortality. Of the 1,233 infantile deaths re- ported in this city in 1906, 222 were due to premature birth; 40 to congenital debility; 28 to malformations, and 9 to difficult labor. The first month is followed by the second, third, and fourth months, probably also because of diminished vital resistance. The tenth, eleventh, and twelfth months are also dangerous months, as this is at the usual period of weaning with its attending danger from digest- ive diseases incident to artificial feeding. We have already referred to diarrheal diseases as the principal cause of infantile mortality. A mortality of 40 per cent from diarrheal diseases and 2.5 per 1,000 from tubercular diseases of the abdominal lympathics and glands can not fail to claim our attention, and certainly points, with more than mere suspicion, to the fact that the morbific agent in these cases is introduced into the body with the food, especially unwholesome and infectious cow's milk. Nor is it improbable that the 21 per cent who die from affections of the respiratory organs are largely the victims of ignorance as regards temperature and clothing and other environments of the child. The infant mortality is everywhere influenced by extremes of heat and cold, but tie hot months, like 186 REPORTS OF THE PRESIDENT'S HOMES COMMISSION". July, August, and September, are the most dangerous on account of the disastrous attacks of diarrheal diseases. The fatal influence of heat is graphically shown in the accompanying chart. (See next page.) The deaths from diarrheal diseases ranged according to months, from 5 in January to 108 in July and 58 in August, after which there is a rapid decline. The same abrupt changes are noted in the large statistical material of German cities in 1905, dealing with 128,035 deaths under one year, the deaths from diarrheal diseases ranging from 1,192 in January to 15,863 in August. High infantile mortality rates have always been considered the opprobrium of the healing art. Dickson asked over fifty years ago, " How shall we prevent the early extinction of half the newborn children of men ? " While powerless to solve all the mysteries con- nected with this subject, an attempt will be made to answer the prac- tical question. Can they be reduced? Space will not permit to enter into detail of infant hygiene, but we must at least point out the fact that the mortality can be greatly reduced by improving the original stock, i. e., the physique and habits of the parents, and plac- ing them, as well as their offspring, under more suitable environ- ments, especially with reference to fresh air, sunlight, exercise, suitable clothing, and habitations, and last but not least, proper food. The influence of favorable hygienic conditions was demonstrated by Casper's statistics, published as early as 1825, showing that the infant mortality rate among royal children was only 57, as compared with 345 per 1,000 among the infants of the poor. Of 170 deaths from infantile diarrhea, investigated by Helle in Graz in 1903 and 1904, not one belonged to a rich family, and but 9 to the well-to-do class, while 161 belonged to the poor and the very poor. Clay cal- culates that of every 100 children born in England, 90 will be alive at the end of the first year of those born in aristocratic families, 79 in the mercantile class, and 68 among the laboring classes. The rela- tion of infantile mortality to the occupation of the women has already been discussed in a previous report. Dr. George Reid, at the National Conference on Infantile Mor- tality, held in London in June, 1906, contrasted the infantile mor- tality in two districts, identical in health conditions, but with the important difference that in one women are largely employed in industrial pursuits, and in the other there is practically no employ- ment for them, with the result that the infantile mortality varied from 149 to 198 per 1,000. The infantile mortality returns in the United States also indi- cate that we are dealing with a class mortality, which is highest in communities where women are employed in mills and other gainful occupations, and in consequence the children fall victims to igno- rance and neglect. Contrast, for example, the census rates for 1900 of Fall River, Mass. (304.7) ; Lowell, Mass. (275.5) ; Nashua, N. H. (261.2); Lawrence, Mass. (246.5); Manchester, N. H. (238.4), all typical mill towns, with the rate at Cambridge, Mass., which was 186.5. The seasonal and climatic influences arc of course the same and, presumably, also, the general quality of the milk supply, hence we must look largely to sociological factors for an explanation, such as has been offered on pages 78-80,° and may be summed up in igno- <» Kober's Industrial Hygiene. MONTHLY DEATHS FROM INFANTILE DIARRHEAL DISEASES DURING 1906 COMPARED WITH AVERAGE MONTHLY DEATHS FOR PAST TEN YEARS. Deaths 110 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 12 11 10 5 ^ ^ ^ y- y^ ^ / ^ / ^ / y / ^ i ^ ^ ^ ^ ^ ^ ^ - ^ >: 1 Fl 1 R 1 1 ^ t ^ m ^ ^ I m ^ ^ ^ Jan. Feb. March April May ur\e July Aug. 5ep^ Oc^ Nou. Dec. H Deaths from Diarrheal Diseases during 1906. Average annual deaths from Diarrheal Diseases for 7 years. Reproduced from the Report of the Health Officer, District of Columbia, 1907. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 187 ranee and poverty. The same explanation applies to tlie excessive rates among colored infants in many of our States and in our own city. During the year 1906 the number of children under two years of age who died in Washington from diarrheal diseases and inflam- mation of the bowels was 318, 146 white and 172 colored. The cor- responding death rate per 100,000, calculated on the basis of the entire population, was for the white population 63.1 and for the colored population 181. If any further ar^ment is necessary to show the influence of sociological factors, it will be found in the fact that 1,792 of the 2,711 infantile deaths investigated by Neuman in Berlin in 1903 occurred in 1-room dwellings, 754 in 2-room, and 165 in 3-room and larger dwellings. ^ The difference in the mortality of legitimate and illegitimate chil- dren is very great and varies, according to Uffelmann, as follows; Legitimate children. nieRitimate children. Per cent. 15.0 22.9 13.0 14.0 Per cent. •60.0 Austria. .. 36.1 Sweden 24.8 85.0 But the most frightful mortality rates are everywhere furnished by the hand or bottle fed children. Doctor Newsholme,<» the medical officer for Brighton, England, states that breast-fed infants contribute but one-tenth of the deaths from infantile diarrhea. W. J. Tyson ^ asserts that three-fourths of the 150,000 infantile deaths in Great Britain were those of bottle-fed children. Indeed, we have evidence that of the 54,027 infantile deaths which have been investigated at home and abroad with reference to feeding, 86.6 per cent had been artificially fed, all of which points to the fact that the quality of the food, chiefly cow's milk, in hand-fed children, plays the most important role. This assumtion finds, moreover, support by the fact that the infantile death rate and diar- rheal diseases in children under five years of age have materially decreased in a number of American cities since the enactment of pure- milk laws, notably in Buffalo, Rochester, Chicago, New York, and Washington. The report of the health officer of the District of Co- lumbia for 1906, page 11, says: High as is the infantile mortality rate even now from diarrhea and Inflam- mation of the bowels, it is far below the figures that formerly prevailed. Dur- ing the five-year period 1880-1884 the death rate from diarrhea and inflam- mation of the bowels among children under 2 years of age was 162 per 100,000 per annum. During the five-year period 1885-1889 the average annual rate was 168. During the next period, 1890-1894, the death rate rose to 175, but in the year 1895 a diminution began. During the period 1895-1899 the death rate from the diseases named was only 135; in the period 1900-1904 it was only 109 ; in 1905 it was 104, and in 1906 it was only 97. The only explanation for the fall in the death rate from infantile diarrhea that I have been able to discover is the enactment, on March 2, 1895, of the law regulating the sale of milk in the District of Columbia and the establishment of dairy and dairy-farm inspection under the provisions of that law. ♦ ♦ ♦ "Journal of Hygiene, April, 1906. * Journal of State Medicine, September, 1904. 188 BEPOETS OF THE PRESIDENT'S HOMES COMMISSION. MATERNAL NURSING. The mortality statistics in hand-fed children are the most eloquent arguments which can be offered in favor of breast feeding. Recent statistics collected by Von Bunge in different parts of Europe indicate that probably 75 per cent of the women could nurse their children. Budin asserts that 448 out of 557 women who at- tended one of the Paris clinics ,were able to nurse their children. Madame Dluski, in an able thesis, maintains that of every 100 healthy women, when the necessary conditions of alimentation and repose are present, 99 are actually able to nurse their offspring. The importance of maternal .nursing is emphasized in different parts of Europe by popular education, and by the enactment of laws requiring, in indus- trial establishments where 50 or more women are employed, special rooms for maternal nursing. On the other hand, statistics collected by Hegar in large obstetrical institutions in Germany indicate that only about 50 per cent of women are capable of nursing their offspring for merely a few weeks, and the question naturally arises : What are the causes of this inability to discharge their sacred maternal duties ? Among them may be mentioned physicial inability as a result of in- sufficient or improper food, hard work, care, hereditary debility and disease, tuberculosis, alcoholism of the woman's own father, modified syphilis, or nervous diseases in the family. Von Bunge believes that, apart from actual disease in the mother, alcoholism is one of the chief causes, as the daughters of the third generation of alcoholics are usually unable to nurse their offspring. The effects of hard work and gainful occupations have been pointed out,** but there is absolutely no excuse for mothers who, although physically able-bodied, are dis- inclined to nurse their children, chiefly as a matter of ease, comfort, and social pleasures, and who, instead of employing a healthy wet- nurse, prefer artificial feeding, and often resort to patent baby foods. Dr. Henry D. Fry,^ professor of obstetrics, Georgetown University, in his excellent monograph on maternity, states that such foods are more often the cause of scurvy than other nourishment. On page 149 he says: Pictures of fat babies smile at us from the pages of newspapers and maga- zines, and the advertisements say they were raised on this or that food product. Unfortunately, many babies have been raised to " worlds unl^nown," but we do not see their pictures. The evidence of this must be sought in graveyards, where tombstones bear silent witness to the high rate of mortality in early life. These remarks are equally applicable to the pernicious use of ** soothing " and " teething " sirups, " babies' friend," etc. Professor Jacobi '' offers some excellent advice when he says : Infants are the future citizens of the Republic. Let the Republic see that no harm accrue from the incompetence or unwillingness to nurse. * ♦ ♦ From a physical, moral, and socio-political point of view, there is only one calamity still graver, that is to refuse to have children at all. ♦ ♦ * The human society of the future will have to see to it that no poverty, no cruel labor laws, no accident, no luxurious indolence must interfere with the nursing of infants. • Kober's Industrial Hygiene, p. 78. » Fry, Henry D., " Maternity," 1907. • The History of Pediatrics, etc., " Jour. Am. Med. Asso.," November 5, 1904. BEPORTS OP THE PRESIDENT S HOMES COMMISSION. 189 We are building hospitals for the sick of all classes ; asylums for the insane, neuropathies, and drunliards; nurseries and schools for epileptics, cretins, and idiots; refuges for the dying consumptives, and sanatoria for incipient tuberculosis. We are bent upon curing and upon preventing. Do we not begin at the wrong end? We allow consumptives and epileptics to marry and to propagate their own curse. We have no punishment for the syphilitic and gonorrheic who ruins a woman's life and impairs the human race. Man, however, should see that his kind must not suffer. One-half of us should not be destined to watch and nurse and support the other half. Human society and the state have to protect themselves by looking out for a healthy, uncon- taminated progeny. Laws are required to accomplish this. * * * As a matter of fact, Indiana, Wisconsin, Michigan, and Connecti- cut have laws prohibiting the marriage of epileptics. Indiana also prohibits marriages of persons suffering from transmissible diseases, and, by an act of 1907, "confirmed criminals, imbeciles, idiots, and rapists, procreation by whom is deemed inadvisable by experts, shall be unsexed by surgical operation." Until there is greater perfection in the physical, moral, and eco- nomical conditions of the human race, there will always be a large percentage of infants deprived of their natural food. In order to appreciate the dangers of artificial feeding it may be well to point out briefly some of THE ANATOMICAL AND PHYSIOLOGICAL CHARACTERISTICS OF INFANTS. The average weight of a healthy newborn male child is 3,500 grams, and of a female 3,000 grams; at the expiration of the first month the child should weigh about one-third more than at birth; during the middle of the fifth month it should have doubled its weight, and at the completion of the first year it should weigh three times its original weight. At the end of the second year the normal child should weight about 12,000 grams, or a little over 26 pounds. Any decided variation should cause the mother to seek proper advice. It should also be re- membered that the anatomical elements of the digestive tract of in- fants are very delicate and vulnerable and especially susceptible to injurious influences, such as cold or improper food, atmospheric temperature, etc. The saliva, up to the tenth month, is scant and in- capable to any considerable extent of converting starchy food into sugar, a property only fully developed about the expiration of the ninth month. The muscular coats of the stomach are delicate, and vomiting is easily provoked ; the gastric glands secrete a juice which is less acid than in after years, and the contents are passed from the stomach into the upper intestinal canal at intervals of one and three-fourths hours. The pancreatic juices for the first few months in life are scant, and up to the fourth or sixth week incapable of converting starch into sugar, but fully prepared to digest the proteids and fats of the milk. The stools of a normal infant scarcely exceed two or three during the twenty-four hours ; they are of a semiunctuous consistency and orange or egg-yellow in color. There can be no question that the natural food is breast milk from a healthy mother — no other food insures to the same extent the physiological development of the child. A normal infant requires a daily supply of milk to the amount of about one-seventh of its weight. 190 BEPOBTS OP THE PBESIDENT's HOMES COMMISSION. The average composition of human milk, after the regularity of lactation has been established, is about as follows: Water, 87.30 per cent; proteids, 1.5 per cent; fats, 4 per cent; sugar, 7 per cent; and mineral salts, 0.2 per cent. The composition of the milk is by no means constant, and is influenced by a number of factors, such as the age of the mother, food, habits, emotions, race, physical peculiarities, etx3. The digestibility of human milk is nearl}^ perfect, as 97 per cent is generally utilized; all of the constituents are absolutely essential to health and a proper growth of the body. CARE OF TPIE BREASTS. The mother should take special care of the nipples and breasts and can prevent much physical suffering, from local inflammatory affec- tions, by washing the parts after each nursing with plain water and careful drying. It is very doubtful whether the practice of washing the nipples during the last three months of pregnancy with alcohol and astringent lotions is productive of good ; indeed. Professor Fry * believes they are harmful by drying up the secretions of the sebaceous glands and making them more liable to crack, and he recommends instead the application of cocoa butter, lanolin, albolene, vaseline, or castor oil. Much can be done at the outset in preventing sunken or depressed nipples by avoidance of tight clothing, but when they do occur they should be treated by the attending physician. FREQUENCY OF NURSING. There is nothing to justify the frequent practice of administering to newborn infants different teas and sweetened water during the first few days after birth. Plain boiled water, at a temperature of 99, may be given ; but above all we should endeavor to establish regu- lar habits at the outset and avoid overfeeding. Professor Heubner believes that the number of feedings heretofore advocated is too ^eat, and a less number is productive of better results. In this he IS supported by other competent observers, and Doctor Schereschew- sky,^ in his excellent article on " Infant Feeding," gives the following schedule, which seems to fulfill the best practice in this direction : Age. in 24 during Night Nursings Interval in 24 during hours. day.'' 4 6 6 4 8 2i 7 3 6 3 5 4 Firstday 4 6 1 Secondday 6 4 1 Third to twenty-eighth dav 8 2i 1 Fourth to thirteenth week 7 3 1 Third to fifth month 6 8 Jifth to twelfth month 5 4 The infant during the first four or five days after birth usually loses about 8 per cent of its weight. It should then regain lost weight and continue to gain at the rate of 120 to 150 grams (4 or 5 «Fry, Henry D., "Maternity," 1907. •Bulletin 41, Public Health and Marine-Hospital Service, 190S. EEPOKTS OF THE PEESIDENT's HOMES COMMISSION. 191 ounces) every week during the first three months, and from the third to the sixth month it should gain about 100 to 120 grams or from 3^ to 5 ounces each week. By weighing the baby regularly we can judge with precision of its general progress. Professor Fry ^ says : A baby that is at a standstill or losing weight is not getting enough food. Crying under these circumstances means more food or a better quality of the food. In order to differentiate between the cries of hunger, colic, or earache, he points out that a hungry baby cries after it has been nursed and cries before the next feeding. He suggests placing the finger in its mouth, when it will stop crying and suck it for a moment and then cry again at its disappoint- ment. Nursing babies may be starving in spite of an abundant secretion of breast milk. The fluid may be abundant in quantity but poor in quality. The nutritive value of breast milk can be ascertained by a simple method. Draw off some and let it stand in a test tube over night. If normal a good layer of cream will form on top — from 3 to 4 per cent. If poor the color is pale blue at first, the next morning watery, and the cream will be only 1 per cent or a little more. Very bad milk will show less than 1 per cent of cream. Again, a starving baby is not nourished properly. To find this out examine the skin over the tibia (shank). If the baby is not getting enough nourishment the skin can be pinched up with the fingers ; if properly nourished the skin is firmly attached to the underlying tissue and the grasp of the fingers slips over it. This point is demonstrated by examining the skin on the back of anyone's hand. Extend the fingers and the skin is easily picked up, like that over the tibia of a starving baby. Close the fist 'and the skin is tight, as one will find it over the shank of a properly nourished baby. WEANING OF INFANTS. It is believed that a normal woman who enjoys a good appetite and a supply of good wholesome food, obeying the ordinary rules of health, will have no difficulty in discharging her maternal duties. Nature probably intended that the infant should subsist upon breast milk until the eruption of the first molars, and many mothers actually nurse their offspring until the twelfth or fifteenth month. If we can appoint our OAvn time, the weaning should be gradual and not considered before the tenth or twelfth month, especially not dur- ing the hot months, provided the health of the mother is good and the child is doing well. It would be very unwise to wean a sick child unless the sickness is caused by the mother's milk. An inadequate supply of breast milk can be made up by mixed feed- ing, and surely even a half supply of normal mother's milk for sick children is better than a full supply of prepared milk. CONDITIONS WHICH MAY COMPEL RECOURSE TO ARTIFICIAL FEEDING. Unfortunately, there are a number of reasons which may render the employment of a wet nurse or recourse to artificial feeding imperative at any period of lactation : 1. A motherless child, or when the mother is suffering from an infectious or communicable disease, such as tvphoid fever, pneumonia,' etc. A tuberculous mother would not only aggravate her disease but also expose the child to infection. 2. Childbed fever and other severe complications of the parturient state, such as hemorrhages, convulsions, inflammation of the kidneys; • Maternity. 192 BEPOETS OF THE PfiESIDENT S HOMES COMMISSION. also in anemic and in cachectic and serious nervous conditions, such as chorea and epilepsy. 3. Inflammatory conditions of the nipples and breast, because of the admixture of pus and disease germs. 4. AVhen no milk is secreted, and deformities and anomalies of the nipple and breast exist which can not be corrected. 5. Return of menstrual period or early pregnancy, if resulting in digestive derangements or malnutrition in the child. If under such circumstances the employment of a wet nurse is im- practicable, artificial feeding must be considered and the question con- fronts us, AVhat is the best possible substitute for human milk, the requirements of which are: 1. That it must offer the same character and amount of nutritive elements and in the same proportion as human milk. 2. The nutritive elements must be present in the same digestible form and of the same consistency, and should be introduced into the stomach at a temperature not less than 98° F. by means of slow suction at proper intervals. 3. This substitute must not contain any morbific or infective agent, whether originally present or introduced during the preparation or keeping of the same. A moment's reflection upon the physiology of infantile digestion will at once suggest the propriety of rejecting all starchy foods before the expiration of the tenth month, except in very limited quantities and previously converted into maltose by boiling, as in barley water. Since milk is the natural food of all mammalia few will be disposed to doubt that some modification of cow's milk offers the best possible substitute. COMPARISON or cow's MILK AND HUMAN MILK. The difference in the composition is shown in the following table: Woman's mUk. Cow's milk. Fat Proteids Sugar Baits Water Calories per kilo Percent 4.00 1.50 7.00 .20 87.30 Per cerU. 3.00 4.50 4.50 .80 87.20 100.00 710.50 100.00 700.00 Human milk contains, therefore, less proteids and salts and more fat and sugar. There appears to be also a difference in the quality •of the casein of the two secretions. The addition of dilute*acid in a test tube to cow's milk precipitates the casein in hard coagula or lumps, while in human milk it separates into a fine powder giving the appearance of light flocculent curds, which readily dissolve in an excess of acid. Since the coagulum in the same quantity of human milk is but one-fifth as large as that of cow's milk, this difference, which is solely one of compactness and solubility, is believed to influence the digestibility of the two secre- KEPORTS OF THE PEESIDENt's HOMES COMMISSION. 193 tions. This statement has been questioned, however, by Heubner, whose studies indicate that when the test-tube experiments are carried on to imitate the movements of the stomach the resulting curd is quite as fine as the curd of human milk. He also verified his conclusions by withdrawing cow's milk shortly after ingestion by infants with a stomach tube. Admitting that Heubner is correct in assuming that cow's milk contains the same constituents, but in different proportions, which can be corrected by modifying it, there still remain differences which are important, especially the fact that human milk is always fresh and, from a healthy mother, rarely contains micro-organisms, while cow's milk is never free from bacteria, and may, moreover, be the vehicle of infectious germs and other morbific agents. 1. It has been shown that certain diseases in the cow are commu- nicable to man through the medium of the milk. This is especially true of tuberculosis, foot-and-mouth disease, anthrax, and cowpox. The writer, in 1903, published 86 cases of milk-borne tuberculosis, and Doctor Salmon has shown, from the vital statistics of Massachu- setts and Michigan, that while there has been a marked reduction in the mortality of phthisis at all other ages, there has been a tremendous increase in the class under 5 years of age. There is also evidence to show that diseases like garget, inflammation of the udder and teats, digestive derangements, and septic fevers in the cow will render the milk morbific to man. 2. It has been shown that cows which have been fed on poisonous forage plants, or have been treated with strong medicaments for any or all causes, are disqualified from producing a pure or sound milk. 3. The writer has collected and taubulatea the history of 195 epi- demics of typhoid fever, 99 of scarlet fever, and 36 of diphtheria, all traceable to the milk supply. In a recent investigation into the causes of typhoid fever in Washington, the bureau of public health definitely traced 85 out of 866 (about 10 per cent) to infected milk. Last but not least the writer desires to emphasize two important milk faults which may be considered sources of constant danger in infant feeding, and perhaps the most important factors in swelling the mortality rates of our helpless babes, viz, milk sediments (dirty milk) and their effects on premature acidity. MILK SEDIMENTS OR DIRTY MILK. Every consumer of milk has doubtless observed the presence of more or less foreign matter at the bottom of the bottle in which it is kept ; indeed, it is a matter of such common occurrence that it hardly excites our attention, and many are disposed to look upon it as a matr ter of course. Professor Soxhlet, of Munich, was perhaps the first to point out that these deposits are largely made up of excrementitious matter from the cow, which, adhering to the udder of the animal, gained access to the bucket during the act of milking. If these sedi- ments are subjected to microscopical examination we will find that they are composed of epithelial debris, hairs of the cow, organic and inorganic dust particles, excrementitious matter, vegetable fibers, S. Doc. 644, 60-2 14 194 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. bacteria, fungi, and spores of every description ; fully 90 per cent of the germs are fecal bacilli — all of which is not only disgusting but extremely suggestive of danger. The number of micro-organisms is largely increased, and we know that under a suitable temperature bac- terial development and consequent decomposition are materially has- tened in such a medium. The greatest danger from milk of this class is the possible presence of ptomains or toxins produced b}^ certain saprophytic germs acting on the albuminoids of the milk. Professor Vaughan, of Ann Arbor, Mich., in 1885, isolated a poison called tyrotoxicon, which is one of the causes of the toxic symptoms in some cases of milk poisoning, cheese and ice-cream poisoning. The presence of the very filth re- ferred to, a summer temperature, and the pernicious habit of placing the milk before cooling in cans and bottles perhaps dirty besides, con- stitute favorable environments for the development of this and analo- gous poisons. Germ development and acidity of the milk are influenced by tem- perature. Milk when it leaves the udder of the cow contains very few germs; the majority gain access during unclean handling, espe- cially when the milking is done in a dirty stable, or from excrementi- tious matter adhering to the udder and teats of the animal. These germs multiply with astonishing rapidity whenever the temperature of the milk is above 50° F., and if disease germs are present their proliferation augments the chances of infection. A temperature of 58° or 60° F. will not subserve the interest of public health. So, for example, Petruschky has shown that at the room temperature a streptococcal content of 300 per cubic centimeter may increase in twenty-four hours to one of 10,000,000, but the same milk kept at 50° F. yielded but 30,000, or but three one-thousandths as many. Von Freudenreich ("Dairy Bacteriology," London, 1895) exposed a sample of milk containing 153,000 bacteria per cubic inch to a temperature of 59° F.; one hour after it contained 539,750 bacteria per cubic inch; two hours after, 616,250; four hours after, 680,000; seven hours after, 1,020,000; nine hours after 2,040,000; twenty-five hours after, 85,000,000. Bryce, of Toronto, has made similar investigations. All of which indicates the extent of germ development which must go on in milk transported over long distances during the summer months, when the mercury ranges from 85° to 95° and the cans are allowed to stand in the sun without ice; and we can appreciate why even 100,000,000 of bacteria per cubic centimeter have been found in samples of Wash- ington milk, far exceeding the number usually found in the sewage of cities. Other cities are, however, similarly afflicted, and nothing short of clean, decent habits in handling the milk and keeping it at a temperature of 50° F. will prevent the mischief. Dr. H. C. Plant, of Leipzig, found, as a rule, that in warm weather the so-called fresh milk delivered in the morning is unfit for young children, and of 47 infants whose milk supply was carefully investigated by him 18 de- veloped serious digestive and intestinal diseases, and 6 died. One of the chief reasons why there are less deaths from infantile diarrhea in the country than in towns and cities, in proportion to the popula- tion, is that the milk used is comparatively fresh, contains fewer germs and less toxins. Without doubt dirty and sour milk, or milk which is on the point of turning, are the chief causes of diarrheal KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 195 diseases in bottle-fed children, and in the more acute cases we have the phenomena of cholera infantum, due most likely to a toxic char- acter of the milk. These views have steadily gained ground and have resulted in great sanitary reforms in our milk establishments, the fruits of which are already apparent in the decrease of deaths from infantile diarrhea in this city. (See page 187.) PRODUCTION or PURE MILK. The Washington market milk compares favorably with the supply in other cities ; there is no evidence to shoAv that it is worse, but there is abundant evidence to indicate that stale, dirty, and infected mar- ket milk is everywhere responsible for a needless sacrifice of human life, and it is clearly the duty of the State to take what precautions it can to prevent sickness and distress. Those who are familiar with the surroundings of our milk farms and the habits of the average dairy employee need no arguments for the necessity for sanitary reforms, and the principles which ought to be carried out should be embodied in effective laws and accepted and enforced in a practical sense. Honorable men will not object to regu- lations calculated to promote the purity of their product and the health of their customers, and as many of the most serious faults in the milk business are the result of ignorance rather than of inten- tional neglect, the difficulties will be materially lessened by proper education and trade competition. Pure natural milk can only be secured at dairies with sanitary buildings, a. pure water supply, healthy, well-fed, and well cared for cows, a well -equipped and well-kept milk room, provisions for thorough cleanliness, intelligent and conscientious people in charge, and clean methods throughout. CERTIFIED MILK.* It was in consequence of a just appreciation of these principles that the so-called " certified milk " came into existence about ten years ago. Responsible bodies of citizens interested in an improved milk supply organized in different cities milk commissions. Such commissions usually select and secure the advice and assistance of four experts — a veterinarian, a physician, a bacteriologist, and a chemist — all more or less familiar wdth the conditions and possibili- ties on dairy farms. The commission sends to each dairyman who supplies milk to the city a circular naming all the particular condi- tions which should be found on every farm where milk is produced for city use, and announcing that where any dairyman notifies the commission that he is fully conforming to the conditions specified, or endeavoring to do so, his dairy will be inspected, and, if it is found to comply in letter and spirit to all the requirements, his name will be placed upon an approved list and he will receive official indorse- ment to the effect that his dairy farm and the herd thereon have « Extract from a Report of the Committee on Sanitary Relations to a con- ference appointed by the Commissioners of the District of Colmnbia to consider and report upon the local milk supply. The writer was chairman of the sub- committee which submitted the report. 196 EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. been thoroughly examined and found to comply with the conditions recommended by the commission. These conditions include a healthy herd, the use of pure feeds, appropriate stabling and care, pure water, and clean and prompt handling of the milk, which is of good composition and quality and so free from pathogenic and unneces- sary bacteria as reasonable safeguards can provide. The attendants are cleanly and free from communicable diseases, and all milk is promptly cooled, immediately after milking, to a temperature of 50° F. Every intelligent dairy farmer insists upon cooling his milk as soon as the bucket is full. The inspections are made unannounced and at irregular intervals, so as to insure maintenance of the prescribed standard. Any neg- lected condition is immediately reported to the commission, which decides whether or not the cause is sufficient to withdraw and cancel the last certificate issued. PASTEURIZED MILK. It must be apparent that it will require time and education to secure compliance with even reasonable safeguards, and it is equally evident that the number of dairy farms now in a position to live up to sanitary requirements will supply but a small percentage of the population, although it is hoped that such dairy farms will be stimu- lated into existence by trade competition and the refusal of the public to buy dirty milk at any price. Until this is accomplished, the com- mittee, in the interest of public health, strongly advocates clarification and pasteurization of all milk. This, to be sure, will not make bad milk good, but it will at least destroy its power to transmit disease germs. PASTEURIZING PLANTS OR MILK DEPOTS. Your committee also believes that this object can be most efficiently Aiid economically secured by the establishment of a pasteurizing plant provided by the District government or, preferably, by private enter- prise, which plant should be under the supervision of the health department. There is every argument from a commercial and sanitary stand- point in favor of a central plant, erected within reasonable distance from the Union Depot, where all the milk for the city should be re- ceived and prepared for distribution. Such a step would result in the creation of suitable conditions for the proper handling and stor- age of milk, sterilization of milk cans and utensils, and the efforts of the local milk dealers to provide decent facilities for their 150 or more dairies scattered over the city, all more or less liable to infection, could be concentrated in one plant with a decided saving of expense. Milk should never be sold by grocery stores or milk shops unless it has been delivered to such establishment in original sealed bottles, and then only when there is provision for maintaining the milk at a tem- perature of 50° F. ADVANTAGES AND DISADVANTAGES OF PASTEURIZED MILK. Your committee is aware that there is a difference of opinion among medical men as to the wholesomeness of pasteurized milk. The ad- vantages and disadvantages have been exhaustively studied by Dr. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 197 M. J. Rosenau, director of the Hygienic laboratory of the United States Bureau of Public Health and Marine-Hospital Service, and in his opinion the advantages so far outweigh the disadvantages that he " unhesitatingly recommends compulsory pasteurization of all milk not certified under class 1 or class 2 of Doctor Melvin's classification." «* Your committee is so strongly impressed with the manifold dangers connected with the milk supply that until the needful reforms in dairy methods are accomplished it recommends to the public the fol- lowing as immediate safeguards : 1. Do not patronize a milk dealer, at any price, whose milk after standing for two hours reveals a visible sediment at the bottom of the bottle. It is evidence of dirty habits, extremely suggestive of danger, and entirely preventable by clean, decent methods without greatly increasing the cost. 2. Subject all your milk to home pasteurization by simply bringing it to the boiling point, and, after cooling, keep the milk on ice. This will destroy germ life and reduce the chances of milk-borne diseases to a minimum. Dr. H. W. Wiley's committee submitted the following recommenda- tions : 1. That the milk which is supplied to infants under the age of 3 years in the District of Columbia should be certified by the health office. Milk should contain not more than 5,000 bacteria per centimeter, should be not more than 12 hours old, and should be delivered in artificially cooled packages. 2. That the health oflEicer of the District be authorized to advertise for dairies which will be willing to so modify their barns, stables, etc., if necessary, as to secure a license from him for the production of certified milk under the most improved sanitary conditions. 3. That each cow furnishing the milk in the dairy be tested, under the supervision of the health officer, for tuberculosis or other contagious or infec- tious diseases; and that any animal so suffering be excluded from the herd. 4. That a daily sample or samples drawn from the supply of each certified milk furnished to the city be secured for the purpose of making the bacterial count and determining the chemical composition, etc. 5. That parents and guardians be urged to use only certified milk, at least for infants' food, in the District of Columbia for all infants under the age of 3 years. 6. That if private dairies can not be induced to furnish certified milk, the Commissioners of the District of Columbia, as a health measure affecting in the highest degree the welfare of the District of Columbia, be asked, if it can be legally done, to establish a municipal dairy for the purpose of furnishing certified milk for the use of infants under 3 years of age. 7. That pending the time which must necessarily elapse for the inauguration of a service of certified milk for infants' use, the health officer be authorized, as a result of inspection, to publish a list of dairies from which the milk supply is drawn, giving the average rating of each dairy, the chemical com- position, and bacterial count of the samples. 8. That for the purpose of securing modified milk for infants in ill health, according to the prescription of physicians, the milk commission of the Dis- oThe classification referred to is as follows: Class 1, certified milk for infants, as hereinbefore described. Class 2, clean, raw milk from healthy cows, as determined by the tuberculin test and veterinary physical examination; the cows to be housed, fed, and milked under good conditions, but not necessarily equal to the conditions provided for in class 1; pure water, as determined by chemical and bacteriological examination, to be provided; the bacteriological count of the milk not to exceed 100,000 bacteria per cubic centimeter, at the time the milk reaches the city, at any season of the year, as determined by the health department at frequent intervals; milk to be delivered to the customer in sterilized containers, to be filled upon the dairy farm, and the temperature of the milk not to exceed 50° F. until delivered to the customer. 198 KEPOKTS OF THE PRESIDENT'S HOMES COMMISSION. trict Medical Society be requested to secure the establishment of a laboratory, under its supervision, in which only certified milk shall be used, and in which, by the use of a separator or otherwise, milk of a definite chemical composition may be prepared from certified milk, in harmony with the physicians' pre- scriptions relating thereto. 9. That a complete chemical and bacteriological laboratory be established in connection with the health office, of a capacity to examine all the samples necessary to secure the certified and modified milks above described. 10. That the term "certified milk," as used herein, is to be applied to mill- secured at dairies subject to a periodic inspection, and the products of which are subjected to constant analysis. The cows providing the milk are properly fed, free from tuberculosis or other contagious diseases, and housed in clean stables, properly ventilated, and they are supplied with wholesome water and food, and kept clean. The milk is drawn under precautions to avoid infection, is immediately strained and cooled and packed in sterilized bottles, which are kept at a temperature not to exceed 50° F. until delivered to the consumer. It is fully realized that milk of this character will cost more to produce and should bring a higher price in the market than ordinary uncertified milk. At the same time it is hoped that the producers of milk will endeavor to keep the prices within the means of the ordinary citizen while making a fair profit on their invested capital. In the language of Professor Harrington, " the public needs proper education that clean milk is a necessity, and that infant sickness and funerals can be reduced at least 40 per cent. * * * j^ model farm properly manned certainly can not compete on equal terms with a filthy farm, where no attempt is made to conduct the business in a decent manner, especially if customers are indifferent. The dirty producer can e^fe'n afford to cut prices and take customers away from the other, if customers care to save a cent and make it up in pus and cow dung." HOME TREATMENT OF NURSERY MILK.« The milk, as soon as delivered, should be placed in a refrigerator upon ice, so that the temperature may not exceed 50° F. If desired for infant feeding, it should stand for one hour, when the upper third (10 per cent top milk) can be taken off. This top milk is then modified, so that the proportion of the constituents may be those of human milk. This is done by mixing 7 ounces of the top milk with 1 ounce or 2 tablespoonfuls of milk sugar, the same quantity of lime- water, and 12 ounces of boiled water. If only 10 ounces be required for twenty-four hours' feeding, the proportion of each ingredient is reduced one-half; if 30 ounces be necessary, add one-half. In case the child presents evidence of feeble digestion, the amount of fats and proteids must be reduced by cutting down the top milk to 6, 5, 4, 3, or even 2 ounces, and sufficient boiled water added to make 20 ounces. After modifying the milk in the manner directed, the correct amount of each feeding is put in a nursing bottle. The necks of the bottles are stopped up with plugs of clean nonabsorbent cotton. The milk should then be pasteurized. For this purpose different pasteurizers have been placed on the market. A very simple and inexpensive method is to place the bottles in a tin kettle, pour warm water around them, and bring the water to a temperature of 180°. The kettle is then covered and removed from the stove, wrapped in «This infomation is obtained largely from Prof. Plenry D. Fry's monograph on " Maternity," Washington, 1907, a work which can be confidently recom- mended. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 199 a piece of flannel blanket, and set upon folded newspapers. At the expiration of half an hour the bottles should be taken out, cooled, and kept on ice until used. When it is time to feed the baby, one of the bottles is removed and set in hot water until the temperature of the milk is 98°. A higher or lower temperature is absolutely in- jurious to the infant. QUANTITY OF FOOD FOR EACH FEEDING. The number of feedings in twenty-four hours has been given on page 190. Doctor Fry believes that a frequent cause of failure to jraise babies on modified milk is that they are overfed. He considers 1 to 2 tablespoonfuls sufficient for each feeding during the first few weeks of life. At 1 month of age give 2 to 3 tablespoonfuls ; at G weeks 3 to 4 tablespoonfuls; at 2 months 4 to 5 tablespoonfuls. In- crease the quantity at the rate of 1 ounce each month up to 6 months of age. Two tablespoonfuls make an ounce. Another trouble is the baby gets the food into its stomach too fast. When nursing at the breast the baby requires from fifteen to twenty minutes to suck the nourishment. When fed with the bottle it often obtains its food in five minutes. In this connection it should be remembered that no substitute for human milk as yet prepared can take the place of a sound mother's milk, and that as long as we are compelled to resort to infant feeding we should feel our way gradually, bearing in mind Biedert's conclu- sions, that a bottle-fed infant thrives best when the minimum amount of food necessary for development is given. If in the course of feed- ing symptoms of diarrhea with green stools appear, it is best to stop the milk altogether and feed the baby with albumen water, barley water, or rice water, and consult a physician at once. Barley water is made as follows: Take 2 tablespoonfuls of pearl barley, add 1 quart of water, boil for three hours, add enough water to keep the quantity to 1 quart, strain through course muslin. Keep well covered in refrigerator, warm to 98° before using it. Rice water is made in the same manner. CARE OF THE NURSERY REFRIGERATOR, NURSING BOTTLES, NIPPLES, UTENSILS, ETC. " It is absolutely essential that intelligent and careful attention should be paid at home to the cleanliness of bottles, nipples, dippers, cooking utensils, etc. The nursery refrigerator must be metal lined and kept clean, aired free from odors, and well supplied with ice (unless the place in which it is kept has a temperature less than 50°). The bottles can be cleaned as follows: Einse with the brush in cold water in which a little washing soda is dissolved, then wash and brush thoroughly with soap and hot water and rinse again in sterile water. Or the bottles as soon as emptied can be filled with cold water to which a little bicarbonate of soda is added. Before being refilled they should be thoroughly washed with a brush and hot soap suds and then boiled for twenty minutes. * * * Never let a nursery bottle stay dirty after use until the milk dries in it. The neck of the bottle should be large enough to permit easy cleaning and it should have no corners or angles on the inside. The nipples 200 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. should be of rubber and made so that they can be easily turned inside out for cleaning. New nipples should always be boiled before use. Immediately after use the nipples should be washed in soda water and kept in a solution of boric acid, and when wanted again they should be rinsed in water. Attention to these details should not be neglected, as the life of the infant depends upon absolute cleanliness of the food at all times, and especially during the warm months." From what has been said on this subject it is evident — 1. That no effort should be spared to secure the enactment of more stringent laws regulating the production and sale of pure milk and cream. 2. The establishment of day nurseries, where the infants of thosa who are obliged to go out to their work may be properly cared for, is urgently called for. 3. The establishment of dispensaries, where intelligent instructions are given in infant feeding and modified milk sold at reasonable rates, would be in the interest of public health and humanity. It is gratifying to note that such a dispensary was started April 13, 1908, in connection with the Neighborhood House in southwest Wash- ington. According to Dr. William J. French, up to October 1, 1908, 261 infants and children have been treated. There were but 3 deaths. The records of the health office show that during 1907 there were 50 deaths in southwest Washington in children under 10 years of age, while during the year 1908 there were but 29 deaths in children of the same age period, in spite of the very hot summer. Doctor French very justly considers the clean, pure milk and the instruction fur- nished by the dispensary factors in this marked reduction of mor- tality rates. Chapter V. THE PREVENTION OF PERMANENT DISABILITIES IN CHILDHOOD. The writer, in his sociological studies of physically defective per- sons who contribute such a large contingent to our charitable institu- tions, has felt convinced that many of these partial and complete dis- abilities could have been prevented by proper care and treatment in childhood. It is now well known that many of the joint deformities in children are amenable to treatment, and that a ruptured child or person may be radically cured. As a member of the Board of Chari- ties he recommended that the physicians to the poor and agents of the Associated Charities be requested to encourage the parents of such children to authorize operative procedures or hospital treatment, for the prevention of permanent disabilities. The result within the past year more than justifies a general acceptance of these principles. The records of the Children's Hospital reveal the gratifying fact that the operations for the radical cure of hernia, for example, have increased from 9 in 1907 to 25 in 1908, and that every child was discharged as cured. The increase in the number of joint cases and deformities treated is also very marked. In order to determine the number of physically defective children in our graded public schools the health officer and the board of educa- tion authorized a general medical survey of the pupils. The exami- EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 201 nation was conducted by the medical inspectors of the schools, under the general direction of Dr. Henry C. Macatee, assistant secretary of the President's Homes Commission. The results have been tabulated by him and will be found in Table A. From this table we learn that out of 43,005 pupils in the graded schools 13,407 were colored and 29,598 were white. Among the colored children 3,784 instances of the defects listed in the table were encountered, or a relation of 28.2 per cent; among the white pupils 11,520 notations of defects, a relation of 38.9 per cent to the whole, were encountered. The difference in percentage of defects between white and colored children is solely due to better condition of the teeth in the colored children. Total defects noted, 15,304, or 35.5 per cent of the pupils examined. These percentages, high as they may appear, are very much lower than the rates reported from New York. Omitting from this consideration the 6,698 pupils who probably needed only dental care — a matter of importance, however, to the general health — we still have to deal with 8,606 pupils, or 20 per cent of the total, whose physical condition should be a matter of grave concern to the parents. Of this number 149 were crippled, 272 de- formed, 461 had strabismus (squint), 312 had discharging ears, 835 defective hearing, 2,176 defective vision, 2,062 were "mouth breathers," 703 were undersized, 727 ill nourished, and 934 were anaemic. It was not deemed best to conduct physical examinations involving the removal of clothing, and hence the number of ruptured children ,could not be determined, but, judging from the reports of the agents of the Associated Charities, the number is sufficiently great for serious consideration. It will be readily conceded that every crippled or deformed child should, if possible, be spared from permanent disability, and no thoughtful parent should hesitate to act when attention is directed to the serious consequences of neglect. Poverty is no excuse for the " do-nothing system," as the medical charities offer adequate facilities for treatment of persons unable to pay for the same. Nor is there an excuse for not attempting to cure discharging ears, defective hearing or vision, since every observer is familiar with the sad consequences of such defects in the ultimate struggle for existence. Parents may not know that a child afflicted with a squint, harelip, or cleft palate may be transformed into a vicious character, because it is the object of constant ridicule within and without school, and that all of this could be avoided by a timely operation. Parents are prob- ably not aware that many of the nervous affections and even mental defects in boys are due to some slight malformation of the genital organs, for which the Hebrews instituted circumcision. Nor is it generally known that anaemic and ill-nourished children and those suffering from enlarged tonsils, cervical glands, or post-nasal growths, and the majorit}^ of " mouth breathers " are peculiarly susceptible to disease in general and to tuberculosis in particular. Lastly, there is no good reason why special attention should not be given to the physical development of undersized children or those affected with slight muscular deformities, which, if left uncorrected, will be a source of regret and even reproach to the teacher and parent. The remedy lies chiefly in education, and for this purpose the study 202 EEPORTS OF THE PRESIDENT S HOMES COMMISSION. of hygiene should be made an important part of the school curric- ulum. In this way the parents may be reached through the child. Instructive visiting nurses should be appointed for the schools, so that they may follow the child to the home and point out to the parents the desirability of securing prompt professional advice in all cases where it is indicated, and especially in instances where neglect is likely to result in permanent disability. In this general educational campaign the medical inspectors of schools, teachers, social-settlement workers, agents, and friendly visitors of the Associated Charities can render a distinct service to the child and the State. Table A. — Inquiry for the PresidenVs Homes Commission — Medical inspection of puUic school children, Washington, D. C. School d a i 5 1 5 t 1 •d 1 3 '> a> > u 1S92 (Munson), Primaryand secondary syphilis. All other venereal Germany France Russia Italy United States Dutch troops (home statistics East Indies British troops: Home statistics Indian statistics 5.50 9.00 13.10 13.90 16.83 14. 80 47.00 101.70 175. 40 21.50 34,90 29.90 57.40 57.96 55.00 408.60 101.90 262. 60 It is a lamentable fact that the very countries in which the senti- ment, both in and out of the profession, is strongly against recogniz- ing the evil, furnish the highest army rates, while in countries where some special regulations are in force preventing the spread of venereal diseases, such as weekly inspections of the men and periodi- cal examination of the women engaged in prostitution, with compul- sory isolation if such are found diseased, the army rates are lowest. The comparative amount of army and civil venereal diseases is not known, because we have no statistics of the amount in civil life. According to Fournier one-seventh of the population of Paris is syphilitic, and the mortality of infants born of syphilitic parents in many hospitals of that city reaches 84 to 86 per cent. According to Doctor Weiss, there are 150,000 syphilitics in Berlin, or 12 per cent of the inhabitants. In 1901 a committee of seven, under the auspices of the Medical Society of the County of New York, made an investigation into the prevalence of venereal diseases, and from the information received from private physicians, reports of the hospitals and dispensaries concluded that there were not less than 243,000 cases of venereal dis- eases treated in one year in that city. During the same year there were only 41,585 other cases of infectious of communicable diseases reported to the health department, viz, measles, 12,570; diphtheria, 11,001; tuberculosis, 8,877; scarlet fever, 7,787; chicken pox, 99. In other words, the morbidity from venereal diseases was nearly six times greater than that from all the above-named infectious diseases combined. Parkes of England says : It Is a question whether a large number of the young men of the upper and middle classes do not suffer in youth from some form of venereal disease. In the lower classes it is perhaps equally common. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 215 Neisser, of Germany, holds that gonorrhea is, with the exception of perhaps measles, the most widespread of all diseases. Other Ger- man authorities have computed that fully three-quarters of the adult male population, and one-sixth or more of the adult females have contracted gonorrhea, and that 15 per cent of the population is syphilitic. Dr. Prince A. Morrow, based upon a large personal experience and the results of the New York and Baltimore investigations by com- mittees on sanitary and moral prophylaxis, says : Assuming from experience and tlie statistics collected in New York and in Baltimore that our population is more virtuous than that of Europe, it must be a conservative estimate that in this country the morbidity from gonorrhea would represent 60 per cent of the adult male population, and that of syphilis from 10 to 15 per cent, which would mean that between 3,000,000 to 4,000,000 cases are annually treated in this country. According to Morrow, 20 per cent of the cases occur before the twenty-first year, 60 per cent before the twenty-sixth year, and 10 per cent of the men who marry infect their wives. The report of the New York committee "would indicate that nearly 30 per cent of all vene- real infections occurring in women in private practice in that city are commu- nicated by their husbands ; " and from his personal observation at the New York Hospital, extending over a period of several years, he concludes that " fully 70 per cent of all women who come therein for treatment were respect- able married women who had been infected by their husbands." VICE DISEASES IN THE DISTRICT OF COLUINIBIA. Dr. Henry C. Macatee, of the President's Homes Commission, has made a special study of the prevalence of so-called " vice diseases " in the District of Columbia. The results have been tabulated and will be found in Table B. The period covers nine years, except in the case of Providence Hospital, Columbia Hospital, and the Children's Hos- pital, for which institutions the data cover only two years. From this table it appears that out of a total of 274,611 patients treated 38,183 cases were vice diseases, viz, 9,869 syphilitic affections, 3,643 cases of chancroids, and 14,435 cases of gonorrheal affections. In addition to the 27,947 cases of sexual diseases there Avere treated 9,510 patients for alcoholism, 409 for delirium tremens, 256 for the opium habit, and 61 for the cocaine habit; an average of 4,243 cases per annum of vke diseases, or nearly one-seventh of all the cases treated in the city hospitals. As a matter of fact, 23.6 per cent of all the cases treated in the Washington Asylum Hospital and 31.6 per cent of those treated in the workhouse were vice diseases. The majority of the patients treated in the hospitals belonged to the dependent classes. We have no statistics as to the prevalence of vice diseases among the middle and upper classes. 216 EEPORTS OF THE PRESIDENT S HOMES COMMISSION". •BQffBasip 80IA :)uao I8J «eOO-*'«**"*0COO icec oc r» •^iq^q 9UIB000 T»t»0»0t^0 •:)iqBq ranido Oi ec CO t~ OS CT> T-i o OiT-iCi-^ l^ lO CO OS to «3 •su9ra3J} ninuipa •uisnoqooiv =f>X-^'-i i-^OrHt>OioioO ! C^ ,-1 T-t r-l CO CSCO {M_^«ci>eooo •spioion'Bqo •siijiqo ■10 puB sijini.{pTptda i-t •weoTit'^ooo >o eo CO CO i-i o i> eo(M t^ O lC t» CO r-! < t*eooaoooot^(NiH •tuq?8in JO ^In:^ou^s -TSbA pu« BTJTAjnA 00 eo c<) i> t> i> •oqna •BiraiBqjqdo •sijiSuidiBS •spuqiiB Sax -pnpxii 'BaqjaouOo 00 CO O r-l CO O tH lO CO ■* e<5 CO ■<*< c< I ;o iC (N .-CM O CO O l(N!N t-H rl i-l o< oouiioiC)«ot^c IIV iCi-IOiO-n'tOOCaoO C^-<*Or-< ■^OJiCCOiCt^t-COtO OC0«0t^t^t000i0TJ< c^eocMO-^c^ioooo cf lo c^~iH F-T i-T t-T iH'ef oo ^05 ic 50 < S S5 "^ 5y ** 3! 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SYPHILIS. This disease first attracted attention in Europe in the latter decade of the fifteenth century. During the siege of Naples by the French troops under the command of Charles VIII in 1495, a disease char- acterized by ulcers on the genitals, general eruptions of the skin, violent pains in the head and limbs broke out among the French sol- diers and the civil population, and after the return of the French soldiers the disease appears to have spread rapidly throughout France and Europe. Quite early in the history it was recognized that the disease was principally contracted during sexual intercourse and hence was named lues venerea, while the populace commonly spoke of it as the Frenchman's disease. The real nature of syphilis remained a mystery until two years ago, when an organism was isolated called the " spirocheta pallida," which is believed to be the causative factor. This micro-organism evidently clings to the secretions of syphilitic ulcers, to the tissues of diseased organs, and possibly also invades the blood and the mammary glands after it has ceased to be a purely local affection. The virus may be conveyed m an extragenital way by kisses, use of infected pipes, cigars, and cigarettes ; by glass blowers and the mouthpieces of wind instruments; by dental and surgical instruments; by the act of suckling, from infants to nurse and con- versely; in tattooing, and during digital examination by physicians, in case of abraded surfaces, hangnails, etc. There is every reason for assuming that the virus may be transmitted to the offspring, either through the sperma or the blood of a syphilitic mother. Syphilis is indeed a disease of the blood and affects every tissue of the body. Apart from the long duration of the disease, and the pecuniary losses involved by care and treatment and arrest of the earning capacity, its effect upon longevity and procreation are most destructive. Syphilis is responsible for 42 per cent of abortions and miscar- riages, from 60 to 86 per cent of the offsprings of syphilitics die before or shortly after birth, and those who survive are subjects of degen- erative and organic defects, transmitted to future generations. Four- nier's personal statistics show that 90 women infected by their hus- bands became pregnant in the first year of married life ; 50 of these aborted, 40 carried the offspring to full term, but of these only 2 sur- vived. He also gives statistics, based upon authentic sources, where syphilis has practically extinguished the posterity of certain families. One table gives out of 216 births 183 deaths; another out of 157 births 157 deaths, or a mortality of 100 per cent. The disease swells the number of inmates of almshouses, asylunis for the insane, and homes for incurables, wrecks the health and happi- ness of many families, and leads to premature decay. Morrow states that " every case of hemiplegia occurring in a man less than 40 years of age, not addicted to alcohol or affected with lesions of the circulatory system, is eight — or, more correctly, nine — times out of ten of syphilitic origin. " The proportion of ocular paralysis resulting from syphilis is about 75 per cent on the average. * * * In statistics embracing 743 cases of cerebral syphilis^ 354 of which were followed up to a known termination, 77 were cured, 68 died, while the remaining 209 sur- EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 221 vived, but with various infirmities of a grave character and in every case irremediable." According to the statistics of Erb, Althaus, Fournier, and others, from 80 to 90 per cent of the cases of locomotor ataxia are of syphi- litic origin. In 3,429 cases of tertiary syphilis Fournier found dis- eases of the nervous system in 1,085 instances, cerebral syphilis in 461, spinal affections in 40, general paralysis in 32 cases. GONORRHEA. This disease, so often regarded as a trivial affection by frivolous young men, is also specific in character, caused by a micro-organism discovered by Neisser in 1879. The organism clings to the discharges in acute and chronic cases and may persist long after the disease is apparently arrested. While at first a purely local affection, it may produce destructive inflammation, resulting in stricture of the urethra; it may also extend to the testicle, prostate gland, bladder, and kidneys, and ultimately affect the heart, joints, and other vital organs. Indeed, the disease is believed to be responsible for more misery, ill health, and race suicide than any other sociological factor. The average duration of acute cases is from four to six weeks, but there are a large number of chronic cases requiring at least six months' careful treatment, and, according to the investigations of a committee of the American Medical Association, 3 per cent of the cases are practically incurable. One of the most baneful effects is the latency of the disease and the great danger of communicating the virus to wives by husbands who considered themselves as having been cured before marriage. It is certainly startling to be told by competent specialists that fully 80 per cent of all the operations for inflammatory diseases peculiar to women, practically all the pus tubes, 75 per cent of the suppurative inflammations of the pelvic organs, 70 per cent of all the work done by specialists for diseases peculiar to women are of gonorrheal origin. It is equally appalling to realize that the same germs are the cause of blenorrhea neonatu- rum, a purulent affection of the eyes of new-born children, which contributes a contingent to our asylums for the blind of from 10 to 20 per cent — from 40 to 60 per cent before the Crede method of pre- vention was instituted. Dr. Swan M. Burnett, professor of oph- thalmology, Georgetown University, expressed the conviction that at least 15,000 of the 50,000 blind persons in the United States lost their sight from this cause, involving a financial loss to the com- monwealth of seven and one-half millions annually. The destructive effects of gonorrhea on the procreative functions have been very properly emphasized in connection with the "race- suicide problem." Neisser maintains that gonorrhea is even a more potent factor than syphilis in sterility, and that more than 45 per cent of all involuntary childless marriages are due to this cause. The remedial measures which have been proposed for the pre- vention of these diseases and which affect not only the offender, but the wives, the offspring and not infrequently also perfectly innocent persons are numerous enough, but not so easy of application. Since the chief source of infection is prostitution, the sanitarian suggests that a person afflicted with a venereal disease is quite as much a 222 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. menace to public health as would be a case of smallpox or any other communicable disease and points with emphasis to what has been accomplished in Europe in the way of official control of prostitution, as a lesser evil, by registration of brothels and their inmates, periodi- cal inspections, and the detection and cure of diseased men and women. He will tell us, and the statistics will support him, that the prevalence of venereal diseases is least where sanitary measures are most vigorously enforced. The medical profession is by no means agreed as to the propriety of this method, mainly because such a system seems too much like a recognition of the inevitableness of the social evil and practically an official sanction of it. Others, moreover, with good reason assert that licensing and sanitary inspection t^nd to produce clandestine prostitution, which has heretofore furnished the largest number of syphilitic cases. On the whole, we may conclude that health officers in this country are not prepared to advocate the European plan of inspection and license. CRUSADE AGAINST THE SOCIAL EVIL.<» The subject of prostitution has always been considered of great sociological and economic importance by persons who have witnessed the sad effects among the inmates of hospitals, prisons, almshouses, asylums for the blind, etc. It is gratifying to note that in 1858, just fifty years ago, a most intelligent and painstaking study was made by Dr. Wm. W. Sanger, resident physician of Blackwells Island, under the auspices of the governors of the almshouse of the city and county of New York. A few passages from the introduction are re- produced, for they are as applicable now as when first indited by his graceful pen : Hitherto reticence has been the policy. This position has been held too long, for it is false in principle and injurious in tendency. The day has arrived when the shroud must be removed, when the public safety imperiously demands an investigation into the matter; when those who regard it as a small wrong may have their attention directed to its real proportions. * * * ^ small matter it decidedly is not. * * * Nor is it unmanageable except when con- cealed. Stripped of the veil of secrecy which has enveloped it, there appears vice arising from an inextinguishable natural impulse on the part of one sex, fostered by confiding weakness in the other ; from social disabilities on one side and social oppression on the other ; from the wiles of the deceiver working upon unsuspecting credulity, and, finally, from the stern necessity to live. The book covers 676 pages, and is the first effort on the Western Continent in sexual and moral prophylaxis, but unfortunately has so far been fruitless on account of the general apathy on the part of the general public. Some of the facts brought out in the detailed investigation of 2,000 prostitutes in New York City are of sufficient interest to be adduced. Of the entire number 750 were between 15 and 20 years, 1,154 be- tween 21 and 39, and 96 over 40 years of age; 1,238 were foreign born and 762 natives of the United States. Of the latter the majority hailed from New York, New Jersey. Connecticut, Massachusetts, Maine, New Hampshire, and Vermont. Doctor Sanger is inclined o I am indebted to my friend Dr. Edward L. Morgan for a number of valuable references to the literature of the subject. REPORTS OP THE PRESIDENT'S HOMES COMMISSION. 223 to attribute this to the employment of a much larger proportion of females in manufacturing and sedentary occupations, and says : A young woman of ardent temperament can not but feel the hardship of this position in life ; * * * thus, when already predisposed in favor of any change, she falls into the hands of the tempter a pliant victim. * * * Be- yond the hardships attendant on her daily labor the associations which are formed in factories or workshops, where both sexes are employed, very fre- quently result disastrously for the female. * * * In speaking of the foreign class the author says : Many of the females become mothers almost as soon as they land on these shores; in fact, the probability of such an event sometimes hastens their de- parture. They exist here in the most squalid misery in some tenement house or hovel. Their children receive none of the advantages of education, for as soon as they can beg they are compelled to aid in the struggle for bread and the most frequent result is that the boys are arrested for some petty theft and the girls become prostitutes, thus contributing to meet the demand caused by the classes already mentioned. In this connection attention is called to Judge De Lacy's letter, page 380. Of the 2,000 persons investigated 490 were married, 71 of whom still lived with their husbands; 103 left their husbands on account of ill usage, 60 were deserted by their husbands, 43 were deserted by husbands to live with other women ; others left their homes on ac- count of nonsupport, drunkenness, infidelity, and in 75 no specific cause was assigned. There were also 294 widows in the general list. The author believes the principal conclusion to be drawn from the table which he presents " is that the majority of this class (widows) are driven to a course of vice from the destitution ensuing on her husband's death. It has been shown that a large number of them are very young and it can be scarcely necessary to repeat that any young woman in a state of poverty will be surrounded with temp- tations she can with difficulty resist. Much as this state of society may be deplored, its existence can not be denied." The section dealing with the hidden springs of the evil is of ex- treme interest. The causes assigned by the women themselves are as follows : Inclination, 513; destitution, 525; seduced and abandoned, 258; drink and a desire to drink, 181 ; ill treatment of parents, relations, or husbands, 164; as an easy life, 124; bad company, 84; persuaded by prostitutes, 71 ; too idle to work, 29 ; violated, 27 ; seduced on board of emigrant ships or in emigrant boarding houses, 24. Doctor Sanger, in discussing the subject of inclination, adduces considerable evidence to show " that if a positive inclination to vice was the proximate cause of the fall, it was but the result of other and controlling influenced." Most pathetic instances of how destitu- tion, seduction, and other predisposing causes led to the degradation will be found on pages 489-522. Of the 2,000 cases examined witli reference to previous occupation, 933 belonged to the servant class, 499 lived with parents or friends, 285 were dressmakers, tailoresses, and seamstresses, and the remain- der were engaged in miscellaneous occupations; 534 claim to have earned only $1 per week; 336, $2 a week; 230, $3; 127, $4; 68, $5; 27, $6; 8, $7; 5, $8; two had earned over $20 a week, and in 663 the question of earnings was not ascertained. 224 REPOETS OF THE PRESIDENT'S HOMES COMMISSION. The investigation revealed the fact that 947 of the 2,000 women became mothers. Of these, 357 single women had 490 children, 357 married women had 791 children, and 233 widows had 636 children. Of the 1,917 children born, 1,185 had died before the inquiry, and 732 were alive. The ratio of mortality was as follows ; Children of — Per cent. Single women • 73 Married women 58 Widows 59 An average of 62 per cent, or more than six deaths for every 10 children born. On page 487 of the book it is shown that 821 of the 2,000 investigated had contracted specific diseases incident to prosti- tution, viz: Gonorrhea in 250 instances, gonorrhea and syphilis in 36, and syphilis in 535 cases. The difficulty of securing such informa- tion is very great and the probability is that the real number far exceeds this average, but the confessed facts are quite sufficient to estimate the amount of public mischief resulting daily from a mass of prostitutes. The appendix to the edition of Doctor Sanger's book, published in 1906, states that Doctor Sanger in 1858 placed the number of public prostitutes in New York at 6,000, or one in every 117 inhabitants, while a conservative estimate would now place their number at 30,000, or one in about 55 of the resident population. In 1902 the committee of fifteen, composed of prominent citizens, presented a report on the social evil with special reference to condi- tions existing in the city of New York, but found it impossible to approximate the number of prostitutes or houses of prostitution; evidence was secured, however, of over 300 separate disorderly apart- ments in tenement houses. In many of these tenement houses as many as 50 children resided. An acquaintance by the children with adult vices was inevitable. Almost any child on the East Side in New York will tell you what a " nafke bias " is. * * * The statistics of venereal diseases among children and the many revolt- ing stories from the red-light district tell how completely they learned the lessons taught them. Mr. George Kibbe Turner, in a recent magazine article, presents a study of the great immoralities in the city of Chicago, and estimates " the gross revenues from prostitution in Chicago in 1906 at $20,000,000, and probably more. There are at least 10,000 profes- sional prostitutes. Annual average receipts of $2,000 each are brought in by these women. They do not themselves, however, have the benefit of this revenue. Much of it is never received by them. They are, in fact, exploited by large business interests. There are four large interests which are concerned in the exploitation of pros- titution. The first of these is the criminal hotels, the second is the houses of ill-fame; the third, the cheap dance halls and saloons, and the fourth, the men — largely Russian Jews — Avho deal in women for the trade." * * * Major Sylvester, the chief of police of Wash- ington, estimates that there are about 400 prostitutes m this city, con- fined almost wholly to a certain district, and that special pains have been taken by the police to prevent minors from frequenting these places. A recent investigation by the Department of Commerce and Labor shows that there are 62 houses of prostitution, with 365 white inmates, EEPOETS OP THE PEESIDENT's HOMES COMMISSION. 225 of whom 68 were of foreign birth, and 16 houses with 105 colored females, all natives of this country. It is gratifjdng to know, from an official source, that the number of prostitutes in Washington is placed at 470. In the crusade against the social evil every effort heretofore made, spasmodically to be sure, has been to apprehend the female offender, and all such attempts have simply resulted in secret prostitution, which is far more dangerous in its social and sanitary aspects. Indeed every attempt to make laws upon the subject which apply to women and not to men is most unjust and establishes a different standard of morality for the two sexes. As expressed by Morrow, "the prostitute is but the purveyor of the infection. She simply returns to her male partner, the pros- tituant, as he is termed, the infection she has received from another prostituant. In the ultimate analysis it will be found * * * that the most essential cause, the causa causans, of prostitution is mascu- line unchastity — the polygamous proclivities and practice of the male, which lead him to seek the gratification of his sexual instinct wherever and whenever he can find a receptive partner. * * * The woman owes her fall to the aggressive solicitations or seductions of the man. She may even be a quasi willing victim, but she yields rather from sentimental feeling than from sexual inclination. * * * Women are the most pitiless and unrelenting in the ostra- cism of those of their sex who have crossed the Rubicon of virtue. The virtuous matron who would shield her daughter from all contact with a fallen sister as contaminating, with most indulgent charity smiles upon the very man who may have been the author of her ruin ; she may, indeed, receive him as a suitor for her daughter if he is otherwise eligible. * * * As a result of this double standard of morality, society practically separates its women into two classes — from the one it demands chastity ; the other is set apart for the grat- ification of the sexual caprices of its men. It thus proclaims the doctrine, immoral as it is unhygienic, that debauchery is a necessity for its men." EDUCATIONAL METHODS. On the whole, the present writer believes the remedy lies in public education. The great majority of the people have no knowledge of the subject, simply because of the erroneous assumption that it is not one which lends itself to general discussion. It is indeed gratifying that such a respectable magazine as the Ladies Home Journal has given attention to topics of this character and insisted for several years upon a greater parental frankness with children about their physical selves. In the editor's personal page, in the issue of September, 1908, we find the following courageous statement : Because of tlie secrecy with which the whole question is enshrouded it Is practically impossible to obtain absolute figures. But so far as the highest authorities have been able, through the most careful inquiries, to secure ac- curate figures, it is a conservative statement to make that at least 60 out of every 100 young men are to-day " sowing their wild oats." Of these 60 young men a startling number are either already making or will make a tragedy of marriage. They produce either childless homes, dead-born or blind babies; children with lifelong diseases with them, or they will send thousands of S. Doc. 644, 60-2 16 226 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. women to the operating table. ♦ * * This frightful condition has been brought about largely by two contributing factors: (1) The parental policy of mock modesty and silence with their sons and daughters about their physical selves, and (2) the condoning in men what is condemned in women. Fathers and mothers, and in consequence girls, have condoned in a young man this sowing of his " wild oats," because it was considered a physical necessity ; that it " would do him good ;" that it " would make a man of him ;" that " it would show him the world" — all arguments absolutely baseless. The reme- dies proposed are along the principles already indicated, viz, knowledge of the subject, and that " we fathers of daughters must rid ourselves of the notion that has worked such diabolical havoc of a double moral standard. There can be but one standard — that of moral equality. Instead of being so painfully anxious about the " financial prospects " of a young man, * * * it is time that we put health first and money second. * * * Let a father ask the young man, as the leading question, whether he is physically clean ; insist that he shall go to his family physician, and if he gives him a clean bill of health, then his financial prospects can be gone into. But his physical self first. That much every father would do in the case of a horse or a dog that he bought with a view to mating. Yet he does less for his daughter, his own flesh and blood. Once let young men realize that such a question would be asked them by the father of the young women whom they would marry; that a physical standard would be demanded, and that knowledge would be more effective for morality among young men than all the preaching and moraliz- ing and exhortations of the past thousand years. Thus, and thus only, can we save our daughters and their unborn children. But in no other way. It should be stated in justice to my friend and teacher that the late Dr. J. Harry Thompson, then in charge of the Columbia Hospital for Women in Washington, as early as 1873 advocated the plan of insisting upon a clean bill of health, and related to the class an in- stance in which the young man, after complying with what he con- sidered a reasonable parental request, told the father : Now, that I have furnished you with evidence of my own physical cleanness, I shall insist upon a similar evidence in your case, as I am equally anxious to perpetuate the purity of my blood. To which request the father unhesitatingly acceded. As a teacher of hygiene I can not find words strong enough in com- mendation of the brave editorial and the excellent article, " The tragedy of the marriage altar" (by Dr. Abraham L. Wolbarst), in the Ladies Home Journal for September and October, 1908. The writer has realized for years the necessity of proper education, for if we expect the parents to impart information on sexual purity, they must acquire it primarily from some competent and reliable source. Few of our magazine writers have heretofore been brave enough to present this question as the Ladies Home Journal has done. For all these reasons I have advocated for years that hygiene should form part of the curriculum in our public schools and the question discussed from the standpoint of sexual hygiene pure and simple. Public lec- turers on the purity of man commit a serious mistake, generally, when they picture the consequences of the social evil without offering a suitable remedy. Many a young man thinks it essential to his health to give vent to his penned up secretions by sexual intercourse and to demonstrate his manhood. If deterred by fear of contracting venereal diseases, in the absence of other remedies he will most likely resort to unnatural methods. We should make a strong plea in favor of continence, and tell our young men that, while the sexual passion is very strong, it can be accelerated or delayed, excited or lowered, by the influence of the will. We should assure them that sexual indulgence is not a physiological EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 227 necessity, and that nature will relieve herself by an occasional noc- turnal emission. By the cultivation of pure thoughts, removal of temptation, normal mental conditions, and especially by cold baths and vigorous physical exercise, and avoidance of an excessive meat diet, continence may not only become possible, but easy. Those who witness the good enects of athletic sports can not fail to appreciate that here is a good field in which to expend exuberant animal spirits, and in this sense " public playgrounds " are a strong factor in the promotion of sexual purity. We can hardly go astray if we follow Doctor Parkes in advising a pure young man to make his home after the age of 22 or 23, and thus secure himself both from the temptations and expenses of bachelorhood. Dr. Howard A. Kelly believes that the Christian standard is the solution of the whole problem of chas- tity. I quite agree with him, provided the church makes an endeavor to combine religious and social work, and until this is accomplished we should not hide the evil because it is not a pleasant subject to talk about. Suggestions as to what the church may do have been offered in a former report, see page 106, Industrial Hygiene, and the desirability of social settlements in connection with schools and churches will be emphasized in connection with the drink evil, see page 248. Among the sensible recommendations submitted by the " commit- tee of fifteen " in the city of New York were, first, " strenuous efforts to prevent, in the tenement houses, the overcrowding which is the prolific source of sexual immorality. * * * Secondly, the fur- nishing, by public or private munificence, of purer and more elevat- ing forms of amusements to supplant the attractions of the low dance halls, theaters, and other similar places of entertainment that only serve to stimulate sensuality and to debase the taste. The pleasures of the people need to be looked after far more earnestly than has been the case hitherto. * * * Thirdly, whatever can be done to im- prove the material conditions of the wage-earning class, and espe- cially of young wage-earning women, will be directly in line with the purpose which is here kept in view. It is a sad and humiliating admission to make, at the opening of the twentieth century, in one of the greatest centers of civilization in the world, that in numerous instances it is not passion or corrupt inclination, but the force of actual physical want that impels young women along the road to ruin." Referring to the question of intimate contact in tenement houses as a predisposing cause to prostitution, it is a matter of satisfaction to record that both General Sternberg and the writer realized this danger when they urged, in 1898, the adoption of model two-story apartment houses with separate entrances and exits for each family so that the sanctity of the home might be preserved. STATE METHODS. The question naturally arises. What can and should the State do to prevent the moral, social, and physical ravages of these diseases ? It must be confessed that the measures looking to the inspection and control of prostitutes are sadly inadequate. It has been suggested by German authors that the evil might be materially lessened by holding the persons who knowingly spread venereal diseases responsible for the damages. Indeed, a German jurist goes so far as to advocate the punishment of persons who neglect to seek treatment when afflicted 228 REPOBTS OP THE PRESIDENT'S HOMES COMMISSION. with sexual diseases. Apart from this the State should certainly insist upon — First. The enforcement of laws or police regulations relating to houses of ill-fame and to the sale of alcohol, particularly to minors. A closer supervision of soliciting in streets and enticing females under a fixed age. There is certainly no good reason Avhy the terrible temptations which greet our young men and women on every street and in many public places should not be removed. A well- trained police force will have no difficulty in recognizing and ban- ishing the solicitors, both male and female, from the streets, and in cautioning young men, especially minors, of the dangers in the red light districts. Second. Health boards can also recommend the enactment of laws for the prevention of syphilis, acquired in an extra genital way, by regulating the profession of barbers, chiropodists, and manicurists, and requiring a special examination of wet nurses, cigar makers, and glass blowers. Apart from the real dangers from these sources, the educational effects of such ordinances will be beneficial. Third. Health boards should also exert their influence toward securing adequate facilities for the treatment of indigent patients. In northern Europe, where venereal diseases are reportable and treatment is within the reach of all classes, these diseases, according to Weiss, have greatly diminished, but here, as Bulkley puts it, " ignored through ignorance, neglected through negligence of our duty, so ostracised and outclassed, venereal diseases, through false shame, concealment, prejudice, carry on their slaughter unhampered, unchecked, and undisturbed, devastating coming generations and ruining the present one." Fourth. Health boards may cooperate with the profession and dispensaries by printing, for distribution, leaflets stating the nature of the diseases, the manner in which they are contracted, and the ways in which they can be transmitted to other persons, and by the encouragement of a general educational campaign in which sexual purity, respect for women, and the possibility of physiological conti- nence should be inculcated. The evil and far-reaching consequences of impure and unlawful gratification should be clearly pointed out. In conclusion, a word of caution is necessary to impress upon the victims of sexual diseases the utter uselessness of securing treatment with various advertised cures. As very properly said by Mr. Samuel Adams Hopkins in Collier's Weekly, September 22, 1906 : All this class of practitioners are frauds and swindlers. Many of them are ex-criminals in other fields. " The old doctors," the " physicians' insti- tutes," the "medical councils," and the "quick cures" are all equally to be shunned. Blackmail is the underlying principle of this business. These treat- ments can not cure; ten to one they only aggravate the disease and render it dangerous or even deadly. But once they have a man in their clutches they need not help him in order to get his money. If he demurs at their charges, a threat to expose the nature of his ailment to his family or employers is enough. * ♦ * Every advertisement of private diseases or " men's special- ists" ought to be a danger signal pointing not only to wasted money, shame, and misery, but often to invalidism and a dreadful form of death, where in 90 per cent of cases reputable treatment would have brought the patient through. In some localities it is against the law to publish advertisements of this class. Pennsylvania has such a law, but it is a dead letter. St. Louis is attempting to enforce its Illegal advertising ordinance, and the St. Louis news- papers are fighting to save themselves the dollars tainted with unspeakable filth. EEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. 229 Chapter VIIL THE TOBACCO HABIT. In view of the fact that our sociological study of 1,217 families in this city shows an average annual expenditure of $12.19 for each family, which at a conservative estimate would amount to $239,655,- 000 for the annual tobacco bill in the United States, it is important to consider the effects of tobacco on the system. Tobacco owes its general effects to the presence of toxic alkaloids known as nicotine, nicotianin, and the " pyridin bases " which are formed during smoking. Syrian and Havana tobacco contain little or no nicotine, while the common grades contain from 3 to 4 per cent. Nicotine is a poison which produces a local irritation of the digestive tract, nausea, and diarrhea. In some instances there may be dizzi- ness, weakness, restlessness, depressed action of the heart, and convul- sions. Strangely enough, man becomes accustomed to these effects and may even experience an agreeable excitation of the nervous system, characterized by increased mental and physical elasticity. There is nothing to justify the assumption, however, that the use of tobacco is free from danger. Professor Seaver's observations on Yale students appear to show that nonsmokers made the best physical gains in weight, chest measure, and lung capacity, and that out of every 100 of the best students only 5 were smokers, while 95 were not smokers. His data were apparently so convincing that Japan, ever ready to profit by the experience of other nations, enacted in 1900 a law prohibiting the smoking of tobacco by persons under the age of twenty — an example well worthy of emulation. Dr. A. A. WoodhuU, U. S. Army, holds that cigarette smoking by the young is harmful, as it arrests the natural elimination of waste and hinders the utilization of fresh material. This explains the fact that the stature of youths who use it is less than those who do not use it. The bad effects of tobacco may be summarized as follows : Tobacco smoke contaminates the air of rooms with coal gas and other prod- ucts of combustion. According to the London Lancet,* 1 ounce of tobacco yields from 1 to 5 pints of carbon monoxide or coal gas, which, when inhaled, is a blood poison. In many instances tobacco in any form produces a chronic inflammation of the throat and stom- ach, which disappears after the removal of the cause. The excessive use of tobacco produces a chronic form of nicotine poisoning, with impairment of vision, nervous irritability or exhaustion, a predispo- sition to neuralgia, and a peculiar affection of the heart, described by Professor Da Costa as the tobacco heart, characterized by irregu- larity of the heart sounds, accelerated action and weakness of the cardiac muscles. Chewing of tobacco is even more to be deprecated than smoking, as the injurious elements are dissolved by the saliva and not infrequently swallowed. Doctor Woodhull points out that cigarette smoking by the young develops a greater tendency to acquire an appetite for alcoholic liquors, premature puberty is induced, in- creasing the sexual propensity and leading to improper sexual prac- tices. There is a consensus of opinion among educators that the use « The Lancet, London, 1908, CLXV. 230 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. of tobacco dulls the memory and intellect. When a promising pupil in a public school begins to decline in his work it is almost certainly found that he has begun the use of cigarettes. On the whole we may conclude that the use of tobacco is not a physiological necessity, and its abuse, like that of other nerve stimu- lants, is doubtless a fruitful cause of a breakdown. It is especially harmful in nervous subjects and those of insufficient will power properly to restrict its use. A German authority maintains, and no doubt correctly, that the danger is greater from smoking cigarettes, because of the ease with which the smoke is inhaled. In any event, the practice of inhaling the smoke into the lungs, or smoking before breakfast, is a bad one. Pipes, cigar or cigarette holders, and the mouth should be kept clean. Symptoms of shortness of breath, obscure pains around the heart and nervous irritability are indica- tions to reduce or stop the habit altogether. Chapter IX. THE ALCOHOL QUESTION. In our sociological survey of 1,217 families in this city we found the average expenditure for alcoholic beverages to be $16.14 per an- num. In view of the importance of the subject from an economic, social, and sanitary point of view, a- study of the alcohol question seems very desirable. Before doing so it will be well to refer briefly to different alcoholic beverages in most common use. FERMENTED LIQUORS (wINe). Among the oldest and best known of alcoholic beverages is wine, which is obtained from the fermented juice of grapes. The juice con- tains water, proteids, grape sugar, levulose, inosite, pectins, tartaric and malic acids and their salts; also small quantities of mineral salts (sulphates and chlorides), coloring matter, and tannic acid. In off years malic acid predominates and there is a deficiency of sugar. The quality of the juice and the resulting wines depend upon the character of the grape (soil, climate, ripening process) and many other factors in the preparation of the must. If a white wine is desired the skins and stems of the grape are re- moved, while for colored wines they are permitted to remain; the blue and yellow pigments during fermentation and under the influ- ence of free acids turn red. Fermentation of the grape juice is usually carried on at a tempera- ture between 60° and 75° F. and is the result of a natural ferment or yeast plant found on the skin of the grape. During fermentation the proteids in the must are to a great extent used up in the forma- tion of yeast cells and the grape sugar and part of the levulose are split up into alcohol and carbonic acid. The inosite remains un- changed, the pectous matter is changed, and a portion of the salts are percipitated in the form of cream of tartar. In addition, gly- cerin and various aromatic ethers, which impart to the wine its flavor, and small quantities of the higher alcohols and free organic acids are formed. The resulting wine may be said to contain, apart from EEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. 231 water, alcohol and carbonic acid, also small quantities of proteids, inbsite, free malic, tartaric and succinic acid, salts, glycerin, and aromatic ethers, and in the case of grapes fermented with their skins also tannic acid and coloring matter. The lighter wines of this and other countries, viz, the Bordeaux, Burgundies, Rhine, and Moselle wines, hock, sauternes, clarets, and champagnes usually contain from 9 to 15 per cent of alcohol by vol- ume. The fortified or stronger wines like port, sherry, tokay, etc., contain from 16 to 27 per cent of alcohol. The amount of sugar varies from in dry wines to 26 per cent in the sweet wines. The natural wines contain little or no carbonic acid as most of it escapes during fermentation. The effervescent wines like champagne are the product of a second fermentation in the bottle, sugar and flavoring extracts having been added for the purpose. The dietetic effects of wine depend entirely upon the amount of al- cohol present. Dry wines usually promote peristaltic action and act upon the kidneys, the red wines commonly retard the movements of the bowels which is due to the astringent effects of tannin. Cheap wines are frequently made from other fruits and even the natural wines have been subject to various forms of adulteration, such as the addition of sugar, glycerin, various ethers, logwood and other coloring agents, like malvey leaves, red beets, carmine, fuchsin, and other analin colors. Unfortunately the manufacture of artificial wines appears to be everywhere extending. Some years ago Petiot considered it perfectly legitimate to extract repeatedly the skin and seeds of grapes with a solution of sugar, which was then permitted to undergo the usual fermentation, the percentage of alcohol varying with the amount of sugar present. Harrington informs us that an artificial wine known as "piquette," and of which over 50,000,000 gallons were made in France in 1898, is made as follows : " To each gallon of water used are added 1 pound of raisins and 1 of dried apples; the mixture is placed in an open vessel and allowed to stand three days. It is then bottled with one-half teaspoonful of sugar and a small piece of cinna- mon in each bottle. It is said to be 'a pleasant and harmless beverage.' " Indeed, so serious and widespread has become the manu- facture of artificial wine in France that the wine growers in 1907 revolted and demanded adequate legislative protection. Harrington and Wiley furnish other examples of the methods followed by those engaged in this nefarious trade: Port. — Cider, 30 gallons; alcohol, 5 gallons; sirup, 4 gallons; kino, one-half pound; tartaric acid, one-quarter pound; port-wine flavor, 6 ounces. White wine. — Dissolve 25 pounds of grape sugar and 1 of tartaric acid in 25 quarts of hot water; add 75 quarts of cold water and 50 pounds of grape pulp, stir, cover, let ferment for four or five days and strain. Claret. — California hock, 40 gallons; extract of kino, 8 ounces; essence of malvey flower, 8 ounces. These samples are given to show how easy it is to deceive the average customer, who often pays a high price for beverages assumed to possess food values or medicinal properties. FRUrr WINES. Homemade wines are often made from the fermented juice of apples, pears, currants, gooseberries, and oranges ; they contain pretty 232 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. much the same ingredients, except inosite, as grape wine. The per- centage of alcohol is, however, less, on account of the deficiency of sugar, unless sugar has been added, which is often done. Apple or pear cider usually contains from 4J to 6 per cent of alco- hol. According to Parkes such wines are sometimes manufactured or stored in earthenware vessels, coated inside with litharge glaze, which readily gives up larg;e quantities of lead to acid liquids and is thus productive of lead poisoning. If the air is not absolutely ex- cluded from all kinds of wine, acetous fermentation ensues, and the liquid is transformed into vinegar. The effects of home-made wines are moderately stimulating, and slightly laxative and diuretic on account of the free organic acids contained therein. It is also held that their habitual use favors the formation of gravel and stone in the bladder and chronic inflammation of the urinary passages. BEERS. Beer is a very ancient beverage, having been used by the Egyptians over two thousand years ago. It was introduced into Germany during the twelfth century and for a long time the art of brewing was largely confined to the cloistered monks. Pure beer is manu- factured from malt, hops, and water. In the first place, clean barley is steeped in hard water and is then allowed to sprout in heaps, which are spread out when the germination has reached the requisite stage. During this process diastase develops which converts the starch into dextrin and maltose, and the insoluble albu- minous matter is rendered soluble. Further germination is prevented by first drying and then parching the malt at a temperature of 125° to 180°; this also develops color and flavor. The malt is then screened for the removal of the sprouts and, after being crushed, is steeped in water at a temperature of 160° F., which has the effect of converting the balance of starch in the wort into maltose. The resulting infusion, after the addition of hops, is now boiled for a couple of hours, during which about one-third of the bitter princi- ples of the hops are taken up, the coagulable proteids are separated and all existing micro-organisms are destroyed. The decoction is then rapidly cooled in tanks and transferred into vats, where, after the addition of yeast, it is allowed to ferment at a temperature of G0° to 66° F. ; during this process the maltose is split up into alcohol and carbonic acid. When fermentation has gone far enough the yeast is removed and the beer is run into casks. Good beer, apart from alcohol, carbonic acid, glycerin, succinic acid, also contains some proteids, sugar, malt extracts, salts, and bitter principles. The percentage of alcohol varies from 3 per cent in the lighter kinds to 6 or 7 per cent in ale and porter. In the 28 specimens exan ined by Mr. C. A. Crampton, of the Internal Revenue Office^ the amount of alcohol averaged 4.63 per cent by weight or 5.79 per cent by volume. The so-called " Weiss beer " is made from a mixture of barley and wheat malt and usually contains more carbonic acid and yeast par- ticles and less alcohol than ordinary beer. Porter, ale, and bock beer are made from a stronger wort and*^ hence contain more alcohol. The chemical analysis shows that beer is not only a beverage, but also a foodstuff, because 2 liters of beer contain about 10 grams of proteids EEPORTS OP THE PBESIDENt's HOMES COMMISSION. 283 and 100 grams of carbohydrates, or nearly one-tenth of the protein ration, and one-fifth of the daily requirements of carbohydrates. In recent years beer has been known to be adulterated by the em- ployment of glucose and invert sugars obtained by the action of dilute sulphuric acid upon rice and com. This sophistication affects not only the nutritive value of the beer by a deficiency of the proteids, but may also be a source of arsenical poisoning, if the sulphuric acid happens to be derived from arseix.cal pyrites. Such an instance occurred in 1900 at Manchester and Sal- ford in the northwest of England, where over 3,000 consumers of beer developed symptoms of arsenical poisoning, such as paralysis and wasting of certain muscles, functional disturbances of certain sensory nerves, with 36 fatal cases from peripheral neuritis. Specimens of the glucose showed from 0.02 to 0.05 per cent of arsenious oxide and the beers made from it contained from 0.10 to 1.60 grains of arsenic per gallon. It is gratifying to note that adulterated beer is quite uncom- mon in this countTj, as none of the 476 samples examined in the State of New York contained hop substitutes. The effects of beer and wine depend upon their purity, the quantity consumed, and the suscep- tibility of the individual. Quite a number of authors believe that these beverages, consumed in moderation, say from one-quarter to one-half liter of wine or from one-half to 1 liter of beer during twenty-four hours, in otherwise normal persons, will have no inju- rious effects, and may even possess certain advantages, such as aiding digestion by promoting the flow of digestive juices, while the bitter principles of hops possess certain tonic properties. On the other hand Buchner, Ogata, and others claim that beer retards digestion, and all agree that if taken habitually in excess, both beer and wine, in the language of Parkes, " lead to the storage up of superfluous fat in the tissues, and they interfere with the proper elimination of effete matter; imperfect oxidation leads to an excessive formation of uric acid, and the plethoric and gouty habit are produced, eventually tend- ing to palpable disease." BRANDY. Brandy, the strongest alcoholic drink, is derived from the distilla- tion of wine, but as commonly sold it is for the most part a mixture " of varying amounts of spirits from the distillation of com grain spirits, etc." Apart from water it contains 55 to 65 per cent of alcohol by volume, or 39 to 47 per cent by weight, in which are held aromatic ethers, also traces of tannin, coloring matter, and various secondary products, including aldehydes, furfural and higher alcohols. Har- rington gives a number of examples showing how fictitious brandy is made, of which the following is reproduced : Boil 5 ounces of raisins and 6 of St. John's bread in water, filter and make up to 10 quarts; mix this with 20 quarts of alcohol, one-half ounce of essence of violet flowers, and 10 ounces of brandy essence. RUM AND ARRACK. Rum is distilled from fermented molasses, and arrack from fer- mented rice or cocoanuts; they contain from 55 to 65 per cent of alcohol by volume and more or less of the objectionable fusel oil and, like other strong drink, are frequently adulterated. 234 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. WHISKY. Whisky is made by distillation of malted grain, especially rye, corn, and wheat, although barley, oats, and potatoes are sometimes used. The mash for Scotch whisky consists of 2 parts of malt, 7 of barley, and 1 each of oats and rye; the mash for Irish whisky is the same with the exception of the rye; the peculiar smoky taste of these whiskies is due to the cresote products evolved in peat and turf fires over which the malt is dried. Good Bourbon whisl^ has an agree- able flavor, the mash being a mixture of corn and rye. All new whiskies, in addition to about 45 per cent of ethylic alcohol, contain amylic alcohol or fusel oil and other impure alcohols. These im- purities are very irritating to the mucous membranes of the throat and stomach and produce rapid intoxication; the fusel oil is also responsible for the headache, nausea, and general depression so often observed after the consumption of impure liquors. The amount of toxicity of the fusel oil depends upon the character of the raw mate- rial, it being greatest when derived from potatoes and least when obtained from grapes. The aldehydes can be removed by redistilla- tion and the fusel oil by charcoal or a fractionating patent still. The fine spirit secured by rectification contains from 72 to 90 per cent of absolute alcohol and only traces of the impurities referred to, while ordinary whisky contains from 35 to 50 per cent by volume of alcohol and almost always some of the toxic principles. It is a familiar but true saying that whisky improves with age in taste and flavor. This is due to the fact that the constituents of fusel oil are converted into nontoxic aromatic ethers which impart the agree- able flavor to aged whiskies and brandies and also constitute, with other compounds, the bouquet in different wines. The new and cheap grades of whisky are decidedly injurious to health and when fusel oil is present to the extent of 1 part per 1,000 it is unfit for use. There is abundant evidence to show that whisky is frequently manufactured from alcohol, water, and various flavoring compounds, of which the following example is given by Harrington : Scotch whisky. — Alcohol, 46 gallons; genuine Scotch, 8 gallons; water, 18 gallons; ale, 1 gallon; cresote, 5 drops in 2 ounces of acetic acid; pelargonic ether, 1 ounce; honey, 3 pounds. The writer fears that in the manufacture of fictitious whiskies methyl or wood alcohol is also used on account of its cheapness ; this, when employed as an intoxicant, has been known to produce total blindness. THE nation's drink BILL.<» As the nation grows in population and wealth, so does its expendi- tures for stimulating beverages. This is the more surprising in view of the warfare waged against the saloon and the milder beverages. The per capita consumption of spirituous liquors for the year ending June 30, 1907, is the highest on record, reaching 23.63 gallons per capita, an increase over 1906 of 1.27 gallons. oThls article appeared in the American Grocer, May 27, 1908, and is repro- duced by permission of the editor. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 235 The advance in the consumption of distilled spirits from 1.52 gallons per capita in 1906 to 1.63 gallons in 1907 is more notable than an increase of 0.12 gallon in the use of wine and a rise of 1.04 gallons in beer. The year was one of phenomenal prosperity, and this may account for the increase in expenditure for stimulants, which was quite as marked for coifee and cocoa as for alcoholic drinks. The use of tea seems to have declined considerably, as it falls below the yearly average for five years. A gain of 1,600,806 in population will not account for the increased use of stimulating beverages. Possibly extensive advertising is re- sponsible for no small share of the increase, which seemingly goes forward in spite of all efforts to check the sale of intoxicating bev- erages and to kill the demand for coffee. " There's a reason," but it baffles solution. There are many theories or opinions, but the finding of a reasonable check to the use of spirituous beverages seems as far away as ever. Legislation does not seem to curb the curse of drink. RETAIL COST OF ALL BEVEEAGES. The various estimates of cost, presented by the American Grocer, compiled, so far as quantity is concerned, from the report of the United States Bureau of Statistics, shows that the average annual cost of alcoholic and nonalcoholic stimulants in the United States, 1905-1907, was as follows : Alcoholic drinks. $1, 466, 584, 327 Nonalcoholic stimulants : Coffee $161, 598, 437 Tea 41, 902, 680 Cocoa 10, 000, 000 213, 501, 117 Total, 1907. 1, 698, 085, 444 1906 1, 660, 489, 520 1905 1, 548, 708, 307 1904. 1, 498, 622, 715 , 1903- 1, 451, 633, 379 Total drink bill, five years, 1903-1907 7, 857, 548, 365 Average annual drink bill, 1903-1907 1, 571, 509, 673 The above represents a per capita expenditure for beverages in 1907 of $19.74 for the 85,817,239 inhabitants of the United States, or $98.70 for each family of five. Yearly average for five years, $19, or $95 per family. The quantities of the four leading beverages consumed annually for three years, 1905-1907, as estimated by the American Grocer, were as follows : Gallons. Beer 1, 686, 667, 659 Coffee 1, 615, 984, 370 Tea 558,500,000 Spirits and wines 156,029,818 236 REPOETS OP THE PRESIDENT'S HOMES COMMISSION. PEB CAPITA CONSUMPTION ALCOHOLIC DKINKS. The following table shows the annual per capita consumption of liquors in the United States for ten years : Year ending June 30— Spirits. Wines. Beer. Total. 1898 Gallons. 1.12 1.18 1.28 1.33 1.36 1.46 1.48 1.45 1.52 1.63 Gallons. 0.28 .35 .39 .37 .63 .48 .53 .42 .55 .67 Gallons. 15.96 15.28 16.01 16.20 17.49 18.04 18.28 18.50 20.19 21.23 Gallons. 17 36 1899 16 81 1900 17.68 1901 17 90 1902. 19 48 1903 19 98 1904 20 35 1905 20 38 1906 22 26 1907 23 53 TOTAL ALCOHOLIC DRINK BILL. Bringing together the quantities of liquors consumed, estimated at the retail cost on the basis of previous reports, it is shown that the American people spent for alcoholic stimulants for the year ending June 30, 1907: Beer $843, 333, 829 Whisky (exclusive of quantity used in arts) 118,456,091 Grand total, 1907 1,466,544,327 1906 1, 450, 855, 448 1905 1, 325, 439, 074 1904 1, 277, 727, 190 1903 1, 242, 943, 118 1902 1, 172, 565, 235 1901 1, 094, 644, 155 1900 1, 059, 563, 787 1899 973, 589, 080 LIQUOB AND TOBACCO TAX. The total revenue of the United States Government in 1907 from spirituous and malt liquors, and from tobacco, the ally of liquor, was $247,458,911, or $2.88 per capita, equal to $14.40 tax on every family. CONCLUSION. We must leave to students of social economy the question of a great nation spending an average of over one and one-half billions annually for stimulating beverages ; a sum about as great as the appropriations of the Congress for a session. Nearly double as much per capita is spent for drink as is spent for the maintenance of public schools. It nearly equals the value of exports of merchandise per capita. It is double the amount of the public debt. It is more than the farm value of the corn crop, which exceeds 2,500,000,000 bushels ; three times the value of the wheat grown ; more than double the worth of the cotton crop. The indirect cost is beyond estimate, and so great is the waste and misery created that States are fighting the evil and endeavoring to banish the saloon as a distributing factor. It is easily the fore- most question of the day, and places the support of a big navy or an army in the shade. KEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. 237 ALCOHOL AS A POODSTHBT. Professor Liebig was perhaps the first to declare that alcohol stands only second to fat as a respiratory material, but wisely added that the s xme effect could be produced in the body by means of saccharine and farinaceous articles of food at one-fourth or one-fifth the cost. Professor Atwater, in order to determine the food value of alcohol, substituted for a portion of the nonnitrogenous food a quantity of ethyl alcohol equivalent in energy to the food which it replaced — 2^ ounces of absolute alcohol per day in six doses — and found what had been taught in fact by Liebig (1) extremely little of the alcohol was given off from the body unconsumed in the breath or otherwise — ^the alcohol was oxidized, i. e., burned as completely as bread, meat, and other ordinary foods in the body and in the same way; (2) in the oxidation all of the potential energy of the alcohol was transformed into heat or muscular energy. In other words, the body transformed the energy of the alcohol just as it did that of sugar, starch, and fat. That is, whether the body was at rest or at work, it held its own just as well when alcohol formed a part of the diet as it did with a diet without alcohol. These experiments clearly demonstrate the food value of alcohol, but Atwater wisely adds that it should be remembered that the physi- ological action of alcohol involves much besides its nutritive effect. Its "influence on the circulatory and nervous functions is especially important. He also said : Whether alcohol is to be called a food or not depends upon the definition of the food. The writer does not question, the scientific deductions made from these experiments, but objects that alcohol should be considered any- thing else than an accessory, to be used with extreme precautions.- Professor Atwater has told us, in one of his excellent bulletins, that " the most healthful food is that which is best fitted to the wants of the user ; the cheapest food is that which furnishes the largest amount of nutriment at the least cost, and the best food is that which is both healthful and cheapest." PHYSIOLOGICAL EFFECTS OF ALCOHOL. Absolute alcohol, on account of its affinity for water, exerts a caustic effect on the mucous membranes. When properly diluted, it is rap- idly absorbed and speedily oxidized. It is a stimulant to the central nervous system and the sympatheticus of the heart and produces a feeling of exhilaration, vivacity of the mind, accelerated pulse, and increased muscular activity. Bunge denies these properties, and claims that its primary action is that of a depressant, and that its apparent good effects are simply due to the obtusing influence upon physical and mental suffering. But this is scarcely a correct assump- tion, as there are individuals in whom the smallest doses produce palpitation of the heart, throbbing of the carotids, and great mental activity. He also claims that alcohol does not produce renewed vigor in tired individuals, but simply obtuses the feeling of exhaustion. Dr. Henry Smith Williams, discussing the relation of alcohol to muscular work, states that alcohol does not increase the capacity to 238 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. do muscular work, but distinctly decreases it. (McClure's Magazine, October, 1908.) Atwater's experiments conclusively show that in the oxidation of alcohol in the system all the potential energy is trans- formed into heat or muscular energy; and there is certainly reason for believing that it is also a stimulant. How else can we explain the action o? brandy in cases of heart failure? It would be absurd to talk here of an obtusing or stupefying effect. It is a stimulant which, like other agents of this class, is followed by a stage of de- pression. Alcohol, in moderate and diluted doses, evidently stimulates diges- tion, as shown by its beneficial effects after a hearty meal; but large quantities interfere with or arrest the peptonizing process, and fre- quently produce acute gastric catarrh. These effects are liable to be observed, when present, to the extent of 10 per cent of the gastric contents. Alcohol also exerts a marked diuretic effect, which is be- lieved to be due to a direct irritation of the renal epithelium. PATHOLOGICAL EFFECTS OF ALCOHOL. The habitual use of immoderate doses of alcohol can not fail to pro- duce serious injury to mind and body. One of the most constant effects is chronic inflammation of the stomach, with consequent im- paired digestion and nutrition. It produces fatty degeneration of the- heart, liver, and arterial coats, a most common cause of apoplexy, probably because it promotes the conversion of albuminoid tissues into fats. The connective tissues of the body increase in amount and their subsequent contraction gives rise to cirrhosis (hardening of the liver), Bright's disease, and chronic meningitis. It is one of the most fruitful causes of insanity and affections of the nervous system — like inflammation of the nerves, palsies, epilepsy, etc. Doctor Maca- tee's investigation shows that during the past nine years 9,510 patients were treated for alcoholism and 409 for delirium tremens in the city hospitals of Washington, the majority of the patients at public expense. It is a lamentable fact that while the mortality from the so-called preventable diseases in the United States has markedly declined in the last two decades, the death rate from Bright's disease, heart dis- ease, dropsy, apoplexy, and pneumonia are apparently greater than in 1890. For reasons just stated we may well pause to inquire whether our ever-increasing " national drink bill " may not be a factor in the undue prevalence of these diseases, as also in the increase of insanity and nervous disorders. ALCOHOL INCREASES THE SUSCEPTIBILITY TO DISEASE. Professor Hodge, of Clark University, in 1895 demonstrated the injurious effects of alcohol upon dogs. The more recent experiments of Taavlaitmen, cited by Babcock," apparently show that in dogs, rabbits, guinea pigs, fowls, and pigeons alcohol distinctly increases the susceptibility to experimental infection; and that the abnormal temperature of experimental diseases persists longer than in infected animals that do not receive the drug. Dr. Reid Hunt, of the Public •Preventive Medicine, p. 83. BEPOETS OF THE PRESIDENT S HOMES COMMISSION. 239 Health and Marine-Hospital Service, in 1906 conducted a similar line of experiments and arrived at the same conclusion. Metchnikoff « attributes this to the fact that alcohol lowers the resistance of the white corpuscles of the blood, which are the natural defenders of the body. Lanceraux has shown that in 2,192 cases of tuberculosis studied by him over one-half were confirmed drunkards, and Guttstadt's Sta- tistics ^ also indicate that consumption is especially common among bartenders and brewers. Indeed, every physician knows that alcohol not only predisposes to tuberculosis, pneumonia, typhoid fever, and other infectious diseases, but also that these diseases are more fatal or run a more severe course in alcoholic subjects — probably because of the impaired digestive functions and a general depraved nutrition of the system, with consequent diminished power of resistance. Apart from the diseases already referred to, alcohol also increases the ten- dency to rheumatism and gout, and according to Babcock " there is a distinct relationship between the incidence of alcoholism, insanity, venery, and crime." EFFECTS OF ALCOHOL UPON LONGEVITY. The following figures, taken from Doctor Ogle's report (Forty- fifth annual report of the registrar-general of England), show the effect of intemperate habits in shortening life: Comparative mortality of males 25 to 65 years of age. All causes complete. Mortality figures Diseases of the nervous system Respiratory system Urinary system Liver Alcoholism Gout Innkeepers- All males, publicans England and Brewers. spirit, wine, Wales. or beer dealers. 1,000 1,361 1,521 119 144 200 182 236 217 41 55 83 39 96 240 10 25 55 3 9 13 Life-insurance tables based upon English statistics cited by Jewett (Town and City, p. 87) : Average expecta- tion of Ufe. Moderate drinkers. Total abstainers. At 20 expect to live to be 62 65 68 35 m 5U 64 At 30 expect to live to be 661 R8 At 40 expect to live to be EFFECTS OF ALCOHOL UPON MENTAL AND MORAL FACULTIES. Perhaps one of the most deplorable effects of alcohol is that it pro- duces structural changes of the cells of the brain and spinal cord — a oThe New Hygiene, p. 25. ^ Klin. Jahrbuch f. 1904. 240 REPOBTS OF THE PRESIDENT'S HOMES COMMISSION. fruitful cause of insanity — ^and leads to a mental and moral deteriora- tion, characterized by the loss of will power, blunted moral sensi- bilities, and the ruin of character; and, saddest of all, these effects are often transmitted through vulnerable anatomical elements to the offspring. A curious record has been complied by Professor Pellman of the University of Bonn. It relates to the career of a notorious drunkard who was bom in 1740 and died in 1800. In investigating her history her descendants were found to have numbered 834, of whom 709 have been traced from their youth. Of these, 7 were convicted of murder, 76 of other crimes, 142 were professional beggars, 64 lived on charity, and 181 women of the family led disreputable lives. Further inquiry, moreover, showed that the family cost the German Government for maintenance and costs in the courts, almshouses, and prisons no less than $1,250,000 — in other words, just a fraction under $1,500 each. It would probably be difficult to find a more remarkable example than this of the evil effects of the drink habit and the transmission of hereditary defects. The statistics of the Elmira Reformatory for 1900 show that 3,363 of the 9,344 convicts had drunken ancestors and the records of every police court reveal the startling fact that about 60 per cent of all sentences are imposed for drink. Ninety-one of the 175 prisoners examined by Dr. Paul B. Johnson in the Washington Workhouse were sentenced for drunkenness and disorderly conduct, and 171 admitted the use of alcohol, most of them to excess. Mr. Boies estimates that the share of alcohol in the expense of crime in the United States is $4.34 per capita, or over $420,000,000 per annum (Jewett, p. 24-25). Professor Demme's statistics of 10 temperate and 10 intemperate families, based upon ten years' study and observation, are also of interest : Children Died before 6 weeks old IdlotB Stunted in growth Epilepsy Nervous in childhood, but cured Ordinary good health in childhood, per cent Temper- Drunkards' families. families. 61 67 5 25 6 5 6 6 81.5 17.6 Moreover, Von Bunge has shown that the daughters of alcoholic fathers in the third generation are usually unable to nurse their offsprings. ALCOHOL AS A CAUSE OF ACCmENTS. Considerable evidence might be adduced to show the relationship of alcohol to railroad and other accidents. Those who are familiar with the effects of intoxicants need no argument in favor of sobriety. All business men and railroad corporations realize the value of sober hab- its among their employees, and quite a number insist upon total abstinence at all times, whether on or off duty. On the whole we may conclude that, for persons in health, alcohol in any form presents no advantages not found in other foodstuffs or stimulants, and which are, moreover, comparatively free from the dangers attending its use. Indeed, the subsequent depressing effects BEPOKTS OF THE PEESIDENt's HOMES COMMISSION. 241 and the baneful influence of its misuse should make us careful in the employment of alcohol, even for medicinal purposes, especially when rest, proper food, and some of the beverages and stimulants like coffee, tea, or beef tea may accomplish the same object. CAUSES OF INTEMPERANCE. The writer has watched with satisfaction the physical development of the population of the United States, which has more than justified the opinion, long since expressed by scientists, that a mixture of the blood of different nations of the same race is better than either of the parent stock. Our typical American is a very different type from his English, French, Irish, or German ancestor. As a result of a commingling of the blood, he has developed into an individual of strikingly superior physical and intellectual qualities, destined to play a very important role in the affairs of the world. And yet one of the dangers which appears to threaten us is the growing evil of intem- perance, which is intimately connected with our mode of life. In a general way, there is no class of men more ambitious, more industri- ous, and more fond of accumulating wealth than our people. The very excellence of our progress and its accelerated speed have quick- ened the pulse, stimulated the nerves and intellect, and fired the amjbi- tion of men until they overleap the limits of their natural powers. Under this high-pressure system the rich and poor alike strain their physical and mental energies. Rest and recreation seem impossible to many and the temporary stimulant derived from the tempting cup offers, for the time being, relief to our physical and mental exhaus- tion. It is, however, a dangerous remedy. It is like the whip ap- plied to the tired horse and the result is generally bad. Professor Kraeplin, one of the foremost experts on insanity in Europe, in his monograph on "Alcohol and Youth," in discussing the causes which lead up to the drink habit, says : The blacksmith offers as an excuse exposure to heat, the liveryman pleads exposure to cold, the masons and bricklayers plead outdoor exposure, the miller blames the dust, the sailor the fog, another his wife, and still others business reverses. From this he concludes that the very diversity of causes assigned show that none of them will stand the test of scrutiny. Mr. Wurm, in a very interesting address on the alcohol question, delivered at Essen, September 20, 1907, takes issue with Kraeplin and proceeds to present some of the causes which operate in the drink habit among wage-earners. The writer quite agrees with him that the dust- producing occupations are at least predisposing factors, especially when the employer makes no attempt to furnish pure water or non- alcoholic beverages to allay the thirst and when the rules and regu- lations for the prevention and removal of dust are totally ignored. In like manner he makes a strong plea for the operatives exposed to extremes of high temperature, the inhalation of injurious and offen- sive gases, and very properly insists that the causes of abnormal thirst should primarily be prevented by efficient and copious venti- lation. He attributes, and we believe correctly, the drink habit so prevalent among painters to the fact that they resort most unwisely, upon the appearance of the first symptoms of lead colic, to alcoholic beverages to allay their suffering, when, as a matter of fact, the most S. Doc. 644. 60-2 17 242 REPOKTS OF THE PRESIDENT'S HOMES COMMISSION. rational preventive measure would be to abolish the use of lead pig- ments altogether. He describes, graphically, the exposure of quarry- men, stonecutters, masons, bricklayers, joiners, teamsters, motormen, etc., to the elements, and points out that the men engaged in con- struction work are rarely supplied with a shack and a cook stove where they can warm up and take their noonday meal. In the absence of suitable conveniences the workmen are compelled to fre- quent the saloons, and here highly seasoned tidbits promote thirst, while the social element is also conducive to excesses. All of these evil conditions are very much aggravated in this country by the per- nicious system of treating. This abominable custom can not be too strongly condemned, as it is almost as vicious as the seduction of a young man to take his first drink. Many a young man has fallen a victim to the habit by the encouragement of his older companions to " be a man and take a drink." Among the causes stated by 171 of the prisoners in the Washing- ton workhouse investigated by Dr. Paul B. Johnson, we find the following: Bad companions, dusty employments, long hours of work, especially at night, exposure to cold and wet, work in hotels and bottling establishments; given toddy, beer, etc., as children 4 years old and upwards ; death of relatives and troubles. Mr. Wurm considers the effects of mental and bodily fatigue as a cause of intemperance and emphasizes the peculiar effects of mental strain combined with monotonous machine work, in which, after all, constant attention is demanded to prevent accidents and spoiled products. Mr. Emmet L. Adams, master of the American Machin- ists, also believes that the monotony of machine work, especially when combined, as in the naval gun shops, with strict orders not to converse during the work, is conducive to mental fatigue and empti- ness, which the wage-earner seeks to counteract by the use of alco- holic beverages. In his opinion long hours, dirty work, and low wages are fruitful causes of discontent and intemperance. POVERTY AND DRINK. Keferring to the effect of low wages as a cause of intemperance, Mr. Wurm quotes Prof. Justus von Liebig, who, in 1860, declared: Alcoholism is not the cause, but the result of distress. It is the exception to the rule for a well-nourished individual to become a drunliard. When, on' the other hand, a man's earnings are insufficient to provide the quantity and quality of food required for the restoration of his working capacity, sheer necessity compels him to have recourse to alcohol. It will be remembered that Liebig was the first to demonstrate the food value of alcohol, and this view may have been justified at a time when wages in Germany were extremely low, and the cost of whisky so nominal as to be classified as one of the most inexpensive articles of food. Wurm also quotes Friedrich Engel, who appears to have been aware of the fact that the social conditions, as observed by him in England in 1845, are not only a cause of alcoholism, but that the drink habit is also very often the primary cause of the low standards of living. Engel says: Seduction and every possible temptation combine to produce the drink habit. Ardent spirits at present constitute the workiugman's only source of pleasure. He returns weary and exhausted from his work to a damp, gloomy, and unat- REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 243 tractive home, devoid of all the ordinary comforts of life. He is sadly In need of good cheer and encouragement; his body weakened by improper food and exposure to bad air demands some form of stimulant. He wants to meet his friends and resorts to the saloon as the only place to gratify his longings. Under such circumstances drunkenness ceases to be a vice. We have, on the other hand, the opinion of John Burns, the Eng- lish statesman, himself a former wage-earner, who, in his lecture on " Labor and drink " (p. 5), declares: Drinking is bad enough in the prosperous, well-fed, and comfortable classes, who can mitigate its heavy drain upon their health, strength, and resources by rest, change, and counter-attractions. But on the poor it is an additional load, piled upon their own backs, too often by their own hands, and nearly always at the time they are least able to bear it. From their strength as a class, from their powers of endurance as individuals, and from their capacity as craftsmen, it is a never-ending drain. On page 12, in speaking of " Poverty and drink," he says : The theory, dogmatically asserted, that poverty causes drink is rudely shaken by the fact that the drink expenditure per middle and upper class family who have the means, is two and a half times greater than that of the working class family, although the effect is less apparent. But the strongest answer is the statistical fact that as wages rise general drunkenness follows, insanity in- creases, and criminal disorder due to drink keeps pace with all three. The converse generally holds good, for in rural districts, where wages are low, drunkenness is lower, and insanity due to drink is scarcer. In support of these views and tables, the prison commissioners' report (p. 16, Judicial Statistics, 1899) : "A year of great prosperity, 1899, was also a year of great drunken- ness." Yet drunkenness in 1899, I am pleased to say, per 100,000, was much lower than in previous periods of prosperity, as for instance in 1884; the year 1875, our busiest year, was the most drunken of any recorded. It may be urged, in extenuation of these deplorable facts, that the determining cause was the previously low wages; also that it is the sudden rise from rural to urban wages that sweeps the appreciated wage-earner from his simple, sober ways to exciting, heavy-drinking habits. If this be accepted, it diminishes enormously the force of the theory that poverty causes drink. * * * Industrial prosperity is always the measure of wages, generally the standard of drunkenness, the gauge of insanity, and too often the stimulus of crime. This is strikingly confirmed by that patient, devoted, and capable investigator Mr. W. D. Morrison: "A glance at the criminal returns for a series of years will at once show that crime is highest in summer and autumn — a time when occupation of all kinds, and especially for the poorest members of the com- munity, is most easily obtained — and lowest in winter and spring, when eco- nomic conditions are adverse." All these facts, instead of pointing to poverty as the main cause of drunkenness, point the other way. Wurm stoutly maintains that in Germany higher wages have created a greater demand for the less harmful but more expensive beverages, like wine and beer, and quotes from the " Volkstimme," of Frankfort, that in all trades where there has been a reduction in the working hours alcoholism has diminished, because the men have an opportunity to enjoy nobler pursuits than to sit around in common saloons. Justice De Lacy, of the juvenile court of Washington, informed the writer that quite a large number of deserted wives, pleading for com- pulsory support, declare that when their husbands earned from $2.50 to $3.50 a day they led exemplary lives, but now, when they are earn- ing from $4 to $5 a day, a number of days are lost in idleness by the drink habit. The writer does not pretent to offer an authoritative view, and pre- fers to adduce the evidence on both sides of the question. He is strongly inclined to the belief, amounting to a conviction, that the 244 REPORTS OF THE PRESIDENT'S HOMES COMMISSION." subject is so broad and the evil effects so far reaching as to deserve a systematic and exhaustive study by a special commission. Reference has been made in a former report to the fact that mal- nutrition, whether the result of insufficient or improperly prepared food, or the consumption of cold ^actuals, is a very fruitful cause of intemperance. In our sociological study of 1,217 families it was found that 760 wage-earners carried dinner pails, and 205 were re- ported as being accustomed to consume alcoholic beverages with their meals. The number in each case was greater among the white than the colored wage-earners. Everyone at all familiar with the subject knows that badly cooked food, especially when consumed from the " cold dinner pail," produces derangements of the stomach and a craving for alcoholic stimulants, which in turn aggravate the original gastric disturbance and readily lead to the drink habit. In addition to the causes mentioned, the unnecessary number of saloons, not infre(juently connected with employment agencies or located in the vicinity of workshops, wharves, and the homes of wage- earners, increase the temptation. Last, but not least, the character- istic American bar — drinks being consumed in rapid succession, aided by the pernicious system of treating — is a very fruitful cause of the drink habit. REMEDIAL. MEASURES. The remedy is difficult to suggest. Prohibition does not prohibit, and all such attempts are repugnant to the masses and lead to the sub- stitution of even greater evils, such as the drug and other morbid habits. In Doctor Johnson's investigation quite a number of the prisoners admitted that when unable to secure liquor they have re- sorted to alcohol diluted with water, hot water and sugar, soda water, sarsaparilla, etc. Wood alcohol was stated to be used in the United States Navy, obtained from shellac varnish stolen from the paint room, the shellac being precipitated by water and the fluid poured off and mixed with hot water and sugar. The following substitutes for liquor were also alluded to : Duffy's malt whisky, Johann Hoff 's malt extract, Jamaica ginger, Peruna, S. S. S., renewed prescriptions, and forged prescriptions. During my army experience at posts situ- ated within the heart of an Indian country and where it was imprac- ticable to establish grog shops, within a reasonable distance, whisky was brought into the garrison through the mail in various disguises, or in express packages and peddled in 2-ounce vials by the soldiers themselves. Others resorted to the purchase of essence of ginger, lemon, vanilla, bay rum, alcohol, patent and proprietary remedies containing alcohol in various percentages ; hence even the most favor- able environment failed to prohibit. It was not until the establish- ment of the canteen system that better conditions were offered. It was the creation of the soliders' club, with the sale of light wines, beers, and nonalcoholic beverages, which reduced drinking to a mini- mum and promoted not only temperance and contentment, but also lessened immorality and crime. In spite of the fact that beer and wine drinking, viewed in the abstract, is unproductive of good, quite a number of friends of tem- perance believe that saloons dispensing light wines and beers should pay a very much lower license tax than those selling stronger alcoholic beverages. They also deprecate the tendency to suppress the sale of beer by the quart, because it is found that the men, instead of " rush- REPOKTS OF THE PRESIDENT'S HOMES COMMISSION. 245 ing the growler," will purchase whisky by the pint or quart with infinitely more harmful effects. So long as human nature is weak, and the masses are not properly educated, the substitution of a lesser evil is not only justifiable but will, in the future, as it has in the past, prevent excesses which are fatal to soul and body. At present every effort toward total absti- nence merely opposes theory to facts and sentiment to statistics. While it is true that nearly one-half of the population of the United States is now living under prohibition liquor laws and nine States have prohibition outright, there is no marked diminution in the con- sumption of alcoholic beverages. One of the immediate effects has been an appalling increase in the number of drug stores in " dry States." The subject was deemed of sufficient importance by Mr. Harry B. Mason, editor of the " Bulletin of Pharmacy," to bring it to the attention of the American Pharmaceutical Association at a meeting held at Hot Springs, September 6, 1908. Mr. Mason said in part: We are facing a great world movement. It has been instituted by society for the protection and maintenance of its own interests. It will continue its onward development whether we like it or not, and as pharmacists we are af- fected in so vital a manner that our future reputation and welfare are largely at stake. Prompt and vigorous measures are necessary if we are to avoid public calumny and disgrace. Why? For the very simple and apparent reason that a small minority of druggists are willing, nay, eager, to take advantage of the downfall of the sa- loon and seize upon the business which it is no longer able to continue. In some of the prohibition States, and in most of the " dry " towns and counties, it is recognized that liquor is a medicinal necessity, and the druggist is conse- quently given the legal right to dispense it for legitimate purposes. Some- times a physician's prescription is demanded ; in other instances it is provided that the sale must be only for " medicinal, chemical, and sacramental purposes," and strict registration of every sale is required ; in still other sections, different methods are prescribed, but the fundamental expectation everywhere is that the pharmacist shall observe the spirit of the law and refrain from selling liquor as a beverage. Now, it is unquestionably wise and proper that, by some method or other, people who need liquor for legitimate purposes should be left with the means of procuring it, and the drug store is the natural and practically the only place to look to in such an emergency. No article in the materia melica is more useful and necessary than liquor, and it would be unfortunate, indeed, if pharmacists were everywhere denied the legal right of dispensing it. It would be nothing short of a professional dis- grace of the most humiliating character if this privilege were to be taken from us through inability on our part to respect it in letter and spirit, and yet this very thing has been done in some States and sections and is threatened in others. Every county or city association in " dry " territory might well make the matter a local issue, take control of the situation, outline a policy, eject mem- bers who violate the law, cooperate with the legal authorities, and convince the public, the newspapers, and the officers of the law that pharmacy is a dig- nified and honorable occupation which will tolerate no liquor abuses. This, as I see it, would prove the most effective method of remedying the evil and averting the crisis. As a result of Mr. Mason's address, the association adopted resolu- tions declaring that any druggist who goes into the illegitimate sale of liquor is a disgrace to the profession and should be ostracized by it, and calling upon the local authorities to assist in exposing and penalizing those druggists who abuse their privileges and who thus drag the name of pharmacy into the mire of infamy and degradation. Laudable as this effort is, it will prove of little avail until higher moral standards reach all classes, including even the liberal profes- 246 REPORTS OF THE PRESIDENT'S HOMES COMMISSIOK. sions. The American Medical Association has preached for years against the nefarious traffic in secret and proprietary medicines, but in spite of solemn protests and ostracism, the frightful list of such harmful compounds increases at the rate of about 200 a year. Mounte- banks and hypocrites are not easily subdued and when compelled to respect the liquor law may have recourse to a number of medicinal preparations which are protected hj patents or trade-marks. The following list of medicinal preparations have been analyzed in the office of the Commissioner of Internal Kevenue and are classed as compound liquors for the sale of which a special tax is required : Patent and proprietary compounds containing sufficient alcohol to he intoxicants. American Alimentary Elixir Angostura Aromatic Tincture Bitters... Aroma Stomach Bitters Aromatic Bitters Atwood's La Grippe Specific Augauer Kidney Aid Augauer Bitters Belvedere Stomach Bitters Bismarck Laxative Bitters Biamarck's Royal Nerve Tonic Blackberry (Karles Medicine Company) Blackberry Cordial (LQtemational Co.). . . Blackberry Cordial (Irondequoit WineCo. ) Blackberry Cordial (Strother Drug Co) . . . Blackberry & Ginger Cordial (Standard Chemical Co.) Black Tonic Bonekamp Stomach Bitters Bonekamp Bitters Brown's Aromatic Cordial Bitters Brown's Utryme Tonic Brown's Vin Nerva Tonic B otanic Bitters Celery Pepsin Bitters Cinchona Bitters Clifford's Cherry Cure Clifford's Peruvian Elixir Cooper's Nerve Tonic Crescent Star Jamaica Ginger Coca Wine Callsaya Cuban Gingeric Dandelion Bitters De Witt's stomach Bitters Dr. Brown's Blackberry Cordial Dr. Brown's Tonic Bitters Dr. Hopkin's Union Stomach Bitters Dr. Hoffman's Golden Bitters Dr. Sterki's Ohio Bitters Dr. Dade's Blackberry Cordial Dr. Bouvler's Buchu Gin Dr. Fowler's Meat & Malt Dr. Gray's Tonic Bitters Dr. Hortenbach Stomach Bitters Dr. Worme's Gesundheit Bitters Dr. Ratthiger's Bitters Dubonnet Dubonnet Wine Duffy's Malt Whiskey (Whiskey) Ducro's Alimentary Elixir Elixir of Bitter Wine (Pleasant Tonic Bitters Co.) Elixir Calisava Eucalyptus Cordial Ferro China Bascal Ferro China Bissler Ferro Quina Bitters Fhie Old Bitter Wine Gastrophan Gentian Bitters Genuine Bohemian Malted Bitter Wine Tonic Gilbert's Rctjuvenating Iron and Herb Jnloe. Alcohol by volume. Per cent. 16.16 45.00 19.60 42.14 32.70 35.65 34.13 20.32 2L14 20.67 16.35 19.84 19.96 2L50 25.62 44.62 20.34 37.03 42.14 19.45 27.32 20.44 18.82 27.44 35.90 24.77 16.55 42.65 10.75 31.09 30.15 23.86 29.04 19.64 15.82 26.30 2L67 28.84 39.83 33.70 18.30 15.89 27.92 27.10 18.74 23.01 16.94 22.96 9.18 32.10 28.87 16.96 18.35 26.10 39.95 13.28 23.81 Ginger Tonic Ginseng Cordis Glycerine Tonic (Elixir Pepsin) Green's Chill Tonic Greiner's Blackberry Cordial Harrison's Quinine Tonic Health Bitters Herbton Herbs Bitters Jack Pot Laxative Bitter Tonic Jarvis Blackberry Brandy Jerome's Dandelion Stomach Bitters. Jones' stomach Bitters Juni-Kola Juniper Kadney Cure Karlsbader Stomach Bitters Katamo K.K.K Kola and Celery Bitters Kola Wine Kreuzberger's Stomach Bitters Kudros Lee's Celebrated Stomach Bitters Lemon Ginger LaxaBark Tonic Magen Bitters MetaMulta Mikado Wine Tonic Milbum's Kola & Celery Bitters Miod Honey Wine Neuropin Newton's Nutdtive Elixir O' Hare's Bitters ObermueUer's Bitters Old Dr. Jacques Stomach Bitters Old Dr. Scroggin's Bitters Our Ginger Brandy Ozark Stomach Bitters Panama Bitters Pepsin Stomach Bitters Peptonic Stomach Bitters. Pioneer Ginger Bitters Quinquina Dubonnet Rimsovo Malto-Sove Vino Chino Rockandy Cough Cure Royal Pepsin Tonic Scheetz Bitter Cordial Severa's Stomach Bitters Sirena Tonic Smart Weed Smith' s B itters , Steinkonig's Stomach Bitters St. Raphael Quinquina Strauss Exhilarator Tatra(Latra) Tolu Rock and Rye True's Magnetic Cordial , U-Go Uncle Josh's Dyspepsia Cure Warner's Stomach Bitters , WestphaUa Stomach Bitters White's Dyspepsia Remedy William's Kidney Relief Zeman's Medicinal Bitter Wine REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 247 The percentage of alcohol was ascertained from the Commissioner of Internal Kevenue in a communication dated November 28, 1908.<* On the whole the problem must be solved by educational methods, and hygiene offers many valuable suggestions. It teaches that intem- perance is a vice the result of a violation of natural laws, and in order to eradicate the evil and far-reaching consequences we must endeavor to remove the primary causes. Reference has been made to mental and physical fatigue as an important predisposing factor. The indi- cations are to regulate our life so that we do not burn the candle at both ends, take more rest, more recreation, and more interest in gen- teel amusements calculated to counteract the influence of saloons. The eight-hour labor law is indicated in the interest of health and morals. Quite a number of clear-headed employers appreciate their responsibility in this matter and have appointed social secretaries, " whose duty it is to watch not only over the health, comfort, and happiness of the force during working hours, but also to obtain sufficient knowledge of their private life to be a real help in times of trouble. The secretary establishes luncheon rooms, rest rooms, mutual aid associations, thrift funds, and penny provident banks. Besides the usual betterment features the secretary also arranges many forms of amusements, such as dances, lectures, and musicales. If this func- tionary did nothing more than to teach working people how to en- joy themselves in a sane, healthy way the work would be justified. * * * The cardinal principle of the social secretary's gospel are sanitation, recreation, and equalization." (Review of Reviews, August, 1906.) Hygiene long ago recognized that dust-producing occupations, ex- posure to extremes of heat and cold, and to the inhalation of offensive gases, etc., are fruitful causes of disease in general and the drink habit in particular, and has also pointed out how the injurous effects may be prevented or at least mitigated. Until this is accomplished by universal factory sanitation, pure drinking water and nonalcoholic beverages should be furnished by the employer. Indeed, efforts are being made in Germany to limit in every reasonable way the con- sumption of alcoholic beverages by the establishment of canteens in industrial plants for the sale of coffee, tea, cocoa, milk, hot soups, and soft drinks of every description, all of which allay thirst, while many are stimulating without the injurious effects of alcohol. In 1905 the breweries of Munich and other Bavarian cities stopped the issue of free beer to employees, but allowed an extra compensation of 25 cents a day for beer money. The consumption has been reduced from an average of 6 quarts to If quarts for each employee a day. Money spent in temperance saloons, especially for warm, whole- some food and drinks, will be a good health investment, provided, of course, they are consumed within reasonable limits. It may be stated in general terms that while coffee, tea, coca, spices, and condiments in moderation stimulate the central nervous system, and increase tem- « Compiled from Circular No. 713, December 3, 1907, and No. 727. Circular No. 713 contains the following paragraph : " It must be clearly understood, however, that the list here given is not exclusive and does not purport to give the names of all the preparations for the sale of which special tax is or may- be required, but embraces only those which have been analyzed by this oflSce, and held to be insufficiently medicated to render them unsuitable for use as a beverage. * ♦ ♦>» 248 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. porarily the elasticity of mind and body, their abuse is fraught with danger, and we may have "coffee and tea topers" who suffer from diseases of the nervous system. One of the most effective weapons against intemperance will be found in the thorough training of our girls in domestic science, preferably in the public schools. Apart from the fact that the aver- age expenditures for food are larger than for any other single item, the question of well selected and properly cooked food and of " home making " generally is of the utmost importance to the health and morals of the community. No woman can aspire to higher accom- plishments than to be a good cook ; and a true " housewife " can do more for the physical and moral development of her family, and the cause of temperance, than all the moralists combined. A thoughtful mother, apart from seeing that her family is supplied with good food, will also make the home attractive, inculcate aesthetic home tastes, and, above all, a spirit of thrift and economy. The habit of saving money can not be too strongly urged upon children, and when once strongly rooted offers one of the best safeguards against expenditures for immoral purposes. The beneficent effects of the provident savings system are fully recognized by charity workers and quite a number of American cities have introduced the stamp- saving system into the public schools. Much may be done for the cause of temperance and general sani- tation by introducing the subject of hygiene as a part of the curricu- lum in our schools and colleges, so that the children, the future parents and citizens, may acquire accurate knowledge upon this and other subjects in relation to health and disease. Apart from educational methods we should bear in mind that man is essentially a social animal and if he asks for bread we have no right to offer him a stone. He needs opportunities for recreation to vary the monotony and turmoil of life, and many a young man, with the best of intentions, has found his way to saloons and places of evil resort for lack of better opportunities. When we supply clean and decent amusements we can indeed hope for a higher cultivation and moral training of the male youth of all classes. The writer notes with gratification that such an effort was made in 1902 by the estab- lishment of the " Everett Clark Club House," the gift of Mrs. Potter, wife of the Bishop of New York, and her son. Lieutenant Clark, U. S. Army, to the members of Grace Episcopal Church, Elizabeth, N. J. The special interest of this gift lies in the fact " that it is a signal example of intelligent contribution to the needs of the whole man — religious, physical, social, and aesthetic. Under one roof there is a chapel, kitchen, restaurant, dining, reading, card, committee, smoking, shuffle board, and billiard room, a swimming tank and other baths, gymnasium, running track, and bowling alleys." (Outlook.) Similar efforts have been made in connection with our local churches, and it is to be hoped that the time is not far distant when every church and school in the land will also become a social center. The writer is familiar with the excellent results obtained in one of the Boston churches, in cooperation with the medical profession, in the cure of consumptive and nervous invalids. While not deprecat- ing such efforts, it must be conceded that the most substantial and permanent results will be achieved by preventive rather than curative EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 249 measures, which primarily involves the removal of the cause. So, for example, every effort to diminish intemperance, the drug habit, and sexual excesses will reduce the number of nervous, mental, and moral wrecks. Likewise every effort to improve the housing condi- tions and standards of living will diminish the number of con- sumptives. It is sincereljr hoped that the wage-earners of this country, in addi- tion to cultivating home life and higher ideals, will hold their meet- ings in buildings wholly divorced from saloons, along strictly ethical lines, and in every way in keeping with the dignity of labor. There is certainly room for special buildings dedicated to the improvement of artisans and their industrial and social conditions. RECREATION AND INEXPENSIVE AMUSEMENTS. [By Mabel T. Boardman.] That all people, from the lowest savages to the most civilized races, crave recreation and amusement is a fact that is recognized by all, but the importance of providing sane and wholesome entertain- ment to satisfy this craving is too much overlooked in the case of the least resourceful people. The playground system, boys' and girls' clubs, and social settlement entertainments are fortunate movements along this line as far as children are concerned, but too little has been done to meet this same desire in the older generation. The habits of intemperance and kindred vices are formed not in a man's working but in his recreation hours. The saloon has been frequently called " The poor man's club," and it is quite natural that a man's social inclination should take him where he may find congenial company. He desires the recreation of a chat with his fellow-men. His home is too small, or too much occupied by his family, for him to gather with them there. The factories, or the other places where he may work, are closed, and where save in the saloon can he find the com- panionship he desires ? He can not frequent a saloon without becom- ing its patron, and while at first he seeks it merely for the sake of social companionship, he may become its habitue for the sake of drink. It is unfortunate that in this country there exist so few places like the beer gardens and halls of Germany, where a man can take his family and at a very small expense listen to good music, gossip with his friends, and spend a sane and wholesome evening. If only the philanthropists of a city would build and partially endow some large amusement hall, so constructed that in summer it could be turned into an almost ©pen-air garden, where every evening a good orchestra would provide popular music, or some unobjectionable vaudeville performance be given, while the men could sit talking and smoking around the tables, their families gathered about them, a great deal could be accomplished in the way of keeping them from the tempta- tions the saloon affords. Young men and women of the families could have a respectable place in which to meet, and, with some over- sight, arrangements might be made for part of the large hall to be devoted to dancing. Soft drinks and beer could be sold. Men and 250 REPORTS OF THE PRESIDENT'S HOMES COMMISSION". women whose daily labor may be of a nature that requires little mental work would find the daily task much lightened, for while their hands are occupied with routine work their minds would be filled with the memories of a pleasant yestereven or the anticipation of another one to come. The dreary and monotonous home lives of.^many of the women would not only be lightened by the opening of such great halls during the afternoon hours, but the opportunity on cold and rainy days in winter, or on the hot days in summer, of keeping their children about them in a physically and morally healthful atmosphere would prove of great benefit. The influence of the mother over her children is far greater than can be that of the father, whose work keeps him so much occupied during the day, and anything that can help to improve and better her existence can not fail to directly affect that of her children. For a time taken out of the drudgery of her daily life amused and entertained, much of the dull and tired feeling that often makes her cross, nagging, and irritable will depart, and the home will become a far happier place for the husband and children. Educational departments have in many cities wisely provided pub- lic lectures on a great variety of subjects, mainly of an educational character, but human nature does not wish to devote all its hours of recreation to improving its mental conditions. It desires relaxation ; it wants to be amused. The children of the larger growth need their play time, too, and it is to the satisfying of this craving on the part of the least resourceful people that too little consideration has been given. Of themselves they can provide little or nothing, and the natural desire for amusement makes them too often the prey of the saloon, the cheap sensational theater, or the morbid shows of the penny-in-the-slot character. Thousands of boys and girls leave school every year at the most formative period of their lives, and the nature of the recreations and amusements they indulge in will have a lasting influence and may properly be considered as having still to do with their education in a broad sense. The enormous growth of the 5 and 10 cent theaters and their popularity in all of our large cities is sufficient proof of the need of cheap amusements. When the enter- tainments provided by them are sane and wholesome, even though not of the most elevated nature, they should be encouraged, but cer- tain powers of supervision over these places should lie m the hands of some civic authority, possibly the board of education. Public lectures of a popular nature, travel monologues with ster- eopticon views, etc., should be provided by the educational depart- ment of the city and the public schools used for this purpose in the evenings. Doubtless volunteers for many such lectures could be secured, so that with lecturers and places provided free of cost, the expense need not be great. The parish halls, chapels, and Sunday school buildings of churches might also be utilized for this purpose. If the importance of healthful and wholesome amusement to gratify this demand of human nature is recognized and provided for, there is no doubt there would result a marked reduction of intemperance among the least resourceful people and a general uplift in their social condition. EEPOBTS OP THE PRESIDEKT S HOMES COMMISSION. 251 Chapter X. THE DRUG HABIT. The writer, as a member of a committee of the Medical and Surgical Society of the District of Columbia, appointed in 1896 to investigate the extent of the opium habit, had occasion to witness the physical and moral impoverishment which results from the use of drugs which enslave. The report of the committee was published as Senate Document No. 74, Fifty-fourth Congress, second session, and shows that during the ten years ending June 30, 1895, 7 persons died from the opium habit, 36 persons died from accidental or negligent opium poisoning, and 36 committed suicide with opium or its preparations. Of the accidental deaths 12 were under 5 years of age, while the remainder were over 20 years of age. The statistics have been extended by Dr. H. C. Macatee, and are as follows: 1 B a 1 Suicides from poison- ing by- Accidoi fatal tal or negligent poisoning by — Year. Nar- cotic poisons. Corro- sive poisons. Miscel- laneous, includ- ing car- bolic acid and gas. Nar- cotic poisons. Corro- sive poisons. Miscel- laneous, includ- ing car- bolic acid and gas. Deaths from alcohol- ism. 5^' H. o i i .0 lO I2 lO 6 "■ ,0 1886 . 1 2 1 1 1887 2 .... 1888 1889 2 1 2 1 5 3 6 4 5 9 7 4 4 2 3 9 1 1 1 3 5 9 3 4 4 5 6 4 9 s 1 d3 4 1890 1891 2 1892 ' * 1893 3 2 3 1 "2 1 di 1894 1895 1 .... 1896 3 9 7 6 1 1 1 3 3 .... .... 2 10 2 1 6 10 12 4 14 20 19 20 /SI ""3' 1 1 ""i" 1 2 8 1 1897 ... 12 a3 1 3 blO :::. 1898 1899 2 1 2 "2 .... 17 1900 21 1901 2 1 34 1902 15 1902 (July 1 to Dec. 31 ) 1 d6 d7 d4 1 d3 1 18 all 9 3 5 :::: 9 1903.. 3 23 22 1904 6 4 1 3 1905 1 24 1906 1 2 .... e-S 03 1907 2 im 32 Total 15 87 .... 40 151 23 70 9 8 24 76 ..... 287 That part of the table for the years ending June 30, 1886 to 1805, inclusive, piled by Doctor Kober, and refers to opium only. " One from cocaine. '' One from paraldehyde. ''One from quick pain killer (opium). " Eleven from opium. « One froffn chloralhydrate. f Nineteen from gas. 252 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. In addition there were treated during the same period in the four hospitals of this city 125 cases of opium poisoning and 70 patients for the opium habit. Doctor Macatee has continued this investigation up to date and finds that during the last nine years 256 patients have been treated for the opium habit in seven of our hospitals, and 62 patients for the cocaine habit in three of our hospitals. The report of the committee referred to says: Witliout a most exhaustive collective investigation it is impossible to even estimate the number of persons treated by physicians for acute or chronic opium poisoning who may recover from the immediate effects of the drug, or who have died victims of the opium habit and in which the cause of death may have been assigned to some remote pathological effects of the drug. The investigation of the committee revealed, however, the fact that " there are quite a large number of persons in this city who have become the victims of the opium habit, and that the different prepa- rations of the drug are used in the following manner: 1. The hypodermic injection of morphia. 2. The use of morphia by the mouth and rectum. 3. The use of alcoholic preparations of opium by the mouth. 4. The use of gum opium by the mouth (opium eating). 5. The use of the extract of opium by inhalation (opium smoking). In regard to the actual extent of the morphine habit and the amount consumed, either by the hypodermic method, by the mouth or rectum, it is difficult to present any definite data, but, judging from the statements of our pharmacists, there is scarcely one who does not recall one or more victims to the drug, and, while many refuse to sell morphia in unusual quantities, it is evident from their sales, general observations, and calls for the drug, that the habit is widespread ; some of the victims use as high as 1 dram of morphia a day, one store alone selling about $100 worth of morphia a month. Quite a large number of pharmacists report sales in unusual quan- tities of the alcoholic preparations of opium, such as McMunn's Elixir, laudanum, papine, Squibb's Mixture, and proprietary or secret medicines containing opium, the demand for McMunn's Elixir being especially active, while paregoric and Squibb's Mixture supply the wants of many victims to the use of narcotics. The use of gum opium (opium eating or chewing) is not so very common. Nevertheless, a sufficient number of sales in suspicious quantities reveals the existence of habitues to this form of the drug. In regard to the use of the extract of opium by inhalation (opium smoking) the data are quite meager. Pharmacists have occasional calls for the extract, but are of the opinion that the bulk is supplied by Chinese merchants. Dr. Wade H. Atkinson recently reported to this society a fatal case from opium smoking in the person of a white man aged 28. Doctor Atkinson, in presenting the case, says : I know of about 20 in this city, and I have asked a few others who could most probably estimate the number correctly. A popular drug clerk estimates the smokers at 150. A very noted clerk in a lunch room who is well acquainted with several smokers consulted with them and estimated the number at 500. A special detective in the police department says he thinks there are not more than 20 smokers, and only one "joint" here. Chinese are not considered in these estimates. I believe a fair average of 150 or 200 habitual smokers are in Washington, and know of two "joints." Investigation into the causes of the opium habit leads to the con- clusion that one class of subjects have contracted the habit by the REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 253 dse of the milder preparations of opium, such as McMunn's Elixir, paregoric, Squibb's Mixture, and some of the various proprietary or secret remedies usually employed as domestic remedies. Another class have evidently acquired the habit by the constant use of prescriptions containing opium or its preparations for the relief of pain, the individuals being at first quite unconscious of the enslaving nature of the drug. Competent and experienced phar- macists are of the opinion that prescriptions containing opiates are more frequently refilled than other prescriptions; that copies of such prescriptions are frequently multiplied for friends, and that sup- positories containing opiates are commonly renewed. The social condition of the foregoing classes appears to be of a mixed character, and includes all grades of society, the rich and intellectual predominating. Another class of persons belong to the moral degenerates, or fast men and women, who have acquired the habit by contact with opium habitues and through solicitation, invita- tion, and persuasion of fallen victims to the vice. In the opinion of many prominent pharmacists the habit, from whatever cause, is readily established, because opium and its preparations are altogether too easily obtained. Before considering the question as to the extent to which the State should exercise control in the interest of public health over the sale of poisons reference should be made to the obli- gations of the physicians in the matter. There can be no successful concealment of the fact that the pro- longed and indiscriminate use of opium and its preparations, espe- cially in neurotic subjects, has been a most fruitful cause of morphin- ism, and while inquiry reveals a decrease in the amount of morphia prescribed by the physicians, there are still a goodly number of so-called " morphine doctors " who have received this appellation by pharmacists because they are in the habit of making it one of the ingredients in nearly all of their prescriptions. In view of the fact that prescriptions containing opiates are fre- quently refilled and taken in increased and unauthorized quantities, and may thus establish a habit, in the absence of legal restrictions all physicians should endeavor to reduce the danger from morphinism to a minimum by a judicious employment of the drug and careful supervision of the patient. While some pharmacists believe that the request of the physician on the prescription " not to be renewed " would be generally respected, others believe that the prescription, having been declared the personal property of the patients, is subject to their orders only. It would possibly be wise not to incorporate opium and its preparations in any prescription, and when its use is indicated it might be dispensed by the physician without the knowledge of the patient as to the nature of the remedy. But perhaps the easiest way to solve the question would be to follow the lead of the New York legislature, which, in June, 1887, enacted a law that no pharmacist, druggist, apothecary, or other person shall refill more than once prescriptions containing opium or morphine, or preparations of either, in which the dose of opium shall exceed one- fourth grain or morphine one-twentieth grain, except with the verbal or written order of a physician. The committee submitted drafts of two bills for consideration which it was believed would go far toward preventing the spread of 254 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. the opium habit, and also expressed the opinion that with regard to the sale of proprietary and secret medicines containing poisonous drugs the contents should be clearly expressed on the label, and the word " poison " added, as required in the sale of poisons under ex- isting acts. No action was taken for several years upon these recom- mendations, which were clearly in the interest of public health and morals. In the meantime the cocaine habit also assumed alarming proportions, so that Major Sylvester, chief of the police, in his an- nual report for 1904 (p. 27) called attention to the fact that ex- amination of the poison register of one dealer's place alone disclosed 40 sales in one day. The goods having been put in properly labeled envelopes, there was no violation of the law. In his report for 1905 (p. 36) he pointed out that parties have been apprehended for peddling the drug from door to door, and that some worthy and capable people have wrecked their own lives and made that of others miserable. In each of his reports he urged appropriate legislative action. A new pharmacy law was finally enacted and approved May 7, 1906, which placed greater restrictions upon the sale of poisons in general and the habit-forming drugs, such as opium, morphine, cocaine, chloral in particular, and also made the filling of pre- scriptions containing such drugs in certain doses, except upon the written order of the signer of the original prescription, unlawful. The chief of police, in his report for 1906, on page 23, says : The cocaine habit and sale is the most diflScult to cope with, and the law should be so complete as to prohibit other than licensed druggists, physicians, dentists, or veterinarians having it in his or her possession except on a physician's prescription, and then the package to bear the name of the physi- cian and the patient for whom prescribed. In the report for 1907 he states " that the sale of cocaine has been largely reduced, but there are many who dispense the dtug under cover." Dr. Paul B. Johnson, in his investigation of 175 prisoners in the Washington workhouse, found that 15 had intimate knowledge of the use of cocaine. " Cocaine was described always as used by sniffing the powder into the nostrils, either from the package, or from the palm of the hand, or from the fingers like snuff, or most often by dipping a short quill into the powder and placing the other end to the nostril. It was stated as easily purchased in drug stores or in the rear of barrooms." Dr. Lyman F. Kebler, Chief of the Division of Drugs of the Bureau of Chemistry, United States Department of Agriculture, in a recent paper on the " dope question," refers to the cocaine habitue as socially inclined, offering a friend a "sniff." * * * In fact, whole circles assemble to enjoy a cocaine spree, where the dope, commonly known as " coke," is passed from one to another to take an allotted sniff. In speaking of the effects, Doctor Kebler states that "cocaine in some cases transforms other- wise safe and tractable citizens into dangerous characters, and in most instances wrecks the individual and all depending on him, as well as jeopardizes the lives of many." Major Sylvester, in a letter dated December 6, 1908, writes as follows : Investigation shows that there were about a half dozen druggists making a specialtv of the sale of cocaine and other drugs, and a dozen or more selling BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 255 such to a few customers; the other druggists in the District would not make such sales except to persons whom they had reason to believe would use the same for legitimate purposes, and some of them would not handle it at all. Upon the passage of the present pharmacy law, such sales were stopped by druggists, except a limited number who continue the sale to customers upon whom they could rely not to betray them, and who were actuated by sympathy rather than other motives; three or four others continued the sale, only to be apprehended and fined. The member of the force detailed as inspector of pharmacy has had occasion to bring to court three physicians for writing prescriptions for morphine and cocaine, all of which were aggravated cases, and he has given notice to others not to indulge in the practice. The department, in this work, has had the cordial cooperation of physicians generally, and finds that in their opinion the drug habit, especially morphine, is due largely to the injudicious prescribing of drugs, and it has evidenced an inclination on the part of physicians to curtail the use of them. In the course of his investigation the inspector found that morphine fiends, with two exceptions, had become addicted to the use of the drug through sick- ness or injury; one of those excepted stated he formed the habit through no other cause than that of the lowest depravity, while the other stated he became addicted to its use through having it prescribed by a physician after getting over a long spree. I am informed that there are one or two physicians who have a few patients whom they feel in duty bound to supply with the drug. It is believed that if the law could be made stringent enough to put the sale of morphine beyond the reach of such persons, after they had been treated under confinement, they would make useful citizens. The morphine, laudanum, and kindred drug users, according to the observation of the inspector of this department, have been greatly reduced in number through the efforts of the medical profession. The habit of opium smoking has never become serious in this city; it was slightly increased with the passage of the pharmacy law, as the drug is easier to get from Chinamen, who are hard to detect. It is confined principally to degraded persons, both white and black, who are beyond reformation. Arrests are made by the police and penalties imposed upon the Chinese engaged in the traffic. I think if the penalties inflicted were a little more severe the effect would be more ample. The inspector states that in the course of his investigation he has learned of no foreign white people who are addicted to the drug habit. He finds that the cocaine habit is by far the greatest menace to society, because the victims are generally vicious. The use of this drug superinduces jealousy and pre- disposes to commit criminal acts. In districts where druggists formerly dis- pensed cocaine disorder has decreased so noticeably that it is commented upon by the neighbors and the police officers on the beats ; it has also had the effect that a large percentage of persons using cocaine will not make an effort to get it when it is accompanied by the risk of arrest. The present source of supply is mainly through druggists who are not now in the business, and clerks who are employed at drug stores, who, it is believed, deliver it to persons to peddle when they can find anyone who will purchase. Others procure it from the near-by suburban towns, localities without this jurisdiction. It is quite a difficult matter to convict these people, as possession of the drug is not held to be sufficient evidence. In Virginia possession is held to be evi- dence of intent to sell, and is punishable by not less than one nor more than five years in jail. Under the present law there is no distinction between a clerk and a proprietor ; if a person is registered he can purchase any amount. No person other than a druggist should have the privilege of handling cocaine. It is believed that there are about a dozen persons who peddle cocaine from time to time, and those who use it are numbered approximately by the in- spector's report at about 100. The number of persons who use morphine can not be approximated, as they are distributed throughout all classes of society. Many who use the drug are not known as such habitues outside of their own homes. There have been a number of peddlers or writers of bogus prescrip- tions arrested and fined from $50 to $200, or sent to jail. My information is that the sale of cocaine is about one-tenth of what it was before the present law went into effect. ♦ * * 256 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. MEDICINAL PREPARATIONS WHICH CONTAIN HABIT-FORMING DRUGS. Doctor Kebler says: There are upon the market many medical preparations which contain as ingredients habit-forming drugs. Such drugs are alcohol, opium and its deriva- tives, notably morphine, codeine, and heroin; cocaine, chloral, Cannahis indica, acetanilid, etc. The presence of most of the habit-forming drugs, under the pro- visions of the pure food and drugs act, must now be declared upon the label of drug products, and the public is thus made aware to some extent of the nature of preparations containing these agents. The drug products which contain opium and it derivatives most fre- quently are the painkillers, cough and consumption cures, and sooth- ing sirups. Below is given a list of some of the medicinal preparations which contain habit-forming drugs other than alcohol: Coco-Bola (cocaine). Dr. Seth Arnold's Cough Killer Godfrey's Cordial (opium). (morphine). Harrison's Opium Elixir (opium). Piso's Cure (CannaMs indica). Wright's Instant Relief (opium). Boschee's German Syrup (morphine). Grossman's Specific Mixture (opium). Shiloh's Cure (heroin). Petit's Eye Salve (morphine). Tubercine (opium). P>rou's Injection (morphine). Hooper's Anodyne; the Infant's Carney Common Sense Cure (morph- Friend (morphine). ine). Pierce's Smart Weed (opium). Habitina (morphine). Colwell's Egyptian Oil (opium). Anglo-American Catarrh Powder; Ag- Maguire's Compound Extract Benne new's Powder (cocaine). (morphine). Captol (chloral). Dr. Fahrney's Teething Syrup (morph- Gowan's Pneumonia Cure (opium). ine). Dr. James' Soothing Syrup (heroin). Jayne's Expectorant (opium). Mrs. Winslow's Soothing Syrup Taylor's Sweet Gum and Mullein Com- ( morphine). pound (morphine). Children's Comfort (morphine). Victor Lung Syrup (opium). D. D. D. Remedy (chloral). Dr. Moffett's Teethina; Teething Mexican Oil (opium). Powders (opium). One Day Cough Cure (morphine, Caji- Tucker's Asthma Cure (cocaine). naMs indica). Rexal Cholera Cure (opium). Tousley's Sneezel ess Snuff (morphine). Fruit-Lax (morphine). Watkin's Anodyne (heroin). Dr. Drake's German Croup Remedy (opium). DANGER OF SOFT DRINKS CONTAINING HABIT-FORMING DRUGS. In this connection attention is directed to the danger of soft drinks containing caffeine, extract of kola nut, and extract of coca leaf, the active principle of the two latter being cocaine. According to Doctor Kebler, see Appendix, there are now nearly one hundred different medicated soft drinks on the market. These beverages are extensively advertised, some, in fact, as head- ache remedies and nerve tonics, and sold at nearly every soda-water fountain or as carbonated goods in all parts of the country without the slightest warning to the public of the harmful ingredients con- tained therein. We restrict the use of coffee and tea in children and delicate nervous individuals, and yet these same persons fre- quent the soda fountains, regale themselves with soft drinks, quite unconscious of their contents, experience the stimulating and re- REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 257 freshing effects and soon fall victims to the habit, so that even " Coca Cola fiends " have come into prominence. We have seen how the opium habit may be acquired by the use of the various proprietary or secret preparations (pain killers), usually employed as domestic remedies, and so the cocaine habit may be developed by the use of these much-lauded soft drinks. It is a significant fact that Mr. Vanzant, the special police officer charged with the execution of the pharmacy law, with the exception of the Chinese opium fiends, has never encountered other foreigners who are addicted to the drug habit. This may be accounted for by the fact that nowhere is the habit of self-medication with secret or proprietary medicines for each and every ailment so widespread as in this country. No wonder that insanity and diseases of the nervous system are on the increase, and that the physical, moral, and mental wrecks of the alcohol and drug habit continue to swell the number of dependents in hospitals, insane asylums and other public insti- tutions. From a careful analysis of the evidence it is apparent that the sale of habit-forming drugs is still carried on through the instrumentality of (1) unscrupulous local dealers, (2) depraved and unscrupulous local physicians, and (3) through dealers, physicians, agents, and peddlers located in other jurisdictions. The writer has reached the conclusion that Major Sylvester's pro- posed amendment to the present law will not prove effective unless a law is enacted permitting the revocation of a license to physicians, dentists, and veterinarians whenever, in the judgment of the court, such persons are abusing the privilege of prescribing these drugs. A law should likewise be enacted regulating the transportation of habit- forming and poisonous drugs in interstate and foreign commerce, as contemplated by House Res. 21982, introduced by Mr. Mann, May 12, 1908. REMEDIAL MEASURES FOR THE VICTIMS OF THE ALCOHOL AND DRUG HABIT. The reports of the chief of police show that during the five years' period ended June 30, 1908, there were 27,985 arrests for intoxication in the District of Columbia, an average of 5,596 per annum. Of these, 18,075 were arrests for simple intoxication, and 8,288 arrests for intoxication and disorderly conduct. There being no law against simple intoxication, those detained for this cause are released by the police after they have sobered up. Such cases are taken up as ob- structions and for their own security and welfare, and of these 18,075 cases no doubt " many were saved from injury, robbery, and sickness, if not from death." In spite of precautions taken by the police, a number of deaths from acute alcohol poisoning have occurred in police cells, indicating the necessity of greater discrimination in the care and treatment of such cases. There were 1,622 arrests, an average of 324 per annum, on the charge of habitual drunkenness, and these, together with those charged with disorderly conduct, are held for the court, and many find their way into the workhouse or jail. It is lamentable that 15 of the 675 arrests of persons under the age of 21 years were arrested as " habitual drunkards." S. Doc. 644, 60-2 ^18 258 REPOKTS OF THE PRESIDENT S HOMES COMMISSION. Nwnl)er of arrests in the District of Columbia for intoxication, and intoxica- tion coupled with disorderly conduct, for the five years ended June SO, 1908. Under 21 years of age. Over 21 years of age. Male. Female. Wkite. Colored. Male. Female. White. Colored. 1904. 2 60 60 2 45 17 214 2,978 1,531 12 150 201 188 2,457 945 38 Intoxication 4 20 19 63 671 Intoxication and disorderly 787 1906. Habitual drunkard ...... 3 69 69 2 47 29 1 16 56 261 3,265 1,469 13 206 198 211 2,674 986 63 4 16 797 Intoxication and disorderly 681 1906. Fahltnn.1 d"iTiVftTd , , ^ 1 65 44 1 37 20 272 3.529 1,518 18 241 236 227 2,883 976 63 Intoxication . ... 9 19 27 43 887 Intoxication and disorderly 778 1907. Habitual drunkard 4 50 51 2 27 27 2 31 49 413 3,521 1,246 25 236 182 341 2,870 692 97 Intoxication 8 25 887 Intoxication and disorderly 736 1908. Habitual drunkard Intoxication 4 50 36 1 4 18 S 29 17 2 25 36 340 3,395 1,215 S9 251 135 278 2,775 684 106 871 Intoxication and disorderly 666 647 128 305 370 25,167 2,143 19, 182 8,128 Doctor Macatee's investigation shows that during the past nine years 9,510 patients were treated in the hospitals of the city of Washington for alcoholism; 409 for delirium tremens; 256 for the opium habit, and 61 for the cocaine habit; the majority of these were treated at public expense. All investigation of the records of the Board of Charities reveals the fact that the daily average number of insane chargeable to the District of Columbia has increased from 1,035 in 1901 to 1,317 in 1908. The board, recognizing that the alcohol and drug habit are two of the best known causes of insanity, in 1907 made provisions, in connection with the old almshouse building, for the cure and treat- ment of such habitues among the dependent classes. A bill intro- duced by Senator Gallinger, April 6, 1908, is now pending before Congress, making habitual drunkenness, the habitual use of opium or other narcotic drugs a misdemeanor, punishable by a fine or incar- ceration in the hospital for inebriates for not longer than two years. The act contemplates a rational care and treatment for the cure of the habit, which is best secured by a good dietetic and hygienic regimen, followed by some useful occupation as soon as the patients are able to work, so as to make them self-supporting during the period of abstinence and restraint. The former system of confining such persons in the workhouse and jail is cruel and wholly ineffective. The crying need for compulsory restraint has been pointed out by the chief of police over and over again, and the appeal for humane and scientific treatment of husbands, fathers, brothers, and wives is "RBPOBTS OF THE PRESIDENT'S HOMES COMMISSION. 259 not of recent date. As a matter of f act,<* Congress, in an act approved March 30, 1876, known as "An act to incorporate the Washington City Inebriate Asyhim in the District of Columbia," approved the principle of compulsory restraint and treatment of inebriates. This act provided for the organization of a private institution authorized to receive both free and pay patients, and provided for commitment by court to said institution. * * * Apparently the incorporators never organized the institution as authorized in the act. ADVERTISED HABIT CURES. It is high time that some rational method for the permanent recla- mation of these unfortunate victims be adopted in this and other communities. As it is now, the rich and poor alike fall an easy prey to advertising charlatans, who profess to cure the drug and alcohol habit, when as a matter of fact these so-called drug cures merely ag- gravate the habit and never cure it, and in the case of the alcohol cures, the patients' stomach and digestion are often permanently in- jured and no real good is accomplished. Mr. Samuel Hopkins Ad- ams, in Collier's Weekly, September 22, 1906, published a list of 16 advertised cures for the opium habit when in each case the remedy contained morphine, and says: The whole purpose is to substitute for the slavery to the drug purchased at the corner pharmacist, the slavery to the same drug disguised, purchased at a much larger price from the " doctor " or " institute " or " society." It was hoped that with the enactment of the pure-food law, which requires that the amount of habit-forming drug in any medicine be stated on the label, such nefarious practices would cease. Imagine my surprise at the audacity of a firm, when shown . by Doctor Kebler a preparation known as " Habitina," recommended as a cure for all drug addictions, etc., when the label disclosed the fact that 1 ounce of the solution contains 24 grains of morphine. Mr. Adams mentions a remedy procured from the Rev. W. N. Richie, D. D., 156 Fifth avenue. New York, which contained 2.12 grains of crystallized morphine per dose; the ordinary dose for medicinal purposes is from one-eighth to one- fourth of a grain. No wonder this courageous writer speaks of the opium, morphine, and cocaine cure quacks as the "wreckers who lure their victims to de- struction by false signals." Nor are we surprised that one of these victims wrote to Mr. Adams : When I tried to stop the remedy I found I could not and It was worse than the morphine itself. I then went back to plain morphine, but found that I re- quired twice as much as before I took the cure. That is what the morphine cure did for me. In the appendix will be found Doctor Kebler's list of 52 alleged cures for drug and liquor habits. As an analytical chemist, he con- firms the belief, long since held by the profession, that the drug cures in almost every instance contain a generous proportion of an opiate and most of the nostrums for the cure of the liquor habit contain some nauseating ingredients or slow emetics. The object of the latter treatment is in most cases to make the victim's stomach so sensitive that it will instantly reject anything of an irritating nature like alcohol. It will be readily conceded that such treatment is of no « Extract from letter of the Board of Charities to the CJommlflsionerB, February 4, 1908. 260 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. real value and is likely to produce permanent injury of the stomach and digestive functions. Mr. Adams's comments in Collier's Weekly on this subject are very much to the point. "The Sunday news- papers and small weeklies teem with advertisements of drink cures which are supposed to exorcise the alcoholic craving when secretly given in the tea or coffee. Few of these concoctions can be described as immediately dangerous, though none of them is really safe. All are swindles. They do not cure the drink habit. Once in a while some drunkard will succeed in breaking his fetters synchronously with the taking of the ' remedy,' and the wcmderful ' cure ' is heralded to the world. But the percentage of these cures is so small as to be practically negligible. * * * Speaking of the safe rule to follow in the cure for the drug and alcohol habit, he says : Reputable sanitariums there are in plenty for this purpose; most physicians know of them. The addict who can not be cured in them can not be cured any- where, and might better buy his poison at the regular rate than at a fancy price from the vicious quacks of the advertising school. THE HARMFUL EFFECTS OF SO-CALLED ETHICAL PROPRIETARY MEDICINES, ACETANILID, ANTIPYRIN, AND PHENACETIN. HEADACHE REMEDIES, ETC. Before considering the nostrum evil in general, attention should be invited to Doctor Kebler's excellent unpublished article on the harm- ful effects of the above remedies when employed promiscuously and without medical supervision. For the purpose of this paper it is simply necessary to state that these preparations were used at one time rather extensively by physicians for the reduction of tempera- ture in fevers and for the relief of pain, especially in neuralgia and headaches. The profession, however, soon learned that the adminis- tration of these drugs was attended quite frequently with profound symptoms of depression and other untoward effects, and this, together with a number of fatalities incident to their use, resulted in a gradual but not complete discontinuance of the drugs. In the meantime, how- ever, the pain-relieving properties of these drugs became known to the laity, and they are extensively used in their original form for the relief of headache and other pains, or as ingredients of many adver- tised cures for headaches, etc. According to Doctor Kebler, there are approximately 365 headache remedies now on the market, and the list is by no means complete; about one-half of these have so far been examined by the Bureau of Chemistry under the pure food and drugs act. (See Appendix.) Among these is the remedy known as Harper^s " Curf orheadake Brain Fude," which acquired recently notoriety in the local courts, and which, according to the Bureau of Chemistry, contained, among other ingredients, acetanilid and antipyrin. In regard to the ridiculous claim that such preparations act as food for the nerves or brain, the judge in the case just referred to, in his charge to the jury, said : If that word " brain food," spelled in the two different ways that it is spelled, would convey to the ordinary citizen the idea that it was a food for the brain as contradistinguished from the idea of a food for the whole body, then it is — and I so charge you in this first prayer — misleading and therefore a violation of the law. REPORTS OF THE PRESIDENT S HOMES COMMISSION. 261 The Department of Agriculture has carried on a very exhaustive investigation into the poisonous properties of these drugs for the very laudable purpose of sounding a note of warning as to the injurious and even fatal effects which may follow their ill-advised, prolonged, or habitual use. The following table shows the number of instances in which poisoning, death, or habitual use has been known to result: Total numher of cases. Poison- ing. Death. Habitual use. Acetanilid 909 592 161 31 15 8 144 7 Acetphenetidin (phenacetin) 18 Total 1,665 64 169 Of this total number, 852 were found in medical literature and 813 were reported by 400 of the 925 physicians to whom letters of inquiry had been directed by the department. Doctor Kebler says : Granting that the 525 physicians who did not reply had no cases to report, the question may be profitably asked — if 925 physicians have observed 813 cases of poisoning by these drugs, 28 deaths which were attributed to their use, and 136 instances of habitual use, how many such cases have in all probability been observed by the 125,000 physicians scattered throughout the United States? THYROID EXTRACTS IN OBESITY OR ANTIFAT CUKES. Doctor Kebler," and more recently Drs. Reid Hunt and A. Seidell,^ of the Hygienic Laboratory of the Public Health and Marine- Hospital Service, have called attention to the frequency with which thyroid preparations are being used in the antifat nostrums. As in the case of the remedies just discussed, so, with thyroid extracts, have physicians become extremely cautious in their employment. These preparations were primarily used for the cure of goitre, and, while they produced a marked reduction in the size of the tumor, it was also found that they caused a marked loss in bodily weight, amounting in some instances from 2 to 11 pounds a week, all of which naturally suggested their employment for the reduction of obesity. But the careful observer soon found that these results were not without serious risks to the general health, and practically abandoned the remedy except in some well-selected cases. The manu- facturer of proprietary remedies seized, however, very promptly upon the opportunity to incorporate what must be considered dan- gerous remedies with other ingredients, and offered them as " Obes- ity Food," "Rengo Fruit," " Kellogg's Obesity Food," "Arbolum Mixture," " Marmola," with the usual assurances of being scientific and effective preparations for the reduction of fat. Since thyroid extract is characterized by Dr. Reid Hunt as " the most powerful tissue-destroying drug known," the effects upon the unfortunate vic- tims of misplaced confidence can be imagined. The employment of these agents for this purpose is, however, of such recent date that no • " Journal A. M. A.,** November 10, 1906. » ** Journal A. M. A.." October 24, 1908. 262 fatalities have been reported. We know, however, that several fatal cases were reported when employed under the supervision of com- petent physicians, and, in November, 1906, in an editorial in the "Journal of the American Medical Association," the danger of " organotherapy " in producing arterial degeneration was pointed out, as well as the necessity of being " careful in the application of such remedies, and especially not to hand over the employment of them too freely to the public under such circumstances that they will be used over prolonged periods without proper safeguards and the careful observation of a trained medical mind." THE NOSTRUM EVIL IN GENERAL." Our sociological study of 1,217 families in this city shows that they expended $2,032.39 per annum for patent or proprietary medi- cines. The annual expenditure in the United States has been esti- mated to be not less than $62,000,000. The far-reaching consequences of this traffic, which impoverishes the health and depletes the pocket- book of a large class of persons, has been made, in a fearless and most commendable manner, the subject of popular education, notably by the Ladies Home Journal, Collier's Weekly, the Journal of the Amer- ican Medical Association, Pharmaceutical Journal, and by Prof. Harvey W. Wiley and his associate. Dr. Lyman F. Kebler, of the Bureau of Chemistry, United States Department of Agriculture. The writer has long since taken a keen interest in the subject be- cause as a sanitarian he felt convinced that the harmful effects of this nefarious business upon the health and general welfare of the community have never been sufficiently emphasized, even by the medical profession. The American Medical Association adopted the following principles over fifty years ago : " It is equally deroga- tory to professional character for physicians to hold patents for any surgical instruments or medicines; to accept rebates on prescriptions or surgical appliances; to assist unqualified persons to evade legal restrictions governing the practice of medicine, or to dispense or pro- mote the use of secret medicines, for if such nostrums are of real efficacy, any concealment regarding them is inconsistent with benefi- ■ cence and professional liberality ; and if mystery alone can give them public notoriety, such craft implies either disgraceful ignorance or fraudulent avarice. It is highly reprehensible for physicians to give certificates attesting the efficacy of secret medicines or other sub- stances used therapeutically." No effective work in the propaganda for reform in proprietary medicines was done, however, until the creation of the Council on Pharmacy and Chemistry in the American Medical Association in February, 1905. This council has rendered, and will continue to render, most meritorious services to the cause of humanity. To show the enormity of the traffic and corresponding dangers, the following statement (the data to December 31, 1900, having been originally collected for my " Oration on State Medicine," delivered before the American Medical Association June 8, 1901), is herewith presented: •The author is indebted to Dr. M. Q. Motter for valuable references to the literature of the subject EEPORTS OF THE PRESIDENT S HOMES COMMISSION. 263 Patents issued hy the United States Patent Office, To Dec. 31, 1900. From Jan. 1, 1901, to Oct. 31, 1908. Disinfectants . . 321 250 48 180 376 56 371 78 9(V> Extracts 65 Hair dyes and tonics 7 Insecticides. . 64 58 Plaster 19 Topical remedies 35 Veterinarv 10 Total 1,680 460 Trade-marks issued: Drugs and chemicals 319 5,974 Medical compounds Under date of November 17, 1908, the Commissioner of Patents in- forms me that trade-marks have been reclassified, and since January 1, 1901, there have been issued in subclass No. 6, chemicals, medicines, and pharmaceutical preparations, approximately 2,105 trade-marks. This means that up to October 31, 1908, the office has issued 2,140 patents and 8,398 trade-marks on drugs, chemicals, and medical com- pounds. By the term patent medicine, as properly employed, it must be un- derstood that the composition is known and can be seen at the Patent Office. The proprietary medicine is a secret preparation protected by a trade-mark and hence preferred by the owner, but both are vaguely termed by the public patent medicines. The proprietary medicines are subject to the control of the state authorities and, if containing alcohol in sufficient quantity to be in- toxicants, are subject to internal-revenue laws. But up- to the enact- ment of the pure food and drugs law, June 30, 1906, nothing was done to control the sale of secret remedies and medicinal preparations con- taining habit- forming drugs, the composition of which need not even be disclosed to the Patent Office. Fortunately, section 8 of the act referred to provides that an article shall be deemed to be misbranded * * * if the package fails to bear a statement on the label of the quantity or proportion of any al- cohol, morphine, opium, cocaine, heroin, alpha or beta eucaine, chloro- form, cannabis indica, chloral hydrate or acetanilid or any derivative or preparation of any such substances contained therein. In conse- quence of this very wise provision of the law we are now enabled to estimate the enormity of the harm which must inevitably result from promiscuous use of such preparations. A most excellent report on " secret drugs, cures and foods " was presented by Special Commissioner Octavius C. Beale to the Parlia- ment of the Commonwealth of Australia, August 8, 1907, in which he discusses the subject under six headings, viz : Prevention of concep- tion and feticide; (2) infanticide and infantile mortality; (3) injury and death to the adolescent; (4) injury and death to adults; (5) ad- vertisements; (6) legislation. In view of the importance of the sub- ject, it is deemed desirable to present here a brief summary of the 264 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. most important facts collected by this painstaking investigator, not only in Australia, but also in the United States, Canada, Great Brit- ain, Germany, and France. PREVENTION OF CONCEPTION AND FETICIDE REGULATION OF FAMILIES. In this section Commissioner Beale writes : The practice of interference with the sexual function is so common and the knowledge of it so universal that it would be thinnest hypocrisy upon the part of any grown person to pretend that modesty may be shocked at considering its causes and consequences. The disastrous effects upon men and women are set forth in plain and decent language in the report of the New South Wales royal commission upon the decline in birth rate and upon mortality of children, which it would be well to reproduce by another inquiry over a wider sphere, or indeed merely to reprint for broadest distribution. Just because deception and falsehood are widespread there is occasion to confront them by candid truth. * * * Before me is a co])y of the second volume. * * * There, upon page after page, are photographs of the advertisements of obscene crea- tures who corrupt society at its core and live like larvae upon their own poison and the corruption it causes. The announcements appear to-day just as before, only more of them. To debauch and degrade humanity is a profitable trade. On those pages are also photographs of numbers of preparations to prevent births, of contrivances toward obscene practices. * * * There is only one remedy — morality by act of Parliament, enforced by severe penalties. * * ♦ No attempt will be made to give a comprehensive statement of the means adopted to induce miscarriage. The unnatural practice is assisted by the free sale of drugs, often at exorbitant prices, under proprietary names. These are openly advertised in Anglo-Saxon countries, which differ therein from one another only in degree, the names and descriptions of the drugs being well understood by dealers and users. In order amply to elucidate the subject of criminal abortion by drugs Mr. Beale quotes the following extract from Taylor's " Medi- cal Jurisprudence " (Vol. II, p. 166, et seq.) : The following generalization, which is strictly warranted by facts, conveys a warning to would-be abortionists, whether professional or habitual, or lay and occasional. There is no drug, and no combination of drugs, which will, when taken by the mouth, cause a healthy uterus to empty itself, unless it be given in doses sufficiently large to seriously endanger by poisoning the life of the woman who takes it. In this country, as explained by Doctor Kebler, the publication of advertising matter inviting attention to means whereby conception can be prevented or abortion produced is specifically prohibited by law. In order to circumvent the law, however, the advertising litera- ture is so framed as to clearly indicate the purpose for which the preparation is intended, such as " French Female Pills, a safe, certain relief for suppressed menstruation. Never known to fail. Safe, sure, speedy," etc. Vital statistics show that the birth rate in England has dropped from 34.3 per 1,000 in 1878 to 28 per 1,000 in 1901 ; in South Aus- tralia from 39 in 1885 to 24 in 1906 ; in Germany from 40.4 in 1881 to 35.3 in 1894. The great decline in the birth rate in France has been a matter of much comment, and the latest statistcis show little or no increase in the French population. The birth rate of Paris, already low in 1881, has further declined from 23.3 to 16.6 in 1894. We have no reliable birth rates for the United States as a whole. The census statistics of 1900 show that the birth rate has increased from 26.9 in 1890 to 27.2 per 1,000 of the mean population in 1900. Harrington, in speaking of the decline in birth rates in foreign coun- REPORTS OP THE PRESIDENT'S HOMES COMMISSION. 265 tries, says among the descendents of the original colonists and earlier immigrants the same decline is most evident. * * * In Massa- chusetts the statistics of 1898 show that the greatest proportion of the number of births belongs to the foreign born, the children of native parentage on both sides representing 32.36, those of mixed parentage 19.42, and those of foreign-born parentage 48.22 per cent of the total births. The crude birth rate was 27.37. Mr. Roosevelt is quoted to have said that " there are fewer descend- ants of the revolutionary forefathers living to-day than there were fifty years ago. We must either alter our ways or we must make way lor the other races — Asiatic or whatever they are — that will certainly replace us." Every thoughtful physician and layman rea- lizes that the declining birth rates are chiefly the effects of vice, un- natural interference, and actual homicide. Dr. H. S. Pomeroy, of Boston, over twenty years ago presented the moral, social, and medical aspects of prevention in his book, " The Ethics of Marriage," which evoked the unqualified approval of the late Mr. W. E. Gladstone. The President of the United States has uttered notes of warning on the " race suicide problem," and Profes- sor Emmet, the eminent gynecologist, asks : Can anyone accustomed to treating the diseases of women say in truth the statement is exaggerated that we can see on any one day more sorrow and misery resulting from the abuse of the married state than would be found in a month from uncomplicated child-bearing? Doctor Kebler has furnished me with a list of 51 so-called female pills or regulators advertised in this country. ( See appendix. ) While quite a number may act as abortifacients, the majority are worthless and frauds pure and simple. Among a number of fraud orders issued by the Postmaster-General during the past two years the following transcript from the records of the Assistant Attorney-General's office, submitted May 29, 1908, in the case of Mrs. A. Kirk and the Reliable Remedy Company, 2317 Brooklyn avenue and Eighteenth and Grove streets, Kansas City, Mo., will be of interest: It will be remembered that on October 29, 1907, a fraud order was issued against the Doctor Price Remedy Company, its officers and agents as such, and Mrs. J. Linson and Mrs. A. Miller, 2904 Woodland avenue, Kansas City, Mo. The scheme against which the order was directed was conducted by a man by the name of Arthur P. Miller, and involved the sale through the mails, by means of advertisements in newspapers and circulars, of pills for women to act as abortifacients, which pills in fact were worthless for the purpose, as was well known to Miller. Miller was indicted November 5, 1907, in con- nection with the above case, and on the following day he entered a plea of guilty and was sentenced to a term of six months in the Bates County jail at Butler, Mo., and to pay the costs of prosecution. A report has now been received from the inspector at Kansas City, Mo., that Miller, as soon as the fraud order was issued October 29, moved his desk into the real estate office of a man by the name of William Abel, Eighteenth and Grove streets, Kansas City, Mo., where the two continued the business until Miller pleaded guilty, and that during the time he was serving the sentence his wife conducted the business for him with Abel. * * * In order to receive the mail, these parties advertised under the fictitious names of Mrs. A. Kirk, 2317 Brooklyn avenue, which is the residence of Abel and Miller, and to those persons who replied to their advertisements they sent circulars under the name of Reliable Remedy Company, Eighteenth and Grove streets, which was the office of Abel, in which circulars the addressee was solicited to remit $2 for pills, which were described in language calculated to cause the reader to believe they would act as abortifacients. * * * The inspector says that about 25 letters are being received dailj hj those persons in connection with the scheme. 266 RBPOBTS OF THE PRESIDENT'S HOMES COMMISSION. The inspector states that he presented the above facts to the United States attorney, who caused the matter to be presented to the grand jury, which re- turned an indictment against both Miller and Abel on May 5, to which indict- ments these parties have entered a plea of not guilty and gave bond of $1,000 each to stand trial. * * * Fraud order issued May 29, 1908. Abel was sentenced September, 1908, to pay $25 and costs. INFANTICIDE BY SYSTEMATIC DRUGGING OP CHILDREN. In discussing the subject of infant mortality in relation to the occu- pation of women, the influence of ignorance and poverty has been emphasized, and we quoted Sir John Simon, on page 78," to the effect that " infants who should be at the breast are improperly fed or starved, or have their cries of hunger and distress quieted by those various fatal opiates which are in such request at the centers of our manufacturing industry." We have also referred to the injury done by abnormal cow's milk and the injurious quality of certain proprie- tary and other artificial foods. But when' we contemplate the fright- ful mortality in illegitimate children, and of the stillbirths, especially in illegitimate offsprings, we may well apprehend that this extraor- dinary destruction of life is induced not only by ignorance or poverty, but also by crime. Of the 66,808 births in Washington from 1879-95, 37,781 were white and 29,127 colored, with 1,136 illegitimate births in the white race and 6,706 in the colored element. Of the 7,249 stillbirths in this city during the same period 2,750 were white and 4,449 were colored ; of this number 2,053 were illegitimate, 307 or 15.1 per cent were white and 1,746 or 84.9 per cent were colored. In this connection it is desirable to point out the serious conse- quences of the systematic drugging of children by " soothing syrups," " teething syrups," " children's comfort," " The infant's friend," etc. Doctor Kebler has furnished me with a list of six such compounds, all containing opium or morphine, not to mention the numerous cough and croup remedies in the market. Nearly every one is familiar with " Mrs. Winslow's soothing syrup ;" it contains morphine ; so does " Doctor Fahrney's teething syrup," for, according to Doctor Kebler, the label declares each ounce contains alcohol, 9 per cent ; morphine, one-seventh grain ; chloroform, two-thirds of a minim ; combined with seven other articles. " For babes. A sure remedy for all ailments incident to babes from 1 day old to 2 or 3 years; * * * contains nothing injurious to the youngest babe and if given in proper dose will always relieve." .Elsewhere upon the label occurs the following statement : " Mothers need not fear giving this medicine to the youngest babe, as no bad results come from the con- tinued use of it. Many children have taken 2 and 3 dozen bottles and to-day are hale and hearty boys and girls." This language shows on the face of it that the manufacturer knows full well that the drug is dangerous. It should be known that children are especially sus- ceptible to the toxic effects of opium and its preparations. In De- cember, 1905, a coroner's jury in Baltimore warned the public not to use " Kopp's baby friend," on account of the death of a white in- fant, aged 3 months and 14 days, who had been given this prepara- tion by his mother while suffering from indigestion. The evidence at • Kober's Industrial Hygiene. BEPOETS OF THE PRESIDENT S HOMES COMMISSION. 267 the inquest, according to the district attorney, showed that not only this child, but probably three others in the neighborhood, had died recently from the use of patent medicines administered to them. The Journal of the American Medical Association, February 9, 1907, reports the death of twin children 6 weeks old in New Castle, Pa., caused, according to Doctors Cooper and Warner, by " Kopp's baby friend." The parents gave it according to the directions accompany- ing the bottle — 6 drops every two or three hours to keep the infant from crying. The children were not sick ; they lived about one day after beginning to take the medicine. When Doctor Warner, the attending physician, saw them, they were in the last stage of opium poisoning. They had not been given any other medicine. In the same issue of the Journal are the reports of the death of a child aged 10 months from " Mrs. Winslow's soothing syrup," another death in a child from the effects of " Monell's teething syrup," and still another from the effects of " Rex cough syrup." Space will not per- mit the presentation of other cases or to point out the extreme danger which lurks in many of the cough, colic, and diarrhea mixtures and other proprietary remedies which have killed children and adults and yet are unblushingly advertised as safe and harmless for babes. Every one at all familiar with the subject knows how frequently nurses have to be discharged for " doping " infants, and the fact that 44 children under 5 years of age have perished in this city during the last 10 years from accidental poisoning is sufficient indication of the dangers attending the promiscuous use of poisonous drugs. DIPHTHERIA CURES. Doctor Kebler has furnished a list of 10 advertised diphtheria cures. In view of the fact that diphtheria antitoxin is the only reliable remedy in this disease there can be no question that recourse to advertised cures is fraught with danger to the child. The death rate from diphtheria and croup in 1890 was 97.7 per 100,000; in 1900 it was only 45.2, a decrease of 52.5 per cent. This splendid gain is almost entirely due to the use of antitoxin. The average diphthe- ria mortality where antitoxin was used in 1902 was 6.48 per cent and where not used it was 32.5 per cent. The earlier the antitoxin is employed the lower are the death rates. The mortality in children when used upon the first day was 1.45 per cent, but when used later than the fourth day it rose to 14.49 per cent. ADVERTISED DIPHTHERIA CUBES. Hesperian Tonic, Dr. J. W. Roberts. Cure for Diphtheria, etc. Humbug Oil. Cures Diphtheria. Colwell's Egyptian Oil. Dr. Colwell's Magic Egyptian Oil, cures diph- theria, etc. Hamlin's Wizard Oil. Cures rheuma- tism, diphtheria, etc. Dr. Winchell's Teething Syrup. A cer- tain preventive of diphtheria. Wizard Oil. Dr. Shoop's Diphtheria Remedy. For the relief and cure of diphtheria. Gar-Gol. An absolute specific * * ♦ for all kinds of sore throat. Pre- ventive of diphtheria. Indian Rattle Snake Oil. We guaran- tee a cure for ♦ * ♦ diphtheria and catarrh. Vapo - Cresoline. "Cures while you sleep " whooping cough, * * * diphtheria, catarrh. 268 EEPOKTS OF THE PRESIDENT'S HOMES COMMISSION. INJURY AND DEATH TO THE ADOLESCENT. In this section Mr. Beale considers the exposure of the young to demoralization and even to debauchery by (a) the sale of intoxicants known as "bracers," which are disguised alcoholics; (&) by prepara- tions of cocaine, of acetanilid, of sulfonal, and other synthetic de- pressants, of opium (to a much less extent); (c) by compounded drugs supposed to excite sexual desire; (d) by preparations intended to prevent conception or to induce abortion; and, finally, (e) by the sale of certain things manufactured in Europe which are designed and sold for the sole purpose of nameless and unnatural vices. The subject of " bracers " has already been discussed in connection with the alcohol habit. Those desiring additional information as to their general composition and effects, not infrequently seen in innocent women and clergymen, can do so by consulting the pages of " Collier's Weekly " for October, 1905, or Mr. Beale's report, pages 90-94. Dr. J. D. Morgan informs me of a recent case of alcoholic multiple neuritis in a most estimable lady who had taken Peruna as a tonic We have already discussed the cocaine and drug habit and the shameful traffic in lost-manhood restorers. It is impossible, in the scope of this article, to give an adequate conception of the enormity of the nostrum evil. Some idea may be formed by a perusal of the 431 pages of Mr. Beale's report and an inspection of the storerooms of the Division of Drugs of the Bureau of Chemistry, United States Department of Agriculture, where thou- sands of preparations may be found, not one-tenth of which have been analyzed for lack of laboratory force. And yet the end is not in sight, but the supply is increased, as will be seen by reference to the sta- tistics of the Patent Office, p. 263, at the rate of about 200 a year. "A most able and veracious physician has truly asserted that quackery has destroyed more in this country (Great Britain) than the sword, famine, and pestilence united, and never was there a period in the history of British medicine at which the force and truth of this opinion was more obvious than at this day." (Cited by Beale from the "Lancet," London, June, 1906, p. 1886.) The Standard Dic- tionary defines a quack as a pretender and quotes the following : South Sermons, Volume II, Sermon XXX, page 133: "Quacks and mounte- banks are doubtless a very dangerous sort of men — they are both of them always very large in pretense and promise, but short in performance and generally fatal in their practice." Dr. M. A. Clark, in a recent article on quacks," quotes Steele in his " Spectator " of July, 1712, as saying : Quack doctors who publish their great abilities in little green billets, distrib- uted to all who pass by, are to a man impostors and murderers. I doubt not but that the editors of our great newspapers of to-day would voice the same sentiment, and yet we find these journals full of advertisements of quacks and quack medicines. OONSUMPnON CURES. Doctor Kebler has furnished me with a list of 35 remedies adver- tised for the prevention and cure of consumption. Many of these preparations contain drugs which enslave, but the chief transgression •Atlanta Joornal Record of Medicine, October, IOCS. REPORTS OF THE PRESIDENT S HOMES COMMISSION. 269 lies not as much in their composition " as in the fraudulent methods used in their exploitation, such as symptom blanks and mystic and misleading statements and false claims made in the advertising litera- ture." The medical profession knows that there is no specific remedy for the disease in any of its stages. It is also well known that no germicide, whether taken internally or inhaled, which would kill the tubercle bacilli, could be administered without serious danger to the patient. It is also well known that good food, pure air, and a rational hygienic regimen offer the best chances for recovery, and that patients wlio resort to all sorts of quack remedies in the early stages of the disease deprive themselves of the most favorable opportunity for a permanent cure. It is true the excuse given by many is inability to pay a doctor or druggist, but, as a matter of fact, no person belonging to the dependent classes need ever go without the most skilled medical care and treatment in connection with our dispensaries and hospitals. I have never known a reputable physician to decline to lend a helping hand in directing such patients into the proper channels. One of the interesting features in connection with the alleged consumption cures is that special attention is given to the dietetic and hygienic regimen, which is, after all, the fundamental basis of success and can be had free as a matter of public education. Among the remedies extensively advertised is " Tuberculozyne," which is claimed as having killed the consumption germs, and that all trace of the disease in blood and tissue was destroyed." Doctor Kebler might have added " Liquozone," which in addition to consumption is alleged to be a cure for 36 other diseases from asthma down to tumors and ulcers. Doctor Kebler's list of remedies advertised for the prevention or cure of consumption is as follows: Acker's English Remedy. (?) Allen's Lung Balsam. (?) Ayer's Cherry Pectoral. Ballard's Horehound Syrup. Birch Mountain Tea. Dr. Bull's Cough Syrup. Chamberlain's Cough Remedy. H and N Consumption Cure. Hickory Bark Cough Remedy. Hoff' s Consumption Cure. Dr. King's New Discovery. Lung-Germine. Mrs. Wesley Magg's Consumption Cure. Mizpah Cure. Peruna. Phoric Electric Method. Piso's Cure. Richardson's B Z Lung Tonic. Roger's Compound Syrup of Liverwort, Tar and Canahalagua. Severas Lung Balsam. (?) Eckman's Alterative. Elchert's Cold and Consumption Cure. Father John's Medicine. Foley's Honey and Tar. Fourneir's Throat and Lung Remedy. Germicidal Vapor Inhalation Treat- ment. Dr. Anderson. Shiloh's Consumption Cure. Dr. Stevens' East India Consumption Cure. Tuberculoids. Vanderpool's Consumption Cure, Victor's Lung Syrup. (?) Vinol. Virgin Oil of Pine. Leach Chemical Co. Wilson's Preparation of Hypophos- phites and Blodgetti. Yonkerman Consumption Cure, " Tu- berculozyne." ASTHMA AND HAT FEVER CURES. The following is Doctor Kebler's account of this class of secret remedies : These nostrums are usually sold over the counter. A few of them, however, can only be obtained from the producer direct. As an example of the latter class may be mentioned Tucker's Asthma Specific. This preparation, which is widely advertised throughout the country and enjoys a large sale, consists of 270 REPORTS OF THE PRESIDENT S HOMES COMMISSION. a small bottle of medicine and a spray atomizer. The price of tlie " treatment " is $12.50. Analysis of a sample of the medicine disclosed the presence of cocaine. The remedy should therefore be a good " repeater." Additional sup- plies of the inhalant can be obtained from the producer upon payment of $1 per ounce. Some asthma cures are sold by the producer only after preliminary correspondence and the use of " symptom blanks," as in case of cancer cures. Hayes' Asthma Cure belongs to this class. The remedies themselves may in general be divided into three classes: Medi- cines intended to be taken internally, medicines intended to be taken by inhala- tion, and medicines intended to be burned and inhaled. The preparation known as Davis' Liquid Asthma Remedy is an interesting example of remedies belong- ing to first of these classes. According to the statement which appears upon the label, the product contains over five grains of chloral hydrate to the dose. The directions state that it should be taken " one tablespoonful twenty minutes after meals, at bedtime, and on arising in the morning." "Adults can repeat dose every two hours." " Dose can be increased or diminished, or taken oftener if needed." The statement also appears that it " keeps you from having asthma." The danger of the formation of the chloral habit through the use of such a preparation is apparent. Following is a list of remedies belonging to the general class of asthma cure.s : Himalaya Asthma Cure. Hart's Swedish Asthma and Hay Fever Cure. Haylene Cure. Dr. Olin's Asthma Cure. Dr. R. Schififmann's German Asthma Cure. Green Mountain Asthma Cure. Papham Asthma Specific. Dr. Olin's Hay Fever Cure. Dr. J. R. Stafford's Olive Tar. Himrod's Asthma Cure. Milk Emulsion. Tucker's Asthma Specific. Brater's Asthma Cure. Dr. B. W. Hair's Asthma Cure. Bryan's Imperial Asthma Cure. Taft's Asthma Cure. Ballard's Horehound Syrup. Japanese Oil. Severa's Lung Balsam. Davis' Liquid Asthma Remedy. Davis' Asthma Powder. Warner's Safe Asthma Cure. Asthma Cure. Birch Mountain Tea. Chilean Asthma Cure. Frontier Asthma Cure. Hayes' Asthma Cure. Upham's Asthma Cure. Ascaco. Asthma Cure. Frank Wetzel, M. D. William's Asthma Cure. Renacol. CATARRH CURES. According to Doctor Kebler : Nostrums belonging to this class are usually intended for local application to the nose or throat and are generally prepared in the form of powder (or "snuff"), ointment (or 'jelly'"), or in stick form for inhalation. In addition, there are liquids intended for use as spray or douche. When the " cure " rises to the dignity of a " treatment," a " constitutional " or " blood " medicine is usually added, as in case of " Gauss' Combined Treatment," " Dr. T. F. Wil- liam's Treatment," etc. The catarrh jellies, catarrh powders, and catarrh cures generally are usually sold over the counter, but the " treatments" are furnished upon application to the advertiser direct. The initial advertisement generally contains an offer of free trial treatment or a free book upon the subject of catarrh, in return for the reader's name and address. Accompanying the book or the trial treatment are numerous testimonials and other advertising litera- ture intended to interest the correspondent and secure a sale of the remedy. It is possible that some of these preparations do good in chronic nasal catarrh in a palliative way through a cleansing or antiseptic effort, but nont» of them can possibly make good the extravagant claims made for them with regard to the cure of the disease. REPOBTS OF THE PKESIDENT S HOMES COMMISSION. 271 A list of preparations belonging to tlie general class of given below: catarrh cures" is Bunsen's Catarrh Cure. Crown Catarrh Powder. Catarrh Powder, Britt, Loeffler & Weil, New York. Tousley's Sneezeless Snuff. Dr. A. W. Chase's Catarrh Powder. Dr. Olin's Catarrh Cure. Catarrh Balm. Sanford's Radical Cure for Catarrh. Century Catarrh Cure. Pond's Extract Catarrh Cure. I. C. R. Instant Catarrh Relief. Ely's Liquid Cream Balm. Dr. Agnew's Catarrh Powder. Allan's Catarrh Cream. Biel's Catarrh Jelly. Dr. Slack's Mexican Ointment Milk's Catarrh Cure. Kondon's Catarrhal Jelly. Cole's Catarrh Cure. Dr. Birney's Catarrhal Powder. Thymo Catarrh Balm. Premuim Prescription. Bear's Catarrh Remedy. Dr. Bvory's Diamond Catarrh Remedy. London Catarrh Cure. London Balm. Bering's Vegetable Specific Catarrh Cure. Old Saul's Catarrh Cure. Hall's Catarrh Cure. Gauss' Combined Catarrh Cure. Century Catarrh Cure. Ozojell. Nosena. Pollantin Powder for Catarrh. Paracamph. Dr. Syke's Sure Cure for Catarrh. Ka-ton-ka. Branaman's Catarrh Cure. McCode Catarrh Cure. Sproule's Catarrh Cure. Botonic Blood Balm. B.B.B. Mederine. Grove's New Discovery for Catarrh. Dr. Shoop's Catarrh Remedy. Mucu-Tone. California Mineral Crystals. Hyomei. Davis' Oil. Dr. Blosser's Catarrh Cure. Catarrh Cure. Dr. W. O. Coffee. Microcide. Dr. W. H. Long's Great Mountain Moss Catarrh Jelly. Adlyne Catarrh Treatment. Blackburn's Victory Catarrh Tablets. SKIN CURES. Doctor Kebler divides nostrums advertised for this purpose into two classes: First, those which are claimed to cure skin diseases, like eczema, parasitic skin affections, etc.; and, second, the products which are claimed to be efficacious in the prevention and cure of less serious skin affections, such as erythema, pimples, and blackheads. They are advertised to prevent and remove wrinkles from the faces of persons of any age; to impart youthful properties to the skin, making it " clear, soft, and velvety ; " and to remove completely and permanently all facial blemishes, pimples, blackheads, freckles, tan, sunburn, sallowness, etc. It is claimed in most cases that they ac- complish these results through a nourishing effect upon the skin, " feeding the skin through and through." For this reason they are often called " skin foods." They are analogous to " nerve foods," " brain foods," etc. With regard to this use of the word " food " in connection with the names of medicinal preparations, it may be w^ell to recall the charge to the jury in the recent case of the United States V. K N. Harper (see p. 260). 272 REPORTS OP THE PRESIDENT S HOMES COMMISSION. Following is a list of the remedies belonging to the general class of skin cures: Med-Aseptic Cold Cream Skin Food. Riker's Violet Cerate Skin Food. Hudnutine Toilet Cerate (Skin Food). Marvelous Cold Cream Skin Food. Excelsior Skin Food. Kingsbury's Velvet Skin Food. De Meridor Granulus Cold Cream Skin Food. Acme Tablets. Dermol. Cuticura Soap. Cuticura Ointment. Cuticura Resolvent. W. W. W. Wood's Ointment. Pompeian Massage Cream and Skin Food. D. D. D. Remedy for eczema, etc. Sartoin Skin Food. Epp-O-Tone Skin Food. Cre-Mo-Jel. Wisdom's Rubertim (Skin Food). Poslam. Palmer's Vegetable Cosmetic Lotion. Zema-Cura. Dr. Agnew's Ointment. Perfect C:k)ld Cream Skin Food. Satin Skin Cream and Skin Food. Red Cross Skin Food. C. C. C. Eczema Cure. Dr. Campbell's Arsenic Complexion Wafers. Crane's Eczema Cure. Para-camph. Rexall. Cream of Almonds. Sempre Giovine. Skin Food. Laird's Bloom of Youth. Mme. Hayden's Skin Food. Parisian Electro Skin Food. Kintho Beauty Cream. Aughinbaugh's Cold Cream. Skin Food. Eureka Complexion Tablets. Nadinola. Gourand's Oriental Cream. Lait Antiphenique. RHEUMATISM CURES. The following is an extract from Doctor Kebler's article on nos- trums and fraudulent methods of exploitation : <» MAGIC FOOT DRAFTS. The following are quotations from the literature: " Magic Foot Drafts are known all over the world as the safest, surest, and simplest cure for all kinds of rheumatism. They cure when everything else fails. Best of all, they cure to stay cured. * * ♦ if 100,000 people from every State and Kingdom of the earth have been cured of rheumatism, of every kind and from whatever cause, by Magic Foot Drafts, can any prejudice exist in your mind to prevent your giving the remedy a fair trial?" No one reading these quotations can arrive at any other conclusion but that "Magic Foot Drafts" are capable of curing all forms of rheumatism. "Magic Foot Drafts " consist of pieces of oil cloth, covered on the unfinished side with a border of adhesive mixture, and the central portion with a plaster composed of the following; Per cent. Poke root 30 Pine tar 62 Corn meal 8 These drafts are to be applied to the hollow of the soles of the feet and are claimed to effect cures in the following manner : " By cutaneous absorption curative elements are taken from the draft. These are carried to the blood by the lymphatics, and neutralize the poisons. ♦ ♦ * It (Magic Foot Draft) stimulates the nerves to activity. The nerves in turn act on the muscles, veins and arteries, increasing the circulation of the blood, compelling it to hasten and deliver up its poisons from the whole system to the sweat glands just beneath the skin, and from thence it Is drawn by the draft through the pores and absorbed. Thus is effected a cure, no matter where the pain Is located, because all the blood of the body passed through the capillarle«." There Is nothing whatever in these drafts to warrant such claims and rep- resentations. They possess no curative element whatever which when ab- sorbed into the blood will neutralize the poisons which are supposed to be the cause of the rheumatism and in this manner effect a cure. •Jouraal Am. Med. Association, Novbr. 10 and 17, 1906. KEPORTS OF THE PRESIDENT S HOMES COMMISSION". 273 A particularly interesting feature connected with this scheme is that the promoters when asked for reasons for their claims drew on the writings of the best authors of the country, such as the late J. M. Da Costa, Dr. H. C. Wood, Dr. J. V. Shoemaker, Dr. H. A. Hare, the medical author of the "American Dispensary," and others. These authors, when informed relative to the use made of their writings, vigorously protested, claiming that any interpretation of their writings which would in any way bolster up the scheme of the " Magic Foot Draft" was absolutely unjustifiable. The following lists have been supplied by Doctor Kebler : BHEUMATISM CURES. Kennedy's East Indian Bitters. Nature's Oil. Kelly's Rheumatic Syrup. Warner's Safe Rheumatism Cure. T. Rheumatic Cure. The Great Blood Purifier. Athlophorus. Griffith's Compound Mixture of Guaiac, etc. Dr. Olin's Rheumatic Cure. Dr. MacDonald's Atlas Compound. Specific No. 18. Fulton's Renal Compound. Silodyne. R. R. R. Radway's Ready Relief. Dr. Shoop's Rheumatic Remedy. Wright's Instant Relief. Japanese Oil. St. Jacob's Oil. Mysterious Pain Cure. Hamlin's Wizard Oil. Denver Mud. Albert's Remedy. Cure for Rheuma- tism, etc. Anchor Pain Dispeller. Toxol. Rexall Rheumatic Cure. Dr. Slack's Mexican Ointment. Dr. McConkey's Vigor of Life. Bogle's Quaker Balm. Celestial Oil. Dr. Radcliffe's Great Remedy Seven Seals. Dr. Kilmer's W. O. Ointment. Fenner's Kidney and Backache Cure. Pnin Balm. White's Wonder Worker Herbs. A. D. S. Rheumatism Cure. Griswold's X-ray Pain Killer. Dr. Bell's Anti Pain. Schrage's Rheumatic Cure. Wood's Rheumatic Cure. Ka-Ton-Ka. Reagan's Positive Cure for Rheuma- tism and Asthma. The Wonderful Wintergreen. Great Rheumatic Cure. Rheumetts. Etts' warranted cure for rheumatism. Bi-Lo-Zone. Yolta Powder. Quinine Whisky. Lane's Rheumatic Cure. KIDNEY AND BLADDER CURES. Dr. Gossom's Kidney and Bladder Cure. A specific for Bright's Dis- ease. Bick's Laxative Kidney and Liver Tab- lets. Cures Kidney and Liver trou- bles in all its forms. Bick's Kidney Pills. Brown's Compound Concentrated Fluid Extract of Buchu. Zoeller's Kidney Remedy. (Formerly Black Gin.) National Kidney and Liver Cure. Jay Neway's Kidney and Liver Rem- edy. McBurney's Kidney, Bladder and Rheumatism Cure. Welch's Aegopodium. Mother Gray's Australian Leaf. Dr. Olin's Kidney Cure. O. K. Specific. Dr. Maid's Celebrated Liver and Kid- ney Tablets. Dr. Kilmer's Swamp Root. Dr. Swan's Celebrated Liver and Kid- ney Cure. Chewalla. Dr. Hobb's Asparagus Kidney Pills. S. Doc. 644, 60-2 iS Dr. Bell's Kidney Pills. Warner's Safe Kidney and Liv<] ire. /Vlma-Bromo. Warner's Safe Diabetes Cure. Palmetto Berry Wine with Asparagus Wine. A Texas Wonder. Hall's Great Dis- covery. Removes Gravel. Marsh Root. Kidney and Liver Cure. Rexall Kidney Cure. Crane's Kidney and Bachache Cure. Begg's Blood Purifier. Allan's Kidney and Liver Cure. Dodd's Kidney Pills. Our Own Kidney and Liver Cure. Cer- tain Cure of Bright's Disease. Kidneyetts. Etts warranted cure for kidneys and all urinary diseases. Bouvier's Buchu Gin for the kidneys and bladder. Dr. Hubbard's Kidney and Bladder Capsules. Doan's Backache Kidney Pills. Var's American Kidney Pills. Fitch's Kidney and Liver Cooler. Munyon's Kidney Cure. 274 KEPORTS OF THE PRESIDENT S HOMES COMMISSION. CANCER CURES. The following is Doctor Kebler's account of the method employed by the sure-cure school in incurable diseases. Additional informa- tion on this subject will be found in " Collier's Weekly," July 14, 1906: The initial step in the sale of these nostrums is usually the publication in the newspapers of an advertisement inviting attention to a certain and speedy- cure for cancer. Following is an illustration : " I have proven cancer can be cured at home; no pain; no plaster; no knife. I have discovered a new and seemingly unfailing remedy for the deadly cancer. I have made most aston- ishing cures. I believe every person with cancer should know of this marvelous medicine and its wonderful cures, and I will be glad to give full information free to all who write me and tell me about their case." Those who seek further information in response to such advertisements receive in reply a stock written letter, shrewdly devised so as to give the impression that the communication is a personal one. Accompanying this is a " symptom blank," which the pros- pective purchaser is requested to fill out, and printed matter, including numer- ous testimonials, all setting forth the claim that the remedy in question is a certain, speedy, and painless cure for cancer. If there is delay in ordering the remedy, the inquirer becomes the recipient of letter after letter in which the attempt is made in every conceivable way to cajole him into purchasing the " cure." The cost of the treatment is from $15 to $25 per month, some con- cerns charging more than others. The sufferer is therefore obliged at the out- set to part with a considerable sum of money before he receives the first supply of " treatment." The result is invariably keen disappointment on the part of the victim. The " treatment " consists of tonic and alterative remedies for internal use and simple applications for use upon the skin. They are indeed painless in most cases and are utterly worthless so far as the permanent eradi- cation of cancer is concerned. Following is a list of concerns engaged in the sale of remedies which are claimed to cure cancer : Dr. Bye, Kansas City, Mo. Dr. Curry Cancer Cure, Lebanon, Ohio. C. Gee Wo Chinese Medicine Co., Port- land, Oreg. Indian Black Vegetable Salve & Reme- dies Co., Brooklyn, N. Y. Dr. Johnson Remedy Co., Kansas City, Mo. Dr. L. T. Leach, Indianapolis, Ind. Mason Cancer Institute, 1700-8 Broad- way, New York. Dr. Mixer, Hastings, Mich. D. Needham's Sons, Chicago, 111. Radio-Sulpho Co., Denver, Colo. E. E. Sonanstine, M. D., Colorado Springs, Colo. Dr. Rupert Wells, St. Louis, Mo. C. Henry Wilson, M. D., Brooklyn, N. Y. EPILEPSY CURES. The methods employed by individuals, institutes, or firms who prey upon this unfortunate class of patients are manifold and can best be judged by an extract of a brief submitted by Assistant Attorney- General Goodwin to the Postmaster-General, dated July 23, 1908, and which is as follows : In re The Epileptic Institute Company and the Epileptic Institute and their officers and agents as such at Cincinnati, Ohio, and Dr. H. J. Luecke at P. O. Box No. 99, Cincinnati, Ohio. On June 6 last this concern was cited to show cause why a fraud order should not be issued against it. ♦ ♦ * The facts of this matter as I find them to be are substantially as follows: This business consists of a medical treatment by mail of the disease of epilepsy. One Otto Kalmus, a resident of Cincinnati, commenced the business in the spring of 1903 under the name of Epileptic Institute, and so continued until July, 1907, when he incorporated it under the name of "The Epileptic Institute Company," he continuing as president and general manager and principal owner. As a private address for patients, who, it was explained, might not care to have it known that they were corresponding with an epileptic institute, use has been made of the name of Dr. II. J. Luecke, REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 275 a physician connected, until recently, with the institute. While not with the institute since last November, Mr, Pyle and Doctor Schoenling explained at the hearing that by agreement with Doctor Luecke his name has continued to be used and that the institute receives that mail addressed to him, which is also directed to box No. 99, in the Cincinnati post-office. Until lately communciation with epileptics was obtained through advertise- ments in newspapers, chiefly those circulated among Germans and other foreigners. * ♦ * More recently the practice has obtained of purchasing the names and addresses of epileptics from, as the inspector says, " other concerns " that have obtained all of the money possible from such unfortunates without effect- ing a cure and then mailing circulars to such persons, urging them to take treatment from the institute. * * * The samples of these circulars are among the papers. They are filled with highly colored and extravagant rep- resentations with reference to the unprecedented success of the institute treatment, which it denominates the " Schonka " treatment as a cure for epilepsy; and among other things, it is represented that this treatment is original with the institute and by its means the institute can successfully treat the heretofore considered incurable disease epilepsy, and in many cases effect a cure ; that the treatment is something not known to medical science and is dif- ferent from anything used by the profession in such cases ; that the physicians of the institute are skilled and experienced specialists and include " one of the foremost examining specialists in America, etc." The time that this institute urges its patients to continue the treatment is from a year to a year and a half, and longer, varying, of course, in different cases. Its charge for medicine ranges from about $3 to $9 a month, the variance depending, it seems, upon the amount which the patient can be induced to pay. Here follow 10 pages of evidence. The report, on page 13, states: The medical treatment so glowingly advertised by this institute as a " cure " for epilepsy is based on the bromides. It is what in general is known as the bromide treatment. Except, and this is where the institute tests its claims for unusual and peculiar efiicacy, that the drug adonis vernalis is used in conjunc- tion with the bromides. In connection with the medical treatment the usual and ordinary rules regarding diet, hygiene, etc., are also given. Dr. L. F. Kebler, Chief of Drug Laboratory Bureau of Chemistry, United States Depart- ment of Agriculture, informed the Assistant Attorney-General " that what is in general known as the bromide treatment is in common use by the profession in treating epilepsy ; that its physiological action has been quite well defined ; that It is not a ' cure ' for the disease, but acts simply as a sedative, and in this way tends to suppress the attacks ; that medical science to-day has no drug treatment that will cure this disease; that the disease is among the most diflScult and intractable of all diseases to treat, and that a small per cent of the more favor- able cases only have been successfully treated, and that the success in these instances has been due most probably to the condition of the patient himelf rather than to the medication." Doctor Kebler has also drawn my attention to the following recognized medical authorities, who speak of the use of bromides in treating this disease, and more especially of evil effects that may follow their long continued use. Here follow quotations from well-known medical authors, strongly opposed to the promiscuous and indiscriminate use of the bromides by epileptics. Of these the opinion of Dr. Wm. T. Sprattling, an authority on this disease and medical superintendent of the Craig Colony for Epileptics at Sonyea, N. Y., a state institution of recog- nized merit, speaking of the evils that may attend the bromide treat- ment, on page 364, says: If pushed too far, death may supervene from acute bromide poisoning. This happened in the case of a boy of 12 years whom I knew, whose parents gave him too frequent doses of a patent nostrum, the essential ingredient of which, as with the bulk of patent epileptic cures, was bromide of potassium. All of the other citations from medical authorities are of similar import. The testimony also shows that in the opinion of such emi- nent physicians as Drs. J. H. Musser, Eichard C. Cabot, N. S. Davis, 276 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. E. L. Hunt, Charles G. Stocton, Wm. P. Sprattling, and Chas. S. Williamson, it is impossible to make a reliable diagnosis of epilepsy in the absence of the patient by the use of what are known as '' symptom blanks " sent through the mails. The evidence further shows that, in the opinion of these physicians, the promiscuous and indiscriminate use of the bromide by epileptics, without the guidance of a physician other than advice sent by mail, is attended by danger to the patient. As to the merits of adonis vernalis, the other drug used by the concern, six of the physicians knew of no instance in which the cure of epilepsy could be attributed to the use of this drug. Dr. Wm. P. Sprattling's answer is qualified as follows : No; not that drug alone. The proper treatment of all the epilepsies — there are many kinds — can only be carried out under the following essential heads: Medical, general, dietetic, and surgical. Epilepsy of any type can no more be properly treated by the use of drugs alone than can tuberculosis be treated by drugs alone. A combination of the essentials is called for in each case — and it is the scientific application of these that alone can produce the best results. The evidence discloses the fact that " there have been connected with this institute since it commenced business in the spring of 1903, three physicians, namely. Dr. E. H. Schoenling, Dr. H. J. Luecke, and Dr. A. L. Guertin. Dr. Schoenling stated at the hearing that for about the first six months, being half owner for the first three months, he attended to the medical end of the business for Mr. Kal- mus, examining the symptom blanks and diagnosing the cases, pre- scribing the treatment, and compounding it as well ; that after he left Doctor Luecke did this work until December, 1907; and that since then he has again done the diagnosing and prescribing, and Doctor Guertin has done the compounding. Doctor Schoenling graduated in 1900, when about 22 years of age, has made no special study of epi- lepsy except in connection with this mail-order business, is not a mem- ber of any medical society, is not regarded in the profession as a specialist, and has most of the time since his graduation worked for $25 a week for a Dr. Charles Shafer, of Cincinnati, who advertises in the public prints, soliciting kidney and urinary and sexual cases. The salary paid him for his work at the institute, he says, has been less than $100 a month ; he stated that he spent but a few hours each day at the institute and regarded it as a sort of side line to his regular work with Doctor Shafer. Doctor Luecke graduated in 1901, went to this institute in 1903, has had no special preparation in epilepsy, does not consider himself a specialist, and was paid by the institute, the inspector says, only $15 a month. He is not a member of any medical society, his professional standing is doubtful, his regular practice is sexual and urinary dis- eases, and in December last his advertisements were excluded from the Cincinnati papers on the ground that they related to the sale of abortifacients and the performing of criminal operations in violation of the statutes of the United States. Doctor Guertin receives $35 a month from the institute for his services, works there but a few hours each day, is not a member of any medical society, his standing in the profession is questionable, he has little or no practice in Cincinnati, and was investigated by this department in 1905 for giving a concern against which was pending a charge of fraud under these statutes, and against which a fraud order was later issued, a testimonial as to its medicine, which he later admitted to the department was done for REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 277 a valuable consideration and without reading the statement which he was paid to sign, and which he repudiated as untrue. He admits he is not a specialist. Those are the self-styled specialists, and " foremost examining specialists of America " of this institute. No comment is needed on these facts to show the utter falsity and fraudulency of the represen- tations in question." The brief, which covers 32 pages, also discloses the fact that this institute has treated in all about 6,000 persons, and concludes as follows : The physicians of the institute were not specialists as pretended, nor did the staff of the institute include the foremost examining specialises of America, but in truth the physicians of the institute were young graduates and men without standing in their profession and following questionable lines of practice, and were men employed at what would seem to be about as small salaries as any at which the required service could be obtained; and the treatment intended to be adniinistered was not entirely harmless, but was of a nature that might wreck the health and even reason and life themselves of the patient. There- fore, while, in what may be said to be a comparatively few instances — as the institute has not disclosed its re(?ords in the great number of its cases — patients have experienced from the treatment what is the ordinary effect of the bromides and may feel satisfied with so much, yet I feel it is not true that the other and the greater share of the patrons of the institute have not been deliberately deluded with false hopes and representations, and defrauded of the money which they probably would not have paid if aware of the facts, in addition to having their health, reason, and life endangered. The answer to the claim that certain of the patrons are satisfied with what benefit they do get from the treatment, is that in that event, were the business conducted with an honest purpose, there should be no occasion for promising any more. The satisfaction of the few is not justification for the defrauding of the many. Furthermore, this scarcely is a case in which the patients are sufficiently familiar with the facts to be able to determine whether they should be satisfied or not, and this is especially so of the patient who has commenced the treatment but comparatively recently, and particularly among the class of people among whom it appears the most of the business of the institute is solicited. I find that the business conducted by Otto Kalmus under the name of the Epileptic Institute and the Epileptic Institute Company at Cincinnati, Ohio, referred to above, is a scheme for obtaining money through the mails by means of false and fraudulent pretenses, representations, and promises, and I therefore recommend the issue of a fraud order. The United States attorney at Cincin- nati has caused criminal proceedings to be instituted against Mr. Kalmus for having devised and used the mails in the operation of a scheme to defraud in violation of section 5084, Revised Statutes, in connection with this Epileptic Institute business. A fraud order was issued July 23, 1908. THE MIRACLE WORKERS. Mr. Samuel Hopkins Adams, in Collier's Weekly, August 4, 1906, gives an excellent account of several magnetic quacks, radio-quackery, etc. The following memorandum is copied from the records of the Assistant Attorney- General's Office in the case of Prof. T. A. Mann, Institute of Radiopathy and Central School of Psychology, and their officers and agents as such at Rochester, N. Y. The Postmaster- General, April 29, 1908, issued an order forbidding the delivery of mail matter and money orders to this concern. * * * ''In these advertisements he endeavors by the use of misleading and ex- travagant assertions to lead the reader to believe that he is a doctor of eminence in the United States, that he has discovered a wonderful 278 EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. force of nature possessing marvelous curative properties, that by means of this power he is able to and will cure diseases which are generally considered hopeless. Among the representations calculated to produce this belief are those to the effect that ' with his phenom- enal poAver this man works wonders, the blind see, the paralyzed walk * * * there is no illness which he can not cure ; ' he gives back health in a most incomprehensible manner to sick people who have been declared by physicians to be incurable; that he can and will cure blindness, deafness, consumption, paralysis, cancer, etc.; that he has found the most marvelous power man has so far invented. * * * His advertisements extended to the foreign press and com- plaints are in the case from the Italian consular agent at New York, from a member of the Berlin Press Association, from Mr. Louis Michel, a prominent American residing in Germany, and from sev- eral other persons, to the effect that Mann is swindling thousands of poor persons in Italy, Germany, France, Spain, South America, Central America, Mexico, and Cuba. One of the pamphlets issued by him states that ' we thoroughly explain to you how to renew youth and how to keep it ; how to acquire force and how to use it to conquer environment.' " ' OTHER FORMS OF QUACKERY. TOPICAL REMEDIES.^* Among these may be mentioned the fraudulent and misleading advertisements in connection with many of the hair restoratives, tonics, hair dyes, and a number of cosmetic preparations especially intended for colored people, like "Glossine," "Anti-Kinkine," " Kink- ine," "Straightine," "Ozonized Ox Marrow," for which it is claimed that they will make kinky, knotty, and curly hair straight. The hair restorers are credited with the property of producing a luxuriant growth of hair, " make the hair grow out on bald spots," " turn gray hair dark," etc. Medical literature contains a number of instances in which symp- toms of lead poisoning and cases of paralysis were traced to the habitual use of cosmetics, hair dyes, and hair restorers. In the Pharmacal Journal (Vol. LXXIV, p. 223) will be found a list of hair restorers. In 12 articles analyzed the percentage of lead varied from 0.3 to 2.32. Other drugs in such preparations have been known to produce violent inflammation of the scalp. In this category also come some of the skin tonics, face lotions, and toilet preparations. One of the 9 analyzed contained 47 grains of corrosive sublimate and this same poison was contained in varying proportions of 1 to 15 grains per ounce in all; and yet it is claimed that they are " perfectly harmless for the removal of freckles," " to make pretty faces, etc." In discussing the subject of skin bleaches and beautifiers, Doctor Kebler says that one of the agents used for improving the complexion was found on analysis to consist largely of Rochelle salts. Another product sold under the designation of " complexion tablets " contained, among other ingredients, strychnin, and he relates an instance where a child 2| years old accidentally consumed a number of these tablets and died from strychnin poison- o See Doctor Kebler's interesting article on nostrums and fraudulent methods of exploitation, Jour. Am. Med. Assoc, Nov. 10-17, 1906. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 279 ing. In this connection he also exposes the fraudulent claims of the Mexican Remedy Company for its "Aquamiel," " a magical bust de- veloper and the most marvelous bust producing, blood enriching, tissue forming preparation — a product of the famous mague plant of Mexico." Analysis showed that the medicine is absolutely worth- less as a tissue developer, etc. In like manner he disposes of the numerous plasters advertised as " positive cures for consumption and other ailments," " the American Herb cure," and " Force of Life remedies," " Nutriola," etc. PRESCRIPTION NOSTRUMS." Since the passage of the food and drugs act, which forbids the use of any statement, design, or device which is false or misleading on the label or package of any drug product, etc., the manufacturers of nostrums found themselves seriously handicapped. But as in all diabolical pursuits, a way appears to have been found to circumvent the provisions of the law. Doctor Kebler informs us that as long as the law does not forbid the publication of misrepresentations and fraudulent statements in newspapers, this opening is taken advantage of by many promoters of medicinal agents. A rather common method is the jmblication in the newspapers of advertisements ex- tolling the virtue of certain remedies in certain diseases. Often the receipt is published in connection with the advertisement or fur- nished upon application free of charge. The prescription, however, always contains at least one product bearing a unique coined name, the nature and composition of which is known only by the advertiser, or the parties interested in furnishing the sale of the remedy. As a result the local druggist is either unable to compound the prescrip- tion, or in doing so he is compelled to obtain it from the parties in question, or the patient is compelled to have the prescription filled by the advertiser at an exhorbitant price. Doctor Kebler states that this is really an old scheme, which was exposed in the " Druggists' Circular," page 3, 1859, in connection with the consumption cure of a fictitious Rev. Edward A. Wilson, and a questionable " Extract Blodgetti." The individual behind this scheme during recent years was a Mr. C. A. Abbott, who himself has no medical knowledge whatever, and it appeared in the recent investigation by the Post- Office Department that wdth regard to the Wilson Remedy, no such ingredient as extract blodgetti was used. This name was used in the prescription solely for the purpose of making it impossible for the average druggist to iill, thereby compelling the patient to send the advertiser $3 for the treatment, although he has no intention of in- cluding extract of blodgetti in the compound furnished by him on such orders. The Postmaster- General promptly issued a fraud order March 20, 1908. Doctor Kebler calls attention to the "Arabian Sea Grass " prescrip- tion in connection with " Le Grande Arabian Recipe," exploited by a Dr. J. A. Lawrence, of Brooklyn, N. Y., " for the cure of catarrh, «» Condensation of the subject-matter contained in a special paper prepared for the Commission by Dr. Lyman F. Kebler, Division of Drugs, U. S. Dept. of Agriculture. 280 BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. bronchitis, hay fever, and all diseases of the mucous membrane," and of which the " Druggists' Circular " in 1885 said : It thus appears that 9 out of the 16 substances either do not exist or are not articles of commerce. The trap is so evident that no druggist need fail to see it, but we have no doubt that many persons are influenced to send the " Doctor " $3 for the medicines. Doctor Kebler writes of a similar scheme under the designation of " Dr. Stevens' East India Consumption Cure," and gives the follow- ing sample of the advertisement used in newspapers : Consumption. An old physician, retired from business, had placed in his hands by an East India missionary the formula of a simple vegetable remedy for the speedy and permanent relief of consumption, bronchitis, catarrh, asthma, and all throat and lung affections; also a positive and radical cure for nervous debility and all nervous complaints. Having tested its wonderful curative powers in thousands of cases, and desiring to relieve human suffering, I will send free of charge to all who wish it this recipe, with full directions for pre- paring and using. Sent by mail, by addressing, with stamp, naming this paper, W. A. Noyes, 847 Powers Block, Rochester, N. Y. As in the case of the Wilson remedy, the patient, upon replying to the advertisement, received printed matter setting forth a prescrip- tion, testimonials, and a story telling how " Dr. Stevens," who in 1886, was afflicted with consumption, was cured through the agency of the " Sativa remedy," which he received from the hands of an aged missionary who had spent many years in India and other countries of the East, and who had given the recipe to his successor, W. A. Noyes, the present owner of the business, with the admonition to carry on the work of making the remedy known to the afflicted as long as was possible. The prescription contained 10 ingredients, among them 2 unknown substances. Investigation by the Post-Office Department developed the fact that there was not, at the time of the investigation nor had there ever been a Doctor Stevens or a missionary connected with the scheme, and a fraud order was promptly issued. It will be readily understood that such schemes can not be carried on for any length of time without attracting the attention of the officials of the Post-Office Department or of the Bureau of Chemistry. The scheme finally evolved, according to Dr. Kebler, is " that the false and misleading representations, statements, and promises should appear in newspapers in the form of ' reading advertisements.' " The advertisement usually contained a prescription, the filling of which required several well-known efficacious agents, together with a " fancy name " product. The prospective patient was advised that the prescription could be filled by any druggist. The druggist, therefore, is made a party to the scheme. In order to render the scheme more effective, it w;is found desirable to place the advertise- ment in papers in such a manner as to make them appear either as editorials or general reading matter. As can readily be seen, this required the acquiescence and cooperation of those interested in the management of newspapers. On inquiry it was found that news- paper managers require an increased rate in placing these advertise- ments, double the regular price being the customary charge. From the large amount of advertising and the number of these remedies, this scheme has apparently been very attractive, not only to the news- papers, but to the promoters of these remedies as well. The earlier REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 281 mail-order remedies were intended for the ignorant classes, but the modernized scheme is for the benefit of the better educated, and that it does appeal to this class is shown by the fact that requests for in- formation concerning the same come from lawyers. Congressmen, doctors, etc. The following is a copy of one of the advertisements: AN editor's advice TO KHEUMATICS. It is truly said that the " Lord tempers the wind to the shorn lamb," and He also seems to send for every ill a remedy. Modern science has done much to develop these remedies, yet sufferers from rheumatism occasionally find it hard to believe that there exists any positive relief for their distress. Never- theless, we are in a position to recommend to our readers who suffer from rheumatism or kidney or bladder trouble or any derangement of the urinary or^^ans an unfailing relief for their pains. This, we know, will be all the more welcome news because the remedy is easily produced. Go ask your druggist for one-half ounce fluid extract cascara aromatic, 1 ounce of concentrated compound, and 4 ounces of aromatic elixir. The compound is put up only in 1-ounce bottles, so be sure you get the right article. Take these three things home, put them in a bottle, mix them, and take 1 teaspoonful after each meal and at bed time. For children, from one- third to one-fourth of this dose will be enough. In order to make a permanent cure doubly certain it is best to continue taking the remedy for several days after all pain and swelling have disappeared. You will then be as free from pain as if you had never known what rheumatism was. Investigation by Doctor Kebler shows that " since the passage of the federal law about 40 of these prescription nostrums have been launched. * * * The price charged is exorbitant to a degree. * * * This is admitted even by the promoters, but the contention is that it is necessary to charge a high price because of the extensive and expensive advertising necessary to bring the remedies to the atten- tion of the public. The men back of these schemes are usually nt)w, or have been, connected with some advertising agency or have acted in the capacity of advertising agent of some newspaper. They have no knowledge of medicines and claim none is needed, because the large pharmaceutical manufacturers are prepared not only to supply the medicine but the medical data as well. The afflictions usually aimed at for treatment by these remedies are those affecting the lungs, stomach, liver, kidneys, and heart." ErnCIENT WORK OF THE POST-OFFICE DEPARTMENT AND OF THE DEPART- MENT OF AGRICULTURE IN ENFORCING THE LAW AROUSES OPPOSITION. Sufficient evidence has been presented to indicate that the executive departments of the Government are determined to administer the law upon the principle that " Righteousness exalteth a nation." It was to be expected that the promoters of fraudulent transactions would leave no stone unturned to accomplish their purpose. In the lan- guage of " Collier's Weekly," June 23, 1906 : There was an ominous presumption of foreknowledge in what Attorney Lan- nen, representing the National Food Manufacturers' Association in its fight for adulterated foods, said at the pure food hearing : " I say that it will be but a short time (sic) before the Post-Office Department will be made to conform to better rules in promoting justice." On March 12, 1906, a bill was introduced by Mr. Crumpacker in the House of Representatives to provide for a judicial review of 282 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. orders excluding persons from the use of United States mail facili- ties." The effect of this legislation, in the judgment of the Post- Office Department, would be to paralyze the good work by the Gov- ernment in suppressing " fake get-rich schemes," " quack medicinal cure-alls," and an inconceivable variety of confidence games per- petuated through false and misleading advertisements, such as have in the past cost the public millions of dollars. According to the report of the Postmaster-General " over 2.400 fraud orders have been issued by the Post- Office Department under authority of the act of 1890 and the supplemental act of 1895. In less than 30 of these cases has the propriety of the order been chal- lenged in court, and in none of them has it been held erroneous or unwarranted. This record is of exceeding significance, and shows clearly that the administration of these statutes by the Post-OfRce Department has been marked by the utmost care and conservatism. The period of time extends over the administration of many different Postmasters-General of varying political parties, and the same thor- oughness and judicial caution have characterized the administration of the statutes by all of these officers. This record is strong assur- ance that their future enforcement will be marked by full regard for the rights and privileges of all citizens." The following are extracts from the statement of the case by the People's Lobby: FRAUD ORDERS NOW REVIEWED BY THE COURTS. From this excerpt it is clear that the courts do now review the action of the Postmaster-General in issuing orders. In order to relieve the department of unjust criticism, however, the Postmaster-General is not opposed to an express provision of the law for a review in the manner provided by the bill prepared by Representative Foster, a member of the Judiciary Committee, which meas- ure was passed over in favor of the Crumpacker bill. Although the measure is of such vital importance, it was never submitted to the Postmaster-General for his opinion, nor was he asked to appear before the Judiciary Committee of the House. The Assistant Attorney- General for the Post-Office Department appeared of his own volition and argued against the bill. * * * It is positively asserted by the Post-Office Department that the influences behind the Crumpacker bill are B. G. Lewis, of St. Louis, Mo., " Prof." Thomas F. Adkin, of Rochester, N. Y., and the "Hon." E. F. Hanson, of Chicago, 111. Lewis was the promoter of the People's United States Bank, which was organ- ized to transact all its business through the mails. A fraud order was issued against the People's Bank, July 6, 1905, because of the alleged false and fraudulent representations which the Postmaster-General declared Lewis made in the promotion of his scheme. Of these one of the most important was the promise that no loan of funds should be made to the president or to any of the directors of the bank. Up to the time of the issuance of the fraud order loans had been made to Lewis and to certain of his business enterprises aggregating $907,538.83 upon insufficient security or no security at all. The action of the Postmaster-General in issuing a fraud order against the People's Bank was reviewed by the United States circuit court of appeals, and the Postmaster-General was fully sustained. Adkin was the head of the so-called " New York Institute of Physicians and Surgeons," of Rochester, N. Y., which, in advertising a treatment for disease denominated " vitaopathy," made such extravagant claims as in the following advertisement : " Dead man talked back to life. Miraculous rescue from grave. Medical science completely upset by Rochester wonder-worker, who restores life and heals the sick without the use of drastic drugs or the surgeon's knife; hope- less invalids restored to health. KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 283 " I feel that it is my duty as a Christian to use this wonderful power that has been given to me for the benefit of all mankind to cast out from their body the evils of disease. I have cured them that quiclily that I have been credited with working miracles." Adkin and the " New York Institute of Physicians and Surgeons " were de- nied the use of the mails, and the action of the Post-Office Department was sustained by the supreme court of the District of Columbia. Hanson organized the " Nutriola Company " at Belfast, Me., and subsequently moved his patent medicine business to Chicago, 111. A fraud order was issued against this concern. Furthermore, Hanson was indicted and convicted on the charge of misusing the mails because some of his literature was improper and obscene. * * * The Congressional Record bears out the charge that the Crumpacker Bill was railroaded through the House. Three days before the holiday recess the sponsor oi this measure secured the passage of a resolution placing it on the calendar as a privileged bill. It is of particular importance to note that Mr. Crumpacker put through his resolution largely on this statement : " I submitted the bill to Mr. Overstreet, the chairman of the Committee on the Post-Office and Post-Roads * * * and he said the bill ought to be passed. He has had experience enough to believe the bill ought to pass, and all I am asking now is to give the bill a status on the calendar so as it can be taken up on its merits." Mr. Overstreet was absent when this statement was made. As a matter of fact, the chairman of the Committee on the Post-Office and Post-Roads made the strongest speech in opposition to the bill when it came up for final action January 7, 1907, and objected privately to Mr. Crumpacker that morning on the inadequate time to be allowed for the consideration and discussion of so vital a measure. Representative Mann, of Illinois, also opposed the bill in a vigorous manner. The Crumpacker Bill is now in the Judiciary Committee of the Senate, where it is hoped more consideration will be given to the protection of the public and less weight attached to the interests of borrower Lewis, the " Hon." E. F. Hanson, and " Professor " Adkin. It is gratifying to note that the bill was held up by the Senate Judiciary Committee for a careful consideration. CONCLUSIONS AND RECOMMENDATIONS. A review of the evidence in the foregoing pages reveals the fact that existing laws are insufficient to cope with the evil. The enactment of Mr. Mann's bill, House resolution, and other amendments to the poison law. while steps in the right direction, will not prevent im- proper traffic in the habit-forming drugs so long as we have to deal with unscrupulous persons even in the ranks of the medical, dental, or veterinary profession — and for whom adequate punishment should be provided whenever, in the judgment of the court, they have abused their professional rights and privileges. As far as the sup- pression of quackery is concerned, nothing short of a total exclusion from the mails of letters, newspapers, circulars, pamphlets, or publi- cations of any kind containing any advertisement of secret remedies for the cure and treatment of disease, will reach the evil. As a matter of fact, no physician should be permitted to prescribe by mail. In view of the importance of the subject, it is recommended that a special commission, composed of representatives of the Post-Office Department, Prof. H. W. Wiley, of the Bureau of Chemistry, and medical officers of the Public Health and Marine- Hospital Service, be appointed for the purpose of investigation and the formulation of such legislation as may be deemed necessary in the interest of public health and morals. 284 REPOBTS OF THE PRESIDENT'S HOMES COMMISSION. Ill the meantime, it is earnestly recommended that the Postmaster- General be requested to publish with the monthly supplements to the Official Postal Guide a bulletin setting forth the essential facts in connection with the fraud orders issued during the preceding months, such bulletins to be posted in post-offices and to be distributed in sufficient numbers along the rural-delivery routes. It is also recom- mended that all information concerning the harmful ingredients in foods, medicines, soft and alcoholic drinks which may come to light during the execution of the pure food and drugs law, be published by the Department of Agriculture in the same manner as farmers' bulletins are now being published. The public is entitled to be warned, and for this purpose it is essential that the indisputable facts should emanate from some official source. The Journal of the American Medical Association has done good work in educating the medical profession, and many of our lead- ing magazines have disseminated knowledge of this kind among their readers ; but, after all, the masses must be reached in the manner indicated, as the majority of newspapers will not publish the facts. Chapter XL SOCIOLOGICAL STUDY OP 1,251 FAMILIES. [By G. H. Weber, Statistician of the Commission.] SCOPE. The investigation, which was conducted during the months of February to June, inclusive, covered a total of 1,251 families, occupy- ing 1,054 houses, and comprising 5,157 persons. The plan of the commission was to investigate only those families whose incomes were below $1,000 per annum. In some cases, where family incomes were greater, but where the families lived under the same general conditions and on the same streets and alleys, they were also in- cluded. In selecting the streets, courts, and alleys the aim has been to take a number of alleys where the living conditions were worst, a fairly equal number where they were medium, and a corresponding number where the conditions were the best. This was done in order to give, as nearly as possible, a true picture of the housing, social, and economic conditions of these people as a whole. It has also been the aim of the commission to have the investiga- tion cover a proportion of white and of colored families equal to that of the total white and colored families of that class in Washington. The following table shows, by streets and sections, the number of houses, families, and persons included in the investigation: EEPORTS OP THE PRESIDENT S HOMES COMMISSION. 285 WHITE. Northwest: Twenty-seventh street Cissel alley Temperance avenue Lingers court Potomac street Jackson Hall alley Valley street Bank street Snow aUey JefEerson street Thirtieth street Purdys court Total. Northeast: Gales street Twentieth street. Brewers court . . . Pleasant alley... Kjamer street... Total. Southeast: L street K street Fourteenth street. Twelfth street Fifth street Thirteenth street. Greorgia avenue... Mechanics place . . Total. Southwest: Rileys court , Twelfth street Maryland avenue. Huntoon place Armory place Union street McLean street Willow Tree alley. Nolans court F street Total Total, all sections. COLORED. Northwest: Twenty-seventh street Cissel alley Temperance avenue Lingers court Brainard street Potomac street Jackson Hall alley Kings court Philips court Cleveland street Shepherd alley Valley street O street alley Bank street Snow alley Number of houses, 23 10 al 65 a 12 21 1 2 o38 2 12 C127 Number of families. 109 144 («) ol86 d566 13 5 e33 e27 7 /5 el6 9 16 44 13 29 36 6 42 143 29 148 33 191 Number of persons. Adults. 64 29 2 4 25 53 66 3 5 134 436 104 27 33 12 116 292 372 558 594 Children under 16 years. a Not including 1 house occupied by both colored and white persons. bNot including 2 houses occupied by both colored and white persons. eNot including 6 houses occupied by both colored and white persons. «lNot including 7 houses occupied by both colored and white persons, « Including 1 house occupied by both colored and white i)ersons. /Including 2 houses occupied by both colored and white iwrsong. 227 220 301 1,000 286 REPORTS OF THE PRESIDENT S HOMES COMMISSION. Number ofhouses. Number of families. Number of persons. Adults. Children under 16 years. Total. COLORED— ccntinued. Northwest— Continued. Goat alley. . . . . 39 a 10 3 A7 16 4 113 45 17 57 22 2 170 Jefferson street 67 Johnson avenue 19 Total 6 353 m 1,261 535 1,796 Northeast: Gales street 6 12 11 6 15 11 16 46 22 6 34 17 22 Levis street 80 39 Total 29 32 84 57 141 Southwest: Armory place 3 38 31 o34 6 »8 41 49 46 10 »-25 100 118 109 34 4 47 43 73 9 29 Van street 147 Willow Tree aUey 161 Nolans court 182 F street 43 Total a 112 ■ M 386 176 562 Tot^l, all sentions C494 d657 d 1, 731 768 2,499 Total, white and colored cl,060 d 1,251 d3,389 1,768 5,157 o Including 1 house occupied by both colored and white persons. b Including 6 houses occupied by both colored and white persons. c Including 7 houses occupied by both colored and white persons. d Includes 2 mixed families, 7 white and 5 colored adults living together, all counted as colored. Of the 1,251 families investigated 594, or 47^ per cent, were white and 52J per cent were colored, and of the total persons constituting these families 2,658, or 51J per cent, were white, and 2,499, or 48^ per cent, were colored. LIVING CONDITIONS. The poorer people of Washington, unlike those of most other cities, live mainly in small one- family houses. This is shown by the fact that 2,151 families visited occupied 1,054 separate houses. These houses are nearly all old two-story brick or frame buildings without such modem conveniences as hot and cold water, bathrooms, or inside water-closets. Cases of overcrowding were common, especially among the colored people, in some instances as many as eight or ten people occupying one bedroom at night. Cases were also common where families crowded in one or two rooms at night when sitting or dining rooms could have been utilized for sleeping purposes. In general, however, where apartments were small and families large, all avail- able space, even the kitchens, were used as bedrooms. While the num- ber of families keeping boarders or lodgers was comparatively small, not a few cases were found where members of families of both sexes, old and young, slept in the same rooms with lodgers. The moral and sanitary effects of such conditions are obvious. KEPORTS OP THE PRESIDENT S HOMES COMMISSION, 287 INCOME AND EXPENDITURES. In the case of 1,217 families, for which fairly accurate returns were made concerning income and expenditures, 476, or 39 per cent, had a family income of $500 or less per annum; 159, or 13 per cent, had an income of from $500 to $600 ; 153, or 12^ per cent, from $600 to $700 ; 153, or 12i per cent, from $700 to $800 ; 89, or 7 per cent, from $800 to $900 ; 93, or 8 per cent, from $900 to $1,000 ; 82, or 7 per cent, from $1,000 to $1,500; and 12, or 1 per cent, had an annual income of over $1,500. The average income and expenditures for each of these groups are shown in absolute and relative figures in the following tables : Average annual expenditures of one family. Income. Num- ber fami- lies in class. Aver- age size of fami- lies. Average income per family. Rent. Food. Fuel and light Cloth- ing. Insur- ance. Sick- and death. Class A, $500 or under Class B, SoOO to S no Class C, $000 to $700 Class D, $700 to SSOO Class E, $800 to S9:)0 Class F, $900 to $1,000 Class G, $1,000 to $1,500... Class H, $1,500 and upward 476 159 153 153 89 93 82 12 3.11 3.94 4.18 4.40 4.79 4.77 5.48 4.50 $351. 35 546. 31 638.57 749. 91 846. 93 921. 41 , 182. 93 1,899.58 $72. 69 97.44 106.16 119. 04 115. 12 127. 36 135. 52 100.58 $146.85 220. 55 265.55 296.54 341.65 340.73 378. 74 401.00 $26. 25 33.88 32.18 38.01 37.03 38.91 41.81 49.83 $32. 54 53.62 69. 67 82.75 97.68 104. 13 148. 48 193. 16 $12.25 20.24 19.05 16.08 23.79 24.22 31.08 32.83 $5.43 5.05 6.77 9.90 10.51 8.80 15.46 47.83 Income. Class A, $500 or under Class B, $.500 to $000 Class C, $600 to $700 Class D, $700 to $800 Class E, $800 to $900 Class F, $900 to $1,000 Class G, $1,000 to $1,500... Class H, $1,500 and upward Num- ber fami- lies in class. 476 159 153 153 89 93 82 12 Aver- age size of fami- lies. 3.11 3.94 4.18 4.40 4.79 4.77 5.48 4.50 Patent medi- cines. $0.97 1.18 1.69 1.35 1.40 .97 3.71 2.08 Liquor, $8.82 16.44 21.08 18.67 12.77 15.31 14.78 21.25 To- bacco. $4.72 7.64 11.10 13.12 13.52 16.25 12.53 19.50 Amuse- ment. $5.02 11.27 14.52 28.91 30.95 41.41 38.40 73.00 Miscel laneous or other $34.34 69.36 74.23 82.35 102. 64 109.90 210. 02 241.16 Total. $349.88 636.67 622.00 706.72 787. 06 827. 99 1,030.53 1,182.22 Sur- plus. $9.64 16.57 43.19 59.87 93.42 152. 40 717.36 288 EEPOBTS OF THE PKESIDENt's HOMES COMMISSION. Showing same averages hy percentage. Income. Num- ber fami- lies in class. lies, ^^^ Rent. Food. Fuel and light. Cloth- ing. Insur- ance. Sick- and death. Class A, 1500 or under Class B, $500 to $600 Class C, S600 to $700 Class D, $700 to $800 Class E, $800 to $900 Class F, $900 to $1,000 Class G, $1,000 to $1,500. . . . Class H, $1,500 and upward. 476 159 153 153 89 93 82 12 3.11 3.94 4.18 4.40 4.79 4.77 5.48 4.50 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 21.37 17.56 17.17 15.64 13.31 13.60 10.96 5.37 43.68 43.59 41.40 40.21 41.92 38.43 33.38 21.03 6.74 5.41 4.88 4.89 4.33 4.05 3.34 2.77 8.99 9.90 10.53 11.14 11.59 11.70 11.55 10.23 2.80 3.04 2.67 2.27 2.77 2.90 2.39 1.90 2.12 .81 1.00 1.40 1.30 1.10 1.34 3.22 Income. Num- ber fami- lies in class. Aver- age size of fami- lies. Patent medi- cines. Liquor. To- bacco. Amuse- ments. Miscel- laneous or other. Total. Sur- plus. Class A, $500 or under Class B, $500 to $600 Class C, $600 to $700 Class D, $700 to $800 Class E, $800 to $900 Class F, $900 to $1,000 Class G, $1,000 to $1,500.... Class H, $1,500 and upward. 476 159 153 153 89 93 82 12 3.11 3.94 4.18 4.40 4.79 4.77 5.48 4.50 0.29 .16 .18 .18 .13 .11 .23 .14 1.97 2.33 3.27 2.32 1.39 1.89 1.41 .90 1.21 1.45 1.82 1.71 1.52 1.76 1.19 1.02 1.47 2.76 2.68 3.52 3.43 3.95 3.97 4.00 7.76 10.78 11.20 10.78 12.04 11.89 14.01 14.08 98.39 97.73 96.82 94.10 93.76 91.42 86.29 64.58 3.18 2.42 3.18 5.90 6.28 8.58 13.71 35.42 Average weekly expenses {per cent). Income. Meats. Fats. Sugar. Bread. Vege- tables. Fruit. Coffee. Tea or cocoa. Class A, $.500 or under 1.13 1.67 1.84 2.16 2.38 2.27 2.76 3.31 0.24 .38 .38 .42 .51 .51 .85 .95 0.13 .19 .18 .21 .23 .22 .28 .30 0.48 .62 .65 .64 .82 .74 1.00 1.75 0.53 .80 1.06 1.42 1.50 1.65 1.34 1.02 0.16 .13 .18 .22 .23 .33 .35 .38 0.13 .17 .23 .27 .28 .33 .35 .32 0.07 Class B, $500 to $600 .13 Class C, $(J00 to $700 .15 Class D, $700 to $800 .15 Class E, $800 to $900 .18 Class F, $900 to $1,000 .20 Class G; $1,000 to $1,500 .17 Class H, $1,500 and upward .11 These fibres show actual money received and expended. In the expenditures no items appear unless they represent money actually paid out. Where items of rent, food, clothing, etc., were unpaid at the close of the year they do not figure in the expenditures. The average family, with an income of $500 or less per annum, expended about $6 per month for rent, this item constituting about 21 per cent of the total family income. The average monthly rents for the other six groups were about $8, $9, $10, $9.50, $10.50, and $11, respectively. It will be observed, by consulting the second table, that the proportion of income paid for rent diminishes steadily with the increase in the family income. Thus, an average family with an income of $500 or less expended 21 per cent for rent; an average family with an income of $500 to $600 expends 17^ per cent; $600 to $700, I7i per cent; $700 to $800, 15f per cent; $800 to $900, 13i per cent; $900 to $1,000 13§ per cent, an average family with an income of $1,000 to $1,500, and living in the territory investigated, expends only about 11 per cent of its income for rent. BEPOETS OF THE PBESIDENt's HOMES COMMISSION. 289 In the matter of food the average family earning $500 or less expended about $147 per year, or about 44 per cent of the total in- come. This proportion also decreases almost steadily with the increase in income, the average family in the highest class paying propor- tionately onlj^ about 21 per cent of its income for food. The same is true with regard to fuel and light, for which the average family of the lowest income group pays $26, or 6f per cent, for fuel and light, while the average family of the highest income group pays about $42, or 2| per cent. While for these necessities of life, i. e., shelter, food, heat, and light, the proportion of expenditure increases with the decrease of income, it is not so with other items. In the matter of clothing, the propor- tion increases steadily from 9 to about 11 J per cent in the first six income groups, namely, those of $1,000 and under, and then decreases to lOJ per cent in the highest income group. The proportion of the income paid for insurance varies irregularly in the different income groups, being distinctly higher, however, in the case of families with incomes of less than $1,000 than in the case of families whose incomes are higher. The items of amusements, like that of clothing, increases proportionately with the increase in family income. The other items of expenditure show no marked tendency to increase or decrease in family income. The expenditures for liquor and tobacco, as shown in the table, are probably less than those actually incurred, as all the investigators report a tendency on the part of the families visited to minify this item of expense. As it is, however, it shows that by eliminating this useless expense an average family earning $500 or less per annum could save over $12 per year, which, if added to the rent, would materially improve the home conditions of the family. In the case of the other families with incomes of $1,000 or less per annum, the average annual expenditures for liquor and tobacco range, in the different income groups, from about $24 to $32. Taken as a whole, the families investigated could add on an average of at least one room each to their overcrowded homes if the money expended for intoxi- cants and tobacco were devoted to the payment of rent. Sickness and death (including expenditures for patent medicines) caused an annual expenditure ranging, in the different income groups, from about $6.50 to $50 per annum. The surplus remaining after deducting the annual family expend- itures from the annual family incomes, as shown by the income groups, increased steadily with the family income, ranging in amount from $6.40 in the lowest group ($500 per annum and under) to $718.92 in the highest group. It must be remembered that this last group consists largely of families who live in the environments where they were found on account of business interests, such as families of grocers, saloon keepers, etc., or of foreign males who maintain cooperative households and send a large part of their earnings to their dependents abroad. The 1,123 families whose incomes were less than $1,000 per annum had an average income per family of $559 per year. Of this average income, $435, or 78 per cent, were expended for actual necessities, namely, for rent, food, fuel, clothing, insurance, sickness, medicines, S. Doc. 644, 60-2 ^20 290 KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. and death. This leaves but $124, or 22 per cent, for all other expendi- tures and for savings. Of this balance $23, or 4 per cent of the entire income, were expended for intoxicating liquors and tobacco ; $15, or 3 per cent, for amusements; $63, or 11 per cent, for miscellaneous; leaving $23, or 4 per cent of the average income, to be laid aside as savings. OCCUPATIONS. Of the total occupants of the houses visited, the occupations of 2,413 wage-earners were ascertained. Of these 821 were white males, 708 were colored males, 153 were white females, and 731 were colored females. It will be noticed that of the white people visited and whose occupations were reported, only about 17J per cent were females, while of the colored people over one-half of the wage-earners were females. Of the white males, about 42J per cent were skilled workers, such as carpenters, painters, machinists, etc.; 27^ per cent were unskilled laborers; 9i per cent were clerks, salesmen," etc. ; 8 per cent were peddlers and hucksters ; 6 J per cent were drivers and teamsters. The remaining 7J per cent were shopkeepers, persons engaged in personal or domestic service, and various other occupations. Of the colored male wage-earners, 56J per cent were unskilled laborers; 19^ per cent were drivers and teamsters; 7^ per cent were engaged in personal or domestic service; 5f per cent were skilled workers ; 2 per cent were clerks, salesmen, etc., and the remaining 8| per cent were in other occupations. Of white female wage-earners, 38J per cent were clerks, saleswomen, etc.; 15| per cent were dressmakers and seamstresses; 7| per cent were laundresses; 7 J per cent were engaged as cooks and domestic servants; 6J per cent were charwomen; 5 J per cent were shop- keepers, and 4 per cent were waitresses and dish washers ; the remain- ing 15 per cent being employed as nurses, hucksters, and in other occupations. Of the colored female wage-earners, 57j per cent were laundresses ; 34J per cent were cooks and domestic servants ; 3 per cent were dress- makers and seamstresses; 2i per cent were charwomen, and the re- maining 2J per cent were waitresses, dish washers, nurses, school- teachers, shopkeepers, etc. These occupation statistics show that the colored population was engaged mainly in the unskilled manual occupations and in personal or domestic service, while the white population were mostly engaged in somewhat higher-class work. The two following tables show the number of persons engaged in each of the leading occupations in each section of the city and in the entire district covered by the investigation: KEPORTS OF THE PRESIDENT S HOMES COMMISSION. Occupation of males. 291 White. Colored. Occupation. o gJ 5^ it 1® CO !* 3 S3 i i 5 3 6 1 1 7 2 18 1 io 16 4 37 35 7 10 ■■4' 4 ""'5' 2 14 4 5 10 2 ...... 39 109 16 28 1 5 1 1 21 3 11 3 17 2 15 2 ■■■42' 41 6 17 '"'h' 1 12 J5 25 13 34 18 12 168 226 46 76 5 65 17 5 39 12 Carpenters 2 2 2 2 48 16 Machinists . 25 13 Painters 2 2 36 18 Tinners 7 50 41 17 21 4 48 11 4 13 12 Other skilled laborers 23. 276 107 10 42 8 3 1 46 3 14 8 2 3 8 110 23 3 8 34 400 138 15 53 8 5 1 48 202 Unskilled laborers 626 Drivers and t^arnstprs . . 184 Clerks, salesmen, etc 91 Personal service 58 Peddlers and hucksters 73 Shop keepers 2 22 Other independent workers 6 2 87 Total 239 155 259 168 821 522 32 154 708 1,529 Occupation of females. White. Colored. Occupation. ^ 6^ II !^+i 5^ ^ 4 15 ""9 1 ....„ 5 3 18 1 8 ""3" 1 3 ....„ 1 1 10 59 2 24 3 12 3 10 1 9 20 30 Clerks, saleswomen, etc 59 Cooks 61 13 ...... 19 3 80 21 82 Dressmakers and seamstresses Hucksters 10 45 3 3 2 324 4 13 1 2 4 81 1 418 6 2 170 2 6 6 430 Nurses 9 School teachers 2 Servants, domestic Shop keepers 2 2 2 4 3 3 2 1 4 3 2 10 ""2 9 8 6 17 143 23 2 1 1 179 10 Waitresses and dish washers Miscellaneous 5 5 12 23 Total 44 26 53 30 153 565 26 140 731 884 Of the total number of white wage-earners enumerated, 101, or lOJ per cent, were reported as being members of labor organizations ; and of the colored wage-earners only IJ per cent belonged to labor unions. HOUKS OF LABOR. The hours of labor of these wage-earners varied from two to eight- een per day, the number working more than ten and less than eight being comparatively small. Of the total number reporting hours of labor, 25f per cent worked eight hours per day ; 11^ per cent worked nine hours, and 22 per cent worked ten hours per day. These, to- gether with a small number working eight and one-half and nine and one-half hours per day, make the total number working from eight to ten hours per day equal to about 61 per cent of the persons whose hours of labor were reported. Of the rest about 3J per cent of the entire number worked less than eight hours; 22 per cent worked over ten hours, and 13J per cent worked at irregular hours. 292 BEPOKTS OF THE PRESIDENT S HOMES COMMISSION. Those working over ten hours per day were mainly colored laun- dresses and female domestic servants. The following table shows the number of white and colored wage- earners classified according to the number of working hours per day : Time employed per day. White. Colored. i 1 i 1 *5 5 •3 1 % 1 55 1 1 1 |1 r li hours 2 hours 2 2 3 3 5 2i hours S hours 4 1 6 4 1 7 4 8i hours 1 1 1 1 1 4 2 2 4 hours . . 1 8 44 hours 1 1 1 1 5 hours 2 1 . .... 1 5 2 7 11 bi hours 2 11 2 3 16 If. 6i hours 1 2 1 71 1 5 1 5 5 303 15 155 8 226 11 23 1 7 hours '"'82' 9 36 2 S3 3 4 86 4 30 6 115 11 6 1 84 '""29' ....„ 8 2 10 15 7i hours 6 8 hours 131 4 60 2 165 1 41 8 ...... ....„ ...... 91 12 230 5 83 3 227 2 54 633 8i hours . 20 9 hours 238 9? hours 11 10 hours 49 453 IO5 hours . . 13 11 hours . 15 1 77 12 hours . . 13 1 2 7 2 3 9 29 3 8 172 13 37 3 1 6 3 ....„ 73 3 \ 1 251 19 40 7 2 280 13 hours 22 14 hours 2 1 48 15 hours 7 ' 1 2 4 17 hours . 1 26 1 154 2 89 1 15 3 127 4 Irregular 57 71 23 281 Total 224 186 349 201 960 759 46 2% 1,101 2,061 EMPLOYMENT. In the case of 2,439 wage-earners returns were maiXe concerning the continuance of employment during the year covered by the in- vestigation. Of these, 993 were white and 1,446 were colored wage- earners. Of the white wage-earners, 581, or 58 J per cent, were employed the entire year; 42, or 4J per cent, were idle an average of 11 weeks on account of illness, and 370, or 37J per cent, were idle an average of 16J weeks for other reasons. Of the whole number of white wage- earners (including those working full time) the average time lost during the year was about 6J weeks out of the 52. The colored wage-earners show a larger proportion of unemploy- ment, if the latter is measured by the number of persons idle, but the average time lost of all colored wage-earners is almost the same as that of the white. Thus, of 1,446 colored wage-earners, 634, or 43} per cent, worked the full 52 weeks; 161, or llj per cent, were idle an average of 5.4 weeks on account of sickness, and 651, or 45 per cent, were idle an average of 13.4 weeks for other reasons. The average period of idleness of aU colored wage- earners was a little less than EEPORTS OF THE PRESIDENT S HOMES COMMISSION. 293 6J weeks. It appears, therefore, that while the white wage-earners are more steady in their employment, their periods of unemploy- ment, both on account of illness and for other rea^ns, are longer than those of the colored wage-earners. The figures of unemployment are shown by color and geographical section in the following table : WeeJcs employed. 05 S ^ Wage-earners idle on aceouut of illness. Wage-earners Idle for other reasons. Num- ber. Total weeks idle. Weeks idle per person. Num- ber. Total weeks idle. Weeks idle per person. WHITE. Northwest 268 177 342 206 158 80 204 139 12 13 15 2 Ill 190 148 16 9.3 14.7 9.8 8.0 98 84 123 65 1,627 1,569 1.834 1,039 16.6 Northeast 18.7 Southwest 15.0 Southeast . . . 16.0 Total 993 581 42 465 11.1 370 6,069 16.4 COLORED. Northwest 1,088 57 301 611 43 80 122 1 38 673 5 199 5.5 5.0 5.2 455 13 183 6,869 150 1,694 15.1 Northeast 11.5 Southwest 9.3 Southeast Total 1,446 635 161 877 5.4 651 8,713 13.4 Total white and colored 2,439 1,215 203 1,342 1 6.6 1,021 14,782 14.5 Average weeks idle per wage-earner : White 6.5 Colored 6. 6 The reasons given for unemployment are very meager, the persons visited being generally averse to answering this inquiry. In the case of white wage-earners, the reasons given were inability to secure work in 43 cases ; illness in 42 cases ; old age in 4 cases ; drunkenness in 3 cases; bad weather in 3 cases, and laziness in 1 case. Among the colored people the causes assigned were illness in 161 cases; in- ability to secure work in 62 cases; laziness in 11 cases; bad weather in 11 cases; old age in 8 cases; drunkenness in 5 cases; incapacity in 2 cases, and lack of skill in 1 case. wage-earners' lunches. Inquiries concerning the meals of wage-earners brought out the in- formation that in 678 cases they were compelled to eat cold victuals, 750 carried dinner pails, and 205 were reported as being accustomed to consume alcoholic beverages with their meals. The number in each case was greater among the white than among the colored wage- earners. SICKNESS. The returns concegrning illness show that of a total population of 5,157 persons enumerated, there had been 613, or 12 per cent, sick during the past year. It is very likely, however, that in this enumer- ation many cases of slight illness had been forgotten by the families when visited, as the actual sickness rate must have been much higher. This rate was considerably higher among the colored than among 294 REPORTS OF THE PRESIDENT S HOMES COMMISSION, the white population. The average duration of sickness per case was reported to be 29J days for a total of 607 cases. The average dura- tion of illness was reported to be much longer in the case of colored than of white persons, namely, 22.4 days and 35.6 days, respectively. The deaths reported during the past year were likewise surpris- ingly few, although the investigators made a special effort to obtain complete returns. Thus, there were reported but 23 deaths among the white, and 34 deaths among the colored population, making a death rate of 9 and 13 per 1,000 respectively, figures which are ob- viously too low. The most frequent causes of death reported were tuburculosis, 11 cases; pneumonia, 7 cases; heart disease and indi- gestion, each 4 cases. The cases of permanent disability as shown by the returns are com- paratively few, namely, 42. The age was reported in 39 cases, of which 3 were persons 19 years of age or under; 14 persons 20 to 49 years; 19 persons 50 to 79 years, and 3 persons 80 years of age or over. The most frequent causes of permanent disability were rheuma- tism, 8 cases ; senility, 7 cases, and tuberculosis, 5 cases. INSURANCE. A surprisingly large number of persons were found to carry life or sick insurance. Iii tabulating insurance returns only members of families, exclusive of boarders and lodgers, were considered, because such returns concerning the latter would necessarily be incomplete. It was found that of a population of 4,889, 2,202, or 45 per cent, car- ried life insurance of some sort, and 855, or 17J per cent, carried in- surance against sickness. The insurance was almost entirely carried in either industrial insurance companies or in fraternal or other mutual benefit associations, and the premium payments were usually made in weekly installments. About the same proportion of white and colored persons carry this insurance, although there were pro- portionately more white carrying life insurance and proportionately more colored people carrying sick insurance. The next table gives the details by color and geographical sections : 1 1 Members of fami- lies, exclusive of boarders and lodgers. Members of families carrying— Entire city. ^1 Sick insurance. WHITE. Northwest 143 112 148 191 611 501 620 861 863 831 160 851 27 Northeast... . 25 Southeast 7 Southwest 81 Total . . . 694 2,693 1,195 90 COLOEED. Northwest 471 82 1,664 127 720 41 691 Northeast 84 Southeast Southwest 166 605 246 140 Total 657 2,296 1,007 765 Grand total 1,251 4,889 2,202 855 EEPORTS OP THE PRESIDENT S HOMES COMMISSION. 295 INSTALLMENT PAYMENTS. The investigators found it exceedingly difficult to obtain informa- tion concerning installment payments on furniture, clothing, and money borrowed, and in many cases the families refused to answer this inquiry. The returns, therefore, are necessarily somewhat meager. Transactions of this kind were found to be much more frequent among the colored than among the white population. Of 136 fami- lies who answered affirmatively the inquiry concerning furniture purchases on the installment plan, 35 were white and 66 were colored. The total cost of the furniture so purchased was greater, however, in the case of the white than of the colored people, namely, $3,235 and $2,871, respectively. Under furniture were also included one watch, one graphophone, and four pianos. Clothing was reported purchased on the installment plan in 5 cases of white and 8 cases of colored families, the total cost of the clothing being $121 and $162, respectively. The furniture and clothing installment payments were usually made weekly. LOAN COMPANIES. The practice of borrowing money for repayment on the installment plan appears to have been confined mostly to the colored people, only 3 white families having reported such transactions as against 26 colored families. The total amount borrowed in this way was $130 by the white, and $420 by the colored families. It was not possible in all these cases to ascertain the terms of repayment upon which these loans were made, but a sufficient number of cases is given below to show the exorbitant rates paid for the same: Amount Monthly Number Amount Charges. borrowed. payments. of months. repaid. m $3.50 6 $21.00 $6.00 14 3.40 6 20.40 6.40 20 3.00 8 24.00 4.00 15 O.70 a46 32.20 17.20 10 2.60 6 15.60 5.60 10 2.95 6 17.50 7.50 10 2.20 8 17.60 7.60 15 2.65 10 26.50 11.50 20 8.50 10 35.00 15.00 25 3.80 10 38.00 13.00 10 2.25 8 18.00 8.00 15 3.00 6 18.00 8.00 15 3.70 6 22.20 7.20 25 4.50 9 40.50 15.50 15 2.75 9 24.75 9.75 10 3.00 6 18.00 8.00 10 O.70 o28 19.60 9.60 15 2.70 9 24.30 9.30 25 6.10 6 36.60 11.60 6 2.60 2* 6.50 1.60 a Weekly. ILLITERACY. In tabulating the statistics of illiteracy only those persons were con- sidered who had passed the school age, namely, 14 years and over. Of 4,161 such persons, 502, or 12.1 per cent, were unable to read or 296 EEPORTS OF THE PRESIDENT S HOMES COMMISSlOlT. write. The percentage of illiteracy was more than three times as great among the colored than among the white population, namely, 17.5 and 5.4 per cent, respectively. In the case of both white and colored the percentage of illiteracy was greater among the males than among the females. The following table shows the data concerning illiteracy by sex and color for each section : Total persons 14 years of age and over. Illiterates 14 years of age and over. Male. Female. Both sexes. Male. Female. Both sexes. ■WHITE. Northwest . 310 154 189 323 264 155 195 280 574 309 384 603 30 3 1 38 20 5 50 Northeast 8 Southeast I Southwest 4 42 Total 976 894 1,870 72 7.37 29 3.24 101 Per cent 5 40 COLORED. Northwest 523 42 689 48 1,212 90 102 3 169 8 271 Northeast 10 Southeast Southwest 176 490 989 62 58 120 Total 741 1,227 2,291 167 22.5 235 19.1 401 Per cent 17 5 Grand total 1,717 2.121 4,161 239 13.9 264 12.4 502 Percent 12 1 SCHOOL ATTENDANCE. Figures showing school attendance are given in the next table Children 7 to 14 years of age. P bo a SI'S 4!> c3 Total. Attending school. Not at- tend- ing school. •^8 s| II ill i "■ Si 3 O60 a WHITE. Northwest no 102 162 123 2 4 3 39 8 9 3 54 92 79 110 64 101 91 153 118 8 11 10 5 6 12 7 5 10 Northeast 13 1 13 Southeast 10 Total 497 1 2 46 69 345 463 34 30 4< GOLOBED. Northwest 249 32 110 1 80 7 1 2 167 28 82 205 29 100 44 3 10 10 i 26 Northeast 5 2 14 12 Southeast Total 391 3 44 10 277 834 57 18 43 Grand total . . 888 4 2 90 79 622 797 91 48 89 EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 297 It will be observed that a considerable number of children of com- pulsory school age were found who had either not attended school at all during the past year or who attended less than one-half of the school term. Thus, 91 children from 7 to 14 years of age had been kept out of school the entire year, and 96 were in school less than twenty weeks during the year. Those not attending at all were mostly colored children. On the other hand 48 children under 7 years and 89 children over 14 years of age were found attending school. In 40 cases children were kept out of school some time during the year on account of a lack of the necessary clothing. Of these 7 were white and 33 were colored children. Chapter XII. THE BUSINESS RELATIONS OF WAGE-EARNERS. [By James Bbonson Reynolds.] In proportion as wealth increases devices for its protection increase in number, quality, and efficiency. As wealth diminishes its safe- guards diminish. When extreme poverty is reached the supposed agencies of protection are frequently not only nonprotective, but actually predatory. Among such are employment agencies where the wage-earner seeks work; pawn shops and loan companies for the wage-earner's borrowing; industrial insurance companies and mutual benefit societies for his saving, and installment-payment con- cerns where he purchases on credit. Believing that the regulation, protection, and promotion by the government of these instrumentalities are quite as important to the industrial class as the protection of the home and the workshop through sanitary and factory legislation, this commission has in- dorsed the recommendations made to the President by the writer that a new department of housing and labor be created to have direct and complete supervision of these business enterprises. This pro- posed department would not merely exercise the powers of restraint at present intrusted chiefly to the police, but in addition would pro- mote efficiency of service. In view of the recommendation above mentioned^ it is appropriate to indicate the present condition of these enterprises and to state the character and extent of the improvements advocated. EMPLOYMENT AGENCIES. There were formerly about 25 employment agencies in the District. They were nominally under the control of the police, but a careful investigation showed that the police gave them very slight attention unless specific complaints were presented. Most of these agencies were indifferent to the character and occupation of the employers to whom they sent employees. This was especially true in regard to domestic agencies. The agencies which placed laborers took advan- tage of the applicants through fraud and misrepresentation and were careless in the fulfillment of their obligations to employers and employees. 298 EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. The present employment agency law, passed in 1907, while inade- quate in some respects, has produced a decided improvement in the service and paved the way for further progress. At present there are only eleven licensed employment agencies. Before taking out a license an agent must give a bond and furnish evidence of ability to carry on the business in proper manner. The character of the appli- cant is investigated by the police department. These agencies have been inspected at frequent intervals in the past, and with the begin- ning of the new license year the inspection will be made monthly. Complaints against agencies under the present law are investigated by the District Commissioners. During the past year nine hearings were granted to persons bringing charges against employment agen- cies. This service is probably as good as could be obtained under the existing law, but there are two serious defects in the law. 1. Supervision by the police is inadequate. The work of the police must inevitably be confined to penal offenses. The regulation and supervision of the efficiency of employment agencies is necessary and should be performed by some properlj constituted public authority. The effective distribution of labor is of such supreme importance to the entire community that either employment agencies must receive competent public supervision, or the European method of government employment agencies, such as those of France and Germany, should be adopted. This commission has preferred to adopt the more con- servative alternative. 2. Complaints should be tried not by the head of the Distirct gov- ernment, as at present, but by the official having direct oversight of the agencies. If the proposed department of housing and labor were established, the chief of the appropriate bureau or the head of the department, both of whom would be closely in touch with the service, should be the proper parties to conduct investigations and trials. PAWN SHOPS. There are at present eight pawn shops in the District of Columbia. The legal rate of interest charged is 3 per cent a month. The present law has some excellent features. A report on articles pawned is made daily to the police, and pawn shops are directly connected with police headquarters by an electric call bell. The records are open at all times to police inspection, and a proper bond must be filed to secure the observance of the law and the recovery on judgments against pawnbrokers. The pawn shop is the only public agency for lending money to which the poor can resort, and since it is likely that recourse thereto will occur m times of extreme need, the terms of lending should be as moderate as circumstances will permit. It is commonly supposed that the pawnbroker lends as little as possible on articles pawned. Careful inquiry and investigation reveal the fact that the high rate of interest disposes the pawnbroker to lend as much as possible. As the pawnbroker takes advantage of the improvidence of the bor- rower and derives his profit from the interest charge, he determines the amount to be advanced by his estimate of the likelihood of the redemption of the article pawned. If a lower rate of interest were charged, a smaller sum would be loaned, but a lighter burden would KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 299 be imposed on the borrower. The experience of the Provident Loan Society of New York City, which has rendered most important service to the community, is suggestive. Regular New York pawn shops charging 3 per cent a month for the first six months, and 2 per cent thereafter, report that from 70 to 80 per cent of the articles pawned are redeemed. The Provident Loan Society, charging but 1 per cent a month, reports that from 98 to 99 per cent of articles pawned are redeemed. It is probable that the loans made by the Provident Loan Society on given articles are frequently less than corresponding loans made by the pawn shops. The policy of the Provident Loan Society, however, encourages redemption of valuable articles, while that of the average pawn shop encourages improvir dence with ultimate heavy loss. Such features in the conduct of pawn shops merit the careful attention of public authorities quite as much as do the discovery and return of stolen articles, now the main concern of the police. LOAN COMPANIES. There are no official statistics regarding loan companies in the District. Their number is variously estimated to be from 50 to 80. They are wholly without public supervision, though Commis- sioner West states that '' the question of licensing, regulating, and inspecting these loan companies is, in my judgment, one of the most important matters to be accomplished." During the last ses- sion of the Congress a measure was drafted at the request of Com- missioner West by the corporation counsel of the District and introduced in both Houses. Investigations made by Commissioner West showed that these companies sent out circulars to school teach- ers, department clerks, and others, urging them to borrow money. The natural result of this solicitation was to stimulate the borrowing habit. It was also reported to this commission by various chiefs of the National Government that their subordinates were frequently led, through the plausible representations of the companies, to reck- less borrowing, leading to subsequent embarrassment. It is beyond question that such companies render a necessary service, but they should be so supervised and controlled by public authority that their transactions would be beneficial instead of debauching. The borrowing of money for repayment on the installment plan, found in the investigation of this commission to be confined mostly to colored people, is a device of certain loan companies which merits the most careful scrutiny. It was not possible in all the cases investi- gated to ascertain the terms of repayment upon which loans were made, but a sufficient number were secured to show that exorbitant rates were charged. INSURANCE. When the department of insurance was created January 1, 1902, the superintendent found eleven companies undertaking industrial or sickness, accident, and death insurance. Seven of these were District of Columbia corporations. They had 19,661 policies in force, representing $656,917 worth of insurance. The four foreign cor- porations had 4,978 policies in force, representing $179,587 worth of insurance. 300 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. The superintendent at first refused to relicense them, but subse- quently, recognizing that it would be a hardship to thousands of in- nocent policyholders to deprive them of their insurance, consented to grunt licenses. At the present time nearly all of the companies refuse to pay the tax on their premium receipts, and consequently they are not licensed or examined pending the final decision by the court of their obligation to be taxed. There is, however, supervision over the Metropolitan, Prudential, and other large insurance corporations which obey the law as con- strued by the department. The lack of law governing the industrial assessment companies is fully appreciated by the Commissioners, and various bills to remedy existing deficiencies have been introduced at the request of the Commissioners and of the insurance department. As insurance is one of the most notable agencies for the encourage- ment and practice of saving and thrift, its thorough supervision is highly in the public interest. We also believe that the friendly or mutual benefit societies which are under public supervision in most European countries should be under government inspection in the District. Such inspection would undoubtedly be in the interest and to the advantage of the members of such societies, but as many organizations prefer their independ- ence without interference, rather than the protection aiforded by gov- ernment supervision, it might be sufficient to provide that the super- intendent of insurance should have power to inspect and report the condition and solvency of such organizations upon the request of the officers or of a certain number of members paying dues and eligible to benefits. INSTALLMENT PAYMENTS. The purchase of articles on the installment plan offers undeniable advantages to people with limited means, and especially to those beginning housekeeping with small capital and no reserve. It must, therefore, be regarded as an established and valuable feature of the business relations of the wage-earning class. Abuses under the sys- tem are, however, not infrequent and impositions are often practiced. Some measure of public supervision should be exercised over such transactions, at least to the extent of requiring that concerns doing business on this plan should be registered and their transactions sub- ject to the scrutiny of the department of housing and labor. Chapter XIII. THE SCALE OF WAGES AND THE COST OF LIVING. [By Geo. M. Kobeb, M. D.] The Bureau of Labor has conducted an investigation on the subject of wages based on a large number of establishments in the chief manu- facturing and mechanical industries in the United States. The re^ suits are set forth in Bulletin 77, July, 1908. The retail prices of food are shown in a succeeding article of the bulletin. From these investigations we learn that, with the single exception of the year 1907, the scale of wages per hour has increased with the increased cost of living. In brief, wages in 1907 were 28.8 EEP ORTS OF THE PRESIDENT S HOMES COMMISSION. 301 per cent higher than the average for the entire period from 1890- 1899, or 31.6 higher than in 1894, the year of lowest wages. The variation in the purchasing power of wages may be measured by using the retail prices of food, the expenditures for which constitute nearly half of the expenditures for all purposes in a workingman's family. From this study we learn that the retail price of the principal article of food weighted, according to family consumption of the various articles, was 20.6 per cent higher in 1907 than the average price paid for the ten years' period 1890-1899, or 26.3 per cent higher than in 1896, the year of the lowest prices during the same period. Com- pared with the average for the same year period the purchasing power of an hour's wages in 1907, as measured in the purchase of food, was 6.8 per cent greater than in the decade 1890-1899. The differences between 1906 and 1907 are set forth as follows : In the year 1907 the average wages per hour in the principal manufac- turing and mechanical industries of the country were 3.7 per cent higher than in 1906, and the retail prices of food were 4.2 per cent higher in 1907 than in 1906, indicating that the purchasing power .of an hour's wages, as measured by cost of food, was one-half of 1 per cent less in 1907 than in 1906. Unfortunately all of these valuable data are based upon a study of industries in which skilled, and presumably organized, wage-earners are employed, who, it may be presumed, have insisted upon an equit- able basis of wages. The writer fears that the great army of the working classes earning $10 or less a week have not participated to the same extent in the general advance of wages, and yet have had to carry the burden of increased cost of living. The following table shows the articles for which the price in 1907 was higher than the average price for the decade of 1890-1899, and also the articles for which the price in 1907 was lower during the same period : Article. Bread, wheat Vinegar Tea Molasses Rice Beef, salt Milk, fresh, unskimmed Flour, wheat Beans, dry Beef, fresh: Roasts Steaks Fish, fresh Potatoes, Irish Fish, salt Cheese Relative price, 1907. 104,5 104.5 105.3 107. 108. 114. 116. 117. 118.8 119.1 120.6 120.6 120.6 121.6 123.2 Article. Apples, evaporated Veal Butter Mutton Pork, salt (ham) Chicken (year or more old) , dressed Corn meal Lard Eggs Pork: Salt, dried, or pickled Fresh Pork, salt (bacon) Sugar Coffee Prunes Relative price, 1907. 124.6 125.0 127.6 130.1 130.7 131.4 131.6 134.2 137.7 142.2 142.5 157.3 99.6 95.0 88.4 It is especially deplorable that there should have been such a marked advance in the necessaries of life, such as meats, beans, pota- toes, corn meal, and pork or bacon, which with bread constitute the foundations of a substantial diet for wage-earners. The bulletin does not take into consideration the items of clothing and dry goods. The cost of clothing, according to a recent report of 302 BEPOBTS OF THE PKESIDENT's HOMES COMMISSION. the chamber of commerce, since 1900 has advanced 30 per cent, ging- ham 30 per cent, bleached cotton goods 60 per cent. The tables on pages 197-200 are also of extreme interest; for in- stance, the table on page 197, based on the average food cost of 2,567 families, distributed over five geographical divisions in the United States, shows that the average cost of food for each family in 1890 was $318.20. In 1896, the year of lowest prices, it fell to $296.76, since which time it has gradually risen to $374.75 in 1907. The tables on pages 199 and 200 show the purchasing power of a dollar from 1890 to 1907 of various articles of food of the grade used by the 2,567 workingmen's families. Some of the principal items are here reproduced in a condensed form : 1890. 1907. Fresh beef 7.81 10.06 9.89 10.09 6.33 16.74 4.23 6.39 10.86 46.57 1.22 6.47 8 59 Salt beef . do Fresh pork do.... 6 73 Fish.. do 8 63 Egrg'g dozen 8.89 14 40 i^ ::::::::::::::::::::::::::::::::::::::: Butter . . . . . . . . . . . . pounds 3 29 Cheese do 6 12 Lard do 7 95 Com meal do 35 39 LID The following table shows the average expenditures of 2,567 work- ingmen's families for each of the principal items entering into the cost oi living, and per cent of average total expenditure in 1901 (expenditure based on all families) : Item of expenditure. Average. Per cent of total expendi- ture. Food $326.90 99.49 8.16 6 3.98 32.23 8.15 83.73 26.03 48.08 6.79 1.53 19.44 8.87 5.18 7.62 2.39 26.31 8.36 12.28 12.44 10.93 20.64 46.13 42 54 Rent 12.96 Mortgage: 1.06 .52 Fuel 4.19 Lighting 1.06 Clothing: Husband 4.39 Wife - - . 8.39 Children 6.26 .75 Insurance: Pronerty .20 Life ^ . 2.53 Organizations: Labor .50 Other .67 .99 Charity .81 Ti'iimitnrp and iitpnsila 3.42 1.09 A.musement8 and vacation 1.60 Intoxicating liauors L62 L42 2.67 OthfiT nurooses 5.87 768.64 100.00 • Including interest paid by 18 families. »Not including interest paid by 13 families, included in principal. REPORTS OF THE PRESIDENT S HOMES COMMISSION. 303 In Bulletin 93 of the Census of Manufactures, 1905, published in May, 1908, we find some interesting data of earnings of wage-workers. The investigation covers 3,297,819 wage-earners, of which 79.4 per cent were men; 17.9 per cent were women, and 2.7 per cent were children. The average weekly earnings of all classes was $10.06. For men 16 years and over it was $11.16 ; for women $6.17, and for chil- dren under 16 years $3.46. The greatest number of men is reported in the $12 to $15 per week group, and of women in the $6 to $7 group, while the greatest num- ber of children is reported in the group receiving less than $3 a week. The important fact revealed by these tables is that out of the total number of men included in the statistics 1,215,798, or 46.5 per cent, earned $10 or less a week. It would be extremely interesting to learn how many of this group were married men. At all events the writer believes that an explanation for the large army of women and chil- dren engaged in wage-earning occupations may be found in these figures. It is simply impossible for a family of five to maintain a decent standard of living on an income of $10 a week, and hence the wives and children are compelled to participate in the fierce struggle for existence. COMPENSATION OF GOVERNMENT EMPLOYEES. Bulletin 94 of the Bureau of the Census, issued April 13, 1908, deals with statistics of 185,874 employees, of which 172,053 were males and 13,821 females. The largest class, viz, 43,790 persons, or 23.6 per cent of the total number, receive from $900 to $1,000 per annum ; next in numerical importance is the class earning less than $720 per annum, represented by 35,331 persons or 19 per cent of the total; 11.7 per cent of the total earn $720, but less than $840 a year; 5.7 per cent earn between $840 and $900, and 18.4 per cent earn $1,000 but less than $1,200 a year. The approximate average compensation is $948. Of the employees under 20 years of age, 71.2 per cent are paid at a rate of less than $720 and 13.6 per cent at a rate of $900, but less than $1,000, making a total in these two classes of 84.8 per cent. Of the 25,351 Government employees residing in the District of Co- lumbia, 12,901, or about one-half of the total, are married. The fol- lowing shows the number of married employees in different salary groups : Compensation, Total employees. Married employees. Less than $720 $720, but less than $840 $840. but less than $900 $900, but less than $1,000. . $1,000, but less than $1,200 $1,200, but less than $1,400 $1,400, but less than $1,600 $1,600, but less than $1,800. $1,800, but less than $2,000. $2,000, but less than $2,500. $2,500, and over By piecework 6,501 2,236 602 1,516 2,453 4,537 2,469 1,361 1,163 841 617 1.046 2,028 1,267 827 533 1,113 2,514 1,552 949 906 681 504 304 EEPOBTS OF THE PBESIDENT's HOMES COMMISSION, Since the bulletin contained no specific data on the question of the exact earnings of married men earning less than $720 a year, inquiries on this point were addressed to the departments, and the following table shows the number of married men employed in the respective departments and the wage groups : « Department of Agriculture Treasury Department Department of the Interior Department of Commerce and Labor. War Department Navy Department Postmaster-General , Department of the Interior Department of State Interstate Commerce Commission Salary «600 to 8700. 90 188 205 42 122 54 51 13 771 Salary $500 to $600. 47 115 19 3 195 Salary below «500. 67 From this table it appears that there are 1,033 married men in the Government employ in this city earning less than $660 a year, 262 of whom receive $600 a year or less. In addition to the foregoing, according to information kindly fur- nished by Commisisoner West, and the disbursing officer, Mr. Wilson, there are 515 married employees in the District government earning less than $500 a year; 450 married employees earning between $500 and $600, and 251 married employees earning between $600 and $720 a year. A general survey of the situation justifies the conclusion that the cost of living has lar outstripped the present rates of wages of men earning less than $720 a year and of salaried employees m general. This can only be remedied by an increase in wages or a decided de- crease in the cost of the necessities of life. Since the latter is beyond the general control of wage-earners, except in so far as increased wages affect the cost of the products of labor, an increase in earnings amounting to at least 25 per cent appears urgently called for. No effort should be spared to improve the standards of living of poorly paid wage-workers, especially of married men earning less than $2 a day. Justice likewise demands an increase of 25 per cent in the pay of salaried employees, especially where no such increase has been made during the past ten years, in order to compensate for the increased cost of living. It has come to the knowledge of the committee that a large number of employees in the navy-yard who have purchased homes and own an equity in the property, are likely to suffer financial losses should the intentions of the department to have the work done elsewhere and reduce the number of employees here be carried out. This should be avoided, if possible, on account of the evident hardships involved. It is believed that the best interests of the service and of wage- v7orkers would be subserved if a reasonable assurance of permanent employment could be given. •This does not include employees in the Government Printing Office and Navy-Yard. KEPORTS OF THE PRESIDENT 's HOMES COMMISSION. 305 In the sociological study of our least resourceful neighbors we find ample food for reflection. We encounter families who, although the husband earns $2.50 a day when he works, are on the borderland of dependency, because he takes three drinks of whisky a day at 5 cents each and consumes 25 cents' worth over Sunday, which means not only an expenditure of $59.80 a year for drink, but also considerable loss of work on account of preventable illness. While the conditions as a whole in our family groups whose income is less than $700 a year indicate a fierce struggle for existence, some splendid examples of neat and healthful homes, of thrift and happi- ness, could be cited for the emulation of less competent neighbors. The explanation is to be found in the fact that the parents lead a strictly temperate life, the mother is a good home maker and anxious to better the future of her children, and her spirit of economy, thrift, and ambition animates every member of the household. These prin- ciples should be inculcated into the minds of ever}^ child. An at- tempt has been made in several cities to introduce the Provident Stamp Saving System into the public schools. There can be no ques- tion that all such efforts, and the establishment of postal savings banks, would stimulate provident habits. If it is possible for the agents and friendly visitors of the Associated Charities to collect over $12,000 a year in this city from the least resourceful people as stamp savings deposits for emergency purposes, there is no good reason why the great army of better paid wage-earners, including salaried em- ployees, should not cultivate similar habits of thrift and economy. While it is true that a goodly number have established their homes and are gradually paying for them, it is equally true that in these days of inordinate desire for pleasure, dress and social rivalry, a very discreditable number live wholly beyond their income and sooner or later fall into the hands of the " loan and salary sharks." Chapter XIV. SUPPRESSION OF USURY IN THE DISTRICT OF COLUMBIA. [By Geo. M. Kobeb, M. D.] INTRODUCTION. In view of the great number of cases of exorbitant rates of interest charged by salary and loan sharks which have come under the notice of the writer in connection with the Associated Charities, and also in our sociological study of families, it was deemed desirable to se- cure additional information on the subject with a view of formulat- ing suitable recommendations for the suppression of the evil. Mr. Charles F. Weller, of the Associated Charities, and Mr. George S. Wilson, of the Board of Charities, referred in their discussion of the subject to the efforts of the " Society for Savings " to bring about a more tolerable state of affairs. In a number of interviews with offi- cers of that society it was learned that they had entered the field, for which there was an urgent need, with the hope of ameliorating the condition of a large number of government employees by offering a S. Doc. 644, 60-2 ^21 306 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. better service at a reasonable price. The society found itself handi- capped, however, by engaging in a business which can not be carried on at the present legal rate of interest (6 per cent), and also because good citizens do not care to invest funds which are loaned in violation of the law. The officers, anxious to extend the usefulness of the society, and at the same time to conduct a strictly legitimate business, have made a careful study of the remedial legislation in other States, with a view of promoting similar legislation in the District of Columbia. The principles embodied in modern legislation of this class are based upon the theory that money-lending concerns are a necessity; that small loans of this character can not be made at a less rate of interest than 2 to 3 per cent a month during the first year of the loan ; that legalization of such rates will attract the capital of reputa- ble citizens and stimulate wholesome competition, which will ulti- mately result in the reduction of the interest rate to about 1 per cent per month. From the experience of the Provident Loan Society, of New York, conceived and managed as a true business philanthropy, it is apparent that a business in small loans can not be now conducted, except as a purely charitable proposition, at less than 1 per cent per month. This subject is one of great importance to a very large number of officials and employees of the government and of wage-earners in general. The writer therefore requested Mr. J. T. Exnicios, the manager and treasurer of the Society for Savings, to present the result of his study of existing conditions in this city, and of the most enlightened legislation which has been enacted in Massachusetts, New York, and elsewhere to safeguard this unfortunate class of borrow- ers against the vicious practices employed by unscrupulous concerns. This he has done in a very satisfactory and comprehensive manner. From a careful study of existing evils the writer feels convinced that the bill framed by the commissioners, and known as H. R. 11772 and S. 2296 will, if enacted with a few minor amendments, have a most salutary effect. The amendments suggested by Mr. Exnicios are in line with legislation in other States. One of these is the reduc- tion of a license tax from $1,000 to $100 per annum. The tax in Massachusetts is only $50 a year, but the law requires that all exami- nations of the affairs of such concerns made by the bank commis- sioners of the State shall be at their expense. New York, Rhode Island, and Maryland require no license tax. It is very evident that all such charges are placed by indirection on the borrower. For this reason, no doubt, the recorders' fee on chattle mortgages in Massachusetts is only 75 cents, and no notarial certificate is required on this class of mortgages, while the charges in this juris- diction amount to $2.85, which greatly increases the cost of small loans. The provisions of the bill, on the whole, are excellent. Sections 4 and 5 are especially commendable, as tjiey require a register to be kept of all loans and transactions, subject to official inspection. The execution of such a law, in order to safeguard against abuses, re- quires careful official supervision, such as contemplated by the recom- mendations to the President, April 29, 1907, of Mr. James B. Reyn- olds, in the creation of a bureau of labor. BEPOETS OF THE PRESIDENT'S HOMES COMMISSION. 307 THE USURY EVIL IN THE CITY OF WASHINGTON. [By J. T. ExNicios.] I. THE MONEY BOBBOWEE. In the city of Washington there is a very large number of per- sons who are unable to secure loans from banks, trust companies, or real- estate brokers, because having nothing in the form of assets except their labor or earning capacity to offer as security, or possibly household effects, and perhaps jewelry. These people might be di- vided into three classes or groups : First, the government clerks and employees, who can offer nothing as security for money but their individual notes secured by the in- dorsement of their fellow-clerks. Second, that class of persons who, for various reasons, do not care to have their needs made known to their friends on account of their standing in the community, and offer as security for money obtained their jewelry or other personal effects, and who, while possessing homes and furniture, hesitate to give a chattel mortgage on their household furniture because of the publicity attendant upon the re- cording of such mortgages. Third, that very large class of people who, not having steady em- ployment or regular sources of income, and who, usually on account of the small wages earned, and having large families depending upon them, are unable to lay aside any savings to meet emergencies, are compelled to mortgage their household effects; and as such people nearly always need money, and emergencies arise when they must have it quickly, they instinctively turn to the only source open to them, the loan shark. The money lender exists here because he is needed and renders an indispensable service to those whose living depends on the work- shop, the office, the city, or the National Government, where men and women are earning salaries and wages. Salary earners are a never-failing source of income and support to him. He is par- ticularly active among clerks in every department and bureau of our Government; among school teachers, firemen, policemen, and other city employees, the newspaj)er office and the railroad office, but more especially among the laboring class, where he not only trades and fattens on their necessities but on their ignorance. The cruel part of the whole system is the pettiness of the loans made to the laboring class. The loan seldom exceeds $25, and the need arises from sickness or trouble in the workman's family. His pay is small, just enough to live on ; he may be going through that period in the life of a family when children are born, or when they are being educated, the expenses come closer to the danger line. Wife or child may fall ill and an extra outlay has to be met; other ex- penses, such as rent or grocery accounts, get behind, creditors begin to press, the man is worried and miserable, and seeks relief from the only source at his command, the loan shark, whose advertisement offers money an easy payments and long time. He calls on the ad- vertiser, anxious, flustered, disheartened; is received cordially, and assured suavely that such difficulties are common and of daily occur- rence ; told to call again ; his record is investigated meanwhile and 308 BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. his household furniture appraised. On his return he secures the small sum needed, signs some papers " as a matter of form," and is tied hand and foot for perhaps years. Very few attempt to evade these obligations, and as a consequence the loan sharks have very few occasions for bringing suit to enforce payment of these loans to the last penny. He indulges in threats, but rarely executes them, for his great dread is publicity. n. THE MONEY LENDERS AND THEIE METHODS. There are many money lenders and money-lending concerns in Washington (about 72), with an invested capital of approximately a million dollars, loaning money at exorbitant rates of interest upon mortgages of furniture and household effects, other personal prop- erty, and indorsed notes. The rate of interest charged varies very much ; often the rate is as low as 10 per cent per month ; sometimes as high as 25 per cent, and occasionally even a higher rate of interest is exacted. The following are a few of the many advertisements which can be found in our daily papers : Potomac Guarantee Loan Gompa/ny, 925 F street N. W, $10 for one month costs $0.60 (or 72 per cent per annum). $20 for one month costs $1.05 (or 63 per cent per annum). $30 for one month costs $1.45 (or 58 per cent per annum). We also make a small charge for appraising property, etc. Union Loan and Trust Company, 810 F street NW. $10 for one month costs $1.50 (or 180 per cent per annum). $20 for one month costs $2.25 (or 135 per cent per annum). $25 for one month costs $2.50 (or 120 per cent per annum). Mutual Loan and Trust Company, 913 G street NW. 35 cents a week pays interest and principal on a $10 loan. 50 cents a week pays interest and principal on a $15 loan. 75 cents a week pays interest and principal on a $20 loan. 90 cents a week pays interest and principal on a $25 loan. $1.50 a week pays interest and principal on a $50 loan. $2.75 a week pays interest and principal on a $100 loan. Now, these sums are paid by the borrower for a period of fifty-two weeks, hence the cost of $10 is $8.20, or 161 per cent per annum ; $15 is $11, or 140 per cent per annum; $20 is $19, or 180 per cent per annum; $25 is $21.80, or 171 per cent per annum; $50 is $28, or 109 per cent per annum ; $100 is $43, or 83 per cent per annum. The Surety Loan Company, Ninth and F streets NW., whose charges are on $10 for one month, $1 ; on $15 for one month, $1.50 ; on $20 for one month, $2. That is 10 per cent per month, or 120 per cent per annum. " No more, no less," to quote their advertisement. Added to these various rates are the charges for notary fees, record- ing mortgages, etc., running from $3 to $10. Borrowers in many instances pay this heavy interest for months, and even for years, without decreasing the amount of the original debt, and often lose the property mortgaged by them, even when they have paid the amount of the principal borrowed with lawful interest, for under such rates a borrower can seldom pay up the principal of REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 309 his loan, but goes on, year after year, paying this heavy interest, often in the end to have all he possessed taken from him when the lender demands his principal. Some of these concerns operate two or three companies, located at different addresses and under different names, and incidentally suggest to the borrower that, being unable to loan more than a part of the sum desired, they might succeed in securing the additional amount by applying to , furnishing the address of one of the other offices, when, after paying over again the usual charges for recording, notary fee, appraisement, etc., the borrower receives the amount necessary to make up the original sum asked for. We have in mind a particular case where the sum required was $30 on fur- niture. After going to three of these (allied) concerns the borrower secured the amount, $10 at each place and paid the regular fees at each place. At a hearing before the subcommittee on judiciary of the Com- mittee on the District of Columbia, United States Senate, May 6, 1908, on various bills introduced for the suppression of usury in the District of Columbia the testimony of Senator Gallinger, Com- missioner Macfarland, and Mrs. Charlotte Everett Hopkins all point to the grossest forms of abuses and exorbitant rates of interest which, in the opinion of Senator Gallinger, " no community ought to permit anyone to exact from poor people." All the cases cited differ only in degree, not in kind, and how many of them there are in any one year no one can ever tell, but there are thousands of loans made annually, and as the profits must be enor- mous the suffering entailed must be in due proportion. These con- ditions have continued for a number of years and naturally have grown worse, and though staggering and almost incredible they are borne out by facts on record. The foregoing statement also covers fully the abuses that were wont to exist in the States of New York, Massachusetts, Rhode Island, and Maryland until public opinion through the legislatures of these States enacted laws which put a stop to the evil practice. III. MEANS OF PBEVENTION TRIED IN WASHINGTON SINCE 1905. In January, 1905, there was incorporated in this city the Society for Savings of Washington, modeled after similar concerns in a num- ber of the States, for the purpose, among others, of lending money to deserving persons on indorsed notes. It was never for a moment contemplated that the new venture should be in any sense a charity ; in fact, it was realized that to lend money as a work of charity would fail to reach the very class of persons whom it was desired to afford a means of relieving a temporary embarrassment, namely, persons who, while not able to obtain loans from banks, trust com- panies, or real estate brokers, are able and willing to pay reasonably for the accommodation. The capital stock was fixed at $50,000, most of which is now paid in. In the beginning, after considerable effort, a sum of about $7,500 was raised and operations were started. The loans made were neces- sarily small, averaging $25, and never exceeding $50, to any one per- son upon indorsed notes and confined almost exclusively to clerks in the various Government departments, and at a rate of interest of 3 310 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. per cent per month. After the first year, and upon increasing the capital employed, the rate was reduced to 2J per cent per month, and is now 2 per cent per month, with a small charge according to the amount loaned, in some cases 25 cents, as upon a $25 loan, which costs 75 cents for one month, but never exceeding $3 in any one year, and this latter sum is charged only when loans are made on household goods (including charges of every character, among which is $2.35, the actual fee for court recording, and 50 cents for notary fee, or $2.85), which feature of the business was adopted about the beginning of this year. In some very deserving cases a charge of IJ per cent per month has been made, and only one-half per cent a month in one case, that of a young man, a messenger in one of the departments, who became deeply involved with a number of money lenders to the extent of about $500. * * * Much good, it is believed, has been done by this society, and a great deal more could be done were it possible to secure the funds needed ; but its business being what may be termed " outlawed," the directors have labored under a handicap that is almost disheartening. Small sums of money can not be loaned at the legal rate of interest (6 per cent), pay operating expenses, no matter how economically the business is conducted, stand the inevitable losses through uncol- lectible notes, and pay a fair dividend on the capital invested. This has been demonstrated time and again in every State of the Union and in foreign countries as well. If there could be any doubt of the correctness of this statement, legislation which has been enacted in many of the States will prove its truth. This legislation will be more particularly referred to further on. IV. BEMEDY PROPOSED. The most effective way to get rid of the loan and salary shark is to meet him on his own ground. Legislation will not kill him. In try- ing to exterminate him legislation is apt to abolish the service and furnish nothing to replace it. ^ ^ The logical way to get rid of him is to supply a better service at reasonable rates. Along this line some very effective work is now being done under protection of the law in other cities and could be done here by the enactment of a suitable bill, which has been drafted by the District Commissioners and is known as S. 2296 and H. R. 11772. Under its provisions the business will become legalized, the stigma which now attaches to those carrying on a business not strictly lawful would be wiped out, and a better class of our citizens would engage therein, more capital would be attracted, and there would be more competition, with the consequent lowering of the interest charged and a resulting benefit to the borrower and the community. A BILL To regulate the business of loaning money on security of any kind by persons,, firms, and corporations other than national banks, savings banks, and trust companies and real-estate brokers in the District of Columbia. Be it enacted hy the Senate and House of Representatives of the United States of America in Congress assemtled. That hereafter It shall be unlawful and Illegal to engage in the business of loaning money on any security of any kind, direct or collateral, tangible or intangible, without procuring license; and all persons, firms, joint-stock companies, voluntary associations, and corporations engaged In said business shall pay a license tax of one thousand dollars per annum to the District of Columbia. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 311 Sec. 2. That applications for licenses to conduct such business must be made In writing to the Commissioners of the District of Columbia, and shall contain the full names of applicants, if natural persons, and the full names of the officers and directors, by whatever name known, of corporations, companies, and associations, the addresses of all persons named therein and the place where such business is to be conducted, and such other information as the said commissioners may require. Every license granted shall date from the first of the month in which it is issued and expire on the thirty-first day of the following October. Every application shall be filed not less than one week prior to the granting of such license, and notice of the filing of such application shall be posted in the office of the assessor of the said District. Protests may be made by any person to the issuing of such license, and when such protests are filed with the said commissioners the latter shall give public notice of and hold a public hearing upon such protests before issuing such license. The said commissioners shall have power to reject any application for license for failure to observe this act, and for such failure to suspend or revoke any such license for cause shown, after notice and hearing. Sec. 3. That each application shall be accompanied by a bond to the District of Columbia in the penal sum of five thousand dollars, with two or more suffi- cient sureties, and conditioned that the obligor will not violate any law relating to such business. The execution of any such bond by a fidelity or surety company authorized by the laws of the United States to transact business therein shall be equivalent to the execution thereof by two sureties, and such company, if excepted to, shall justify in the manner required by law of fidelity and surety companies. If any person shall be aggrieved by the misconduct of any such licensed person, firm, corporation, company, or association, and shall recover a judgment therefor, such person may, after a return unsatisfied either in whole or in any part of any execution issued upon such judgment, maintain an action in his own name upon such bond herein required in any court having jurisdiction of the amount claimed. The Commissioners of the District of Columbia shall furnish to anyone applying therefor a certified copy of any such bond filed with them upon the payment of a fee of twenty-five cents, and such certified copy shall be prima facie evidence in any court that such bond was duly executed and delivered by the person* firm, corporation, company, or . association whose names appear thereon. Sec. 4. That every person, firm, corporation, company, or association conduct- ing such business shall keep a register, approved by said commissioners, show- ing, in English, the amount of money loaned, the date when loaned and when due, the person to whom loaned, the property or thing named as security for the loan, where the same is located and in whose possession, the amount of interest, all fees, commissions, and renewals charged, under whatever name. Such register shall be open for inspection to the said commissioners, their officers and agents, on every day, except Sundays and legal holidays, between the hours of nine o'clock in the forenoon and five o'clock in the afternoon. Sec. 5. That no such person, firm, corporation, company, or association shall charge or receive a greater rate of interest or discount upon any loan made by him or it than two per centum per month and a sum not exceeding three dollars for the first examination of the property to be mortgaged, or the in- vestigation of the credit or responsibility of indorsers or sureties when an indorsed note is taken as security, and for drawing the necessary papers, which charge shall include all services of every character in connection with the loan, except upon the foreclosure of the security, and no additional sums, either in the way of bonus or otherwise, shall be required or exacted of bor- rowers; nor shall it be lawful to divide or split up loans under any pretext whatsoever for the purpose of requiring or exacting any other or greater charge than herein prescribed. The foregoing interest and charge may be deducted from the principal of the loan when the same is made. No such loan greater than five hundred dollars shall be made to any one person. Sec. 6. That the enforcement of this act shall be intrusted to the Commis- sioners of the District of Columbia. Complaints against any licenses or appli- cant shall be made in writing to the said commissioners, and reasonable notice thereof, not less than one day, shall be given to said licensee or applicant by serving upon him a concise statement of the facts constituting the complaint, and a hearing shall be had before the said commissioners within one week from the date of the filing of the complaint, and no adjournment shall be taken for longer than one week. A daily calendar shall be kept of all hearings by the said commissioners, which shall be posted in a conspicuous place in their 312 EEPOBTS OP THE PEESIDENt's HOMES COMMISSION. public office for at least one day before the date of such hearings. The said commissioners shall render their decision within eight days from the time the matter is finally submitted to them. Said commissioners shall keep a record of all such complaints and hearings, and may refuse to issue and shall revoke any license for any good cause shown, within the meaning and purpose of this act; and when it is shown to their satisfaction that any license or applicant under this act, either before or after conviction, is guilty of any conduct in violation of this law, it shall be the duty of the said commissioners to revoke or reject the license of such licensee or applicant, but notice of the charges preferred shall be presented and reasonable opportunity shall be given said licensee or applicant to be heard in his defense. Whenever for any cause such license is revoked, said commissioners shall not issue another license to said licensee until the expiration of at least six months from the date of revocation of such license. Sec. 7. That any violation of this act shall be punished by a fine of not less than five dollars and not greater than two hundred dollars. The said commis- sioners shall cause the corporation counsel to institute criminal proceedings for the enforcement of this act before any court of competent jurisdiction. Sec. 8. That nothing contained in this act shall be held to apply to the legiti- mate business of institutions which are members of the Bankers' Association of the District of CJolumbia, building and loan associations, or to the business of pawnbrokers or real-estate brokers, as defined in the act of Congress of July first, nineteen hundred and two. Sec. 9. That the Commissioners of the District of Columbia are hereby author- ized and empowered to make all rules and regulations necessary in their judg- ment for the conduct of the said business and the enforcement of this act in addition hereto and not inconsistent herewith. Sec. 10. That all acts and parts of acts inconsistent herewith are hereby repealed. Sec. 11. That this act shall take effect from and after its passage. V. amendments peoposed and approval of the bill. Be it enacted ^y the Senate and House of Representatives of the United States of America iti Congress assembled, That hereafter it shall be unlawful and illegal to engage in the business of lending money on any security of any kind, direct or collateral, tangible or intangible, without procuring license, and all persons, firms, joint-stock companies, voluntary associations, and corporations engaged in said business shall pay a license tax of one thousand dollars per annum to the District of Columbia. First, amend this section by inserting after the word " money," in line 4, the words " upon which a rate of interest greater than 6 per cent per annum is charged," so that it shall read : " The business of loaning money, upon which a rate of interest greater than 6 per cent per annum is charged," etc. Second, substitute " one hundred " for " one thousand," in line 8, so that it shall read : " Business shall pay a license tax of one hundred dollars per," etc. Reasons, — All States which now have laws governing the loaning of money specifically state in the acts that all persons, firms, etc., loaning money at more than the legal rate of interest, etc., which shows that the provision has been carefully looked into and deemed necessary. It might be said in this connection that Senator Johnston and Hon. J. M. Thurston stated they " thought it might be a wise provision," at the hearing before the subcommittee on judiciary of the Committee on the District of Columbia, May 6, 1908, at which the former was present as a member of said committee, and the latter as attorney representing some money lenders. As to the amount of license tax, the State of Massachusetts exacts a tax of only $50 per year, but requires that all examinations of the affairs of these concerns made by the bank commissioners of the State BEPOBTS OP THE PBESIDENt's HOMES COMMISSION. 313 shall be at their expense. The State of New York does not require a license, nor does the State of Ehode Island, nor the State of Maryland. That $1,000 per annum should not be exacted as a license charge or tax seems to require no argument. It would be wringing from the lenders a sum which is much too large, and would hold an inducement for some of them to place this charge by indirection on the borrower. Further, Commissioner West states: "Though this tax of $1,000 was inserted, they were not insisting upon that amount, and it might well be reduced." (Senate hearing. May 6, 1908, p. 21.) Section 2: This section is in line with the practice and laws in force in States hereinbefore mentioned. Section 3 : Same reason as applied to section 2. Section 6 : Same as section 2. Sections 9, 10, and 11 : Same as section 2. Sec. 4. That every person, firm, corporation, company, or association con- ducting such business shall keep a register approved by said commissioners, showing in English the amount of money loaned, the date when loaned, and when due, the person to whom loaned, the property or thing named as security for the loan, where the same is located, and in whose possession, the amount of interest, all fees, commissions, and renewals charged, under whatever name. Such register shall be open for inspection to the said commissioners, their officers and agents, on every day, except Sunday and legal holidays, between the hours of nine o'clock in the forenoon and five o'clock in the afternoon. The only way to regulate this business is through publicity, for laws, no matter how drastic their provisions, can and will be evaded ; but when the people who carry on this business are compelled to lay bare to the proper officials each and every transaction they have en- gaged in, you then strike at the root of the evil, and are in a position to apply the needed remedy. It has been stated that this section is' impracticable, or, if practicable, it would involve considerable ex- pense and labor. We denjr this for the reason that now, and for many months past, the Society for Savings has in daily use such a register, and after experience feels that it is the only method whereby it can be seen at a glance that charges have been paid by the bor- rower, and for what purposes. We think, though, this section would be strengthened were it amended so as to require an annual state- ment in the form of a trial balance of its books, on the 31st day of December in each year, specifying the different kinds of its liabili- ties and the different kinds of its assets, stating the amount of each, together with such other information as may be called for. This statement should be furnished to the District Commissioners on or before the 20th day of January in each year by each individual or company engaged in this business, and they should also print this statement or trial balance in at least one newspaper of general circu- lation in Washington, in such manner as may be directed by the District Commissioners. Inspection by state officials designated by law and annual reports of the business are required in New York, Massachusetts, and Rhode Island, likewise the publishing of annual reports. Sec. 5. That no such person, firm, corporation, company, or association shall charge or receive a greater rate of interest or discount upon any loan made by him or it than two per centum per month, and a sum not exceeding three dol- lars for the first examination of the property to be mortgaged, or the investi- gation of the credit or responsibilty of indorsers or sureties when an indorsed note is taken as security, and for drawing the necessary papers, which charge shall include all services of every character in connection with the loan, except 314 BEPOBTS OP THE PRESIDENT'S HOMES COMMISSION. upon the foreclosure of the security, and no additional sums, either in the way of bonus or otherwise, shall be required or exacted of borrowers; nor shall it be lawful to divide or split up loans under any pretext whatsoever for the purpose of requiring or exacting any other or greater charge than herein prescribed. The foregoing interest and charge may be deducted from the principal of the loan when the same is made. No such loan greater than five hundred dollars shall be made to any one person. The provisions of section 5 restricting the amount of such loans and legalizing a rate of interest not higher than 2 per cent per month, and a fixed charge not in excess of $3 for examining the property to be mortgaged and drawing the necessary papers, are taken from the acts of State legislatures, which will be now noticed at some length, as also will be the business of some of the corporations operating under them. By the laws of the State of New York, chapter 326, Laws of 1895, as amended by chapter 706, Laws of 1895, entitled "An act to provide for the incorporation of associations lending money on personal property, and to forbid certain loans of money, property, or credit," it is provided : Sec. 3. ♦ * * It [every such corporation] shall be entitled to charge and receive upon such loan made by it without the actual delivery to it of the property pledged or mortgaged, which charge shall include all services of every character, in connection with said loan, except upon the foreclosure of the security, interest or discount at a rate of not exceeding three per centum per month for a period of two months or less, and not exceeding two per centum per month for any period after said two months ; and also a sum not exceeding three dollars for the first examination of the property to be pledged or mort- gaged and for drawing and filing the necessary papers. It will be observed that section 5 of the proposed bill is copied •substantially from this law. VI. METHODS IN FORCE IN NEW YOEK, MASSACHUSETTS, BHODE ISLAND, AND MARYLAND. The laws of the above-named States will now be noticed at some length, as will be also the business of some of the corporations operat- ing under them. New York. — The Provident Loan Society of New York was organ- ized under chapter 295 of the Laws of 1894. The New York legis- lature granted a special charter to carry on this business to Otto T. Bannard, Charles C. Beaumen, Henry R. Beekman, William L. Bull, Frederic R. Coudert, Charles F. Cox, John D. Crimmins, R. Fulton Cutting, Robert W. de Forest, William E. Dodge, Charles S. Fair- child, David H. Greer, Abratn S. Hewitt, James J. Higginson, Adrian Iselin, jr., D. Willis James, John S. Kennedy, Seth Low, Solomon Loeb, Alfred B. Mason, Victor Morawetz, J. Pierpont Morgan, Oswald Ottendorfer, Jacob H. Schiff, Gustave H. Schwab, Charles S. Smith, James Speyer, Walter Stanton, J. Kennedy Tod, Abraham Wolff, and Cornelius Vanderbilt, together with such per- sons as they may associate with themselves. These gentlemen are among the most prominent and substantial in the city of New York. Section 3 of said act reads as follows : Said society shall be entitled to act as pawnbroker, and shall be subject to and entitled to all the benefits of all the provisions of the laws of this State concerning pawnbrokers, except that it shall not be required to obtain a license or file a bond. KEPORTS OF THE PEESIDENT's HOMES COMMISSION. 315 This society is allowed under the law to charge interest at the rate of not exceeding 3 per cent per month, and, notwithstanding its stu- pendous capital and the fact that it is classed as a benevolent society, it actually charges as interest on all loans made 1 per cent per month. From the thirteenth annual report of said society, for the year 1907, it appears that the capital employed at the close of the year 1907 was $5,001,586.14, that the amount loaned during said year was $10,601,000, and that the average single loan was $37.46. On page 11 of the report of 1905, in advocating making pawn offices accessible to the working classes, this statement will be found : The need of the workng classes, who form the great army of borrowers, can best be met by making the pawn office accessible to them. Convenience of ac- cess is even more important than a low rate of interest. This is evidenced by the great growth of our own Eldridge street branch, on the East Side, where the transactions already largely exceed those of the Fourth avenue office. It is also evidenced by the fact that many prefer to patronize an adjacent pawn- broker whose rate of interest is much higher than that charged by this society rather than go a little out of their way to one of our offices. The benevolent purpose of the society will be far better effectuated by an increase in the num- ber of our branches than by any lowering of the rate of interest, even if such a course were otherwise desirabre. Most loans are, or are intended to be, for a short period when made. Car fares and loss of time count for more than a higher interest charge. Could there possibly be any stronger argument as to the necessity for legalizing a reasonable rate of interest on such loans than the operations of this society ? It has a vast capital, most of it made up by gifts or bequests and contributions from the rich, and is operated not primarily for profit, and yet it actually charges 1 per cent per month on its loans and is allowed by law to charge 3 per cent per month. The report of the president for 1907 shows that — In 1895, our first full year, we had one small loaning office, which made 20,804 loans, amounting to $377,845 ; in 1907, with six loaning offices in operation, 283,- 045 loans, amounting to $10,601,557, were made. In 1895, 18,214 loans, amount- ing to $322,596, were repaid, whereas in 1907 the number was 254,663, amount- ing to $9,840,379. Again, the interest earnings, amounting in 1895 to $23,847, reached in 1907, the large sum of $564,534. The enormous attention to detail involved in the successful conduct of this business becomes apparent when one considers that the average of the loans made in 1907 was $37.46. The same comparison holds good as to the personnel and organization of the society. From a rented office with a staff of four or five people, employing $100,000 capital, it has become a great fiscal institution of $5,000,000 capital, a large, well-trained staff of about sixty employees, with six offices. * ♦ * Of course, everyone will realize that the smaller the loan on personal prop- erty the less the margin of profit, as the percentage of operating expenses is proportionately larger when a small loan is made than when made in large amounts. The executive committee decided that on November 1, 1907, in view of the increased cost of capital and the greater cost of handling an increasing volume of small loans (192,060 being for $25 and under, 91,754 being for $10 and under, and 44,450 being for sums of $25 to $50) all renewals, as well as all new loans, should be at the interest rate of 1 per cent per month or fraction thereof, except those repaid within two weeks from date of making, when one- half per cent only would be charged. Mr. Frank Tucker, the vice-president and executive officer, at a conference held with a committee of our Society for Savings of Washington, in July, 1908, stated that the handling of small loans a't 1 per cent per month was purely a charitable propo'sition and so 316 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. regarded by his society, but an absolute impossibility to any concern with a smaller capital, and submitted the following figures as proof : Number of loans made 1907, 283,045. Operating expenses, excluding dividends, $127,052.62, or a cost per loan of 45 cents. Cost of $10 loan to society, 45 cents. Dividend of 6 per cent per annum on $10, 60 cents. A loan of $10 cost the society for one year, $1.05. Ten dollars at 1 per cent per month earns the society for one year $1.20, or a loan of $10 for the first nine months merely earned its cost of handling, but that 2 per cent per month was more reasonable and a fair business propo- sition. The Provident Loan Company, of Buffalo, was incorporated under the aforementioned act, and a reading of the annual reports of said company and of the other companies or societies hereinafter men- tioned will be interesting to those who care to investigate further into this matter. The rate of interest charged by the Provident Loan Company, of Buffalo, is 3 per cent per month for the first month, and 2 per cent for each month thereafter, and a charge of $3 for ex- amination of property and recording of mortgages, etc., the rate allowed by law. It is said in one of the annual reports of this com- pany that "its purpose is the same as that of the Workingmen's Loan Association, of Boston, founded by Robert Treat Paine in 1887, and its methods of business are closely patterned after those in use by that association." (See First Annual Report, September 9, 1895, to September 30, 1896.) The Workingmen's Loan Association, of Boston, was one of the pioneers in this line of business. The law under which it was incorporated and its operations will be alluded to further on. Massachusetts. — By an act of the legislature of the State of Massa- chusetts entitled " An act to incorporate the Pawner's Bank," ap- proved April 5, 1859, it is provided by section 4 that — The charge on all loans to cover expenses of every kind, including interest, shall be uniform, and not to exceed one and one-half per cent per month. This act was amended by an act entitled "An act to amend the charter of the Pawner's Bank of Boston," approved June 21, 1869. Section 2 thereof reads as follows: The charge on loans, to cover expenses of every kind, including interest, need not be uniform, but may be regulated by the bank, but it shall in no case exceed two per cent per month. This so-called bank is still in business, but it is now operated under the name of the Collateral Loan Company of Boston. The total amount of the loans made by it for the year 1905 amounted to $2,092,566.08. The average single loan was $22.78. The Workingmen's Loan Association of Boston was incorporated by an act of the legislature of Massachusetts approved March 8, 1888, entitled "An act to incorporate the Workingmen's Loan Asso- ciation." By this act a charter was granted to Robert Treat Paine, Charles W. Dexter, John S. Blatchford, Francis C. Foster, John D. W. French, I. Wells Clarke, George W. Pope, Charles H. Wash- burn, Robert Treat Paine, second, Thomas T. Stokes, and Henry R. Gardner, and their associates and successors. The association was authorized to loan money upon pledge or mortgage of goods and chattels, and on safe securities or every kind, or upon mortgage of BEPORTS OP THE PRESIDENT'S HOMES COMMISSION. 317 real estate. The capital stock of the association is $125,000. The amount of outstanding loans on April 1, 1908, was $215,826.64, the number of borrowers was 3,585, and the average single loan was about $60. ( See the Twentieth Annual Report of the Workingmen's Loan Association, dated April 16, 1908.) In a pamphlet published by the Massachusetts board of managers. World's Fair, in 1893, entitled " Origin and system of the Workingmen's Loan Associa- tion," on page 5 appears the following statement : The charge for interest is 1 per cent per month. An additional charge is made on the making of each loan sufficient to cover all money expended in investigation and recording the mortgage, and to give the company in ordinary cases $1.65 for the time spent in appraisal and drawing papers. Nearly all of the loans of the company are made on chattel mortgage of furniture and household effects. This has been amended, and at the present time, October, 1908, the association, in addition to its regular rate of 1 per cent per month, charges for investigation, recording of mortgages, etc., the sum of $2.50 on loans under $50, $3 on loans of $50 to $250, and $5 on loans over $250 ; $1 is the cost charged for renewals. No loan is made for less than $25 on account of the cost of handling, which amounts to $3.77, although the cost of recording chattel mortgages in Massachusetts is but 75 cents, and no notarial certificate is required on this class of mortgages. The association also charges 25 cents on loans under $50, and 50 cents on loans from $50 to $100, to compensate the association for the risk of loss of goods mortgaged, by fire, though no insurance policy is taken out on the goods mortgaged as security for such small loans. Thus it will be seen that the association receives interest on its ordinary small loans for short periods of time of at least 2 per cent per month, and sometimes more. Robert Treat Paine, of Bos- ton, a gentleman of national reputation, was the first president of this association, and he has been continuously reelected to the same office to the present time. In 1908 the legislature passed an act entitled " An act to regulate further the business of making small loans " (chap. 605, 1908), which act confers on the police commissioner of Boston, and upon the mayor in other cities, the power to make the rate of interest to be charged upon small loans of $200 or less, upon which a rate of in- terest greater than 12 per cent per annum is charged, and for which no security, other than a note or contract with or without indorsers is taken, having due regard to the amount of the loan and the time for which it is made. It also fixed the charges or cost as follows : Sec. 3. ♦ * * An amount not exceeding $2 if the loan does not exceed $25 ; not exceeding $10 if the loan exceds $100 ; not exceeding $3 if the loan exceeds $25 but does not exceed $50; and not exceeding $5 if the loan exceeds $50 but does not exceed $100, may, if both parties to the loan so agree, be paid by the borrower or added to the debt, and taken by the lender as the expense of mak- ing the loan, and such amount shall not be counted as part of the interest on the loan. A greater amount than that above specified shall not be taken for such purpose, and any money paid, promised, or taken in excess of such amount shall be deemed to be interest. Under the power conferred on the police commissioner of Boston to make the rate of interest that may be charged on said class of small 318 EEPORTS OF THE PEESIDENt's HOMES COMMISSION. loans, for which no security is taken other than a note or contract with or without indorser, he has made the following rates : Sec. 3. Interest may be charged by persons licensed under this rule as fol- lows: On loans not exceeding $50, at the rate of 36 per cent per annum ; on loans of over $50, at the rate of 30 per cent per annum. The license tax for this class of business is $50 per annum. Rhode Island. — By an act of the general assembly of the State of Rhode Island, passed February 28, 1895, entitled " An act to incorpo- rate the Workingmen's Loan Association," it is provided that the rate of interest on loans to be made by said association "shall not exceed 1 per cent a month." (See sec. 4 of said act.) This act was amended on May 27, 1897, and the rate of interest on such loans was raised not to exceed 2 per cent per month, which rate is still in force. Section 4 of said act as amended reads as follows : All loans shall be for a time fixed, and for not more than one year, and the mortgagor or pledgor shall have a right to redeem his property mortgaged or pledged at any time before it is sold, pursuant to the contract between said mortgagor or pledgor and said corporation, or before the right of redemption is foreclosed, on the payment of the loan and interest at the time of the offer to redeem. No loan of more than one thousand dollars shall be made to any one person. The rate of interest upon any loan made by said corporation shall not exceed two per cent a month. No dividend shall be paid in excess of six per cent per annum. 'Maryland. — An act of the Maryland legislature of 1902, regulating the loaning of money when, as security for such a loan, a lien is taken upon household furniture and effects, musical instruments, typewrit- ers, and sewing machines, authorizes a charge for the examination or valuation of property offered as security for a loan and the prepara- tion of the necessary papers, as follows: On sums of $1 to $50, a charge of $5 ; on sums of $51 to $100, a charge of $6 ; on sums of $101 to $1,000, a charge of $6 plus 5 per cent of increase over $100 ; on sums of $1,001 and upvrard, a charge of $6 plus 5 per cent of increase over $100 and plus 2\ per cent of increase over $1,000. The said act also authorizes the collection of the amount actually to be paid for recording papers, revenue stamps, and fire-insurance premiums. While all of the loans under this act only bear interest at the rate of 6 per cent per annum, it is plain that the fixed charges by law more than raise the actual rate of interest to 2 per cent per month on ordinary short-time loans. Chapter XV. HOW TO BENEFIT THE POOR IN THE SLUMS, [By Wm. F. Downey.] For many years the board of trade and other civic associations have shown a deep interest in the material improvements in Washington. Each year we have the reports of various committees on improve- ments, embracing the departments of public buildings, parks, bridges, harbors, streets, trees, sewers, manufactures and commerce, rail- roads, etc., in which recommendations are made that millions of dol- lars be appropriated for such improvements. REPOBTS OF THE PRESIDENT'S HOMES COMMISSION. 319 While it is very commendable of our citizens to use every means possible pertaining to the manufacturing and commercial progress and material welfare of our city, we should not overlook that portion where the poor dwell in slums, alleys, and courts, in unsanitary and uninhabitable abodes. We can not truthfully boast of or take pride in our capital city until we improve the conditions of our slum prop- erty and remove the festering plague spots which are equally a men- ace to the health and morals of the community. Our attention must be directed to these slums and plague spots where the poor are forced to live. As long as these sources of pov- erty and crime are allowed to exist in our city, and are tolerated by law, there is little use in attempting to reform them ; such evil haunts are so many poison springs constantly throwing forth their putrid waters over our city, and until they are purified all moral efforts will avail but little. The surgeon who is called to treat a patient does not devote his services to the sound parts of the body, but immediately directs his attention to the diseased spot. So it behooves us to apply our reme- dies to the slums and plague spots of the community, where poverty prevails, immorality is rampant, and crime originates and flourishes. We notice that the health authorities in every town and city in the land are endeavoring to prevent or check infectious diseases, and if anyone becomes infected, that one is immediately quarantined. Similar precautions are taken in the case of steamers arriving in port with contagiously diseased patients on board. While this all-im- portant attention is given to such cases, why should we permit greater evils to exist which spread their blasting effects through the com- munity, and transfer the contagion from generation to generation, such as consumption and other diseases, emanating from immoral lives due to dens of infamy, low saloons, etc. ? Insanitary and unin- habitable dwellings, where people are crowded together, breed and spread considerable disease. For instance, many people live in these places at night, and work in homes all over the city during the day. In this way the disease germs are carried into many homes, endanger- ing the health of our little ones and blighting the happiness of our people. Much praise is due to Mr. Charles F. Weller, and those connected with the Associated Charities for the light they have thrown on the slum problem, and the aid they have rendered to those who dwell there; also the Washington Sanitary Housing Company, which has aided so many people of limited means to secure houses a moderate rental. Squalid shacks have disappeared from certain quarters and their sites are now occupied by habitable dwellings ; the purpose which brought about this change is worthy of commendation. Every effort which elevates and improves land and houses is entitled to its meed of praise. But while the housing movements have benefited a class of people who are able to pay moderate rents, what has become of the unfortunates who dwell in shacks? It is an easy matter to stigmatize the unfortunate with the names their depraved habits deserve, but what of their reform; has there been anything done to elevate them, to cleanse them, to withdraw them from their evil associates? 320 BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. This is the work under present contemplation. These poor crea- tures should not be driven to desperation; we should see to it that means are available to effect their temporal, physical, and moral welfare. It may be a work meriting all praise to beautify a portion of the city in which we live, enhancing the value of property and of elevat- ing human life. Indeed, it will be cheerfully conceded that such work is deserving of the highest praise. But how incomparably better is the merit of the effort and toil spent in uplifting frail mem- bers of the human family. They are for eternity, and should they not be impressed with the knowledge of the fact " Whatsoever you do to the least of these, you do unto Me," said the Savior of men. Shacks and shanties may be transformed into residences and man- sions, but they will crumble away. The depraved citizen of the slums is destined for eternity ; he is made in the image of God. His being known, should it not be glorious work to restore the Image, which has been well-nigh obliterated by dissipation and sin? The merit of an undertaking is due to the object and the aim. Judged by this canon how supremely meritorious is the work of redeeming and uplifting those who have fallen away from their high inheritance as children of God, and who are held in the thrall of base servitude. To beautify a city and to make habitable homes is a work of com- merce and art; to uplift and fortify frail humanity is to cooperate with Christ in the work of redemption. If the Government can build prisons for the criminals, almshouses for the poor, asylums for the afflicted, and public schools, libraries, etc., on which millions of dollars have been spent, it would seem that in common sense and in logic there can be no condemnation for an application of the same solicitude to the aid of those who are in a condition of semiparalysis, owing to economic conditions. A little government aid extended to these unfortunates in the form of a loan to build them habitable dwellings would tend immensely toward their uplifting and improvement. The home is the very foundation and corner stone of society, and should be particularly guarded against the contamination of all vice. All unsightly and insanitary property should be condemned and purchased by the Government, improved in a uniform manner, and inexpensive an dhealthful habitations erected for the poor, who could rent or purchase these homes on installment plans, at low rates of interest. Should this be done, all would be benefited, for not like money spent in the erection of prisons, poorhouses, libraries, schools, etc., that never return to the public exchequer, the money expended on such homes would return in the form of re^lar monthly pay- ments, and this in turn could be used for the continuance and spread of the good work of elevating the masses. It is manifestly unfair to exact exhorbitant rents from the poorer classes; the poorer a man is the more he is at the mercy of the owner, and this is the very man the city should try to assist. Think of it — these families paying rents for shacks, which give a gross return to the owner of from 9 per cent all the way to 35 per cent; renters pay from $6 per month to $12.50 which bring in these large returns of interest. (See report of committee on building model houses in Washington, D. C., 1908.) The fact that these renters pay from $6 to $12.50 per month shows that they are among the BEPOETS OF THE PEESIDENt's HOMES COMMISSION. 321 poorer classes. It is the sick man who needs medicine ; likewise the poor man needs assistance. In many instances there is little or no chance of his coming to the front without this assistance. How many poor helpless creatures born in the slums would, if opportunity were given to them, develop in a pure atmosphere a noble manhood and womanhood, which would make them the pride of the country, instead of becoming or remaining a burden to the com- munity? They might become some of the best citizens and bright- est statesmen if their childhood days were rescued from unhallowed surroundings. This is no dream, but the actual experience of the writer, who has succeeded in helping numbers of individuals and families to become self-helpful and rise to the highest grade of citizens. We read in the newspapers of the day of eminent men, well quali- fied to speak on the subject, making an outcry against the wasteful use of coal, iron, and timber and predicting a famine of the same in future generations. While this subject is very commendable, I sin- cerely hope the day is not far distant when the distinguished people will also consider the temporal and moral welfare of the citizens, which I think should be regarded as the most important of all subjects, as it does not only pertain to the permanent and thorough improvement and beautifying of our national capital city, but pertains chiefly to the uplift of our citizens. It is only the Federal Government which controls the affairs of the city of Washington, which could undertake such a necessary and meritorious work, by having an act passed by Congress giving power to appoint three men — an engineer, an architect, and a sanitary engi- neer — with power to condemn, purchase, and improve property m squares having narrow minor streets, and alleys without proper open- ings. Many of such squares are crowded with insanitary and unin- habitable dwellings, which make them a menace to the health and morals of the unfortunate people who are forced to dwell there. This seems to be the only correct way to deal practically with this question, and it readily appeals to the intelligence and desire of every good citizen who has the welfare of our city and citizens at heart. See the great advantage which would be derived from such an undertaking. The commission suggested, of three gentlemen, would first map out the improvements to be made in such squares, and after the condemnation of certain lots and parts of lots, then to erase all unsightly buildings from the land, so that the improvements could be made in a uniform manner by grading and beautifying the land, and erect houses on the most suitable plan. The streets in such squares should not be less than 40 feet wide from building to build- ing to be divided in the following manner : Take 10 feet in the center for a parking, where trees could be planted, giving good shade in summer to the occupants of the houses on each side of the street and affording 15 feet roadway for each side of the street. This parking and arrangement of the streets through squares would afford the children ample playgrounds and save them from the many dangers liable to happen on the public streets from trolley cars, teams, au- tomobiles, etc. Of course there are other methods for street construc- tion, but the one here suggested would no doubt be desirable, and S. Doc. 644, 60-2 22 322 KEPORTS OF THE PRESIDENT'S HOMES COMMISSION". give the houses air and sunshine, so essential to afford a bright, healthful home. The police department could carry on this work without additional expense to the Government ; the police officers could not only be made preservers of law and order, but also, as far as possible, suppress and remove every source of evil, particularly those endangering the morals of our youth. They could also be made the sanitary inspectors and collect the monthly rents and installments from the people who rent or purchase these houses. This money would go right back into the funds of the Government, and be available for the improvement of other such property, which in time would eliminate every unde- sirable and uninhabitable house in the city. If such an arrangement would be adopted it would bring about an entire change in our city government, for instead of the police officers being the prosecutors and persecutors of our unfortunate and crimi- nal classes, who are ruined by the existing vices spread nearly every- where, they would suppress and remove as far as possible the vices and save the citizens. I predict if this plan was put in operation it would reduce the criminal class more than 50 per cent. The police- man should act as the good Samaritan, which would elevate him to the highest rank in public service and make him beloved and re- spected by every good citizen. In this way they could be made the greatest power for good. While this plan is perhaps new in our country, somewhat similar plans have worked successfully in several foreign countries. I know that foreign experiences do not apply fully to our country, and a plan might work successfully there and not here on account of different political and social conditions, but the problem is about the same and its solution is of basic importance. We can profit by foreign ex- perience and modify the plan so as to meet our social and political conditions. I submit the plan herein outlined. Having the problem to deal with in the United States, we should be the leaders and not the followers. Granting, then, that the problem exists and that the United States should lead in its solution, I know of no city where it could be tried to better advantage than in the city of Washington, and its success here would mean in time its success in every city in our country. There is no reason why our city should not be the finest in the world, morally as well as materially and intellectually, and it soon would be if we set about it in the right way. We have already secured pres- tige as a center of art, letters, and legislation. Let us endeavor like- wise to protect and influence our citizens to the highest moral stand- ard by aiding them to secure better homes and to guard and protect them from the contaminating influence which now confronts them everywhere. Appendix A. HEALTH OF EMPLOYEES IN THE GOVERNMENT PRINTING OFFICE, WASHINGTON.^ [By Wm. J. Manning, M. D., Medical and Sanitary Officer, Government Printing Office.] Owing to improved hygienic conditions in modern printing offices, type foun- dries, and stereotype and electrotype foundries, lead poisoning now exists to a very limited extent in these trades. In tlie Government Printing Office at Washington, where upward of 4,500 employees are gathered in one building, excellent hygienic conditions prevail. Every ten minutes the air in each room is changed by a very simple device, consisting of air shafts leading from the basement to the roof, and which are pierced in each room near the ceiling with suitable openings. A revolving fan placed just below the roof creates a suction, so that a constant supply of fresh air is available at all times, owing to the vacuum thus formed. The electrotype and stereotype foundries are placed on the topmost floor, the modern, rapidly moving elevators making this practicable, so far as the em- ployees are concerned. At that height from the ground currents of air are con- stantly in motion, with a consequently greater diffusion of the gases than would prevail on floors nearer the ground. In the large newspaper buildings of the cities in the United States the same idea is being carried out, these rooms being placed as high in the air as possible. In the type-founding and stereotyping trades employees whose duties call them to work over the fumes of the melting pots are most exposed to the injurious influences of lead, although the large amount of alloy present tends to lessen the danger. " Finishers " of the plates, who handle only the smooth, hard, bright slabs of the alloyed metal, which are free from all oxides, run the least risk of lead poisoning. The fact that there is little or no dust, coupled with the fact that the small particles which rub off the plates on the hands of the workman are in the metallic state and perfectly dry renders it less liable to be absorbed. In contradistinction to this is the case of the painter. Here the lead, being in the form of a carbonate (white lead) and being mixed with such an excellent absorbing material as oil, is much more rapidly absorbed. EMERGENCY BOOM, GOVERNMENT PRINTING OFFICE, WASHINGTON, D. a In type foundries practically the same conditions exist as in electrotype foundries. Those who work in the vicinity of the melting pots are much more liable to the toxic vapors which arise from the melting pot. This is particularly the case where the lead is impure and contains volatile substances which, com- bining with the lead fumes, might possibly add to the toxic influences of the lead. Hence, in " fluxing " the metal, when wax is used as the agent, as little as possible should be used. Females are, as a rule, employed in this country to sort, finish, and pack the type. Here, as with the " finishers " in the electrotype foundries, the metal is bright and free from oxides, besides being largely alloyed ; hence, the chance °' Doctor Manning's article on Plumbism, which is here reproduced, was sub- mitted by him in competition for a prize offered by the Internationales Arbeit- sant, Basel, Switzerland. The article was purchased for publication by that office on account of merit. 828 324 KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. of absorption with toxic results is greatly lessened. Doctor Osier has pointed out that the ratio of women susceptible to lead poisoning is small as com- pared with men. Why they are thus immune is hard to say ; but, so far as type founding is concerned, probably the above statement indicates the cause. With the compositor the chances of absorption of lead from the type metal by the skin is probably nil. Only a small portion of the epidermis of the fingers (the apex of the thumb and forefinger) is brought in contact with the metal both in " distributing " and in " setting," and the epidermis at these parts is in a more or less thickened, dense condition. Thus, the compositor is protected from absorbing the metal, even when the type is covered with the hydrate which is formed by the long-continued action of air and water. It is well known that substances are absorbed but slightly, if at all, through the skin that is in a thickened condition. If one will stop to consider that the small atoms which become separated from the metal type in one way and another are in a metallic form the chances of absorption are even more remote. The danger to the compositor, as with the melting-pot tender, would seem to lie in inhalation. With the former the introduction into the system would be by dust, and with the latter in the form of gas. When foreign bodies are taken into the system in a state of fine subdivision, the favorite seat will be found, as a rule, in the bronchi and the lungs. The process, so far as compositors are concerned, might be termed plumbiosis. The dust which is not carried directly into the alveoli of the lungs by the air breathed finds lodgment on the membrane of the bronchi and the ramifications thereof. That considerable dust is carried down the esophagus into the stom- ach and from there swept out into the intestines is not to be doubted. Might not these fine particles cause the " colic " or active peristalsis by the stimulation of the circular and longitudinal muscular fibers in a mechanical way on the muscles themselves or in a chemic way by a stimulation of the nerves con- trolling these fibers? This "colic" is one of the first symptoms complained of by the patient. That the white blood corpuscles play an important part in carrying this finely divided substance throughout the body is also probable, the mode of action being to inclose the fine particles and try to dissolve them, and, failing in that, to transport them to distant points in the body and to the various organs. In that condition known as anthracosis, or coal-miner's consumption, the lung is found to be covered with black dust. The same conditions are found in those suffering from stonecutter's consumption, the lack of carbon rendering the pigment somewhat lighter in color. The condition is known as lithosis. In the knife and saw sharpener's trade the dust is in the form of steel and the consequent disease is known as siderosis. In each case the fine dust finds lodgment in the lungs. The lungs become so pigmented after long exposure to these conditions, and the alveoli so congested and choked, accompanied by a low form of inflamma- tion that the substances set up, that this, with the unhygienic surroundings and bad ventilation, might explain why so many compositors die each year from tuberculosis. Certainly the tubercle bacilli find a congenial environment in which to begin their fatal work. To the above conditions must be added, of course, the toxic influence of the lead itself, together with the persistent astrin- gent effect of the lead on the air cells. Lead is a very feeble antiseptic and does not seem to inhibit the growth of the bacilli. The lymph nodes very likely play an important part in carrying the lead through the body to produce plumbism. When lymph nodes become loaded with foreign material of any nature they are apt to break down and the circulation carries the substances to various parts of the body. This would seem to explain the peculiar color of those suffering from plumbism, and it might explain why the kidneys become so irritated and why albumin is found in the urine. Certain tissues seem to have an affinity for the lead thus carried and it is deposited in them. The blue line on the gums which is pathognomic of lead poisoning may be the result of this. It may be that sulphur, which has such a strong affinity for lead and which might be taken into the mouth in articles of food and drink causes this pigmentation. It is strange that the blue line does not make its appearance on any other part of the body. Certain it is that the potassium sulphite when added to a bath will bring out this pigment over the entire body, which remains until the lead in the skin is either eliminated or the affinity is satisfied. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 325 Lead poisoning in the chronic form, as already stated, is very rare among type founders, electrotypers, stereotypers, and in the printing trades in this country. It may present itself in the regular type or the symptoms may be hidden. The characteristic symptoms are the blue line on the gums, and the wrist drop, due to the paralysis of the extensors of the forearms. In some cases it first makes its appearance in anaemia and in loss of strength. Anses- thesia may appear in spots on different parts of the body, the spots varying in size from half a dollar to tracts as large as the hand. They may appear on the arms, legs, or on the back. In some cases, however, these symptoms are entirely absent. Albumin may appear in the urine. Doctor Osier describes cases that have come under his care where the symptoms resembled gout and rheumatism. The joints would swell and become very red and tender, the patient suffering all the while intense pain. Doctor Wood mentions cases where the symptoms resembled actue poliomyelitis. In other cases there was simply a failure of health, ansemia, nervous phenomena, etc., the patient having ill-defined, sharp, shooting pains. The pain from the colic seems to merge from the umbilicus in all instances. Arteriosclerosis has been noticed with atrophy of the kidneys and hypertrophy of the heart, the enlargement of the latter organ probably being due to the redoubled effort of the heart to force the blood through the various contracted distal organs. This contraction may be due in a measure to the astringent action of the lead which is noticed upon all tissues when lead is applied in its various forms. The treatment in these cases may be divided into the preventive and cura- tive, the former relating, of course, only to the trades mentioned in this article. Among the measures which might be taken in the prevention of plumb ism in the printing, type founding, and electrotyping and stereotyping trades would be, first of all, the location. The rooms devoted to the melting of type metal should be situated as high as possible in the air, and on the topmost floor of the building. The pots should be covered with iron hoods that will cover the entire top of the melting pot proper. The hood should set as near the metal as possible, in such a way that it will not interfere with the manipulation of the ladles or dippers. Hoods with small pipes when used as fume chambers do not answer. It has been found that to be of any service or benefit, the pipe leading from the hood or fume chamber should be nearly as large as the cham- ber itself, and should lead to a smoke chimney or into the outside air. The heat generated should supply draft enough to carry the fumes off in this way. It might be aided by placing a revolving circular ventilator in the pipe from the outside and operated by the wind. The whole thing might be made very cheaply of galvanized iron. Various face masks have been suggested, but none seem to be practical, and after they are worn for some time really become a greater danger than if they had not been used, owing to the lack of cleanli- ness. Cotton and such substances in the nose are useless, because the workman will then breathe through his mouth. The rooms should be at least 10 feet high. Windows should be placed on both sides of the room, so that a current of air may be in constant motion and a fresh supply always on hand. In winter or bad weather a very simple way to obtain fresh air consists in placing a board 3 or 4 inches high lengthwise under the lower window sash. This will enable the fresh air to enter between the lower and upper windows without causing a direct draft on the workmen. The personal treatment on the part of the workman should be a change of underclothing after work, a bath at least three times a week in hot water with plenty of soap, and at the same time the vigorous application of a flesh brush to the skin. The object here is twofold — to keep the pores free and to remove any particles that may have lodged there, and hence lessen the danger of absorption, while at the same time helping the pores to eliminate that which has been absorbed. The bowels should be kept open by the use of such simple laxatives as sweet oil, castor oil, calomel and soda, etc. An electrotyper who has been in the business for some forty years, and who is now the chief of the largest foundry in the world, informed me that it was his custom to take a teaspoonful of sweet oil every other day, and that he had never suffered from any ill effects of plumbism. So far as compositors are concerned, the preventive treatment just described would apply to them. The principal danger here is the bad ventilation, in- sanitary surroundings, and the dust (principally graphite and minute particles of type metal) which becomes detached by the abrasion of the pieces against each other while being handled. To offset this, " cases " should be blown out by a bellows at least once each week ; if possible, in the open air. The bottoms 826 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. in the different boxes, instead of being fiat and square cornered, and covered with paper, should be slightly concave at the bottom, with the corners rounded somewhat like a cash till, the idea being to keep the dust from lodging in the corners, where it is difficult to remove even with a bellows. In cases con- structed in this manner the dust is, by its own weight, constantly working its way toward the center of each box, where it can easily be removed. A practical method of removing the caked dust is in vogue in the Govern- ment Printing Office at Washington. The type forms after leaving the electro- type foundry are placed on a raised rack which drains into a shallow tank some 6 inches in depth, a pipe connecting this with a sewer. The forms are placed in a horizontal position — that is to say, the side of the chase rests on the rack. Steam under pressure is conducted by a rubber hose and the face of the type is thoroughly " blown," as is the reverse of the form. Later, when the This chamber consists of a zinc-lined box about 6 feet in length, 4 feet wide, and 4 feet high, a trapdoor opening from the top being the only opening. In the bottom is placed a coil of steam pipe which covers the entire floor of the box, one end of the pipe being left open. The pages of type are placed on shallow perforated trays somewhat like a " galley," each tray fitting in a copper rack, consisting simply of two loops of copper, somewhat like an inverted U, with pins attached on which the trays set. Each rack holds eight pages, or a " sig- nature," on the eight trays. After the box is filled, steam is turned on and the type is thoroughly boiled for an hour or more. The pages are lifted in and out by means of hooks. This method not only removes the graphite but disinte- grates the type and " loosens " it, permitting easy distribution. It also leaves the type very clean and aseptic, lessening the chances of infection by the ab- sence of germs. The method of letting cold water run on the forms and thus cleansing them is not so thorough, because the graphite " cakes " and clings to the type and the dust is thrown into the compositor's case with the type, making the cases very dusty and dirty. Each compositor should supply himself with a small brush, suitable for the hands, to be used each time he washes. A private drinking cup is desirable. In acute cases of lead poisoning the treatment consists in the administration of alkaline carbonates, soap, soluble sulphates, sodium chloride, etc., washing out the stomach with large drafts of water, etc. Alum has been given, and at one time was considered almost a specific. Sweet oil and castor oil will be found useful. Milk should be taken in large quantities. The idea is first to combat the symptoms and then eliminate the lead. Opium can be given for pain. Warm sulphureted baths are very beneficial. They can be made by dissolving 4 ounces of potassium sulphide in 30 gallons of water in a wooden tub. These baths discolor the skin, from the formation of lead sulphide, and should be repeated every few days until this effect ceases. During each bath the patient should be well washed with soap and water to remove discoloration. The various kinds of typesetting machines all have a melting pot attached to each machine, and where many are in use, unless there is plenty of pure air constantly entering the room and perfect ventilation provided, the fumes from each pot should be conducted by pipes to a chamber in which a vacuum is present, so that the fumes may be instantly removed and carried out into the atmosphere. The virtue of the machine lies in the fact, so far as health is concerned, in the absence of dust, and with the additional advantage on the part of the operator that he does not lay himself open to exposure in handling the metal to so great a degree as in the case of the hand compositor. There are other alloys that would take the place of lead in type metal, but owing to the excessive cost and high fusing point their use is not practical. DOCTOB manning's METHOD FOB THE COLLECTION, DISINFECTION, AND DISPOSAL OF SPUTA. From a sanitary point of view the collection, cleaning, and disinfection of the spittoons in the Government Printing Office is a matter of considerable importance. This will be readily understood when it is remembered that there are over 4,300 persons oujrnirod during the twenty-four liours, all working in eight-hour shifts, and ilmt no fewer than 1,200 cuspidors must be cleaned at the end of each shift. The method now Installed under Doctor Manning's direction effects this with- out direct digital contact. It consists in a central sterilizing chamber situated in the basement of the Printing Office, with a cement floor, graded toward the REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 327 center and made up of two inclines. All edges, angles, corners, and returns of tho floor are well rounded and the base of each of the four walls have 6-inch " sanitary bases " in order that all parts of the room may be self cleansing and draining. The walls of the sterilizing chamber are composed of white, glazed, vitrified brick. The cuspidors are collected by means of a specially designed sanitary clutch which picks up the cuspidors in an automatic manner, one above the other, in " uests " of five, without the janitor or cleaner in any manner touching his person or in any way coming in contact with the infected or soiled cuspidors, avoiding entirely the irksome, repulsive features which characterize • the meth- ods in vogue at the present time as concerns the washing of spittoons, and greatly minimizes the danger of contraction of tuberculosis by all concerned, and serves, in addition, to draw attention and illustrate a lesson in hygiene to the unthinking and careless. The vessels thus collected are carried by means of the clutch or holder to specially designed wooden, zinc-lined box trucks with detachable sides. Each truck is capable of holding 175 cuspidors for transmission to the sterilizing chamber. As 5 soiled cuspidors are taken to the truck they are replaced by 5 sterilized cuspidors picked up and distributed by the same mechanism, all of which is accomplished by the use of one hand only of the operator. After the trucks are filled they are transmitted from the respective floors to the basement on a freight elevator and wheeled directly into the sterilizing chamber. In the chamber is fitted up an iron rack similar in form to that shown in photograph taken of Government Printing Office exhibit at the International Congress on Tuberculosis, and is constructed of strips of 1-inch angle iron, from which hang suspended at intervals of 10 inches steel- wire clutches, shaped somewhat like an inverted letter U, into which are thrust the cuspidors after they have been dipped and washed in boiling water (212° F.), and from whence they are taken after they have been drained or dried, and replaced in trucks for transmission back to the floors of building. A galvanized-iron trough, connected directly with the sewer, is placed at the base and in front of the iron rack. The hot, boiling water is piped directly into this trough after it has been heated for this purpose by jets of steam entering the pipe through which the cold water flows. The contents of cuspidors are emptied directly into the trough by means of short forceps which grasp the lip of the cuspidor, whence it escapes to the sewer. After the vessel has been made thoroughly clean and sterilized by immersion in the boiling water, the operator, still grasping the forceps, presses the vessel into the steel spring clutch on rack, where it drains and dries, as shown in photograph. After the cuspidors have all been washed and sterilized in the manner described, they are quickly removed from the spring clutch on iron rack by the cleaner and replaced in truck. As each layer is laid down in the truck, from 2 to 4 ounces of a solution made up of bichloride of mercury 7.3 grains; citric acid, 7.7 grains to each gallon of water, which, in addition, is colored with eosin to differentiate the solution and to warn persons that the liquid is not water, is poured into each spittoon, where it remains until all the vessels are washed again. This gives a strength solution suflicient to kill the most resistant disease germs, yet when still further diluted with water in the trough during the cleaning process, renders the solution harmless to plumbing work or the piping of sewers. The bichloride is used for its germicidal power, while the citric acid is added to retard the coagulation of the albumin in the saliva and expectorations, and thus render the action of the bichloride of mercury more potent. It is one of the most powerful antiseptics known to science. The entire cost of the chemical disinfectants named amounts to less than $12 per annum. Five gallons can be made for about 1 penny. The cuspidors are specially designed to permit of easy cleaning and self- draining, largely on account of the character of the curves employed. Angles which would interfere with the cleaning process have been avoided, and the stream of water will readily reach all the internal surfaces. The constriction, or neck, is sufficiently wide to permit the stream of the hose to enter with full force. A certain amount of constriction at the neck seemed desirable to hide the contents of cuspidor when in use. They were designed, however, with the special object of easy cleaning and without direct digital contact, because it would seem almost inhuman to ask a cleaner to place his hand, 328 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. containing even a sponge, in the ordinary stock cuspidor and wash the interior in a thorough and sanitary manner. All of this repulsive work has been avoided, so that by the new method the operator does not touch the cuspidor with his hands until he plucks the washed and sterilized cuspidor from the rack and places it in the truck. Hard vitrified china ware has been used to construct the cuspidors, as this is the only material that will withstand the corrosive action of bichloride of mercury and at the same time present a smooth, white surface for sanitary cleansing. Approximately about 3,800 barrels of sawdust are used each year for cus- pidors in the Government Printing Office, at a cost of about $100 per month. While, of course, this item will be saved, together with the cost of handling and carting away of the foul and polluted sawdust, the main object has been to reduce to a minimum the danger of infection through tuberculosis sputa among the employees." • * • * * The report of Doctor Manning, in charge of the sanitary division of the Government Printing Office, shows that of 4,556 employees in the building from January 1, 1906, to February 29, 1908, 1,153 employees received treatment at the emergency room, 595 were medical cases inclusive of 9 cases of lead colic. Of these, 516 resumed work, 76 were sent home for treatment, and 3 died. Of the 558 surgical cases, 517 resumed work and 41 were sent home for treat- ment. The emergency department is well equipped, and the results have in every way justified its establishment. !Ajppendix B. EEGTJLATION OF DANGEROUS TRADES IN ENGLAND. In addition to the general provisions regarding ventilation, etc., which apply to all manufacturing establishments, the English factory and workshop act .(1901) contains a chapter of special provisions for dangerous and unhealthy industries, which is reprinted below, together with the special rules and regu- lations issued by the government officials in accordance with the grant of authority therein made. FACTORY AND WORKSHOP ACT, 1901. Past IV. — Dangerous and Unhealthy Industries, (i) SPECIAL PROVISIONS. SECTioif 73. (1) Every medical practitioner attending on or called in to vl«it a patient whom he believes to be suffering from lead, phosphorus, arsenical, or mercurial poisoning, or anthrax, contracted in any factory or workshop, shall (unless the notice required by this subsection has been previously sent) send to the chief inspector of factories at the home office, London, a notice stating the name and full postal address of the patient and the disease from which, in the opinion of the medical practitioner, the patient is suffering, and shall be entitled in respect of every notice sent in pursuance of this section to a fee of 2 shillings and 6 pence, to be paid as part of the expenses incurred by the secretary of state in the execution of this act. (2) If any medical practitioner, when required by this section to send a notice, fails forthwith to send the name, he shall be liable to a fine not ex- ceeding 40 shillings. « All of the mechanical devices used in the above method have been designed by Doctor Manning, and were awarded a special gold medal by the Interna- tional Congress on Tuberculosis, 1908. EEPORTS OF THE PEESIDENT 's HOMES COMMISSION. 329 (3) Written notice of every case of lead, phosphorus, arsenical, or mercurial poisoning, or anthrax, occurring in a factory or workshop shall forthwith be sent to the inspector and to the certifying surgeon for the district ; and the pro- visions of this act with respect to accidents shall apply to any such case in like manner as to any such accident as is mentioned in those provisions. (4) The secretary of state may, by special order, apply the provisions of this section to any other disease occurring in a factory or workshop, and thereupon this section and the provisions referred to therein shall apply accordingly. Sec. 74. If in a factory or workshop where grinding, glazing, or polishing on a wheel, or any process is carried on by which dust, or any gas, vapor, or other impurity, is generated and inhaled by the workers to an injurious extent, it appears to an inspector that such inhalation could be to a great extent pre- vented by the use of a fan or other mechanical means, the inspector may direct that a fan or other mechanical means of a proper construction for preventing such inhalation be provided within a reasonable time, and if the same is not provided, maintained, and used, the factory or workshop shall be deemed not to be kept in conformity with this act. Sec. 75. (1) In every factory or workshop where lead, arsenic, or any other poisonous substance is used, suitable washing conveniences must be provided for the use of the persons employed in any department where such substances are used. (2) In any factory or workshop where lead, arsenic, or other poisonous sub- stance is so used as to give rise to dust or fumes, a person shall not be allowed to take a meal or to remain during the times allowed for him for meals in any room in which any such substance is used, and suitable provision shall be made for enabling the persons employed in such rooms to take their meals elsewhere in the factory or workshop. (3) A factory or workshop in which there is a contravention of this section shall be deemed not to be kept in conformity with this act. Sec. 76. (1) A woman, young person, or child must not be employed in any part of a factory in which wet spinning is carried on unless sufficient means are employed and continued for protecting the workers from being wetted, and where hot water is used for preventing the escape of steam into the room occu- pied by the workers. (2) A factory in which there is a contravention of this section shall be deemed not to be kept in conformity with this act. Sec. 77. (1) In the part of a factory or workshop in which there is carried on (a) the process of silvering of mirrors by the mercurial process, or (?)) the process of making white lead, a young person or child must not be employed. (2) In the part of a factory in which the process of melting or annealing glass is carried on a female, young person, or a child must not be employed. (3) In a factory or workshop in which there is carried on (a) the making or finishing of bricks or tiles not being ornamental tiles, or (&) the making or finishing of salt, a girl under the age of 16 years must not be employed. (4) In the part of a factory or workshop in which there is carried on (a) any dry grinding in the metal trade, or (6) the dipping of lucifer matches, a child must not be employed. (5) Notice of a prohibition contained in this section must be affixed in the factory or workshop to which it applies. Sec 78. (1) A woman, young person, or child must not be allowed to take a meal or to remain during the time allowed for meals in the following factories or workshops, or parts of factories or workshops; that is to say, (a) in the case of glass works in any part in which the materials are mixed; and (6) in the case of glass works where flint glass is made, in any part in which the work of grinding, cutting, or polishing is carried on; and (c) in the case of lucifer- match works, in any part of which any manufacturing process or handicraft (except that of cutting the wood) is usually carried on; and (d) in the case of earthenware works, in any part known or used as dippers' house, dippers' drying room, or china scouring room. (2) If a woman, young person, or child is allowed to take a meal or to remain during the time allowed for meals in a factory or workshop or part thereof in contravention of this section, the woman, young person, or child shall be deemed to be employed contrary to the provisions of this act. (3) Notice of the prohibition of this section shall be afl3xed in every factory or workshop to which it applies. 330 KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. (4) Where it appears °^ to the secretary of state that by reason of the nature of the process in any class of factories or workshops or parts thereof not named in this section the taking of meals therein is specially injurious to health, he may, if he thinks fit, by special order extend the prohibition in this section to the class of factories or workshops or parts thereof. (5) If the prohibition in this section is proved to the satisfaction of the sec- retary of state to be no longer necessary for the protection of the health of women, young persons, and children, in any class of factories or workshops or parts thereof to w^hich it has been so extended, he may, by special order, rescind the order of extension, without prejudice to the subsequent making of another order. (it) REGULATIONS FOR DANGEROUS TRADES. Sec. 79. Where the secretary of state is satisfied that any manufacture, machinery, plant, process, or description of manual labor, used in factories or workshops, is dangerous or injurious to health or dangerous to life or limb, either generally or in the case of women, children, or any other class of persons, he may certify that manufacture, machinery, plant, process, or description of manual labor to be dangerous : and thereupon the secretary of state may, sub- ject to the provisions of this act, make such regulations as appear to him to be reasonably practicable and to meet the necessity of the case. Sec. 80. (1) Before the secretary of state makes any regulations under this act, he shall publish, in such manner as he may think best adapted for inform- ing persons affected, notice of the proposal to make the regulations, and of the place where copies of the draft regulations may be obtained, and of the time (which shall not be less than twenty-one days) within which any objection made with respect to the draft regulations by or on behalf of persons affected must be sent to the secretary of state. (2) Every objection must be in writing and state — (a) the draft regulations or portions of draft regulations objected to, (ft) the specific grounds of ob- jection, and (c) the omissions, additions, or modifications asked for. (3) The secretary of state shall consider any objection made by or on be- half of any persons appearing to him to be aifected which is sent to him vrithin the required time, and he may, if he thinks fit, amend the draft regulations, and shall then cause the amended draft to be dealt with in like manner as an original draft. (4) Where the secretary of state does not amend or withdraw any draft I'cgulations to which any objection has been made, then (unless the objection eitlior is withdrawn or appears to him to be frivolous) he shall, before making the regulations, direct an inquiry to be held in the manner hereinafter provided. Sec. 81. (1) The secretary of state may appoint a competent person to hold an inquiry with regard to any draft regulations, and to report to him thereon. (2) The inquiry shall be held in public, and the chief inspector and any ob- jector and any other person who, in the opinion of the person holding the in- quiry, is affected by the draft regulations, may appear at the inquiry either in person or by counsel, solicitor, or agent. (3) The witnesses on the inquiry may, if the person holding it thinks fit, be examined on oath. (4) Subject as aforesaid, the inquiry and all proceedings preliminary and incidental thereto shall be conducted in accordance with rules made by the secretary of state. (5) The fee to be paid to the person holding the inquiry shall be such as the secretary of state may direct and shall be deemed to be part of the expenses of the secretary of state in the execution of this act. Sec. 82. (1) The regulations made under the foregoing provisions of this act may apply to all the factories and workshops in which the manufacture, machinery, plant, process, or description of manual labor certified to be dan- gerous is used (whether existing at the time when the roirulations are made or afterwards established), or to any specified class of such fnctorios or work- shop. They may provide for the exemption of any specified class or factories or workshops either absolutely or subject to conditions. (2) The regulations may apply to tenement factories and tenement work- shops, and in such case may impose duties on occupiers who do not employ any person, and on owners. <»For orders extending the prohibition in this section, see post. REPOETS OF THE PRESIDENT'S HOMES COMMISSION. 331 (3) No person shall be precluded by any agreement from doing, or be liable under any agreement to any penalty or forfeiture for doing, such acts as may be necessary in order to comply with the provisions of any regulation made under this act. Sec. S3. Regulations made under the foregoing provisions of this act may, siniong other things — (a) prohibit the employment of, or modify or limit the period of employment of, all persons or any class of persons in any manufacture, machinery, plant, process, or description of manual labor certified to be danger- ous, and (6) prohibit, limit, or control the use of any material or process, and (c) modify or extend any special regulations for any class of factories or workshops contained in this act. Sec. 84. Regulations made under the foregoing provisions of this act shall be laid as soon as possible before both houses of Parliament, and if either house within the next forty days after the regulations have been laid before the house, resolve that all or any of the regulations ought to be annulled, the regu- lations shall, after the date of resolution, be of no effect, without prejudice to the validity of anything done in the meantime thereunder or to the making of any new regulations. If one or more of a set of regulations are annulled, the secretary of state may, if he thinks fit, withdraw the whole set. Sec. 85. (1) If any occupier, owner, or manager, who is bound to observe any regulation under this act, acts in contravention of or fails to comply with the regulation, he shall be liable for each offense to a fine not exceedhig £10 ($48.67) and, in the case of a continuing offense, to a fine not exceeding £2 ($9.73) for every day during which the offense continues after conviction therefor. (2) If any person other than an occupier, owner, or manager, who is bound to observe any regulation under jthis act, acts in contravention of or fails to comply with the regulation, he shall be liable for each offense to a fine not exceeding £2 ($9.73) and the occupier of the factory or workshop shall also be liable to a fine not exceeding £10 ($48.67), unless he proves that he has taken all reasonable means by publishing, and to the best of his power enforcing, the regulations to prevent the contravention or noncompliance. Sec. 86. (1) Notice of any regulations having been made under the foregoing provisions of this act, and of the place where copies of them can be purchased, shall be published in the London, Edinburgh, and Dublin Gazettes. (2) Printed copies of all regulations for the time being in force under this act in any factory or workshop shall be kept posted up in legible characters in conspicuous places in the factory or workshop where they may be conveniently rend by the persons employed. In a factory or workshop in Wales or Mon- mouthshire the regulations shall be posted up in the Welsh language also. (3) A printed copy of all such regulations shall be given by the occupier to any person affected thereby on his or her application. (4) If the occupier of any factory or workshop fails to comply with any pro- vision of this section as to posting up or giving copies, he shall be liable to a fine not exceeding £10 (49.67). (5) Every person who pulls down, injures, or defaces any regulation posted up in pursuance of this act, or any notice posted up in pursuance of the regula- tions, shall be liable to a fine not exceeding £5 ($24. .So). (6) Regulations for the time being in force under this act shall be judicially noticed. Special rules and regulations* White lead factories. Red and orange lead works. Yellow lead works. Lead smelting works. Factories using yellow chromate of lead. Earthenware and china works. Electric accumulator factories (regulations). Iron-plate enameling works (using lead, arsenic, or antimony), Tinning and enameling works (using lead or arsenic). Paint and color works (extractions of arsenic). Brass and compound metal mixing or casting shops. Chemical works. Bichromate or chromate of potassium or sodium works. Explosive works (using di-nitro-benzole) . 332 EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. Vulcanized india-rubber works (using bisulphide of carbon). Lucifer match factories using white or yellow phosphorus. Felt-hat factories (regulations). Handling of dry and dry-salted hides and skins imported from Asia. Wool and hair sorting (regulations). Flax and tow spinning and weaving (regulations). File cutting by hand (regulations). Bottling of aerated water. Spinning by self-acting mules (regulations).^ Loading goods on docks and wharves (regulations). Use of factory engines and cars (regulations). White-Lead Factories. [Form 247 — February, 1903.] In these rules " persons employed in a lead process " means a person who is employed in any work or process involving exposure to white lead, or to lead or lead compounds used in its manufacture, or who is admitted to any room or part of the factory where such process is carried on. Any approval given by the chief inspector of factories in pursuance of rules 2, 4, 6, 9, or 12 shall be given in writing, and may at any time be revoked by notice in writing signed by him. DUTIES OF OCCUPIERS. 1. On and after July 1, 1899, no part of a white-lead factory shall be con- structed, structurally altered, or newly used, for any process in which white lead is manufactured or prepared for sale, unless the plans have previously been submitted to and approved in writing by the chief inspector of factories. 2. (a) Every stack shall be provided with a standpipe and movable hose, and an adequate supply of water distributed by a hose. (&) Every white bed shall, on the removal of the covering boards, be effect- ually damped by the means mentioned above. Where it is shown to the satisfaction of the chief inspector of factories that there is no available public water service in the district, it shall be a suflSicient compliance with this rule if each white bed is, on the removal of the covering boards, effectually damped by means of a watering can. 3. Where white lead is made by the chamber process, the chamber shall be kept moist while the process is in operation, and the corrosions shall be effect- ually moistened before the chamber is emptied. 4. (a) Corrosions shall not be carried except in trays of impervious material, (6) No person shall be allowed to carry on his head or shoulder a tray of corrosions which has been allowed to rest directly upon the corrosions, or upon any surface where there is white lead. (c) All corrosions before being put into the rollers or wash becks shall be effectually damped, either by dipping the tray containing them in a trough of water or by some other method approved by the chief inspector of factories. 6. The flooring around the rollers shall either be of smooth cement or be cov- ered with sheet lead, and shall be kept constantly moist. 6. On and after January 1, 1901, except as hereinafter provided — (o) Every stove shall have a window, or windows, with a total area of not less than 8 square feet, made to open, and so placed as to admit of effectual through ventilation. (6) In no stove shall bowls be placed on a rack which is more than 10 feet from the floor. (c) Each bowl shall rest upon the rack and not upon another bowl. (d) No stove shall be entered for the purpose of drawing until the temper- ature at a height of 5 feet from the floor has fallen either to 70° F., or to a point not more than 10* F. above the temperature of the air outside. (e) In drawing any stove or part of a stove there shall not be more than one stage or standing place above the level of the floor. Provided that if the chief insi)ector approves of any other means of ventilat- ing a stove, as allowing of effectual through ventilation, such means may be adopted, notwithstanding paragraph (a) of this rule; and if he approves of any other method of setting and drawing the stoves, as ellectually preventing white EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 333 lead from falling upon any worker, such method may be followed, notwith- standing paragraphs (6) and (e) of this rule. 7. No person shall be employed in drawing Dutch stoves on more than two days in any week. 8. No dry white lead shall be deposited in any place that is not provided either with a cover or with a fan effectually removing the dust from the worker. 9. On and after January 1, 1900, the packing of dry white lead shall be done only under conditions which secure the effectual removal of dust, either by exhaust fans or by other efficient means approved in each case by the chief inspector of factories. This rule shall not apply where the packing is effected by mechanical means entirely closed in. 10. The floor of any place where packing of dry white lead is carried on shall be of cement, or of stone set in cement. 11. No woman shall be employed or allowed in the white beds, rollers wash becks, or stoves, or in any place where dry white lead is packed, or in other work exposing her to white lead dust. 12. (a) A duly qualified medical practitioner (in these rules referred to as the "appointed surgeon") shall be appointed by the occupier for each factory, such appointment to be subject to the approval of the chief inspector. (6) No person shall be employed in a lead process for more than a week without a certificate of fitness granted after examination by the appointed surgeon. (c) Every person employed in a lead process shall be examined once a week by the appointed surgeon, who shall have power to order suspension from employment in any place or process. (d) No person after such suspension shall be employed in a lead process without the written sanction of the appointed surgeon. (e) A register in a form approved by the chief inspector of factories shall be kept, and shall contain a list of all persons employed in lead processes. The appointed surgeon will enter in the register the dates and results of his exam- inations of the persons employed, and particulars of any directions given by him. The register shall be produced at any time when required by His Majesty's inspectors of factories or by the certifying surgeon or by the appointed surgeon. 13. Upon any person employed in a lead process complaining of being unwell, the occupier shall, with the least possible delay, give an order upon a duly qualified medical practitioner. 14. The occupier shall provide and maintain sufficient and suitable respirators, overalls, and head coverings, and shall cause them to be worn as directed in rule 29. At the end of every day's work they shall be collected and kept in proper custody in a suitable place set apart for the purpose. They shall be thoroughly washed or renewed every week, and those which have been used in the stoves, and all respirators, shall be washed or renewed daily. 15. The occupier shall provide and maintain a dining room and a cloakroom in which workers can deposit clothing put off during working hours. 16. No person employed in a lead process shall be allowed to prepare or partake of any food or drink except in the dining room or kitchen. 17. A supply of a suitable sanitary drink, to be approved by the appointed surgeon, shall be kept for the use of the workers. 18. The occupier shall provide and maintain a lavatory for the use of the workers, with soap, nailbrushes, and at least one lavatory basin for every five persons employed. Each such basin shall be fitted with a waste pipe. There shall be a constant supply of hot and cold water laid on, except where there is no available public water service, in which case the provision of hot and cold water shall be such as shall satisfy the inspector in charge of the district. The lavatory shall be thoroughly cleaned and supplied with clean towels after every meal. There shall, in addition, be means of washing in close proximity to the workers of each department, if required by notice in writing from the- inspector in charge of the district. There shall be facilities, to the satisfaction of the inspector in charge of the district, for the workers to wash out their mouths. 19. Before each meal, and before the end of the day's work, at least 10 min- uts in addition to the regular meal times shall be allowed to each work«* for washing. 334 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. A notice to this effect shall be affixed in each department. 20. The occupier shall provide and maintain sufficient baths and dressing rooms for all persons employed in lead processes with hot and cold water, soap, and towels, and shall cause each such person to take a bath once a week at the factory. A bath register shall be kept containing a list of all persons employed in lead processes and an entry of the date when each person takes a bath. This register shall be produced at any time when required by His Majesty's inspectors of factories or by the certifying surgeon or by the appointed surgeon. 21. The dressing rooms, baths, and water-closets shall be cleaned daily. 22. The floor of each work room shall be cleaned daily, after being thoroughly damped. DUTIES OF PERSONS EMPLOYED. 23. No person shall strip a white bed or empty a chamber without previously effectually damping, as directed in rules 2 and 3. 24. No person shall carry corrosions or put them into the rollers or wash becks otherwise than as permitted by rule 4. 25. No person shall set or draw a stove otherwise than as permitted by rules 6 and 7. 26. No person shall deposit or pack dry white lead otherwise than as per- mitted by rules 8 and 9. 27. Every person employed in a lead process shall present himself at the ap- pointed times for examination by the appointed surgeon, as provided in rule 22. 28. No person, after suspension by the appointed surgeon, shall work in a lead process without his written sanction. 29. Every person engaged in [stripping] white beds, emptying chambers, rollers, wash becks, or grinding, setting, or dra-wing stoves, packing, paint mix- ing, handling dry white lead, or in any work involving exposure to white-lead dusts, shall, while so occupied, wear an overall suit and head covering. Every person engaged in stripping white beds, or in emptying chambers, or in drawing stoves, or in packing, shall in addition wear a respirator while so occupied. 30. Every person engaged in any place or process named in rule 29 shall, be- fore partaking of meals or leaving the premises, deposit the overalls, head coverings, and respirators in the place appointed by the occupier for the pur- pose, and shall thoroughly wash face and hands in the lavatory. 31. Every person employed in a lead process shall take a bath at the factory at lenst once a week, and wash in the lavatory before bathing; having done so he shall at once sign his name in the bath register, with the date. 32. No person employed in a lead process shall smoke or use tobacco in any form or partake of food or drink elsewhere than in the dining room or kitchen. 33. No person shall in any way interfere, without the knowledge and concur- rence of the occupier or manager, with the means and appliances provided for the removal of dust. 34. The foreman shall report to the manager, and the manager shall report to the occupier, any instance coming under his notice of a worker neglecting to observe these rules. 35. No person shall obtain employment under an assumed name or under any false pretense. Arthxjb Whitelegge, Chief Inspector of Factories. M. W. Ridley, One of His Majesty's Principal Secretaries of State. 1st June, 1899. Note. — These rules must be kept posted up in conspicuous places in the fac- tory to which they apply, where they may be conveniently read by the persons employed. Any person who is bound to observe these rules and fails to do so, or acts in contravention of them is liable to a penalty ; and in such cases the occu- pier also is liable to a penalty unless he proves that he has taken all reasonable means by publishing, and to the best of his power, enforcing the rules, to pre- vent the contravention or noncompliance. (Factory and workshop act, 1901, sees. 85 and 86.) REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 335 Red and Orange Lead Works. [Form 261— February, 1904.] DUTIES OF OCCUPIERS. In drawing charges of massicot, or of red lead, or of orange lead, from the furnace they shall not allow the charges of massicot, or of red lead, or of orange leiid, to be discharged onto the floor of the factory or workshop, but shall ar- range that it be shoveled, not raked, into wagons. They shall arrange that no red or orange lead shall be packed in the room or rooms where the manufacture is actually carried on. They shall arrange that no red or orange lead shall be packed in casks or other receptacles except in a place provided with a hood connected with a fan, or shall provide other suitable means to create an effective draft. They shall provide sufficient bath accommodation for all persons employed in the manipulation of red and orange lead, and lavatories, with a good supply of hot water, soap, nailbrushes, and towels for the use of such persons. They shall arrange for a monthly visit by a medical man who shall examine every worker individually, and who shall enter the result of each examination in a register book to be provided by the said occupiers. They shall provide a sufficient supply of approved sanitary drink for the workers. DUTIES OF PERSONS EMPLOYED. In case where the cooperation of the workers is required for carrying out the foregoing rules, and where such cooperation is not given, the workers shall be held liable in accordance with the factory and workshop act, 1891, section 9, which runs as follows : '* If any person who is bound to observe any special rules established for any factory or workshop under this act, acts in contravention of, or fails to comply with, any such special rule, he shall be liable on summary conviction to a fine not exceeding £2 ($9.73)." Yellow Lead. [Form 263 — February, 1904.] DUTIES OF occupiers. They shall provide washing conveniences, with a sufficient supply of hot and cold water, soap, nailbrushes, and towels. They shall provide respirators and overall suits for the persons employed in all dry processes. They shall provide fans or other suitable means of ventilation wherever dust is generated in the process of manufacture. They shall provide a sufficient supply of epsom salts and of an approved san- itary drink. DUTIES OF PERSONS EMPLOYED. In cases where the cooperation of the workers is required for carrying out the foregoing rules and where such cooperation is not given, the workers shall be held liable, in accordance with the factory and workshop act, 1891, section 9, which runs as follows : " If any person who is bound to observe any special rules established for any factory or workshop under this act, acts in contravention of, or fails to comply with, any such special rule, he shall be liable on summary conviction to a fine not exceeding £2 ($9.73)." Respirators.— A good respirator is a cambric bag with or without a thin flexible wire made to fit over the nose. Safiitary drink suggested. — Sulphate of magnesia, 2 ounces ; water, 1 gallon ; essence of lemon, sufficient to flavor. 336 BEPOETS OF THE PRESIDENT'S HOMES COMMISSION. Lead Smelting Works. [Form 264— January, 1906.] DUTIES OF OCCUPIEBS. They shall provide respirators and overall suits for the use of all persons employed in cleaning the flues, and take means to see that the same are used. They shall arrange that no person be allowed to remain at work more than two hours at a time in a flue. (A rest of half an hour before reentering will be deemed sufficient.) They shall provide sufficient bath accommodation for all persons employed in cleaning the flues, and every one so employed shall take a bath before leaving the works. They shall provide washing conveniences, with a sufficient supply of hot and cold water, soap, nailbrushes, and towels. DUTIES OF PERSONS EMPLOYED. In cases where the cooperation of the workers is required for carrying out the foregoing rules, and where such cooperation is not given, the workers shall be held liable, in accordance with the factory and workshop act, 1891, section 9, which runs as follows : " If any person who is bound to observe any special rules established for any factory or workshop under this act, acts in contravention of, or fails to comply with, 4ny such special rule, he shall be liable on summary conviction to a fine not exceeding £2 ($9.73)." Special Rules for Factories oe Workshops in which Yellow Chromate OF Lead is Used, ob in which Goods Dyed with It Undergo the Proc- esses OF Building ob Noddling, Winding, Reeling, W^eaving, ob any otheb Tbeatment. [Form 270 — February, 1904.] DUTIES OF occupiers. They shall provide washing conveniences, with a sufficient supply of hot and cold water, soap, nailbrushes, and towels. They shall provide respirators and overall suits for the persons employed in all dry processes. They shall provide fans and other suitable means of ventilation wherever dust is generated in the process of manufacture. They shall provide a sufficient supply of epsom salts, and of the sanitary drink mentioned below, or some other approved by His Majesty's inspector of factories. Respirators. — ^A good respirator is a cambric bag with or without a thin flexible wire made to fit over the nose. Sanitary drink. — Sulphate of magnesia, 2 ounces ; water, 1 gallon ; essence of lemon, sufficient to flavor. DUTIES OF PERSONS EMPLOYED. Every person to whom is supplied a respirator or overall suit shall wear the same when at the special work for which such are provided. Every person shall carefully clean and wash hands and face before meals and before leaving the works. No food shall be eaten in any part of the works in which yellow chromate of lead is used in the manufacture. Abthub Whitelegge, E. M. Chief Inspector of Factories. Under section 9, Factory Act, 1891, any person who Is bound to observe any special rules is liable to penalties for noncompliance with such special rules. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 337 Amended Special Rules foe the Manufacture and Decoration of Earthen- ware AND China. [As established, after arbitration, by the awards of the umpire. Lord James of Hereford, dated 30th of December, 1901, and 28th of November, 1903.] [Form 923— October, 1905.] DUTIES OF occupiers. 1. Deleted. 2. After tbe 1st day of February, 1904, no glaze shall be used which yields to a dilute solution of hydrochloric acid more than 5 per cent of its dry weight of a soluble lead compound calculated as lead monoxide when determined in the manner described below. A weighed' quantity of dried material is to be continuously shaken for one hour, at the common temperature, with one thousand times its weight of an aqueous solution of hydrochloric acid containing 0.25 per cent of HCl. This solution is thereafter to be allowed to stand for one hour, and to be passed through a filter. The lead salt contained In an aliquot portion of the clear filtrate is then to be precipita.ted as lead sulphide and weighed as lead sulphate. If any occupier shall give notice in writing to tlie inspector for the district that he desires to use glaze which does not conform to the above-mentioned con- ditions, and to adopt in his factory the scheme of compensation prescribed in Schedule B, and shall affix and keep the same affixed in his factory, the above provisions shall not apply to his factory, but instead thereof the following provisions shall apply : All persons employed in any process Included in Schedule A other than china scouring shall be examined before the commencement of their employment, or at the first subsequent visit of the certifying surgeon, and once in each calendar month by the certifying surgeon of the district. The certifying surgeon may at any time order by signed certificate the sus- pension of any such person from employment in any process included in Schedule A other than china scouring, if such certifying surgeon is of opinion that such person by continuous work in lead will incur special danger from the effects of plumbism, and no person after such suspension shall be allowed to work in any process included in Schedule A other than china scouring without a certificate of fitness from the certifying surgeon entered in the register. Any workman who, by reason of his employment being intermittent or casual, or of his being in regular employment for more than one employer, is unable to present himself regularly for examination by the certifying surgeon, may procure himself at his own expense to be examined once a month by a certifying surgeon, and such examination shall be a sufficient compliance with this rule. The results of such examination shall be entered by the certifying surgeon in a book to be kept in the possession of the workman. He shall produce and show the said book to a factory inspector or to any employer on demand, and he shall not make any entry or erasure therein. If the occupier of any factory to which this rule applies fails to duly observe the conditions of the said scheme, or if any such factory shall by reason of the occurrence of cases of lead poisoning appear to the secretary of state to be in an unsatisfactory condition, he may, after nn inquirj^, at which the occupier shall have an opportunity of being heard, prohibit the use of lead for such time and subject to such conditions as he may prescribe. All persons employed in the processes included in Schedule A, other than china scouring, shall present themselves at the appointed time for examination by the certifying surgeon, as provided in this rule. In addition to the examinations at the appointed times, any person so em- ployed may at any time present himself to the certifying surgeon for examina- tion, and shall be examined on paying the prescribed fee. All persons shall obey any directions given by the certifying surgeon. No person after suspension by the certifying surgeon shall work in any proc- ess included in Schedule A, other than china scouring, without a certificate of fitness from the certifying surgeon entered in the register. Any operative who fails without reasonable cause to attend any monthly examination shall procure himself, at his own expense, to be examined within fourteen days there- after by the certifying surgeon, and shall himself pay the prescribed fee. S. Doc. 644, 60-2 23 338 REPORTS OF THE PRESIDENT S HOMES COMMISSION. A register, in the form whicli has been prescribed by the secretary of state for use in earthenware and chhia works, shall be kept, and in it the certifying surgeon shall enter the dates and results of his visits, the number of persons examined, and particulars of any directions given by him. This register shall contain a list of all persons employed in the processes included in Schedule A, or in emptying china biscuit ware, and shall be produced at any time when required by His Majesty's inspectors of factories or by the certifying surgeon. 3. The occupier shall allow any of His Majesty's inspectors of factories to take at any time sufficient samples for analysis of any material in use or mixed for use. Provided that the occupier may at the time when the sample is taken, and on providing the necessary appliances, require the inspector to take, seal, and deliver to him a duplicate sample. But no analytical result shall be disclosed or published in any way except such as shall be necessary to establish a breach of these rules. 4. No woman, young person, or child shall be employed in the mixing of unfritted lead compounds in the preparation or manufacture of fritts, glazes, or colors. 5. No person under 15 years of age shall be employed in any process included in Schedule A, or in emptying china biscuit ware. Thimble picking, or threading up, or looking over biscuit ware shall not be carried on except in a place sufficiently separated from any process included in Schedule A. 6. All women and young persons employed in any process included in Schedule A shall be examined once in each calendar month by the certifying surgeon for the district. The certifying surgeon may order by signed certificate in the register the suspension of any such women or young persons from employment in any process included in Schedule A, and no person after such suspension shall be allowed to work in any process included in Schedule A without a certificate of fitness from the certifying surgeon entered in the register. 7. A register, in the form which has been prescribed by the secretary of state for use in earthenware and china works, shall be kept, and in it the cer- tifying surgeon shall enter the dates and results of his visits, the number of persons examined in pursuance of rule 6 as amended, and particulars of any directions given by him. This register shall contain a list of all persons em- ployed in the processes included in Schedule A, or in emptying china biscuit ware, and shall be produced at any time when required by His Majesty's in- spector of factories or by the certifying surgeon. 8. The occupier shall provide and maintain suitable overalls and head cov- erings for all women and young persons employed in the processes included in the Schedule A, or in emptying china biscuit ware. No person shall be allowed to work in any process included in the schedule, or in emptying china biscuit ware, without wearing suitable overalls and head coverings, provided that nothing in this rule shall render it obligatory on any person engaged in drawing glost ovens to wear overalls and head coverings. All overalls, head coverings, and respirators, when not in use or being washed or repaired, shall be kept by the occupier in proper custody. They shall be washed or renewed at least once a week, and suitable arrangements shall be made by the occupier for carrying out these requirements. A suitable place, other than that provided for the keeping of overalls, head coverings, and respirators, in which all the above workers can deposit clothing put off during working hours, shall be provided by the occupier. Each respirator shall bear the distinguishing mark of the worker to whom it is supplied. 9. No person shall be allowed to keep, or prepare, or partake of any food, or drink, or tobacco, or remain during meal times in a place in which is carried on any process included in Schedule A. The occupier shall make suitable provision to the reasonable satisfaction of the inspector in charge of the district for the accommodation during meal times of persons employed in such places or processes, with a right of appeal to the chief inspector of factories. Such accommodation shall not be provided in any room or rooms in which any process included in Schedule A is carried on, and no washing conveniences mentioned hereafter in rule 13 shall be main- tained in any room or rooms provided for such accommodations. SuitTible provision shall be made for the deposit of food brought by the workers. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 339 10. The processes of the towing of earthenware, china scouring, ground lay- ing, ware cleaning after the dipper, color dusting, whether on glaze or under- glaze, color blowing, whether on glaze or under-glaze, glaze blowing, or transfer nialiing, shall not be carried on without the use of exhaust fans, or other efficient means for the effectual removal of dust, to be approved in each partic- ular case by the secretary of state, and other such conditions as he may from time to time prescribe. In the process of ware cleaning after the dipper, sufficient arrangements shall be made for any glaze scraped off which is not removed by the fan, or the other efficient means, to fall into water. In the process of ware cleaning of earthenware after the dipper, damp sponges or other damp material shall be provided in addition to the knife or other instrument, and shall be used wherever practicable. Flat-knocking and fired-flint sifting shall be carried on only in inclosed re- ceptacles, which shall be connected with an efficient fan or other efficient draft, unless so contrived as to prevent effectually the escape of injurious dust. In all processes the occupier shall, as far as practicable, adopt efficient measures for the removal of dust and for the prevention of any injurious ef- fects arising therefrom. 11. No person shall be employed in the mixing of unfritted lead compounds, in the preparation or manufacture of fritts, glazes, or colors containing lead without wearing a suitable and efficient respirator provided and* maintained by the employer, unless the mixing is performed in a closed machine or the ma- terials are in such a condition that no dust is produced. Each respirator shall bear the distinguishing mark of the worker to whom it is supplied. 12. All drying stoves as well as all workshops and all parts of factories shall be effectually ventilated to the reasonable satisfaction of the inspector in charge of the district. 13. The occupier shall provide and continually maintain sufficient and suit- able washing conveniences for all persons employed in the processes included in Schedule A, as near as practicable to the places in which such persons are em- ployed. The washing conveniences shall comprise soap, nailbrushes, and towels, and at least one wash hand basin for every five persons employed as above, with a constant supply of water laid on, with one tap at least for every two basins, and conveniences for emptying the same and running off the waste water on the spot down a waste pipe. There shall be in front of each washing basin, or convenience, a space for standing room which shall not be less in any direction than 21 inches. 14. The occupier shall see that the floors of workshops and of such stoves as are entered by the work people are sprinkled and swept daily; that all rust, scraps, ashes, and dirt are removed daily, and that the mangles, workbenches, and stairs leading to workshops are cleaned weekly. When so required by the inspector in charge of the district, by notice in writing, any such floors, mangles, workbenches, and stairs shall be cleansed in such manner and at such times as may directed in such notice. As regards every potter's shop and stove, and every place in which any proc- ess included in Schedule A is carried on, the occupier shall cause the sufficient cleansing of floors to be done at a time when no other work is being carried on in such room, and in the case of potters' shops, stoves, dipping houses, and majolica painting rooms, by an adult male. Provided that in the case of rooms in which ground laying or glost placing is carried on, or in china dippers' drying room, the cleansing prescribed by this rule may be done before work commences for the day, but in no case shall any work be carried on in the room within one hour after any such cleansing as aforesaid has ceased. 15. The occupier shall cause the boards used in the dipping house, dippers' drying room, or glost placing shop to be cleansed every week, and shall not allow them to be used in any other department, except after being cleansed. When so required by the inspector in charge of the district, by notice in writing, any such boards shall be washed at such times as may be direcLcJ in such notice. 340 KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. DUTIES OF PERSONS EMPLOYED. Itj. All women and young persons employed in the processes included In Schedule A shall present themselves at the appointed time for examination by the certifying surgeon as provided in rule 6 as amended. No person after suspension by the certifying surgeon shall work in any proc- ess included in the schedule without a certificate of fitness from the certifymg surgeon entered in the register. 17. Every person employed in any process included in Schedule A, or in emptying china biscuit ware, shall, when at work, wear a suitable overall and head covering, and also a respirator when so required by rule 11 as amended, which shall not be worn outside the factory or workshop and which shall not be removed therefrom, except for the purpose of being washed or repaired. Such overall and head covering shall be in proper repair and duly washed. The hair must be so arranged as to be fully protected from dust by the head covering. The overalls, head coverings, and respirators, when not being worn, and clothing put off during working hours, shall be deposited in the respective places provided by the occupier for such purposes under rule 8 as amended. 18. No person shall remain during meal times in any place in which is carried on any process included in Schedule A, or introduce, keep, prepare, or partake of any food or 'drink or tobacco therein at any time. 19. No person shall in any way interfere, without the knowledge and concur- rence of the occupier or manager, with the means and appliances provided by the employers for the ventilation of the workshops and stoves, and for the removal of dust. 20. No person included in any process included in Schedule A shall leave the works or partake of meals without previously and carefully cleaning and wash- ing his or her hands. No person employed shall remove or damage the washing basins or conveni- ences provided under rule 13. 20a. The persons appointed by the occupiers shall cleanse the several parts of the factory regularly, as prescribed in rule 14. Every worker shall so conduct his or her work as to avoid, as far as practi- cable, making or scattering dust, dirt, or refuse, or causing accumulation of such. 21. The boards used In the dipping house, dippers' drying room, or glost placing shop shall not be used in any other department, except after being cleansed, as directed in rule 15. EXEMPTION F#E PBOCESSES IN WHICH NO LEAD OB OTHEB POISONOUS MATERIAL IS USED. 22. If the occupier of a factory to which these rules apply gives with reference to any process included in Schedule A, other than china scouring, an undertak- ing that no lead or lead compound or other poisonous material shall be used, the chief inspector may approve in writing of the suspension of the operation of rules 4, 5, 6, 7, 8, 15, 16, 17, and 21, or any of them in such process ; and there- upon such rules shall be suspended as regards the process named in the chief Inspector's approval, and in lieu thereof the following rule shall take effect, viz, No lead or lead compound or other poisonous material shall be used in any process so named. For the purpose of this rule materials that contain no more than 1 per cent of lead shall be regarded as free from lead. Note. — ^These rules must be kept posted up in conspicuous places in the factory to which they apply, where they may be conveniently read by persons employed. Any i)erson who is bound to observe these rules and fails to do so, or acts in contravention to them, is liable to a penalty, and in such cases the occupier also is liable to a penalty unless he proves that he has taken all reasonable means, by publishing and to the best of his power enforcing the rules, to prevent the contravention or non-compliance. Schedule A. Dipping or other process carried on in the dipping house. Glaze blowing. Painting in majolica or other glaze. EEPOKTS OF THE PKESIDENT^S HOMES COMMISSION. 341 Drying after clipping. Ware cleaning after the application of glaze by dipping or other process. China scouring. Glost placing. Ground laying. S!or blowtag } ^'•«*«^ «"-^'^^« "^ nnder-glaze. Lithographic transfer malting. Maliing or mixing of fruits, glazes, or colors containing lead. Any other process in which materials containiiic; lead are used or handled In the dry state, or in the form of spray, or in suspension in liquid other than oil or similar medium. Schedule A. — Notice to workmen employed in process named in Schedule A, other than china scouring, CONDITIONS or COMPENSATION. 1. Where a workman is suspended from working by a certifying surgeon of the district on the ground that he is of opinion that such person by continued work ill lead will incur special danger from the effects of plumbism, and the certifying surgeon shall certify that in his opinion he is suffering from plumbism arising out of his employment, he shall, subject as hereinafter mentioned, be entitled to compensation from his employer as hereinafter provided. (a) If any workman who has been suspended as aforesaid dies within nine calendar months from the date of such certificate of suspension, by reason of plumbism contracted before said date, there shall be paid to such of his de- pendents as are wholly dependent upon his earnings at the time of his death or upon the weekly compensation payable under this scheme, a sum equal to the amount he has earned during a period of three years next preceding the date of the said certificate, such sum not to be more than £300 ($1,459.95) nor less than £150 ($729.98) for an adult male, £100 ($486.65) for an adult female, and £75 ($364.99) for a young person. (&) If the workman does not leave any dependents wholly dependent as aforesaid, but leaves any dependents in part dependent as aforesaid, a reason- able part of that sum. (c) If he leaves no dependents, the reasonable expenses of his medical at- tendance and burial, not exceeding £10. 2. With respect to such payments the following provisions shall apply — (a) All sums paid to the workmen as compensation since the date of the said certificate shall be deducted from the sums payable to the dependents. ( & ) The payment shall, in case of death, be made to the legal personal repre- sentative of the workingman, or, if he has no legal personal representative, to or for the benefit of his dependents, or, if he leaves no dependents, to the person to wliom the expenses are due; and if made to the legal personal representative, shall be paid by him to or for the benefit of the dependents or other person entitled thereto. (c) Any question as to who is a dependent, or as to the amount payable to each dependent, shall, in default of agreement, be settled by arbitration as here- inafter provided in clause 9. {d) The sum allotted as compensation to a dependent may be invested or otherwise applied for the benefit of the person entitled thereto, as agreed, or as ordered by the arbitrator. (e) Any sum which is agreed or is ordered by the arbitrator to be invested may be invested in whole or in part in the post-office savings bank. 3. Where a workman has been suspended and certified as provided in condi- tion 1, and while he is totally or partially prevented from earning a living by reason of such suspension, he shall be entitled to a weekly payment not exceed- ing 50 per cent of his average weekly earnings at the time of such suspension, such payment not to exceed £1 ($4.87). The average may be- taken gver such period, not exceeding twelve months, as appears fair or reasonable, having regard to all the circumstances of the case. 4. In fixing these weekly payments regard shall be had to the difference between the amount of the average weekly earnings of the workman at the time of his suspension and the average amount, if any, which it is estimated that he will be able to earn afterwards in any occupation or employment, and to any paymaits (not being wages) which he may have received from the employer in 342 BEPOKTS OF THE PKESTDENt's HOMES COMMISSION. respect of the suspension, and to all the circumstances of the case, including his age and expectation of life. 5. If it shall appear that any workman has persistently disobeyed the special rules or the directions given for his protection by his employers, and that such disobedience has conduced to his suspension, or has not presented himself for examination by the certifying surgeon, or has failed to give full information and assistance as provided in condition 6, his conduct may be taken into con- sideration in assessing the amount of the weekly payments. 6. It shall be the duty of every workman at all times to submit to medical examination when required and to give full information to the certifying sur- geon and to assist to the best of his power in the obtaining of all facts necessary to enable his physical condition to be ascertained. 7. Any weekly payment may be reviewed at the request either of the employer or of the workman, and on such review may be ended, diminished, or increased, subject to the maximum above provided, and the amount of payment shall, in default of agreement, be settled by arbitration. 8. Any workman receiving weekly payments under this scheme shall submit himself, if required, for examination by a duly qualified medical practitioner provided and paid by the employer. If the workman refuses to submit himself to such examination or in any way obstructs the same, his right to such weekly payments shall be suspended until such examination has taken place. 9. If any dispute shall arise as to any certificate of the certifying surgeon or as to the amount of compensation payable as herein provided, or otherwise in relation to these provisions, the same shall be decided by an arbitrator to be appointed by the employer and workman, or in default of agreement by the secretary of state. The said arbitrator shall have nU the powers of an arbitra- tor under the arbitration act, and his decision shall be final. The fee of the arbitrator shall be fixed by the secretary of state, and shall be paid as the arbitrator shall direct. 10. No compensation shall be payable under these provisions unless notice of claim in writing is made within six weeks of the date of the certificate of suspension, or of the death, provided that the want of such notice shall not bar the claim if in the opinion of the arbitrator there was reasonable excuse for the want of it. A claim for compensation by any workman whose employment is intermittent, or casual, or who is regularly employed by more than one employer, shall only arise against the employers for whom he has worked in a process included in Schedule A within one month prior to his suspension. The said employers shall bear the compensation among them in such proportion as in default of agreement shall be determined by an arbitrator as herein provided. 11. " Employer " includes an occupier, a corporation, and the legal repre- sentatives of a deceased employer. "Workman " includes every person, male or female, whether his agreement be one of service or apprenticeship or otherwise, and is expressed or implied, orally, or in writing, and shall include the personal representatives of a deceased workman. " Dependents " has the same meaning as in the workmen's compensation act, 1897. The terms contained in this notice shall be deemed to be part of the contract of employment of all workmen in the above-named process. Electric Accumtjlatobs. Whereas the manufacture of electric accumulators has been certified in pur- suance of section 79 of the factory and wojdishop act, 1901, to be dangerous ; I hereby, in pursuance of the powers conferred on me by that act, make the following regulations, and direct that they shall apply to all factories and work- shops or parts thereof in which electric accumulators are manufactured. In these regulations " lead process " means pasting, casting, lead burning, or any work involving contact with dry compounds of lead. Any approval given by the chief inspector of factories in pursuance of these regulations shall be given in writing, and may at any time be revoked by notice in writing signed by him. KEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 343 DUTIES OF OCCUPIER. 1. Every room in wbich casting, pasting, or lead burning is carried on sliall contain at least 500 cubic feet of air space for each person employed therein, and in computing this air space, no height above 14 feet shall be taken into account. These rooms and that in which the plates are formed shall be capable of thorough ventilation. They shall be provided with windows made to open. 2. Each of the following processes shall be carried on in such manner and under such conditions as to secure effectual separation from one another and from any other process : (a) Manipulation of dry compounds of lead. (6) Pasting. (c) Formation, and lead burning necessarily carried on therewith. (d) Melting down of old plates. Provided that manipulation of dry compounds of lead carried on as in regula- tion 5 (&) need not be separated from pasting. 3. The floors of the rooms in which manipulation of dry compounds of lead or pasting is carried on shall be of cement or similar impervious material, and shall be kept constantly moist while work is being done. The floors of these rooms shall be washed with a hose pipe daily. 4. Every melting pot shall be covered with a hood and shaft so arranged as to remove the fumes and hot air from the workrooms. Lead ashes and old plates shall be kept in receptacles specially provided for the purpose. 5. Manipulation of dry compounds of lead in the mixing of the paste or other processes shall not be done except (a) in any apparatus so closed, or so arranged with an exhaust draft, as to prevent the escape of dust into the workroom ; or, (&) at a bench provided with (1) efiicient exhaust draft and air guide so arranged as to draw the dust away from the worker, and (2) a grating on which each receptacle of the compound of lead in use at the time shall stand. 6. The benches at which pasting is done shall be covered with sheet lead or other impervious material, and shall have raised edges. 7. No woman, young person, or child shall be employed in the manipulation of dry compounds of lead or in pasting. 8. (a) A duly qualified medical practitioner (in these regulations referred to as the " appointed surgeon " ) , who may be the certifying surgeon, shall be ap- pointed by the occupier, such appointment unless held by the certifying surgeon to be subject to the approval of the chief inspector of factories.- (&) Every person employed in a lead process shall be examined once a month by the appointed surgeon, who shall have power to suspend from employment in any lead process. (c) No person after such suspension shall be employed in a lead process without written sanction entered in the health register by the appointed sur- geon. It shall be sufficient compliance with this regulation for a written cer- tificate to be given by the appointed surgeon and attached to the health register, such certificate to be replaced by a proper entry in the health register at the appointed surgeon's next visit. (d) A health register in a form approved by the chief inspector of factories shall be kept, and shall contain a list of all persons employed in lead processes. The appointed surgeon will enter in the health register the dates and results of his examinations of the persons employed and particulars of any directions given by him. He shall on a prescribed form furnish to the chief inspector of factories on the 1st day of January in each year a list of the persons suspended by him during the previous year, the cause and duration of such suspension, and the number of examinations made. The health register shall be produced at any time when required by His Majesty's inspectors of factories or by the certifying surgeon or by the ap- pointed surgeon. 9. Overalls shall be provided for all persons employed in manipulating dry compounds of lead or in pasting. The overalls shall be washed or renewed once every week. 10. The occupier shall provide and maintain — (a) A cloakroom in which workers can deposit clothing put off during work- ing hours. Separate and suitable arrangements shall be made for the storage of the overalls required in regulation 9. (6) A dining room unless the factory is closed during meal hours. 344 BEPOETS OF THE PRESIDENT'S HOMES COMMISSION. 11. No person shall be allowed to introduce, keep, prepare, or partake of any food, drink, or tobacco, in any room in which a lead process is carried on. Suitable provision shall be made for the deposit of food brought by the workers. This regulation shall not apply to any sanitary drink provided by the occupier and approved by the appointed surgeon. 12. The occupier shall provide and maintain for the use of the persons em- ployed in lead processes a lavatory, with soap, nailbrushes, towels, and at least one lavatory basin for every five such persons. Each such basin shall be pro- vided with a waste pipe, or the basins shall be placed on a trough fitted with a waste pipe. There shall be a constant supply of hot and cold water laid onto each basin. Or, in the place of basins the occupier shall provide and maintain troughs of enamel or similar smooth impervious material, in good repair, of a total length of 2 feet for every five persons employed, fitted with waste pipes, and without plugs, with a sufficient supply of warm water constantly available. The lavatory shall be kept thoroughly cleansed and shall be supplied with a sufficient quantity of clean towels once every day. 13. Before each meal and before the end of the day's work, at least ten min- utes, in addition to the regular meal times, shall be allowed for washing to each person who has been employed in the manipulation of dry compounds of lead or in pasting. Provided that if the lavatory accommodation specially reserved for such per- sons exceeds that required by regulation 12, the time allowance may be pro- portionately reduced, and that if there be one basin or 2 feet of trough for each such person this regulation shall not apply. 14. Sufficient bath accommodation shall be provided for all persons engaged in the manipulation of dry compounds of lead or in pasting, with hot and cold water laid on, and.a sufficient supply of soap and towels. This rule shall not apply if in consideration of the special circumstances of any particular case, the chief inspector of factories approves the use of local public baths when conveniently near, under the conditions (if any) named in such approval. 15. The floors and benches of each workroom shall be thoroughly cleansed daily at a time when no other work is being carried on in the room. DUTIES OF PERSONS EMPLOYED. 16. All persons employed in lead processes shall present themselves at the appointed times for examination by the appointed surgeon as provided in regu- lation 8. No person after suspension shall work in a lead process, in any factory or workshop in which electric accumulators are manufactured, without written sanction entered in the health register by the appointed surgeon. 17. Every person employed in the manipulation of dry comiX)unds of lead or in pasting shall wear the overalls provided under regulation 9. The overalls, when not being worn, and clothing put off during working hours, shall be de- posited in the places provided under regulation 10. 18. No person shall introduce, keep, prepare, or partake of any food, drink (other than any sanitary drink provided by the occupier and approved by the appointed surgeon), or tobacco in any room in which a lead process is carried on. 19. No person employed in a lead process shall leave the premises or partake of meals without previously and carefully cleaning and washing the hands. 20. Every person employed in the manipulation of dry compounds of lead or in pasting shall take a bath at least once a week. 21. No person shall in any way interfere, without the concurrence of the occupier or manager, with the means and appliances provided for the removal of the dust or fumes, and for the carrying out of these regulations. These regulations shall come into force on the 1st day of January, 1904. A. Akkrs-Douglas, One of His Majesty's Principal Secretaries of State, HoMX Office, Whitehall, 2Ut November, 1903, REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 345 WoEKs OB Pabts of Woeks, in Which Lead, Aesenic, oe Antimony is Used in THK Enameling of Ieon Plates. [Form 251— January, 1906.] Duties of occupiers. 1. They shall provide washing conveniences with a suflacient supply of hot and cold water, soap, nailbrushes, and towels, and take measures to secure that every worker wash face and hands before meals and before leaving the works. 2. They shall provide suitable respirators, overall suits, and head coverings for all workers employed in the processes of grinding, dusting, and brushing. 3. They shall adopt measures on and after the 1st day of October, 1894, in the dusting and brushing processes for the removal of all superfluous dust, by the use of perforated benches or tables supplied with fans to carry the dust down through the apertures of such benches or tables, the underpart of which must be boxed in. 4. They shall provide a sufficient supply of approved sanitary drink, and shall cause the work people to take it. 5. They shall arrange for a medical inspection of all persons employed, at least once a month. They shall see that no female is employed without previous examination and a certificate of fitness from the medical attendant of the works. They shall see that no person who has been absent from work through illness shall be reemployed without a medical certificate to the effect that he or she has recovered. 6. Upon any person employed in the works complaining of being unwell, the occupier shall, with the least possible delay, and at his own expense, give an order upon a doctor for professional attendance and medicine. It is to be understood that this rule will not apply to persons suffering from complaints which have not been contracted in the process of manufacture. 7. They shall provide a place or places free from dust and damp in which the operatives can hang up the clothes in which they do not work. (It is recommended that they shall provide for each female before the day's work begins some light refreshment, such as a half pint of milk and a biscuit.) DUTIES OF PEESONS EMPLOYED. 8. Every person to whom is supplied a respirator or overall and head cover- ing shall wear the same when at the work for which such are provided. 9. Every person shall carefully clean and wash hands and face before meals, and before leaving the works. 10. No food shall be eafen by any person in any part of the works except in the apartment specially provided for the purpose. 11. No person may seek employment under an assumed name or under any false pretense. Respirators. — A good respirator is a cambric bag with or without a thin flexible wire made to fit over the nose. Sanitary drink suggested. — Sulphate of magnesia, 2 ounces ; water, 1 gallon ; essence of lemon, sufficient to flavor. Aethub Whitelegge, His Majesty's Chief Inspector of Factories. Note. — These rules must be kept posted up in conspicuous places in the fac- tory to which they apply, where they may be conveniently read by the persons employed. Any person who is bound to observe these rules and fails to do so or acts in contravention of them, is liable to a penalty; and in such case the occupier also is liable to a penalty unless he proves that he has taken all reasonable means by publishing and, to the best of his power, enforcing the rules to prevent the contravention or noncompliance. 346 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. WoEKS IN Which Lead ob Arsenic is Used in the Tinning and Enameling of Metal Hollow Waee and Cooking Utensils. [Form 385 — March, 1906.] DUTIES OF OCCUPIERS. They shall provide washing conveniences with a sufficient supply of hot and cold water, soap, nailbrushes, and towels, and take measures to secure that every worker wash face and hands before meals and before leaving the works. They shall see that no food is eaten in any room where the process of tinning or enameling is carried on. DUTIES OF PERSONS EMPLOYED. Every worker shall wash face and hands before meals and before leaving the works. No worker shall eat food in any room where the process of tinning or en- ameling is carried on. Arthur Whitelegge, His Majesty's Chief Inspector of Factories. Note. — These rules must be kept posted up in conspicuous places in the fac- tory to which they apply, where they may be conveniently read by the persons employed. Any person who is bound to observe these rules and fails to do so or acts in contravention of them, is liable to a penalty, and in such case the occupier also is liable to a penalty unless he proves that he has taken all reasonable means by publishing and, to the best of his power, enforcing the rules to prevent the contravention or noncompliance. Processes in the Manufacture of Paints and Colors and in the Extraction OF Arsenic. [Form 249 — June, 1904.] duties of occupiers. 1. They shall provide washing conveniences, with a sufficient supply of hot and cold water, soap, nailbrushes, and towels, and take measures to secure that every worker wash face and hands before meals and before leaving the works; and, in addition to the above, sufficient bath accommodation for the use of all persons employed in the manufacture of Milan red, vermilionette, or Persian red, 2. They shall provide suitable respiratcis and overall suits, kept in a cleanly state, for all workers engaged in any department w^here dry white lead or ar- senic is used in either the manufacture or paint mixing, and overall suits for .those engaged in grinding in water or oil, and for all workers in Milan red, vermilionette, or Persian red, wherever dust is generated. 3. They shall provide a sufficient supply of approved sanitary drink, which shall be accessible to the workers at all times, and shall cause such approved sanitary drink to be taken daily by workers in any department where white lead or arsenic is used in the manufacture, and shall provide a supply of aperient medicine, which shall be given to the workers, when required, free of charge. 4. No food shall be eaten in any part of the works where white lead or arsenic is used in the manufacture. DUTIES OF persons EMPLOYED. 5. Every person to whom is supplied a respirator or overall suit shall wear the same when at the special work for which suctf are provided. 6. Every person shall carefully clean and wash hands and face before meals and before leaving the works. 7. No food shall be eaten in any part of the works in which white lead or arsenic is used in the niauufacLure. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 347 8. No person shall smoke or use tobacco in any part of the works in which white lead or arsenic is used in the manufacture. Aethur Whitelegge, His Majesty's Chief Inspector of Factories, Note. — These rules must be kept posted up in conspicuous places in the works to which they apply, where they may be conveniently read by the persons em- ployed. Any person who is bound to observe these rules and fails to do so or acts in contravention of them, is liable to a penalty ; and in such case the occu- pier also is liable to a penalty unless he proves that he has taken all reasonable means by publishing and, to the best of his power, enforcing the rules to pre- vent the contravention or noncompliance. PfiOCESSES IN THE MIXING AND CASTING BrASS, GUN MeTAL, BeLL MeTAL, WHITB Metal, Delta Metal, Phosphor Bronze, and Manila Mixture. [Form 271 — February, 1904.] DUTIES OF OCCtrPIERS. 1. They shall provide adequate means for facilitating, as far as possible, the emission or escape from the shop of any noxious fumes or dust arising from the above-named processes. Such means shall include the provision of traps or of louver gratings in the roof or ceiling of any shop in which such processes, or either of them, is or are carried on ; or in case of a mixing or casting shop which is situated under any other shop, there shall be provided an adequate flue or shaft (other than any flue or shaft in connection with a furnace or fireplace) to carry any fumes from the mixing or casting shop, by or through any such shop that may be situated above it. 2. They shall cause all such mixing or casting shops, whether defined as fac- tories or workshops under the factory and workshop act, 1878, to be cleaned down and limewashed once at least within every twelve months, or once within every six months is so required by notice in writing from His Majesty's inspector of factories and workshops, dating from the time when these were last thus cleaned down and limewashed ; and they shall record the dates of such cleaning down and limewashing in a prescribed form of register. 3. They shall provide a suflicient supply of metal basins, water, and soap for the use of all persons employed in such mixing or casting shops. 4. They shall not employ or allow within their factory or workshop the em- ployment of any woman or female young person, in any process whatever, in any such mixing or casting shop, or in any portion thereof which is not entirely separated by a partition extending from the floor to the ceiling. DUTIES OF PERSONS EMPLOYED. 5. They shall not partake of or cook any food in any such mixing or casting shop within a period of at least ten minutes after the completion of the last pouring of metal in that shop. Arthur Whitelegge, His Majesty's Chief Inspector of Factories. July 10, 1906. Women and young persons under 18 years of age must not be allowed to take a meal in any casting shop or to remain there during the time stated on the notice aflixed in the works as being allowed for meals. These rules must be kept posted up in conspicuous places in the works to which they apply, where they may be conveniently read by the persons em- ployed. Any person who is bound to observe these rules and fails to do so or acts in contravention of them, is liable to a penalty ; and in such case the occupier also is liable to a penalty unless he proves that he has taken all reasonable means, by publishing and to the best of his power enforcing the rules, to prevent the contravention or noncompliance. 348 EEPOETS OF THE PRESIDENT'S HOMES COMMISSION. Chemical Works. [Form 258 — Reprinted December, 1901.1 1. In future every uncovered pot, pan, or other structure containing liquid of a dangerous character, shall be so constructed as to be at least 3 feet in height above the ground or platform. Those already in existence which are less than 3 feet in height, or in cases where it is proved to the satisfaction of an inspector that a height of 3 feet is impracticable, shall be securely fenced. 2. There shall be a clear space around such pots, pans, or other structures, or where any junction exists a barrier shall be so placed as to prevent passage. 3. Caustic pots shall be of such construction that there shall be no footing on the top or sides of the brickwork, and dome-shaped lids shall be used where possible. 4. No unfenced planks or gangways shall be placed across open pots, pans, or other structures containing liquid of a dangerous character. This rule shall not apply to black ash vats where the vats themselves are otherwise securely fastened. 5. Suitable respirators shall be provided for the use of the workers in places where poisonous gases or injurious dust may be inhaled. 6. The lighting of all dangerous places shall be made thoroughly efficient. 7. Every place where caustic soda or caustic potash is manufactured shall be supplied with syringes or wash bottles, which shall be inclosed in covered boxes fixed in convenient places, in the proportion of one to every four caustic pots. They shall be of suitable form and size, and be kept full of clean water. Similar appliances shall be provided wherever, in the opinion of an inspector, they may be desirable. 8. Overalls, kept in a cleanly state, shall be provided for all workers in any room where chlorate of potash or other chlorate is ground. In every such room a bath shall be kept ready for immediate use. In every chlorate mill, tallow or other suitable lubricant shall be used In- stead of oil. 9. Respirators charged with moist oxide of iron or other suitable substance, shall be kept in accessible places ready for use in cases of emergency arising from the sulphuretted hydrogen or other poisonous gases. 10. In salt cake departments suitable measures shall be adopted by maintain- ing a proper draft and by other means to obviate the escape of low-level gases. 11. Wei don bleaching powder chambers, after the free gas has, as far as may be practicable, been drawn off or absorbed by fresh lime, shall, before being opened, be tested by the standard recognized under the alkali act. Such tests shall be duly entered in a register kept for the purpose. All chambers shall be ventilated as far as possible, when packing is being carried on, by means of open doors on opposite sides and openings in the roof so as to allow of a free current of air. 12. In cases where the cooperation of the workers is required for carrying out the foregoing rules, and where such cooperation is not given, the workers shall be held liable in accordance with the factory and workshop act, 1S91, section 9, which runs as follows : "If any person who is bound to observe any special rules, established for any factory or workshop under this act, acts in contra- vention of, or fails to comply with, any such special rule, he shall be liable on summary conviction to a fine not exceeding £2 ($0.73)." Arthur Whitelegge, His Majesty's Chief Inspector of Factories. Amended Special Rules for Chemical Works in Which is Carried on the Manufacture op Bichromate or Chromate of Potassium or Sodium. [Form 260— January, 1906.] In these rules " persons employed In a chromo process " means a person who Is employed in any work involving contact with chromate or bichromate of potassium or sodium, or involving exposure to dust or fumes arising from the manufacture thereof. Any approval given by the chief inspector in pursuance of rule 10 shall be givra In writing, and may at any time be revoked by notice in writing signed by him. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 349 DUTIES OF OCCTJPIEES. 1 No uncovered pot, pan, or other structure containing liquid of a dangerous character shall be so constructed as to be less than 3 feet in height above the adjoining ground or platform. ^ ^ ^ ^ This rule shall not apply to any pot, pan, or other structure constructed before January 1, 1899, or in which a height of 3 feet is impracticable by reason of the nature of the work to be carried on, provided in either case that the structure is securely fenced. 2. There shall be a clear space round all pots, pans, or other structures con- taining liquid of a dangerous character, except where any junction exists, in which case a barrier shall be so placed as to prevent passage. 3. No unfenced plank or gangway shall be placed across any pot, pan, or other structure containing liquid of a dangerous character. 4. The lighting of all dangerous places shall be made thoroughly efficient. 5. The grinding, separating, and mixing of the raw materials (including chrome ironstone, lime, and sodium and potassium carbonate) shall not be done without such appliances as will prevent, as far as possible, the entrance of dust into the workrooms. 6. ** Batches," when withdrawn from the furnaces, shall either be placed in the keaves or vats while still warm, or be allowed to cool in barrows or other receptacles. 7. Evaporating vessels shall be covered in, and shall be provided with ventilat- ing shafts to carry the steam into the outside air. 8. Packing or crushing of bichromate of potassium or sodium shall not be done except under conditions which secure either the entire absence of dust or its effectual removal by means of a fan. 9. No child or young person shall be employed in a chrome process. 10. The occupier shall, subject to the approval of the chief inspector, appoint a duly qualified medical practitioner (in these rules referred to as the appointed surgeon), who shall examine all persons employed in chrome processes at least once in every month, and shall undertake any necessary medical treatment of disease contracted in consequence of such employment, and shall, after the 30th day of April, 1900, have power to suspend any such person from work in any place or process. (&) No person after such suspension shall be employed in any chrome process without the written sanction of the appointed surgeon. (c) A register shall be kept in a form approved by the chief inspector, and shall contain a list of all persons employed in any chrome process. The ap- pointed surgeons shall enter in the register the dates and results of his exami- nations of the persons employed and particulars of any treatment prescribed by him. The register shall be produced at any time when required by His Majesty's inspectors of factories or by the appointed surgeon. 11. Requisites (approved by the appointed surgeon) for treating slight wounds and ulcers shall be kept at hand and be placed in charge of a re- sponsible person. 12. The occupier shall provide sufficient and suitable overall suits for the use of all persons engaged in the processes of grinding the raw materials, and sufficient and suitable overall suits or other adequate means of protection approved in writing by the appointed surgeon, for the use of all persons en- gaged in the crystal department or in packing. Respirators approved by the appointed surgeon shall be provided for the use of all persons employed in packing or crushing bichromate of sodium or potassium. At the end of every day's work they shall be collected and kept in proper custody in a suitable place set apart for the purpose. The overalls and respirators shall be thoroughly washed or renewed every week. 13. The occupier shall provide and maintain a cloakroom in which workers can deposit clothing put off during working hours. 14. The occupier shall provide and maintain a lavatory for the use of the persons employed in chrome processes; with soap, nailbrushes, and towels, and a constant supply of hot and cold water laid onto each basin. There shall be at least one lavatory basin for every five persons employed in the crystal de- partment and in packing. Each srcli basin shall be fitted with a waste pipe, or shall be placed in a trough fitted with waste pipe. 350 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 15. The occupier shall provide and maintain sufficient baths and dressing rooms for all persons employed in chrome processes, with hot and cold water laid on, and a sufficient supply of soap and towels ; and shall cause each person employed in the crystal department and in packing to take a bath once a week at the factory. A bath register shall be kept containing a list of all persons employed in the crystal department and in packing, and an entry of the date when each person takes a bath. The bath register shall be produced at any time when required by His Majesty's inspectors of factories. 16. The floors, stairs, and landings shall be cleaned daily. DUTIES OF PERSONS EMPLOYED. 17. No person shall deposit a " batch " when withdrawn from the furnace upon the floor nor transfer it to the keaves or vats otherwise than as prescribed in rule 6. 18. No person shall pack or crush bichromate of potassium or sodium other- wise than as prescribed in rule 8. 19. (a) Every person employed in a chrome process shall present himself at the appointed times for examination by the appointed surgeon as provided in rule 10. ( 6 ) After the 30th day of April, 1900, no person suspended by the appointed surgeon shall work in a chrome process without his written sanction. 20. Every person engaged in the processes of grinding the raw materials shall wear an overall suit, and every person engaged in the crystal department or in packing shall wear an overall suit or other adequate means of protection approved by the appointed surgeon. Every person employed in packing or crushing bichromate of sodium or potassium shall in addition wear a respirator while so occupied. 21. Every person employed in the processes named in rule 20 shall before leaving the premises deposit the overalls and respirators in the place appointed by the occupier for the purpose, and shall thoroughly wash face and hands in the lavatory. 22. Every person employed in the crystal department and in the packing shall take a bath at the factory at least once a week ; and, having done so, shall at once sign his name in the bath register, with the date. 23. The foreman shall report to the manager any instance coming under his notice of a workman neglecting to observe these rules. Arthur Whitelegge, Chief Inspector of Factories, M. W. Ridley, One of Her Majesty's Principal Secretaries of State. February, 1900. Note. — These rules must be kept posted up in conspicuous places in the fac- tory to which they apply, where they may be conveniently read by the persons employed. Any person who is bound to observe these rules and fails to do so or acts in contravention of them, is liable to penalty; and in such cases the occupier also is liable to a penalty unless he proves that he has taken all rea- sonable means by publishing and, to the best of his power, enforcing the rules, to prevent the contravention or noncompliance. Manutactuee of Explosives in which Di-Nitro-Benzole is Used. [Form 257 — December, 1904.] 1. No person to be employed without a medical certificate, stating that he or she is physically fit for such employment. 2. An examination of the workers at their work to be made at least once a fortnight by a certifying surgeon, who shall have power to order temporary sus- pension or total change of work for any person showing symptoms of suffering from the poison, or if after a fair trial he is of opinion that any person is by constitution unfit, he shall direct that such person shall cease to be employed. 3. A supply of fresh milk, and of any drug that the medical officer may con- sider desirable, shall be kept where the workers in his opinion may require it. 4. No meals to be taken in the workrooms. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 351 5. There shall be provided separate lavatories for men and women, with a good supply of hot water, soap, nailbrushes, and towels, and whenever the skin has come in contact with di-nitro-benzole, the part shall be immediktely washed. 6. Overall suits and head coverings shall be supplied to all workers in shops where di-nitro-benzole is used, these suits to be taken off or well brushed before meals and before leaving the works, and to be washed at least once a week. 7. Suitable respirators (capable of being washed), folds of linen, or woolen material of open texture, or other suitable material, shall be supplied to those workers liable to inhale dust, and the wearing of such respirators shall be urged where the workers derive benefit from their use. 8. Where di-nitro-benzole has to be handled, the hands shall always be pro- tected from direct contact with it, either by the use of india-rubber gloves (kept perfectly clean, especially in the inner side), or by means of rags which shall be destroyed immediately after use. 9. Where di-nitro-benzole is broken by hand, the instrument used shall be a wooden bar, spade, or tool with a handle long enough to prevent the worker's face from coming into contact with the material. 10. In all rooms or sheds in which the process, either of purifying, grinding, or mixing materials of which di-nitro-benzole forms a part, is carried on, efficient " cowls," ventilating shafts, and mechanical ventilating fans shall be provided to carry off the dust or fumes generated. 11. Drying stoves shall be efficiently ventilated, and, when possible, be charged and drawn at fixed times, and a free current of air shall be admitted for some time prior to the workers entering to draw either a part or the whole of the contents. 12. In the process of filling cartridges, the material shall not be touched by hand, but suitable scoops shall be used, and where patent ventilated cartridge- filling machines are not used, there shall be efficient mechanical ventilation arranged in such a manner that the suction shall draw the fumes or dust away from and not across or over the faces of the workers. 13. A register, in a prescribed form, shall be kept, and it shall be the duty of a responsible person named by the firm to enter, at least once a week, a state- ment that he has personally satisfied himself that each and all of the special rules have been observed, or if not, the reason for such nonobservance. The surgeon to enter in this register the dates of his visits, the results of such visits, and any requirements made by him. 14. The " dipping " rooms to be efficiently ventilated. Arthur Whitelegge, His Majesty's Chief Inspector of Factories. Note. — These rules must be kept posted up in conspicuous places in the fac- tory to which they apply, where they may be conveniently read by the persons employed. Any person who is bound to observe these rules and fails to do so or acts in contravention of them, is liable to a penalty; and in such case the occu- pier also is liable to a penalty unless he proves that he has taken all reasonable means by publishing and, to the best of his power, enforcing the rules, to pre- vent the contravention or noncompliance. Vulcanizing of India Rubber by Means of Bisulphide of Carbon. [Form 274 — October, 1906.] I. — DUTIES OF employers. 1. No child or young person shall be employed in any room in which bisul- phide of carbon is used. 2. After May 1, 1898, no person shall be employed for more than five hours in any day in a room in which bisulphide of carbon is used, nor for more than two and a half hours at a time without an interval of at least an hour. 3. In vulcanizing waterproof cloth by means of bisulphide of carbon — (a) the trough containing the bisulphide of carbon shall be self-feeding and covered over ; (&) the cloth shall be conveyed to and from the drying chamber by means of an automatic machine; (c) no person shall be allowed to enter the drying chamber in the ordinary course of work; {d) the machine shall be covered over and the fumes drawn away from the workers by means of a downward-suction fan maintained in constant efficiency. 4. Dipping shall not be done except in boxes so arranged that a suction fan shall draw the fumes away from the workers. 352 EEPOETS OF THE PRESIDENT'S HOMES COMMISSION. 5. No food shall be allowed to be eaten in any room in which bisulphide of carbon is used. 6. A suitable place for meals shall be provided. 7. All persons employed in rooms in which bisulphide of carbon is used shall be examined once a month by the certifying surgeon for the district, who shall, after May 1, 1898, have power to order temporary or total suspension from work. 8. No person shall be employed in any room in which bisulphide of carbon is used contrary to the direction of the certifying surgeon given as above. 9. A register in the form which has been prescribed by the secretary of state for use in india-rubber works shall be kept, and in it the certifying surgeon will enter the dates and result of his visits, with the number of persons examined, and particulars of any directions given by him. This register shall contain a list of all persons employed in rooms in which bisulphide of carbon is used, and shall be produced at any time when required by His Majesty's inspector of fac- tories or by the certifying surgeon. II. — DUTIES OF PERSONS EMPLOYED. 10. No person shall enter the drying room in the ordinary course of work, or perform dipping except in boxes provided with a suction fan carrying the fumes away from the workers. 11. No person shall take any food in any room in which bisulphide of carbon is used. 12. After May 1, 1898, no person shall, contrary to the direction of the certify- ing surgeon, given in pursuance of rule 7, work in any room in which bisulphide of carbon is used. 13. All persons employed in rooms in which bisulphide of carbon is used shall present themselves for periodic examination by the certifying surgeon, as pro- vided in rule 7. 14. It shall be the duty of all persons employed to report immediately to the employer or foreman any defect which they may discover in the working of the fan or in any appliance required by these rules. Arthub Whitelegge, His Majesty's Chief Inspector of Factories. Note. — These rules are required to be posted up in conspicuous places in the factory or workshop to which they apply, where they may be conveniently read by the persons employed. Any person who willfully injures or defaces them is liable to a penalty not exceeding £5 ($24.33). Occupiers of factories and work- shops, and persons employed therein, who are bound to observe these rules, are liable to penalties in case of noncompliance. ( Factory and workshop act, 1891, sec. 9, and factory and workshop act, 1901, sees. 85 and 86. ) Lucifer-Match Factories in Which White or Yellow Phosphorus is Used. [Form 384 — January, 1904.] In these rules " phosphorous process " means mixing, dipping, drying, boxing, and any other work or process in which white or yellow phosphorus is used ; and " person employed in a phosphorous process " means any person who is employed in any room or part of the factory where such a process is carried on. " Double-dipped matches " means wood splints, both ends of which have been dipped in the igniting composition. " Certifying surgeon " means a surgeon appointed under the factory and work- shop acts. Any approval or decision given by the chief inspector of factories in pursuance of these rules shall be given in writing, and may at any time be revoked by notice in writing signed by him. Rules^5 (a), 5 (&), 6, 8, and 19, so far as they affect the employment of adult workers, shall not come into force until the 1st day of October, 1900. duties of employers. 1. No part of a luclfer-match factory shall be constructed, structurally altered, or newly used, for the carrying on of any phosphorous process, unless the plans have previously been submitted in duplicate to the chief inspector of factories, and unless he shall have approved the plans in writing, or shall not within six EEPORTS OF THE PKESIDENT's HOMES COMMISSION. 353 weeks from the submission of the plans haye expressed his disapproval in writing of the same. 2. Every room in which mixing, dipping, drying, or boxing is carried on shall be efficiently ventilated by means of sufllcient openings to the outer air, and also by means of fans, unless the use of fans is dispensed with by order in writing of the chief inspector; shall contain at least 400 cubic feet of air space for each person employed therein; and in computing this air space no height above 14 feet shall be taken into account; shall be efficiently lighted; shall have a smooth and impervious floor. A floor laid with flagstone or hard bricks in good repair shall be deemed to constitute a smooth and impervious floor. 3. (a) The processes of mixing, dipping, and drying shall each be done in a separate and distinct room. The process of boxing double-dipped matches or matches not thoroughly dry shall also be done in a separate and distinct room. These rooms shall not communicate with any other part of the factory unless there shall be a ventilated space intervening; nor shall they communicate with one another, except by means of doorways with closely fitting doors, which doors shall be kept shut except when some person is passing through. (&) Mixing shall not be done except in an apparatus, or so arranged and ventilated by means of a fan as to prevent the entrance of fumes into the air of the mixing room. (c) Dipping shall not be done except on a slab provided with an efficient exhaust fan, and with an air inlet between the dipper and the slab, or with a hood so arranged as to draw the fumes away from the dipper and to prevent them from entering the air of the dipping room. (d) Matches that have been dipped and can not at once be removed to the drying room shall immediately be placed under a hood provided with an effi- cient exhaust fan, so arranged as to prevent the fumes from entering the air of the room. (e) Matches shall not be taken to a boxing room not arranged in compliance with subsection (/) of this rule until they are thoroughly dry, and matches shall not be taken to a boxing room that is so arranged until they are dried so far as they can be before cutting down and boxing. (/) Cutting down of double-dipped matches and boxing of matches not thor- oughly dry shall not be done except at benches or tables provided with an effi- cient exhaust fan, so arranged as to draw the fumes away from the worker and prevent them from entering the air of the boxing room. Provided, that the foregoing rule shall not prevent the employment of any mechanical arrangement for carrying on any of the above-mentioned processes if the same be approved by the chief inspector as obviating the use of hand labor, and if it be used subject to the conditions (if any) specified in such approval. Provided further, that If the chief inspector shall, on consideration of the special circumstances of any particular case, so approve in writing, all or any of the provisions of the foregoing rule may be suspended for the time named in such approval in writing. 4. Vessels containing phosphorous paste shall, when not actually in use, be kept constantly covered, and closely fitting covers or damp flannels shall be provided for the purpose. 5. (a) For the purpose of these rules the occupier shall appoint, subject to the approval of the chief inspector, a duly qualified and registered dentist, herein termed the " appointed dentist." It shall be the duty of the appointed dentist to suspend from employment in any phosphorous process any person whom he finds to incur danger of phos- phorous necrosis by reason of defective conditions of teeth or exposure of the jaw. (6) No person shall be newly employed in a dipping room for more than twenty-eight days, whether such days are consecutive or not, without being examined by the appointed dentist. (c) Every person employed in phosphorous process, except persons employed only as boxers of wax vestas or other thoroughly dry matches, shall be exam- ined by the appointed dentist at least once in every three months. (d) Any person employed in the factory complaining of tootache, or a pain or swelling of the jaw, shall at once be examined by the appointed dentist. (e) When the appointed dentist has reason to believe that any person em- ployed in the factory is suffering from inflammation or necrosis of the jaw, or is in such a state of health as to incur danger of phosphorous necrosis, he shall S. Doc. 644, 60-2 ^24 354 REPORTS OP THE PRESIDENT'S HOMES COMMISSION. at once direct the attention of the certifying surgeon and occupier to the case. Thereupon such person shall at once be examined by the certifying surgeon. 6. No person shall be employed in a phosphorous process after suspension by the appointment dentist, or after the extraction of a tooth, or after any opera- tion involving exposure of the jawbone, or after inflammation or necrosis of the jaw, or after examination by the appointed dentist in pursuance of rule 5 (d), or after reference to the certifying surgeon in pursuance of rule 5 (e), unless a certificate of fitness has been given, after examination, by signed entry in the health register, by the appointed dentist or by the certifying surgeon in cases referred to him under rule 5 (e). 7. A health register, in a form approved by the chief inspector of factories, shall be kept by the occupier, and shall contain a complete list of all persons employed in each phosphorous process, specifying with regard to each such per- son the full name, address, age when first employed, and date of first em- ployment. The certifying surgeon will enter in the health register the dates and results of his examinations of persons employed in phosphorous processes, and particu- lars of any directions given by him. The appointed dentist will enter in the health register the dates and results of his examinations of the teeth of persons employed in phosphorous processes, and particulars of any directions given by him, and a note of any case referred by him to the certifying surgeon. The health register shall be produced at any time when required by His Majesty's inspectors of factories, or by the certifying surgeon, or by the ap- pointed dentist. 8. Except persons whose names are on the health register mentioned in rule 7, and in respect of whom certificates of fitness shall have been granted, no person shall be newly employed in any phosphorous process for more than twenty-eight days, whether such days are consecutive or not, without certificate of fitness, granted after examination by the certifying surgeon, by signed entry in the health register. This rule shall not apply to persons employed only as boxers of wax vestas «T other thoroughly dry matches. 9. The occupier shall provide and maintain sufficient and suitable overalls for all persons employed in phosphorous processes, except for persons employed only us boxes of wax vestas or other thoroughly dry matches, and shall cause them to be worn as directed in rule 20. At the end of every day's work they shall be collected and kept in proper custody in a suitable place set apart for the purpose. They shall be thoroughly washed every week, and suitable arrangements for this purpose shall be made by the occupier. 10. The occupier shall provide and maintain (a) a dining room, and (6) a cloakroom in which workers can deposit clothing put off during working hours. 11. No person shall be allowed to prepare or partake of any food or drink in any room in which phosphorous process is carried on, nor to bring any food or drink into such room. 12. The occupier shall provide and maintain for the use of the workers a lavatory, with soap, nailbrushes, towels, and at least one lavatory basin for every five persons employed in any phosphorous process. Each such basin shall be fitted with waste pipe. There shall be a constant supply of hot and cold water laid onto each basin. Or, in the place of basins, the occupier shall provide and maintain enamel or galvanlzed-iron troughs, in good repair, of a total length of 2 feet for every five persons employed, fitted with waste pipes and without plugs, with a sufficient supply of warm water constantly available. The lavatory shall be kept thoroughly cleansed, and shall be supplied with a sufficient quantity of clean towels twice in each day. There shall, in addition, be means of washing in close proximity to the workers In any department, if so required in writing by the inspector in charge of the district. 13. The occupier shall provide for the use of every person employed in a phosphorous process an antiseptic mouth wash approved by the appointed dentist, and a sufficient supply of glasses or cups. 14. The floor of each room in which a phosphorous process is carried on shall be cleared of waste at least once a day, and washed at least once a week. 15. A printed copy of these rules shall be given to eacli person on entering iiprk Is being carried on and (6) the means of access provided in pursuance of regulatioM 4 and 6 shall be efflcientiy lighted, due regard being had to the REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 367 safety of the ship and cargo, of all persons employed, and of the navigation of other vessels, and to the duly approved by-laws or regulations of any authority having power by statute to make by-laws or regulations subject to approval by some other authority. 8. All iron fore-and-aft beams and thwart-ship beams used for hatchway covering shall have suitable gear for lifting them on and off without it being necessary for any person to go upon them to adjust such gear. PART in. 9. All machinery and chains and other gear used in hoisting or lowering in connection with the processes shall have been tested, and shall be periodically examined. All such chains shall be effectually softened by annealing or firing when necessary, and all half-inch or smaller clu.ins in general use shall be so annealed or fired once in every six months. If the chains are part of the outfit carried by a seagoing ship, it shall be a suflicient compliance with this regulation as regards softening by annealing or firing of half-inch or smaller chains that no such chains shall be used unless they have been so annealed or fired within six months preceding. As regards chains, the safe loads indicated by the test, the date of last anneal- ing, and any other particulars prescribed by the secretary of state, shall be entered in a register which shall be kept on the premises, unless some other place has been approved in writing by the chief inspector. 10. All motors, cogwheels, chains and friction gearing, shafting, and live elec- tric conductors used in the processes shall (unless it can be shown that by their position and construction they are equally aafe to every person employed as they would be if securely fenced) be securely fenced so far as is practicable without impeding the safe working of the ship without infringing any require- ment of the board of trade. 11. The lever controlling the link motion reversing gear of a crane or winch used in the processes shall be provided with a suitable spring or other locking arrangement. 12. Every shore crane used in the processes shall have the safe load plainly marked upon it, and if so constructed that the jib may be raised or lowered either shall have attached to it an automatic indicator of safe loads or shall have marked upon it a table showing the safe loads at the corresponding inclina- tions of the jib. 13. The driver's platform on every crane or tip driven by mechanical power and used in the processes shall be securely fenced, and shall be provided with safe means of access. 14. Adequate measures shall be taken to prevent exhaust steam from any crane or winch obscuring any part of the decks, gangways, wharf, or quay, where any person is employed. PAET IV. 15. No machinery or gear used in the processes, other than a crane, shall be loaded beyond the safe load; nor a crane, unless secured with the written permission of the owner by plates or chains or otherwise. No load shall be left suspended from a crane, windli, or other machine unless there is a competent person actually in charge of the machine while the load is so left. 16. A boy under 16 shall not be employed as driver of a crane or winch, or to give signals to a driver, or to attend to cargo falls on winch ends or winch bodies. 17. Where in connection with the processes goods are placed on a wharf or quay other than a wharf or quay on a shallow canal: (a) A clear passage lead- ing to the means of access to the ship required by regulation 4 shall be main- tained on the wharf or quay; and (&) if any space is left along the edge of the wharf or quay, it shall be at least 3 feet wide and clear of all obstructions other than fixed structures, plant, and appliances in use. 18. No deck stage or cargo stage shall be used in the processes unless it is substantially and firmly constructed and adequately supported, and, where necessary, securely fastened. No truck shall be used for carrying cargo between ship and shore on a stage so steep as to be unsafe. Any stage which is slippery shall be made safe by the use of sand or otherwise. 338 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 19. Where there is more than one hatchway, if the hatchway of a hold exceed- ing 7 feet 6 inches in depth, measured from the top of the coamings to the bottom of the hold, is not in use and the coamings are less than 2 feet 6 inches in height, it shall either be fenced to a height of 3 feet or be securely covered. Provided, That this regulation shall not apply during meal times or other temporary interruptions of work during the period of employment And provided, That until the 1st of January, 1908, the fending may be the best the circumstances will allow without making structural alteration. Hatch coverings shall not be used in connection with the processes in the construction of deck or cargo stages, or for any other purpose which may expose them to damage. 20. No cargo shall be loaded by a fall or sling at any intermediate deck unless a secure landing platform has been placed across the hatchway at that deck. PABT V. 21. No person shall, unless duly authorized, or In case of necessity, remove or interfere with any fencing, gangway, gear, ladder, life-saving means or appli- ances, lights, marks, stages, or other things whatsoever, required by these regulations to be provided. 22. The fencing required by regulation 1 shall not be removed except to the extent and for the period reasonably necessary for carrying on the work of the dock or ship, or for repairing any fencing. If removed it shall be restored forthwith at the end of that period by the persons engaged in the work that necessitated its removal. PAET VI. 23. No employer or persons in the processes shall allow machinery or gear to be used by such persons in the processes that does not comply with Part III of these regulations. 24. If the persons whose duty it is to comply with regulations 4, 5, and 7 fail so to do, then it shall also be the duty of the employers of the persons employed for whose use the means of access and the lights are required to comply with the said regulation within the shortest time reasonably practicable after such faih re. 2o. The certificate of the ship's register and any other certificate or register referred to in these regulations shall be produced by the person in charge thereof on the application of any of His Majesty's inspectors of factories. A. Akebs-Douglas, One of His Majesty's Principal Secretaries of State, Home Office, Whitehall, 24th October, 1904. Factoby Engines and Cabs. Whereas the nse of locomotives, wagons, and other rolling stock on lines of rail or sidings in any factory or workshop or any place to which the provisions of section 79 of the factory and workshop act, 1901, are applied by that act, or on lines of rail or sidings used in connection with any factory or workshop or any place as aforesaid, and not being part of a railway within the meaning of the railway employment (preventions of accidents) acts, 1900, has been certified in pursuance of the said section to be dangerous: I hereby, in pursuance of the powers conferred upon me by that act, make the following regulations and direct that they shall apply to all places before mentioned. These regulations shall come into force on the 1st day of January, 1907, except regulations 1, 2, and 22, which shall come into force on the 1st day of January, 1908. Subject to the exemptions below, it shall be the duty of— (i) The occupier of any factory or workshop and any place to which any of the provisions of the factory and workshop act, 1901, are applied, and (n) the occupier of any line of rails or sidings used in connection with a factory or workshop, or with any place to which any of the provisions of the factory and workshop act, 1901, are applied, to comply with Part I of these regulations. And It shall be the duty of every person who by himself, his agents or work- men, carries on any of the operations to which these regulations apply, and of REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 369 all agents, workmen, and persons employed to comply with Part II of these regulations. And it shall be the duty of every person who by himself, his agents, or work- men, carries on any of the operations to which these regulations apply, to com- ply with Part III of these regulations. In these regulations : Line of rails means a line of rails or sidings for the use of locomotives or wagons excepting such lines as are used exclusively for (a) a gantry crane or traveling crane, or (b) any charging machine or other apparatus or vehicle used exclusively in or about any actual process or manufacture. Wagon includes any wheeled vehicle or nonself-moving crane on a line of rails. Locomotive includes any wheeled motor on a line of rails used for the move- ment of wagons and any self-moving crane. Gantry means an elevated structure of wood, masonry, or metal, exceeding 6 feet in height and used for loading or unloading, which carries a line of rails, whereon wagons are worked by mechanical power. Nothing in these regulations shall apply to: (a) A line of rails of less than 3 feet gauge, and locomotives and wagons used thereon. (6) A line of rails not worked by mechanical power. (c) A line of rails inside a railway goods warehouse. (d) A line of rails forming part of a mine within the meaning of the coal mines regulation act, 1887, or of a quarry within the meaning of the quarries act, 1894, not being a line of rails within or used solely in connection with any factory or workshop not incidental to the maintenance or working of the mine or quarry or to the carrying on of the business thereof. (e) Pit banks or mines to which the metaliferous mines regulation act, 1872, applies, and private lines of rails used in connection therewith. (/) Lines of rails used in connection with factories or workshops, so far as they are outside the factory or workshop premises, and used for running pur- poses only. (g) Wagons not moved by mechanical power. (h) Buildings in course of construction. (i) Explosive factories or workshops within the meaning of the explosives act, 1875. ij) All lines and sidings on or used in connection with docks, wharves, and quays not forming part of a factory or workshop as defined in section 149 of the factory and workshop act, 1901. (k) Wagon or locomotive building or repairing shops, and all lines and sidings used in connection with such shops if such shops are in the occupation of a rail- way company within the meaning of the regulation of railways act, 1871. (I) Depots or car sheds being parts of tramways or light railway undertak- ings authorized by Parliament, and used for the storage, cleaning, inspection, or repair of tramway cars or light railway cars. PABT I. 1. Point rods and signal wires in such a position as to be a source of danger to persons employed shall be sufficiently covered or otherwise guarded. 2. Ground levers working points shall be so placed that men working them are clear of adjacent lines, and shall be placed in a position parallel to the adja- cent lines, or In such other position, and be of such form as to cause as little obstruction as possible to persons employed. 3. Lines of rails and points shall be periodically examined and kept in efficient order, having regard to the nature of the traffic. 4. Every gantry shall be properly constructed and kept in proper repair. It shall have a properly fixed structure to act as a stop-block at any terminal point; and at every part where persons employed have to work or pass on foot there shall be a suitable footway, and if such footway is provided between a line of rails and the edge of the gantry the same shall, so far as is reasonably practicable, having regard to the traffic and working, be securely fenced at such a distance from the line of rails as to afford a reasonably sufficient space for such persons to pass in safety between the fence and a locomotive, wagon, or load on the line of rails. S. Doc. 644, 60-2 25 370 EEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 5. Coupling poles or other suitable mechanical appliances shall be provided where required for the purpose of regulation 11. 6. Proper sprags and scrotches, when required, shall be provided for the use of persons in charge of the movement of wagons. 7. Where, during the period between one hour after sunset and one hour be- fore sunrise, or in foggy weather, shunting or any operations likely to cause danger to persons employed are frequently carried on, efficient lighting shall be provided either by hand lamps or stationary lights, as the case may require, at all points where necessary for the safety of such persons. 8. The mechanism of a capstan worked by power and used for the purpose of traction of wagons on a line of rails shall be maintained in efficient condition, and if operated by a treadle, such treadle shall be tested daily before use. PAST II. 9. When materials are placed within 3 feet of a line of rails and persons em- ployed are exposed to risk or injury from traffic by having to pass on foot over them or between them and the line, such material shall, as far as reasonably practicable, be so placed as not to endanger such persons, and there shall be adequate recesses at intervals of not more than 20 yards where the materials exceed that length. 10. No person shall cross a line of rails by crawling or passing underneath a train or wagons thereon where there may be a risk of danger from traffic. 11. Locomotives or wagons shall wherever it is reasonably practicable without structural alterations be coupled or uncoupled only by means of a coupling pole or other suitable mechanical appliance, except where the construction of loco- motives or wagons is such that coupling or uncoupling can be safely and con- veniently performed without any part of a man's body being within the space between the ends or buffers of one locomotive or wagon and another. 12. Sprags and scrotches shall be used as and when they are required. 13. Wagons shall not be moved or be allowed to be moved on a line of rails by means of a prop or pole, or by means of towing by a rope or chain attached to a locomotive or wagon moving on an adjacent line of rails when other rea- sonably practicable means can be adopted; provided that this shall not apply to the movement of ladles containing hot material on a line of rails in front of and adjacent to a furnace. In no case shall props be used for the above purpose unless made of iron, steel, or strong timber, hooped with iron to prevent splitting. 14. Where a locomotive pushes more than one wagon, and risk of injury may thereby be caused to persons employed, a man shall, wherever it is safe and rea- sonably practicable, accompany or precede the front wagon or other efficient means shall be taken to obviate such risk. Provided that this regulation shall not apply to the following : (a) Fly shunting. (6) Movement of wagons used for conveyance of molten or hot material or other dangerous substance. 15. No person shall be upon the buffer of a locomotive or wagon in motion unless there is a secure handhold, and shall not stand thereon unless there Is also a secure foot place ; nor shall any person ride on a locomotive or wagon by means of a coupling pole or other like appliance. 16. No locomotive or wagon shall be moved on a line of rails until warning has been given by the person in charge to persons employed whose safety is likely to be endangered. Provided that this regulation shall not apply to a self-moving crane within a building or to a charging machine or other vehicle so long as it is used in or about any actual process of manufacture. 17. Where persons employed have to pass on foot or work, no locomotive or wagon shall be moved on a line of rails during the period between one hour after sunset and one hour before sunrise, or in foggy weather, unless the ap- proaching end, wherever it Is safe and reasonably practicable, is distinguished by a suitable light or accompanied by a man with a lamp. Provided that this regulation shall not apply to the movement of locomotivea or wagons within any area which is efficiently lighted by stationary lights. 18. The driver In charge of a locomotive, or a man preceding it on foot, shall give an efficient sound signal as a warning on approaching any level crossing over a line of rails regularly used by persons employed, or any curve where Bight Is Intercepted, or any other point of danger to persons employed. BEPORTS OF THE PRESIDENT'S HOMES COMMISSION. 371 19. A danger signal shall be exhibited at or near the ends of any wagon or train of wagons undergoing repair wherever persons employed are liable to be endangered by an approaching locomotive or wagon. 20. (a) The space immediately around such capstan as mentioned in regula- tion 8 shall be kept clear of all obstruction. (&) Such capstan shall not be set in motion until signals have been exchanged between the man in charge of the capstan and the man working the rope or chain attached to it. (c) No person under 18 years of age shall work such capstan. 21. No person under the age of 18 shall be employed as a locomotive driver, and no person under the age of 16 shall be employed as a shunter. PAST m. 22. All glass tubes or water gauges on locomotives or stationary boilers used for the movement of wagons shall be adequately protected by a covering or guard. H. J. Gladstone, One of His Majesty's Princvpal Secretaries of State, Home Omca, Whitehall, S4th August, 1906. Appendix C. The following is a letter received from Prof. H. W. Wiley, Bureau of Chem- istry, United States Department of Agriculture : Washington, D. C, November 4, 1908. Mr. George M. Kober, 923 H Street NW., Washington, D. C. Dear Sir : Your favor of October 27 at hand, and in reply desire to state that the question of drug habit has received considerable attention by the division of drugs, and could place at your disposal much valuable information. We are collecting this information as rapidly as possible and expect in the near future to submit to the Secretary for approval and publication a bulletin dealing with acetanilid, antipyrin, and phenacetin. We also are in possession of information as to the institutions and their meth- ods of treating unfortunate drug habitues, particularly those addicted to the use of opium, morphine, cocaine, etc. I am inclosing copies of two bills which were introduced at the last session of Congress. The object of these bills is to regulate and minimize the evil at pres- ent resulting from the indiscriminate sale and use of the agents enumerated therein. If you could make it convenient to visit the drug laboratory of this bureau we would be in a position to place at your disposal much information which would be of great assistance to you in your work. Respectfully, H. W. WiLirr, Chief. The following is a letter received from Dr. Lyman F. Kebler, chief, division of drugs, United States Department of Agriculture: Washington, D. C, Novemher 21, 1908, Dr. George M. Kobeb, 1819 Q Street, Washington, D. 0. Dear Sir: I am herewith transmitting data on the following subjects: The harmful effects of acetanilid, antipyrin, and acetphenetidin (phenacetin) ; can- cer cures ; female pills ; soft drinks containing caffeine, etc. ; the dope question ; consumption cures; habit cures, and prescription nostrums. I did not include the list of headache remedies, for the reason that they are not as yet complete. We have found approximately 365 which have a fairly large sale — that is, more than the local sale of a drug store — but not more than one-half of same have been investigated in the division of drugs. I shall be pleased to forward you the entire list, with the understanding that there might be one or two which are not actually headache remedies, but are believed to be such from the trading name. Respectfully, L. P. Kebler, Chief, Division of Drugs. 372 REPORTS OF THE PRESIDENT'S HOMES COMMISSION. SOFT DBINKS CONTAINING CAFFEINE AND EXTRACTS OF COCA LEAF AND KOLA NUT. [By LxHAV F. Kbblbb, M. D., Ph. D., Chief, Division of Drugs, U. S. Department of Agriculture.] During the past decade soda-fountain specialties containing cafifeine, extract of kola nut and extract of coca leaf, the active principle of which is cocaine, have been offered in considerable quantities and, due to extensive and attractive advertising, both as beverages and as headache remedies and nerve tonics, their sale has assumed large proportions. The first appearance of preparations of this type was in the South in the eighties, their introduction following the success which Moxie had attained in the East, though this particular drinli was of an entirely different character. From the South the demand spread to other sections and the number of products has increased until at the present time there are probably over one hundred of them bottled and sold all over the United States. The greatest demand is still in the South, however, and almost every drug store, confectionery shop, and fruit stand has its favorite product on sale. The carbonated goods in bottled form are offered on the trains. People of all classes, young and old, delicate women, and even little children consume these beverages indiscriminately and no warning is ever given of the baneful effect of the powerful habit-forming drugs concealed therein. It is therefore small wonder that the prevalence of the so-called "coca cola fiend" is becoming a matter of great importance and concern. It is well known that some of these products are mixed under the most un- sanitary conditions. The sugar, water, and drug material will be dumped into a pot standing in the cellar of some low building, or even a stable, where the ceiling is covered with dust, cobwebs, and dirt of all descriptions and the floor littered with filth. The steam from the boiling kettle, condensing on the ceiling, collects the dirt in the drops of water and this soon falls back into the mixture. Again, the sirup will boil over onto the floor and a sticky mass remains which soon collects straw and filth of all descriptions and becomes a rendezvous for flies and other vermin, for usually no attempt is made to clean it up. Judging from the names of most of these products it would appear that ex- tract of kola nut is one of the chief ingredients, and, while in certain instances this drug is undoubtedly present, in most cases the caffeine has been added as the alkaloid caffeine obtained from refuse tea sweepings or made artificialy from uric acid occurring in the Guano deposits of South America, or in the citrated form, and the sirup colored with caramel. The cocaine found is usually added in the form of extract of coca leaf. Some of the manufacturers claim that the extract used is prepared from a decocainized coca leaf, the refuse prod- uct discarded in the manufacture of cocaine. An investigation of these products was undertaken about a year ago and it was found ttiat the following products contained both caffeine and extract of coca leaf: Afri CJola, The Afri Cola Co., Atlanta, Ga. Ala Cola, Ala Bottling Works, Bessemer, Ala. Cafe Coca, Athens Bottlmg Works, Athens, Ga. Carre Cola, R Carre Co., Mobile, Ala. Celery Cola, The Celery Cola Co., Birmingham, Ala. ; Dallas, Tex. ; Nash- ville, Tenn., and St Louis, Mo. Chan Ola, L. M. Channell, New Orleans, La. Chera Cola, Union Bottling Works, Columbus, Ga. Coca Beta, the Coca Beta Co., New York City. Coca Beta, Southern California Supply Co., Los Angeles, CaL Coca Cola, Coca Cola Co., Atlanta, Ga. Pilsbury's Coke, A. L. Pilsbury, jr., Co., New Orleans, La. Cola Coke, Lehman-Rosenfeld Co., Cincinnati, Ohio. (This preparation was formerly sold under the name of Rocco Cola.) Cream Cola, Jebeles & Calias Co., Birmingham, Ala. Dope, Rainbow Bottling Co., Atlanta, Ga. Four Kola, Big Four Bottling Works, Waco, Tex, Hayo Kola, Hayo Kola Co., Norfolk, Va. Heck's Cola, Heck & Co., Nashville, Tenn. Kaye Ola, A. W. Kaye, Meridian, Miss. Koca Nola, Koca Nola Co., Altanta, Ga. Koke, Coleman & McKeever, Frankfort, Ky. REPORTS OF THE PRESIDENT'S HOMES COMMISSION. 373 Kola Ade, Wiley Manufacturing Co., Atlanta, Ga, Kola Kola, W. J. Stange Ck)., Chicago, 111. Kola Phos, John Wyeth & Bro., Philadelphia, Pa. Koloko, Halberg Bottling Works, Mobile, Ala. Kos Kola, Sethness Co., Chicago, 111. Lime Cola, Alabama Grocery Co., Birmingham, Ala. Lima Ola, Wine Brew Co., Macon, Ga. Mellow Nip, Rainbow Bottling Co., Atlanta, Ga. Nerv Ola, Henry K. Wampole & Co., Philadelphia, Pa. Revive Ola, O. L. Gregory Vinegar Co., Birmingham, Ala. Rocola, American Manufacturing Co., Savannah, Ga. Rye Ola, Rye Ola Co., Birmingham, Ala. Standard Cola, The Standard Bottling Co., Denver, Colo. Toka Tona, California Commercial Co., Los Angeles, CaL Tokola, Samuel Smith & Co., Chicago, 111. Vani Kola, Vani Kola Company, Canton, Ohio. Vim-0, Vim-0 Company, Eagle Lake, Tex. French Wine of Coca, Wine of Coca Co., Boston, Mass. Wise Ola, The Wise Ola Co., Birmingham, Ala. The following preparations were found to contain caffeine, but there was no evidence to the effect that coca leaf in any form had been used in their manu- facture : Calycine, Calycine Co., Norfolk, Va. Celery Cocoa, Celery Cocoa Co., Los Angeles, Cal, Citro Cola, Miners Fruit Nectar Co., Boston, Mass. Deep Rock Ginger Ale, Abney Bros., Athens, Ga. Fosko, E. Carre Co., Mobile, Ala. Heck's Star Pepsin, Mrs. Ida Heck, Nashville, Tenn. Koke, Coan & Harbin, Bluff City Bottling Co., Memphis, Tenn. Koke Ola, Eagle Bottling Co., Frankfort, Ky. Kalafra, Mead Johnson Co., Jersey City, N. J. Kumfort, The Kumfort Co., Atlanta, Ga. Lime Juice and Kola, Parke Davis & Co., Detroit, Miclu Lon Kola, Lon Kola Co., Danville, Ky. Meg-0, Parr Bros., Baltimore, Md. Mexicola, Celiko Bottling Works, Raleigh, N. C. Pau Pau Cola, Pau Pau Cola Co., Detroit, Mich. Pedro, N. J. Parker & Co., Washington, D. C. Pepsi Cola, C. D. Bradham, New Bern, N C. Speed Ball, E. Pilzer, Speed Ball Co. (Inc.), Washington, D. C To-Ko, The To-Ko Company, Hagerstown, Md. Vril, Brand Bros., Chicago, 111. Besides the above preparations which have been analyzed a number were reported from different parts of the country but no samples were submitted. From their names, and from what evidence there waa submitted, they contain either caffeine of coca leaf extract, or both: Charcola, H. C. Metzger, Meridian, Miss. Cherry Kola, Williamsport, Pa. Cola Soda, Jacob House & Sons, Buffalo, N. T. Coca Ginger, National Beverage Co., Atlanta and Chattanooga. Field's Cola, H. C. Field, High Point, N. C. Imported French Cola, Alabama Grocery Co., Birmingham, Ala. ( Claimed to be carbonated Wiseola.) Jacob's Kola, Tampa, Fla. Koko Ale, Salt Lake City Soda Water Co., Salt Lake City. Kola Cream, The Henzerling Co., Baltimore, Md. Kola Pepsin Celery Wine Tonic, W. J. Miller, Cleveland, Ohio. Kola Vena. Loco Kola, Norton, Va. Mintola, Davis Kelley Co., Louisville, Ky. Mate, Mississippi Ice Co., Clarksdale, Miss. Pikmeup, Scales, Wilson Co., Greenville, S. C Ro-Cola, Savannah, Ga. Schelhorns Cola, Evansville Bottling Co., Evansville, Ind. Vine Cola, California Commercial Co., Los Angeles, Cal. Viz, Alabama Grocery Co., Birmingham, Ala. (Claimed to be carbon- ated Wiseola.) 374 EEPOBTS OF THE PRESIDENT S HOMES COMMISSION. HABIT CUBES. [By Ltman F. Keblke, M. D., Fh. D., Chief, Division of Drugs, U. S. Department of Agriculture. ] Nostrums for the cure of the drug and liquor habits are widely advertised throughout the country in the public press. A request for further information with regard to the subject of one of the advertisements is followed by the receipt of printed matter setting forth the virtues of the remedy, and a " symptom blank " whereon the inquirer is expected to state over his signature the kind of drug he is using and the dose which he is accustomed to take daily. Upon returning this blank, filled out, the inquirer is informed as to the price at which the remedy in quesion can be procured. This is usually at a specified price per bottle, or treatment, treatment being reckoned by the month. Some concerns do not employ the symptom blank, but sell their products to all who apply, without question. In almost every case the remedy contains a generous pro- portion of an opiate, usually in the form of morphine. Ostensibly the treat- ment is based upon the reduction plan; the patient is advised to give up the use of the drug which he was formerly taking and to depend entirely upon the remedy, and to reduce the daily dose of this at regular intervals until he finally does away with its use entirely. This, as a matter of fact, he never does, because he finds it just as diflicult to break away from the morphine-containing "support" as from the straight morphine which he formerly took. Meantime the concern which furnishes the nostrum reaps pecuniary benefit. Most of the nostrums for the cure of the liquor habit depend for their efficacy upon the nauseating qualities of the ingredients which they contain. * * ♦ The remedy can be taken voluntarily by the patient himself, or administered secretly by introducing it surreptitiously into his food or drink. Promises of a most alluring character are held out with regard to the latter method of admin- istration, and the wives and mothers of drunkards have been known to go great lengths to procure the money wherewith to purchase these nostrums. The result of both methods of administration is the same — the patient's stomach and digestion are injured, perhaps permanently, and no real good is accom- plished. A list of the " cures " for the drug and alcohol habit is given below. HABITS. Drug cures, W. J. Carney, 567 Lebanon street, Melrose, Mass. (Opium.) St. Paul Association, 46-48 Van Buren street, Chicago. (Drugs.) Purdy Sanitarium, 614^ Fannin street, Houston, Tex. Harris Institute, 400 West Twenty-third street. New York. (Drugs.) O. P. Coates Co., 917-919 New York Life Building, Kansas City. (Drugs.) Habitina. Dr. Stewart-Hord Sanitarium, 360 Franklin avenue, Shelbyville, Ind. (Drugs.) Waterman Institute, 14-18 Lexington avenue, New York. (Drugs.) Cedarcroft Sanitarium, Lebanon, Tenn. New Malay Opium Cure, Rev. J. C. Ives, 134 East Twenty-fifth street, New York. •*99" Morphine & Opium Cure, Krouskeep, Clark and Van Buren streets, Chicago. St. James Society, Suite 245, 1181 Broadway, New York. (Drugs.) Manine Medical Co., 3201 Locust street, St. Louis. (Drugs.) B. M. Wolley Co., Atlanta, Ga., Box 887. (Opium, whisky, etc.) Alexand^ Cooperative Sanitarium Co., Fulton, Ky. Dr. W. A. Steams, Atlanta, Ga. Dr. W. J. Tucker, Atlanta, Ga. Dr. L. F. Myers, Columbus, Ga. Dr. G. W. D. Patterson, Atlanta, Ga. The Acme Opium Cure, Kirk wood, Ga. James Sanitarium, Memphis, Tenn. Drug Crave Crusade, 41 Union Square, New York. Dr. J. L. Stevens Co., Lebanon, Ohio. Hyoscin. Comstock Remedy Co., Lafayette, Ind. (Fluid Extract Coca.) National Aid Society, 134 East Twenty-fifth street. New York. REPORTS OF THE PRESIDENT S HOMES COMMISSION. 376 Windsor Laboratories, 134 East Twenty-fifth street, Yew York. Malay Opium Co. Ricbie Co., 105 St. James Place, Brooklyn, N. Y. Mackay Treatment Co., 61 Maiden Lane, New York. Scientific Remedy Co., 45 West Thirty-fourth street, New York. Oppenheimer Institute, 159 West Thirty-fourth street, New York. Mrs. Carney, 567 Lebanon street, Melrose, Mass. World Remedy Co., Syracuse, N. Y. H. C. Keith, Losantville, Ind, The Dr. Koonse Cure, 812 Calbtun street. Ft. Wayne, Ind. Compound Oxygen Association, 125 Douglas avenue, Ft. Wayne, Ind. Awaine's Antidote Sanitarium, Cleveland, Ohio, 3731 Cedar avenue. Dr. Rutledge Medical Institute, 477 Ellicott Square, Buffalo, N. Y. Lanoix Cure Co., Kansas City, Mo. Dr. W. J. McKanna, Reidsville, N. C. Delta Chemical Co.. St. Louis, Mo. AlcohoL Orrine. (Alcohol.) White Ribbon Remedy Co., 218 Tremont street, Bdston. Dr. J. W. Haines, 1515 Gleen Building, Cincinnati, Ohio. The Dr. Brannaman Cure, 210 Chaman Building, Kansas City. Aur-Mon-0, 110 West Thirty-fourth street. New York. James Sanitorium, Memphis, Tenn. Mrs. Margaret Anderson, 512 Home avenue, Hillburn, N. Y. Physicians Co-operative Association, Chicago. Parker Willis, 16 State Life building, Indianapolis, Ind. Kansas Anti-Liquor Society, 601 Gray Buildings, Kansas City. Trunk Bros. Drug Co., 400-402 Sixteenth street, Denver, Colo. (Ciga- rette habit.) Rogers Drug & Chemical Co., "Easy to Quit," 1982 Fifth and Race streets, Cincinnati. DE. KEBLEE'S list OF HEADACHE BEMEDIES. A. B. C. Headache Powders. Acetafein (O. C. & Son). Acetalix. Acetanilide Comp. U. S. P. Acetanol. Headache Powders. Ache-Head. Acme Headache Wafers. A. D. S. Headache Wafers. Dr. Agnew's Headache Tablets. Ake-in-the-Head-Tablets. Alex Harmless Headache Powders. Allen's Headache Powders. Alpha Headache Wafers. Ammonol. Analgia (Merrell's) Tablets. Analgine. Anti-headache ( Davis ) . Anti-Headache Moroneys. Antikamnia. Anthony's Headache Powders. Anti-Pain Pills. Armstrong's Headache Powder. Atkinson's "99." Babcock's Headache Pills. " Bar-Ben " Formula A, for headache. Barton's Headache Powders. Beck's Little Wonder Headache Pow- ders. Beck's Universal Headache Tablets. Beekman Headache Wafers. Bell's Coryza Tablets. Bensen's Headache Powders. B enter's Headache Powders. Bergwall's Acme Headache Wafers. Big 4 Headache Powders. Billington's Headache Powder. Bi-Lo-Zone. Bird's Headache Tablets. Block's Headache Cure. Dr. Bob's Headache Powder. Dr. Bonker's Headache Powder. Bouchard's Capsules. Boulanger's Headache Cure. Bovine Headache Powder. Brain Food. (Harper's.) Brangeine. Brant's Headache Tablets. Brazilian Compound Anti-Headache Tablets. Broa's Headache Powders. Bromo Caffeine. (K. & M.) Bromo-Celery. ( Arnold. ) Bromo Compound. (Arnold's.) Bromodine for Headache. Bromo-kamnia. Bromoline. Bromo Lithia. Bromonia. Bromo-QHinine-Laxative. Bromo- Seltzer. Bromo-Soda. (Warner's.) Bromo-Tanilid. 376 REPOKTS OF THE PRESIDENT S HOMES COMMISSION. Bromo Vichy. Bromo Vin. Brook's Headache Powder. Bro-tanilid. Brow-ease. Bull's Headache Specific Caf-Aceton. (Wyeth's.) Caffeine Compound. Campaign Headache Tablets. Capudine. Carey's Heart Tonic Headache Wafers.i Cascara Bromide Quinine. (Hill's.) Catarrh & Headache Snuff. (Mar- shall's.) Celery-Caffeine. ( Chelf s. ) Celery & Caffeine Bromide. (French's.) Celery Fomo. Celery Tea. Celery Vesce. Cencura. For headache. Cephalgine. Cephaline. Cerralgine. Chinese Headache Cure. Dr. Clay's Headache Powders. Clover Headache Powders. Coffee-no. Cold Capsules. (Stott's.) Cole's Headache Cure. Cole's Headache Powder. Coppai's Headache Cure. Coronet Headache Cure. (Bacon.) Courney's Headache 15 minutes. Cran-O-Tone. Craemer's Headache Powders. Crown Headache Powder. Curalgia. Daggett & Ramsdeirs Headache Pow- der. Daisy Headache Powder. Daisy Headache Wafer. Dale, Hart & Co.'s Headache Powder. Darling's Cold Cure. Darlington's Headache Powder. Davidson's Headache Powders. Davis's Headache Cure. De Kalb's Anti-Headache Powders. De Kay's Headache Wafers. De Loste's Headache Powders. Dick's Laxative Cold Cure. Dllliard's Headache Powder. Doris's Headache Buttons. Dutton Headache Powders. Duffs Headache Specific. Eames's Tonic Headache Wafers. EbbS Kolo Caffeine Headache Tablets. Eddy's Headache Specific. Eezee's Headache Cure. Electric Headache Powder. Empire Headache Wafers. Eureka Headache Powder. Eureka Headache Cure. Fabra's Headache Cure. Falling's Headache Powder. Falck's One Minute Headache Cure. Father Schubert's Little Headache Tableta. Fisher's Headache Capsules. Fisher's Quick Headache Cure. Five Minute Headache Powder. Flag Salt. Flower's Sure Headache Cure. Dr. Foote's Headache Powder. Fowler's Magic Headache Powder. Garfield Headache Powders. Geneseo Headache & Neuralgia Rem- edy. G. E. S. S. Headache Tablets. Gessler's Headache Wafers. Getman's Headache Powder. Gibson's Instant Headache Cure. Gipsy Headache Wafers. Goldsmith's Headache Wafers. Goll's Dollar Headache Cure. Good's Headache Cure. Gregory's Headache Powder. Grosser's Headache Cure. Guarana Compound. Guy's Headache Powder. Hageman's Headache Wafers. Haller's Headache & Neuralgia Cure, Haller's Relief Headache Powder. Hall's One-Minute Headache Cure. Hantz's Headache Tablets. Harmless Headache Powder. Dr. Hart's Headache Powder. Hartwig's Headache Tablets. Hawley's Celery Headache Capsules. Head-A-Cure. Headache Antidote. (Edward's.) Headache Chocolates. Headache Konseals. Headache Powders. (Kellogg & Car- rier.) Headachine. Headache Stop. Head-Ease. (Bethea's Liquid.) Head-Ease. (Cumming's.) Head - Ease. ( Peter - Heat - Richard- son's. ) Head-Ease. ( White's. ) Head-Easy. (Stedman's.) Headline. Headache Kolone. Headache Kuro. Headoria. (Pearson's.) Hed-ake. (Preston's.) Hedakur. (Hasson's.) Hed-Kure. (Saenger's.) I. N. Hegeman & Co., Headache Pow- der. Henry's (Dr.) Headache Powder. Hick's Capudine. Hobson's Headache Cure. Hoffman's Harmless Headache Pow- der. Hogan's Headache Powder. Holland's Headache & Neuralgia Pow- der. Holloway's Headache Powder. Howe's Headache Cure. (P. M. Co.) Hufeland's Sure Headache Cure. Hutchln's Headache Pills. L C. R. Cold k Catarrh Relief. EEPOETS OF THE PRESIDENT S HOMES COMMISSION. 377 Imperial Headache Powder. Instant Headache Wafers. (Brown & Hoff.) I. S. M. A. Caffanllld. James's Headache & Liver Pills. Dr. J. W. James's Miniature Headache Powder. Japanese Rapid Headache Powder. Johnson's Headache Powder. Johnson's Utah Headache Salt. Jones's Cold & Grippe Cure. Joslyn's Instant Headache Tablets. Kahle's Headache Powder. Kali-Caffein. (Claimed to be a salt.) Kalluorine. Headache Powder. Kapitol Headache Wafers. Kef. Kelly's Headache Cure. Kennedy's Headache Powder. Kennedy's Headache Tablets. King's Headache Tablets. Knox-a-Cold Tablets. Knill's Orange Headache Pills. Kohler's Headache Powders. Koladine. Kolo-Caffein. Kolone. (Lakln's Hedake.) Koos* Nervine Headache Powder. Kopfaline. Kramer's Headache Capsules. Kra-Nol. Krause's Headache Capsules. La Belle Headache Tablets. Lake's Headache Powder. Lamprey's Headache Cure. Lane's Headache Capsules. Lantz's Gold Coin Headache Cure. Lawrence's Headache Powder. Laxacold. Laxative Bromo Quinine. (Paris Med. Co.) Lemon Seltzer. Lemke's Headache Powder. Lesage's Headache Specific. Leslie's Headache Prescription. Dr. Little's Headache Specific. Little Wonder Headache Powder. Dr. Lord's Headache Powder. Dr. Lung's Headache Powder. Magnet Headache Cure. Marquet's Headache Wafers. Martin's Headache Cure. Man's Headache Powder. McGale's Headache Cure. McGrath's Headache & Neuralgia Tab- lets. Malydor Injection. Megrimine. ( Whitehall's. ) Metzger's Headache Tablets. Meyer's Headache & Neuralgia Cure. Microtine. (Lepper's.) Migrainin. (Baker's.) Migrainoes. (Digestine Co.) Migrain Tablets for Headache. Migrain Tablets. (Squibbs'.) Migrane Tablets. Miles's Anti-Pain Pills. Momad's Headache Capsules. Moore's Harmless Headache Powder. Morgan's Headache Wafers. Morin's (Dr. Ed.) Headache Wafers. Morrison's Headache Cure. Moyer's Headache Tablets. Mueller's German Headache Powder. Munyon's Headache Remedy. Narco Headache Remedy. Narco Cold Tablets. Natronilid. (Peck.) Nature's Headache Tablets. Nervease Powders. Neuralgolyne. Neuralgia Capsules. Neuralgine. Neuralgyline. New Era Headache Cure. " 999 " Headache Powder. Now or Never Headache Powder. (H M. Co.) Nyal's Headache Cure. Oa Oa Headache Powder. O. K. Headache Cure. (Houston Drug Co.) Olusa Headache Powders. Omega Headache Powders. (Bab- cock's.) Orangeine. Orien's Headache Cure. Otto's " Such A " Headache Powder. • Pain in Your Head. (Cooper's.) Pain King. (John's.) Pain King. (Shaker's) Pain Paint. (Goll's.) Pain Paint. (Wolcott's.) Paragon Headache Remedy. Parker's Headache Powder. Pasteur's Stop a Pain Tablets. Peck's Headache Powder. Peek's Headache Powder. Peerless Headache Powder. Perfection Headache Wafers. Perrine's Quick Relief. Headache Powder. Perry's Headache Powder. Perry's Headache Wafers. Phenalgine. Phenine. Headache Powder. Phenokola. Headache Powder. (B. & SO Phenolgin. Phenyo-Cafifein. Phospho-Caffeine Compound. Piatt's Headache Wafers. Positivus Headache Tablets. Poythress Cold & Grippe Cure. Preston's Hed-Ake Cure. Princess Headache Powder. Pusheck's Cold Tablets. Quaker Headache Capsules. Quick Cure. (Dr. Wood's.) Quick Relief Headache Cures. Quickstop. (Mattison's.) Ramee's Sick Headache Remedy. 378 EEPOKTS OF THE PRESIDENT S HOMES COMMISSION. Ramsey's Headache Elixir. Raphael's Headache Wafers. Rawleigh's Quinine 15 Minute Tablets. Red Dragon Seltzer. Rennard's Headache Remedy. Requa's Headache Powder. Rexall Headache Pills. Rexall Headache Powder. Rexall Tablets. Richardson's Headache Powder. Rich's Headache Powder. Rough on Headache Tablets. Royal Headache Powder. Royal Headache Tablets. Salvitae Headache Tablets. Sanderson's Headache Cure. Sand Mountain Headache Tablets. Sanltatis Headache Tablets. Sano Headache Cure. Sawyer's Headache Powder. Schmidt's Headache Cure. Schrader's Headache Powder. Shilling's Bromo Headache Tablets. Shoop's 20-Minute Headache Tablets. Shrader's 10-Minute Headache Powder. Solan's Headache Wafers. Soda Caffo Headache Tablets. So-Doc. Headache Cure. Spen's Headache Tablets. Stanton's Harmless Headache Powder. Schwalb's Electric Headache Powder. S. & D.'s Headache Salt. Severa's Headache & Neuralgia Wafers. S. & H.'s Headache Salt. Shac-Stearn's Headache Cure. Sherlou's Headache Powder. Sherman's Headache Cure. Stark's Headache Powder. Steam's Headache Cure. Stewart's (Dr.) Headache Powder. Scott's Cold & Grippe Tablets. Sunshine Headache Powder. Swift's (Dr.) Headache Cure. Talbot's Headache Wafers. Taylor's Headache Powder. Ten Thousand Dollar Headache Tab- lets. Thieman's Headache Powders. Thurston's Headache Powder. Tousley's Catarrh Powder. Truc's Headache Tablets. Tubb's Cold & Grippe Tablets. Tucker's Fever & Headache Powder. Turkish Headache Powder. Uncle Sam's Kola Headache Powder. Van Marter's Headache Powder. Vegelene Headache Tablets. Vegeta Headache Powder. Vick's " Kadok " Headache Powder. V-0 Headache Relief. Walker's Headache Wafers. Wall's (Dr.) Headache Powder. Ward's Headache Powder. Watkin's Headache Tablets. Wayne's Headache Powder. Webster's Headache Powder. Weeks' Break Up a Cold Tablets. Welliug's Headache Cure. Wheat's Headache Powders. White Seal Headache Powder. White & White Headache Powder. Wing's Headache Specific. Wischerth & Dogler's Headache Pow- der. Wright's Paragon Tablets. Wolfs Headache Cure. Wood's Headache Tablets. Wonder Cure Headache Powders. ' X L Headache Wafers. Yager's Handy Headache Tablets. Yarnell's Columbian Headache Cure. Young's Headache Powder. Yu Kan Headache Powder. Zeman's Headache Powders. Zogat's Headache Powder. Zerbst's Little Giant Headache Remedy. Zerze's Positive Headache Cure. FEMALE PILLS. [By Lyman F. Kebleb, M. D., Ph. D., Chief, Division of Drugs, U. S. Department of Agriculture.] The publication of advertising matter inviting attention to means whereby conception can be prevented or abortion produced is specifically prohibited by law. Hence the manufacturers of drug products which are intended to be used for these purposes are careful not to state openly in their advertising literature the purposes for which their preparations are intended. They manage, how- ever, to convey this information in such a way that those who are interested can readily understand. This is effected largely through the character of the name employed for the preparation, and through the agency of more or less guarded statements which appear upon the label or in the advertising literature. The name of most of these preparations are in themselves characteristic. They often contain the names of drugs which have come to be more or less widely known as emmenagogues or abortifiacients, for example, " Pennyroyal Pills," "Tansy Pills," "Cotton-root Pills." Others are so worded as to be equally characteristic : " Female Regulating Pills," " Female Regulator," " French Pills," ** Female Pills," etc. Each of these terms indicate more or less clearly the purpose for which the preparation is intended. In addition more or less guarded statements appear in the advertising literature. These preparations EEPOETS OF THE PRESIDENT'S HOMES COMMISSION. 379 are rarely recommended for the purpose mentioned above only, but are in most cases recommended for the cure of about all of the diseases to which the peculiar female organism is liable. Among these conditions, " Suppressed Men- struation " is given especial prominence. The following, taken from the adver- tising literature of some of the products in question, are given in illustration . " French Pills. Safe and Positively Infallible. Believes Painful and Sup- pressed Menstruation," etc. * * ♦ Female Beans, Lion Drug Ck)., Buffalo. Feminina, Mansfield Drug Co., Memphis. Dr. Trousseau's Celebrated Female Cure, Dr. Trousseau Chemical Co., New York. Female Pills, Arch Pharmacal Co.^, San Francisco. Dr. Arthur's Pennyroyal & Tansy Pills, Palestine Drug Co., St. Louis. Dr. Bane's Female Pills, A. V. Bane Medical Co., St. Joseph, Mo. Dr. Cheeseman's Female Regulating Pills, Cheeseman Medicine Co., New York. Chichester Pennyroyal Pills, Chichester Chemical Co., Philadelphia. Fiske Clarke's Female Pills, Williams Mfg. Co., Cleveland. Sir Clarke's Female Pills, Job Moses, 150 Nassau street, New York. Dr. Constan's Female Pills, Fred'k K. Ingram & Co., Detroit. Dr. Conte's Female Pills, Dr. Felix Conte, Paris. Madam Dean's Female Pills, United Medical Co., Lancaster, Pa. De Koven's Comp. Pennyroyal Pills, Crescent Chemical Co., Elmira, N. T. Dubois' Female Pills. Du Choin's Female Pills. Ducro's Female Pills, Dr. L. Ducro, Paris. Duponco's Golden Female Pills. Duquoi's Female Pills, Dr. Du Quoi, Paris. Duquoin's Pennyroyal Pills. Golden Female Pills. Female Pills, Hillside Chemical Co., Newburgh, N. Y. John Hooper's Female Pills. Hooper's Green Seal Female Pills. Job Moses' Female Pills, 10 Spruce street, and 150 Nassau street. New York. King's Tansy Female Pills, King Medicine Co., Boston. La Franco Female Pills, La Franco Medical Co., 145 North Eighth street, Philadelphia. La Rues French Tabloids. Lane's Female Pills, Allan Pfeiffer Chemical Ch., St. Louis. Leslie's Pennyroyal Pills, Arthur Chemical Co., St. Louis. Lyon's Tansy Pills, Empire State Drug Co., Buffalo. Mangogo Female Pills, New York & London Drug Co., New York. Monell's Female Pills, C. E. Monell, New York. Mott's Pennyroyal Pills, Williams Mfg. Co., Cleveland. Olive Branch Female Pills, Olive Branch Remedy Co., South Bend. Piso's Female Pills, The Piso Co., Warren, Va. Red Cross Tansy Pills, Norman Lichty Mfg. Co., Des Moines. Dr. Sanderson's Female Pills. Female Pills, S. B. Medicine Mfg. Co., Portland, Oreg. Seguro Compound, Seguro Mfg. Co., 531 K street, Sacramento. Dr. J. Simms's Female Pills, J. H. Simms, Wilmington, Del. Steam's Tansy Pills, New York & London Drug Co., New York. Dr. St. Jean's Female Pills, St. Jean Medical Co., 2004 Lexington avenue, New York. Tansy Cotton Root Female Pills, New York & London Drug Co., New York. Dr. Thomas's Pennyroyal Pills, Arthur Chemical Co., St. Louis. Dr. Larue's Female Regulator. Severa's Female Regulator, W. F. Severa Co., Cedar Rapids, Iowa. Watkins' Female Remedy, J. R. Watkins Medical Co., Winona, Minn. French, Antyseptin Female Remedy, Antyseptin Co., Gouverneur, N. Y. Magnolia Blossoms, Female Suppositories, South Bend Remedy Co., South Bend, Ind. Orange Blossom Female Suppositories, Dr. J. A. McGill Co., Chicago. 380 EEPOBTS OF THE PRESIDENT'S HOMES COMMISSION. Washington, June 15, 1908, Dr. George M. Kober, Chairman Committee on Social Betterment of the President's Homes Commission, Dear Dr. Kober : While you verbally told me to " take my time," pressure of official duty has very much delayed formal reply to your letter, that the committee on social betterment of the President's Homes Commission is very anxious to determine as far as possible the causes of juvenile delinquency, wife desertion, and nonsupport, with special reference to standards of living, intemperance, and other faulty environments, and should be very glad to re- ceive from me the results of my observation and experience. Since there are many causes back of every act voluntarily elicited by the human will, it will be difficult to enumerate them all, even though the inquiry be limited, as you suggest, by special reference to standards of living. Yet certain broad conditions, rather than causes, may be indicated, improvement of which may be brought about by the exercise of the police powers of the state, in the interest of the general good of society, and consequently of the individual also; for, as the President has often reminded us, in the long run we are all going up or going down together. Over twenty years' service as a volunteer helper of the unfortunate has, of course, given me some ideas relative to what the state might do to alleviate conditions, without destroying individual initiative. First, I was early im- pressed that homes in alleys foster vice and crime. Many citizens fear to enter the alleys even in daylight, the alleys are away or aside from the beaten lines of travel, and their isolation and comparative privacy encourage drunken- ness and vagrancy and kindred evils, not only on the part of denizens, but on the part of outsiders glad to avail themselves of the cover of the alleys in their licentiousness. No more efficient work could be performed for social betterment in Washington than to absolutely abolish all human habitations in alleys. It is a service of such transcendent importance to the whole city that it would even be worth while for the whole city to bear the burden of pur- chasing these alley properties and changing these properties into interior parks. Rents in the alleys range from $7.50 to $9 per month for four-room houses, without water in the house, though there may be water in the yard. The renters are drivers receiving from $5 to $7.50 per week as wages, or day laborers, receiving from $1 to $1.50 per day, or hod-carriers, who, when members of the union, receive $2.25 per day, otherwise less. Of course, these work people lose wet weather and are subject to other losses of time from different vicissitudes, such as waiting for building material. Sometimes the renter is a foreigner who is a skilled artisan or stone mason, drawing $4 per day, whose earnings suggest a better environment. When his children are brought into court, charged with shooting crap or other disorderly conduct, with the com- panions made in the alleys, he is brought to a realization that the child is more than the dollar, and readily agrees to get out of the alley into a home more suitable for an aspirant to American citizenship. We have building regulations designed to secure the proper amount of air space for sleepers; yet several families will sometimes crowd into these small alley houses, and this is not the limit, for a lodger at 50 cents a week will often be accommodated upon the floor of the kitchen in addition. The family income is almost invariably increased by the laundry work done in these overcrowded tenements by the women occupants. Think of them, therefore, as nuclei for the spread of contagion. These alley women prefer to do laundry work at their homes in the alleys, where there is the least constraint and the most gossip. Another serious evil is the commingling of the sexes. Children beyond the age of puberty are in the same room, often sleeping in the same bed. Sad are the results. I endeavor in a familiar way to make these people appreciate the situation. In cases of overcrowding, they are reminded that they would not quarter cattle in such cramped shelter, for fear of breeding fever in the animals, and yet the human is infinitely more valuable. Where both sexes are occupying the same sleeping room, the mother or the father is asked if she or he would place in that room a lighted match near a can of gunpowder. Of course not, and they are shown the greater danger from mingling the sexes thus when the passions are strong and there Is much ignorance, and they are reminded that under such conditions common decency becomes impossible. It is not unusual for married couples to have well-grown children sleeping 1^ the same room KEPORTS OF THE PBESIDENT's HOMES COMMISSION. 381 with them sometimes in the same bed. If the poverty be great, such are re- quired to use at least cheap screens as an aid to decency. Sometimes a careful survey of the joint income of the members of the family demonstrates the ability to get additional room, or house space, especially if expenditures for vicious indulgences are cut out. And it is possible to get, even for the rents paid for alley houses, houses of similar size upon the streets of certain localities. The facts herein referred to are brought out in the court hearings; but I early admonished the probation oflBcers to make tactful inquiries along the same lines in their investigations, being careful, however, not to work at these people, but with them, in an endeavor to awaken ideals within the reach of the occupants of the houses in these hives of humanity. The home conditions animadverted on give rise to drunkenness, breaches of the peace, wife desertion, and much of the juvenile delinquency. Out of the habitations of the drunkard or the father who does not provide for those of his own household, go children not with the innocence or the buoyancy of childhood, but children suffering the cravings of hunger and familiar with scenes of debauchery. To satisfy hunger, they must either beg or steal. Often, too, these children find in the tumult of the street, where no one nags them, surcease from the bickerings of the home. The street becomes their most prized rendezvous, to be preferred to the discipline of the school, and, there- fore, herein arises much truancy, and hence arises much of the so-called wanderlust, to be preftxed to the quarrelsome home. The nonsupport law is used to remedy these evils as far as practicable. The delinquent husband is made to go, on Saturday night, while he has his weekly wage in his pocket, to the nearest police station and pay there a stipulated amount to be turned over through the clerk of this court for the support of his wife or children, or both. Either drunkenness or infidelity is an incident in these nonsupport cases, and so a pledge is also exacted to refrain from the use of liquor for the space of a year, and to cut out entirely the illegal in- timacy, a short instruction being given upon the venereal diseases following upon such wrongful indulgences. During the first year of the operations of this court $6,050.59 were thus dis- bursed to needy families. In the eleven months of this fiscal year the amount was $19,235.36, in small sums weekly, from $1.50 up. There are now 236 families upon the relief roll at the court This has saved a burden to the tax- payers, minimized drunkenness, and made lazy men work to support themselves and families. Some of these men have improved so in an economic sense that they have stated they were glad to have been brought into the court. I may add that I wish you every success in your noble work for the better- ment of conditions in the capital of our country, which I am proud to say is my own native city. President Roosevelt will ever be remembered as the President who sought to make this city the embodiment of the highest ideals of American life. Sincerely, yours, Wm. H. Dk Lacy, Judge, ISf? AND REGIONAL PLANNINdl University of California ilCRKELJEY 4., CAUFORMIA >:>^ M >^K> RETURN TO the circulation desk of any University of California Library or to the NORTHERN REGIONAL LIBRARY FACILITY BIdg. 400, Richmond Field Station University of California Richmond, CA 94804-4698 ALL BOOKS MAY BE RECALLED AFTER 7 DAYS • 2-month loans may be renewed by calling (510)642-6753 • 1-year loans may be recharged by bringing books to NRLF • Renewals and recharges may be made 4 days prior to due date DUE AS STAMPED BELOW APR 1 4 2003 OCT 9 2008 1 DD20 15M 4-02 '^^ii i umm?. y> 9^ ^ /^ jirmimi} I.^IJ >/i'«^ " ^iBSl :> > ) la CD3M1M77Mb 3>. • 0^> ) 7/ > > > ■, > :> ' ) > y > > > > :> ^>3 ,?> ► > > > / ■ ■- v^ ) > > > ■ A ""^m, 4 > > > ^f?^'^ > > > -^•- ^^r^^"?^ :3foi :^^^ ^:> > J> > •/ 1 ^&»^' y T3 ► • -^ 1 ^ > .^ ^' -> ^ P ) ■ > > ^'>- "X* > '■ ^ *•'' > ^■t's >•-; / y > ♦^ 1 ' >► ^ Ta;" J"!!—, ^ ',■■■■3 > > o> > •■ :> >^^ im ^^^ > ' >^'',> >. ^. 3» J> le^ ^T-'^^ititf :> y^ >J » > E ^ :> vi> > .. >J> \> 1^ ^ ^ >..>:. :i^ ► i.:;^- ^>mS^ • '/>-,.:> > • ; ►^^ ^:^ ^ :)^13>v:^:J ji^ ' ^i >. . 31 » j%^ fn k'S*^ ^1 • -'^ >a« > ^^\^ ^ . .S -3^ ' -•-^' « 4xf. 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