UC-NRLF LA &&> A 763 DIM EXCHANGE REPORT OF SURVEY OF THE DEPARTMENT OF HEALTH and THE DEPARTMENT OF EDUCATION CITY OF ATLANTA, GEORGIA Made for the Atlanta Chamber of Commerce Committee on Municipal Research By S. G. LINDHOLM For the New York Bureau of Municipal Research December, 1912 Reprinted for the Training School for public service, conducted by the Bureau of Municipal Research, 261 Broadway, New Yorfe City, Wm. H, Allen, Director REPORT OF SURVEY OF The Department of Health City of Atlanta Georgia Made for the Atlanta Cham- ber of Commerce Committee on Municipal Research By S. G. LINDHOLM For the New York Bureau of Municipal Research December, 1912 December 19, 1912. Colonel Frederic J. Paxon, Chamber of Commerce Committee on Municipal Research, 57 Whitehall Street, Atlanta, Ga. Dear Sir: Herewith please find my report on Atlanta's department of health. The emphasis upon the record evidence of work under- taken and work done is due to our conviction based upon ex- perience that in making a preliminary survey we get our best re- sults by noting what public departments attempt to do and what evidence they have of work done and work undone, rather than by actual field tests. The report on the health department is presented under the following headings: Part I. Efficiency of the health department as revealed by records. __.4. Limitations placed upon the Board of Health by_cit code. and ordinances that detract from its efficiency. B. The use made of the powers given by the code to the health department. Part II. Method and procedure of the health control. Part III. Inspection of certain dwelling houses. Part IV. Recommendations. Very truly yours, BUREAU OF MUNICIPAL RESEARCH. Per S. G. Lindholm. 305324 I. EFFICIENCY OF THE HEALTH DEPARTMENT AS RE- VEALED BY RECORDS. In measuring the efficiency of the health department of At- lanta, two factors must be considered: A. The limitations placed upon the board of health by the city code and ordinances that detract from its efficiency. B. The use made of the powers given by the code to the health department. A. Limitations placed upon the board of health by the city code and ordinances that detract from its efficiency. 1. The method of ward election ten members, one from each ward plus three ex-officio members prevents men of re- quired skill and experience to serve upon the board because they do not happen to live within the ward. 2. Wards must elect men that are incompetent to deal with technical problems because of this limitation as to residence. 3. The ward method of electing members both to the board of health and to the general council almost inevitably means that each ward member in the general council selects the board of health member from his own ward thus introduc- ing the element of politics in an election that should be gov- erned solely by consideration of expertness. 4. Professional qualifications are not demanded in any mem- ber of the board. 5. The size of the board two ex-officio and ten ward mem- bers must make it cumbersome in dealing with health problems where quick decisions are frequently necessary. 6. The power of the general council to set aside health ordi- nances must inevitably take the spirit out of the hearth board in enforcing any ordinance that is likely to interfere with private interests. 7. The failure to vest in the health department the power to adopt and give legal sanction to health ordinances bars the health board from formulating and executing a policy by which public health shall be guarded against private inter- ests. 8. The power to create a sanitary code is usually a charter right of the health departments in modern cities. See, for instance, section 1172, New York City charter. 9. The method of election, therefore, makes it unreasonable to demand that the board of health in Atlanta should pos- sess such qualifications for dealing with health problems as are now demanded from health departments in well admin- istered cities. 10. The power of the general council to refuse to enact health ordinances demanded by the board of health and its power to set aside ordinances at the importuning of private interests must make the administration of the board halting and vacillating. B. The use made of the powers given by the code to the health department. 1. Weaknesses inherent in present executive organization of department. a. There is no single executive head. b. The health officer and the chief sanitary inspector are not only independent of each other but c. Are responsible to an inexpert board. d. Thus unity of purpose or action can not be insured, for harmonious personal relations such as seem to exist can not take the place of the right system. 2. Points of efficiency noted in the administrative organiza- tion of department. a. The health officer showed familiarity with modern methods of dealing with infectious diseases. b. The sanatorium for tuberculosis patients is erected upon grounds admirably chosen and with buildings and pa- vilions that seem to combine adequacy with wise economy in construction. c. A creditable system of milk inspection, both of country dairies and of city distribution, including use of score cards, was outlined to the investigator. d. The campaign to exterminate mosquitoes deserves much more than the support it receives from the city. e. The bacteriological laboratory serves as a nerve centre for the health work of the whole city. f. The embryo tuberculosis exhibit at the entrance to the city hall shows what the department would and could do if Atlanta were to finance and organize it adequately. g. This list does not exhaust the commendable features seen by the investigator. The testimony is freely offered that great credit must be given for work accomplished by the present health officer and to his chief adviser, the city bacteriologist. It was evident that they and their staff had striven to do their best with the limitations un- der which they were working. To many of the defects of the department the health officer himself called attention. In calling attention to defects that impressed the investi- gator it is therefore not necessary to apportion here the responsibility between the city, the board or the executive officers. 3. Points of weakness noted in administration of department. a. The staff is not adequately supervised. (1) The inspectors of the department do not render ade- quate reports of hours spent on duty, action taken at each inspection, conditions found in stores, markets, etc., inspected. (2) The notebook carried in the pocket of the inspector from which bi-weekly summaries are submitted to the board does not place before the health officer all the in- formation concerning any one place inspected. No evi- dence was found that these note-books were inspected regularly by the health officer. (3) Lacking definite information of the methods by which the inspectors perform their duties the health officer is not in a position to insure that these methods are the most adequate. (4) Lacking definite records of the sanitary conditions of places inspected the health officer must rely upon per- sonal reinspectcion or general statements from his in- spectors to know whether conditions are improving or his policy of inspection is adequate to cope with the situation. (5) Through the lack of time reports from its inspectors the department is liable to loss through misdirected or delinquent service. b. Health conditions are not adequately supervised. (1) Adequate information as to the existence and spread of communicable diseases is not obtained in the health office. (2) The physicians are not made to live up to their duty of reporting contagious diseases. Whatever policy the health department may adopt in regard to the control of infection it disregards both city ordinances and the fundamenal rule of health control as long as it permits laxity in the reporting of infectious diseases. 8 (3) The department does not demand nor obtain informa- tion as to the probable cause of infection. Its records tell only the name, address and character of disease of the infectious case. (4) The department provides hospital facilities only for smallpox, scarlet fever and diphtheria and in case of the last two infections, for white people only. (5) Cases of measles that can not be isolated in their homes, as those found in living rooms connected with stores, workrooms, etc., must remain a public menace. (6) All cases of infection, smallpox possibly excepted, among colored people are allowed to spread the disease broadcast without any effective interference. (7) The department has not taken steps to secure an ade- quate register of tubercular cases in the city. (8) Of cases that have come to the notice of the depart- ment it does not secure and keep for ready reference such information as is deemed necessary by cities which are attempting to control this disease. (9) The department does not keep records of complaints made by citizens, to what inspector the complaints were referred, what was found upon investigation and what was done by the inspector in regard to the complaints. (10) By destroying the record of the original complaint the health officer puts it beyond his power to trace the action taken or the need for action. The New York City charier recognizes the importance of this citizen co-operation by demanding that all complaints shall be entered in a book. The inspection of this book is one of the important means by which the informed citizen can gauge the efficiency of the health control. (11) The records of inspection of markets, slaughter houses, milk depots and other places are not filed so as to collect all information in one place. (12) Lack of follow-up work in cases needing supervision robs inspection of much of its results. The card, re- porting the scoring of country dairies, is filed away, no notice or warning being sent when the department finds that the scoring is low or conditions bad. (13) These score cards are filled chronologically so that the health officer, in looking at one card, can not tell without a long hunt whether the conditions of the dairy had improved or grown worse since the last inspection. (14) The department keep no records whatever of sani- tary conditions in dwelling houses. II. METHOD AND PROCEDURE OF HEALTH CONTROL. Control of Communicable Diseases. All physicians are required to register with the department. Permits to practice medicine in the city are issued by the state board of medical examiners. There are three bodies of physi- cians recognized homeopaths, allopaths and eclectics. Under the last group many candidates are passed by the examiners who would be considered incompetent by regular practitioners. Midwives charging a fee, are also required to register, but the board makes no attempt to supervise their practice, or even to ascertain the total number in existence. Reporting upon cases of communicable diseases is required by the code, but no efforts are made by the board or the health offi- cer to enforce this ordinance. The reports made come voluntarily from the physicians who, it is said, frequently consult the wishes of the family in regard to reporting. The department is, there- fore, most inadequately informed as to the existence of conta- gious diseases. The code defines as contagious or* infectious the following: Smallpox, cholera, diphtheria, membranous croup, measles, typhoid fever, typhus fever, scarlet fever, yellow fever, and such other diseases as may be publicly declared by the board of health to be contagious or infectious. Among the latter, tuberculosis has recently been included. Cases of scarlet fever, diphtheria and smallpox are quarantined by the department. Quarantine is established and a placard posted upon the report of a physician, or in the case of diphtheria cases upon the positive culture by a bacteriologist. The method of isolation is lenient. In case of diphtheria the nurse and pa- tient are expected to stay in isolation while the rest of the family may continue their usual occupations, provided that they do not enter the sick room. School teachers living in a placarded house are not permitted to continue teaching. In the case of smallpox all members of the family were formerly taken to the quarantine hospital, but now only the patient is removed to the hospital. The members of the family and others having visited the family are vaccinated. No other compulsory measures are taken. The ordinance requires that all grown persons in the city shall be vaccinated and the health officer is given power to enforce this ordinance. He said that every eight or ten years a general vac- cination of all cities is made. At the last general vaccination, forty physicians being employed by the city for this purpose, 10 worked four hours a day until the city has been covered. A pub- lic announcement is first made that all people must be vaccinated within 24 hours, after which time any having neglected it, may be forced to be vaccinated. The vaccine is bought from private laboratories. No attempts have been made by the department to manufacture its own vaccine. -*>> Reports of contagious cases are sent by the health officer to the secretary of the school board, to the Carnegie Library and the private schools. Fumigation is performed by the department on the day requested by the attending physician, or upon the ad- vice of the chief medical inspector. The placarding of houses and the performance of fumigation is made by the two medical inspectors. Neither of these is a physician, but one of them, according to the health officer, has gained through long practice, great efficiency in the diagnosis of smallpox. The records of work performed is kept in a notebook continu- ously carried by both, of which a bi-weekly summary is presented to the board of health. The record of each case is also kept in a card file. Each record contains the following information street address, date of report, name of patient, name of physician re- porting the case. Records of fumigation are kept in a journal containing the following headings : date case is reported, name of patient, address reported, date of fumigation, removed to hos- pital, color (white or colored), by whom reported, name of the disease? It is, therefore, apparent that the records of contagious cases serve only the purpose of supervising individual cases. No rec- ords are obtained indicating the possible source of contagion or any clinical data as are usually obtained by health officers for the study of the spread and control of infection. It is also apparent that such a half-hearted dealing with contagion is of practically no value to the city. The placard as a warning to unnecessary visitors is valuable. It did not appear that the patient or his caretaker were given any instruction in the proper care or methods by which other people may be safeguarded or the patient profited, aside from the injunction that the patient and his nurse should be isolated. Such injunction is usually of no direct value, as the department does not inform itself by frequent reinspections whether such injunc- tion is being enforced. Medical Attention of Indigent Sick. Two physicians are engaged on full time to care for the poor of the city. To them are referred all charity cases requiring medical attention. When not visiting in the homes they may be found in the office of the health department. They are also re- quired to vaccinate children who apply for this purpose at the 11 health office. The records of the visits of the city physicians are kept on cards one card being made out for each patient. The records are kept as follows: Name, color, address of patient, the dates when the visits were made and remarks as to diagnosis and history of the case, a monthly summary of the number of visits made. One city physician said that he averaged 350 visits a month. Aside from a monthly summary of these cards which is submitted to the board, no evidence could be found of any supervision of the work of these physicians. It was left to the judgment and conscience of the physicians to perform their work efficiently. If drugs are required in treating a patient a prescription is left by the city physician at certain drug stores, who have con- tracts with the city to furnish these drugs. Bills for the filling of prescriptions are submitted by these druggists to the health officer, who 0. K.'s them and issues the necessary warrants for their payment. Food Inspection. The health officer stated that there are about 300 markets in the city. The records of the two inspectors of these markets are kept in notebooks by the inspectors. No effort is made to collect the information on conditions found and inspection of the in- dividual markets. To obtain, therefore, the history of the con- ditions of any one market, it would be necessary to collect such information from the various notebooks of the inspectors. It does not appear in what manner the chief officer can obtain definite information as to the conditions of these markets or of the efficiency of the inspectors, except by asking direct questions from the inspectors or from hearsay evidence. That he can say whether the sanitary conditions of the meat markets are improv- ing or whether food is sold under conditions that meet with the requirements of the city ordinances, not to say with the require- ments of a careful consumer, does not appear self-evident to the investigator. It is certain that he can not convince any inquiring citizen or an intelligent health board that the department is doing all it can with its resources, or that the general council has made such provisions for the inspection of markets as necessity re- quires. There are three slaughter houses in the city and all meat slaughtered is required to be inspected before killing. To open a slaughter house a permit is necessary and the consent of the surrounding property owners is required before the permit is is- sued. The health officer said that all small slaughtering pens have been abolished ; that these three abattoirs are in a sanitary condition and that all meat is inspected and stamped by the in- spectors. Asked whether the records of these abattoirs were in- spected by himself or whether he had any evidence that con- 12 demned meat was actually withdrawn from the market and de- stroyed as food, he could only refer to the regulations as to the handling of these products. Reminded that the experience of all cities demonstrates that these inspectors are continually surrounded by temptations to let up on the inspection and even to pass tainted meat and that the most vigorous supervision of the superior officer is necessary to aid the inspectors in resisting these temptations, he admitted that he did not render such aid. Milk Inspection. Two country milk inspectors are traveling from dairy to dairy, scoring conditions found in the dairies on a score card, adapted with slight modifications from the United States score card. These score cards are mailed to the central office where they are filed chronologically. No evidence was found that the central office followed up the information thus obtained from the country milk inspectors, either by writing a letter to the dairyman, point- ing out if the score card indicated such a need, the defects re- ported or demonstrating to the dairyman that the health depart- ment was watching conditions under which milk was produced. The only value of this inspection, therefore, is the contact be- tween the inspector and the dairyman and such advice as the in- spector may offer; that such advice has been given is not re- ported, although it may be assumed that the interest of the in- spector causes him to give it. There was no evidence that the information obtained as to the condition of the dairy was correlated to the conditions in city milk depots or wagons distributing milk from this dairy. The ad- vantage that might be obtained by this power to supervise the distribution of milk and the sources of protection is, therefore in a measure, lost. The efficiency of milk inspection depends now altogether upon the conscientiousness of the inspector ; the health officer might, therefore, be almost entirely eliminated as a factor in the health supervision. Nuisances. Complaints coming from citizens are received over the tele- phone or otherwise and recorded by the receiving clerk on a slip of paper. These slips are distributed to the inspectors of the dis- tricts from which the complaint was entered. After the com- plaint has been referred to the inspector these records are de- stroyed. No records, therefore, of complaints are kept except the notation in the note-book of the inspector of what he did. Whether there was a just cause of complaint or this cause was removed as a result of the inspector's visit, or whether the in- spector visited at all, is not reported to the chief health officer. The method of communicating with the inspectors is as fol- 13 lows : On a board in front of the clerk are rows of hooks, each hook being labeled with the number of the ward, and also hooks for the reports on contagious diseases, fumigations, etc. The slips of paper on which the complaints are recorded are then fixed to the hook of the ward from which the complaint came. Each inspector is supposed to communicate with the office twice in the morning and twice in the afternoon and to him are then referred whatever cases there are in his ward. After this noti- fication the slip containing the record is destroyed. The code provides in paragraph 821 that the chief of con- struction shall keep a complaint book wherein the police sani- tary inspectors or any citizen may make entries of obstacles or defects in the streets and the sewers. The code makes no pro- vision, as is customarily done in cities, for the preservation of the records of complaints made to the health department. Issuance of Plumbing Certificates. The code requires that permits for the proper installation of plumbing in new buildings and in alterations of old buildings must be issued by the board of health. Requests for such permits come from the plumber with the blue prints of the plans. The plumbing plans are then passed upon by the plumbing inspector. After the plumbing has been installed a notice is sent by the plumber of the date when it is ready for inspection and testing. The plumbing inspector re- ports upon the conditions found and the test made after which a permit signed by the health officer is issued. Upon the is- suance of this permit the board of water works is supposed to make the water connection. A most cursory inspection of these records shows evident lack of proper supervision by the health department and proper co- ordination with other departments. No evidence was seen that the water board, for instance, must wait for the plumbing per- mit before it makes the connection with the water meter and issues its water permit. Upon inquiring of the plumbing in- spector whether he was sure that such connection was not made before the issuance of the proper plumbing permit, or even without inspection having taken place, the investigator was in- formed that no such check was made by the health department and that, in fact, he believed that in many cases the water board would make the meter connection without the proper plumbing permit. The plumbing inspectors do not render a daily account of the amount of work done. The only way to find the amount of work done is by counting the number of slips that have been returned by the inspectors, as inspected during the day, which procedure is not customary ; or from the monthly statistical re- port submitted by each inspector to the board. 14 The Laboratory. Dr. Smith, the bacteriologist, makes all the examinations of specimens submitted by physicians or the department inspectors in cases of actual or suspected contagion. He examines all diphtheria cultures and reports to the attending physician. He also examines sputum for the presence of tuberculosis. He makes chemical examination of milk for fat and solid contents and for the presence of dirt, pus and other adulterants. Bac- terial counts of milk are also made. Upon request he examines specimens of blood in cases of suspected typhoid. Tests of the purity of water are occasionally made. Under Dr. Smith's jurisdiction a campaign to exterminate mosquitoes was started in 1903 when an appropriation was made for it. After a few years of successful work a new general council, not understanding its value, cut the appropriation. In 1905, however, the importunities of many intelligent people caused the restoration of part of the appropriation which has been continued ever since. Most of this work is done during the summer when several men are hired, although they have no expert knowledge of the mosquito, to go around and inspect premises and to instruct tenants in methods of destruction. Vital Statistics. It is the duty of the health officer to report to the board all statistics relating to births and deaths. The reporting of births is most incomplete; fewer births than deaths of infants under one year being reported. Birth certificates are not required at the entrance of a child in school. The health officer did not know whether the law demanded a birth certificate as evidence of age when a working certificate was issued to a child; in fact, he was not sure whether an age limit was required of children entering upon profitable employment. As a result no official records of births are accumulated. The state law does not require the issuance of birth or death certificates. Asked whether the records of the cemetery were ever inspected by the health department to ascertain whether the law as to burial permits was lived up to, the health officer said that this was not done. Death certificates were issued in the form prescribed by the United States health bureau. These certificates are copied on special cards which are filed chronologically. These cards were tabulated in the manner required by the census bureau. As to the correctness of the cause of death, stated by the physician, the health officer had a great deal of doubt, but he was compelled to accept the physicians' reports as final. 15 III. INSPECTION OF CERTAIN DWELLING HOUSES. The first row of houses visited was No. 176 to 182 Forsyth Street. The basement rooms of these negro quarters were in- spected. The houses are of brick, two stories and basement. The approach to the first floor from the street forms an arch -, over the basement windows. In the alley underneath, ashes, , dirt and refuse had been thrown. Only half daylight could pen- / etrate to the front basement windows. A hallway, about three feet wide, extended through the base- ment from the front to the rear. This hallway was absolutely dark, it being impossible to see six inches in front of one's self after having taken three steps from the front door. This hall- way was broken in the middle into an angle where it allowed, on the right side, a room with the door in the hallway and a window in the rear, which window, in its turn, looked into a shed ex- tending from the rear wall of the house. On the left of the hallway were two rooms, the front room having two windows opening on the half -enclosed alley above mentioned; and the rear room, serving as a kitchen, opening through a door into the yard, and having one window in the x rear. The floors of the kitchens, in all of the four houses were A flush with the yard permitting the water in the yard to flow into the kitchen. In one of the kitchens, in order to drain this / inflow of yard water, a board has been removed from the floor. Looking through this opening one could plainly see the stagnant water accumulated underneath the floor. In the shed, previously mentioned into which the only window of the room to the right opened, ashes and charcoal underneath a kettle or boiler on the dirt floor showed its use as a laundry. There was no gas in the hallway or basement. The water supply for the people in the house was taken from a hydrant in the front yard. The waterclosets were in the rear, and connected with sewers. The collection of garbage was also made from the alley in the rear. Both in the front and back yards ashes, garbage and remnants of food were scattered all over the ground. The rentals for these rooms were said to be $4.00 a month for the front room and $3.00 a month for the kitchen. The single rooms to the right of the halls were locked, and no information could be obtained concerning them. No. 24 Peters Street. The second floor of this house was visited. The first floor was 16 a wagon repair shop. This house had been a frame building, but the greater part of the clapboards and plastering had fallen down, leaving large openings both in the outside walls and in the partitions. The living rooms opened into a central hallway, and several -white people were found as lodgers. Water was admitted through a pipe running alongside the rear porch, ending in a faucet, from which the drippings were drained into a cup-shaped outlet. The closets were on the rear yard. The rooms rent for $3.00 or $4.00 a month each. No. 349 1-2 Peters Street. The upper floor of this house served as a lodging house for \ white people. Entrance was obtained from the rear porch to two hallways, which divided the floor into three sections. The light to the two outside sections was received through windows in the walls and to the middle section through a skylight. All walls were dilapidated, the plastering falling down. Water was obtained on the rear porch from three hydrants, one for each section. The watercloset was in the yard, and connecting with sewers. These rooms averaged $2.00 a month each. The name of the owner or landlord was shown on a placard on the street door. No. 267 1-2 Peters Street. The upper floor was inhabited by white people. The hallway, forming an "H," divided the floor in a number of two-room apartments, those fronting the street on one side of the middle bar of the "H," having one room with a window opening into the street, and one dark room between the front room and the hallway. Across the hall the two rooms were arranged along- side of each other, both opening into the yard. The rooms on the side bars of the "H" had windows opening to an airshaft about three inches wide, the other side of this airshaft being the brick wall of the adjacent house. The water was obtained from the apartment in the center of the house, where a hydrant and sink were built next to the watercloset. The apartment containing this sink and water- closet was not occupied. The walls consisted of one-inch boards. Tenants complained, with abundance of evidence as to their truthfulness, that the roofs leaked, and that the floors were falling to pieces. In none of the houses seen was there a care- taker, or janitor, to see that proper cleanliness or decency was observed. Negro Section Surrounding Lowe Alley. Here a tract of land, perhaps two acres in extent, is covered by one and two room negro shanties. The light and ventilation 17 in these shanties are obtained principally through the door. A brick chimney runs through the center of the two-story shan- ties, with an open hearth serving as fireplace and cooking stove. In one of the rooms of the first shanty seen there was an old negro sitting before the fireplace, kneading with his hands the dough for cakes which he was evidently frying in a pan in the open fireplace. He had lost one leg. Asked what he did for a living, he said that he had two renters one of these had a bed of his own and paid him twenty-five cents a week, the other, sharing his own bed, paid him fifty cents a week. These two beds and the chair on which the "darky" was sitting, constituted the chief furniture. All of these shanties were raised from one to two feet from the ground. The waterclosets were surface privies with no^ water, presenting on the inside every stage of conceivable filthfj The cans had evidently been emptied within a day or two. Garbage was scattered in all kinds of receptacles, as well as promiscuously on the ground. As the cans could not come within three inches of the seat, no protection from flies or in- sects could be provided. The water supply was obtained either by walking to Peters Street or from a number of wells within the district. Two of these wells were examined. In one of them the brick lining stopped about ten feet from the top of the ground, in the other about four feet. The only protection against surface water run- ning into these wells were loose boards and a slight embankment of dirt against these walls. If the water from these wells were not used for drinking pur- poses, it certainly must have been used for the washing of clothes, which seemed to be the chief industry of the neighbor- hood. These conditions suggest that it would be most desir- able to have an investigation made as to the quantity of soiled clothes collected into this and similar places, the surroundings in which they are washed, the water used in washing them, the places where they are dried, the method of ironing, the manner of storing these clothes both before washing and after they have been washed previous to leaving these shanties for de- livery to the owners. It would also be desirable to investigate the number of vari- ous houses in the city to which the inhabitants of this section go for work during the day. It would be eminently desirable to make a careful study of the methods by which such diseases as are almost inevitable concomitants of these housing condi- tions, are prevented from spreading to the people who receive laundry, or in whose homes the inhabitants of this section per- form service. In this whole section there is not one bath tub. There is no attempt at street lighting. The playground of the children is 18 the mud. There is one church the Warren Methodist offer- ing as a gathering place its single room auditorium. On the edge of this district is a row of two-story frame houses, starting with No. 20 Leonard Street. These are in- habited by white people. Each floor consists of a row of three rooms, renting for $6.30 a month. There is a hydrant on each floor, with a closet in the yard connecting with sewers. The dilapidated condition, the filth, the stagnant water both from the front and rear yards in which the children play seem to de- mand a careful inspection. Three negro lodging houses were inspected. The first, 12 1-2 Ivy Street, occupied the two upper floors of the "Great North- ern Hotel." Each room in this lodging house had a window opening either on the street, or on the rear yard. The rooms contained from two to five beds each. The toilet facilities for the two floors consisted of a single sink and watercloset, to which the men and women lodgers admitted to these premises, were compelled to resort. The hallway was lighted by a gas jet. The second lodging house was 3 1-2 Ivy Street, covering one floor. Here also one watercloset was found with one sink. This lodging house also admitted both men and women lodgers, at payment of 25 cents a night. The caretaker had to hunt for a kerosene lamp to light the hall, as well as the rooms, explaining that the gas meter was out of order, and had been so for over a month. Probably the non-payment of the gas bill caused this disorder. The watercloset was extremely dirty. The third lodging house, only a short distance from this last, also occupied one floor. The hallway, running through the length of the floor, gave access to four rooms on either side. The two central rooms had no windows, only the outside rooms hav- ing a window each, opening on the street or the yard in the rear. Only kerosene lamps were provided. The shouting of women and crying of infants greeted the visitors. It requires no imagination to conceive what must take place in a lodging house where the halls are pitch black, rooms have no ventilation or privacy, the single toilet facility which also serves as the washroom and source of drinking water must be shared by all of the lodgers where the sexes are herded promis- cuously, and even the most elementary observance of cleanli- ness, either of bed clothes or floors and walls are not observed. The oil lamp in such places as these must show its effect on the insurance rates of the district. 19 IV. RECOMMENDATIONS. It is recommended 1. That the making of health ordinances or the sanitary code be the function of the board of health and that no other body have the power to repeal the same as long as they conform to existing laws. 2. That the administrative functions under the board of health be placed under the direction of one head who shall be held responsible for their performance, i. e. 3. That heads of divisions within the department, as the offices of health inspection, sanitary inspection, plumbing inspection, the city physicians, etc., be responsible to the departmental head. 4. That all inspectors be required to render daily reports of work done and time consumed. 5. That the system of record keeping be reorganized. 6. That the letter of the law relating to the reporting of con- tagious diseases be enforced. 7. That in demanding these reports the department also de- mand or by direct inspection ascertain such information as will enable it to take measures for checking and if possible eliminating contagion. 8. That the department establish reasonable control of the practice of midwifery and urge upon the city to provide training schools for midwives. 9. That in case of deaths of infants whose births have not been reported, the department inquire as to whose fault, if anyone's, the neglect of reporting was due. 10. That a tuberculosis register be established, containing such information of the patient's history, family and hous- ing conditions as will help the department to take intelli- gent measures in checking the communication of the dis- ease to others. 11. That the department recognizes the value of citizen co- operation in complaints made of unsanitary conditions; that permanent records be made of each complaint, its in- spection and final disposition. 20 12. That the department publicly report the findings, both of fat contents and of bacterial count of milk and the names of the dealers in milk in the city and that a sufficient num- ber of tests be made that such reports may be made monthly. 13. That the present inspectors be detailed, as far as other duties will permit, to the inspection of so-called "lodging houses" and that the department report speedily to the board and the general council on such fundamental sanitary conditions as ventilation, ratio of water closets to number of lodgers, use of the same water closets by both sexes, lavatories, general cleanliness and fire danger. 14. That the department formulate a plan and submit to the general council a request for an appropriation for the in- spection of housing conditions. 15. That the penalties for committing smoke nuisances be strictly enforced against office buildings and factories. 16. That the board of health secure from the general council action which will define clearly under whose authority the sanitary policing of the watershed shall be undertaken, and that proper supervision of the watershed be at once estab- lished. The principles which actuate the general council to invest city money in a water purification plant and allow surface privies to exist in the closest proximity to the puri- fication plant are more than incomprehensible. REPORT OF SURVEY OF The Department of Education City of Atlanta Georgia Made for the Atlanta Cham- ber of Commerce Committee on Municipal Research By S. G. LINDHOLM For the New York Bureau of Municipal Research December, 1912 22 December 19, 1912. Colonel Frederic J. Paxon, Chamber of Commerce Committee on Municipal Research, 57 Whitehall Street, Atlanta, Ga. Dear Sir: Herewith please find the report on our four days' examination of Atlanta's department of education, presented under the fol- lowing headings: Part I Evidences of progress noted. Part II Weaknesses in the present administration. Part III Defects in administrative records. Part IV Recommendations. Part V Exhibits. For the most part the suggestions are confined to steps which the board of education as now organized and the supervisory and teaching staff as now organized can easily take. If we seem to overestimate the importance of the record and publicity side of school work it is because experience has demonstrated con- clusively that efficient promotion of education is just as impos- sible without controlling and illuminating records as is the effi- cient financing of a city or private business without similarly controlling records. By taking practicable next steps here sug- gested for Atlanta's schools we feel that the way will be opened for the harder steps, some of which may require reorganization, some new legislation or studies of educational methods, program, etc., in other cities. The most productive study of Atlanta's schools would be such a co-operative study of teacher, principal, superintendent, board and public as we have tried to suggest in our constructive recommendations. Very truly yours, BUREAU OF MUNICIPAL RESEARCH. Wm. H. Allen, Director. S. G. Lindhplm, Investigator. 23 Report on the Department [of Education THE FOLLOWING EVIDENCES OF PROGRESS WERE NOTED. 1. Gratifying emphasis is placed upon the need for instruc- tion in the practical arts as in the boys' technological high school, in the commercial high school for girls and in the training school for teachers. 2. Evening school work was not examined but from informa- tion obtained it seemed that th6 city could make no better investment than to extend this work as fast as the demand for such instruction is evident. Any large city needs even- ing schools. As long as Atlanta has no compulsory educa- tion law and the factories take an increasing force of child labor, the city is doubly obliged to provide instruction for the youths who can not take advantage of the regular day school training. 3. The increase in the lowest salary grade from $40 to $55 a month must, it is only fair to infer, enable the school super- intendent to select a higher grade of teachers. 4. The power given to the city superintendent to make his own selection of teachers and to count previous experience in other schools in fixing the salary grade is also a sign of efficient administration. 5. The standards of its medical examination are reason for congratulation. Not only are the methods of examination the best prevailing in other cities, but the follow-up work by which the nurse endeavors to secure treatment for the defective children is recorded so as to show clearly what is left undone. a. The history card showing the records of succeeding ex- aminations makes it possible to compare the physical conditions of the child as he progresses in school and shows the results of the follow-up work. b. A weekly report is made by the chief examiner of the time spent both by the examiners and the nurses, of the number of examinations made and of the visits of nurses. c. In no department seen was so complete a record made of the work of officials as well as of results obtained. The experience of the medical inspectors as well as of the city superintendent demonstrates the wisdom of making 24 these records as checks upon work done and of the effi- ciency of Results obtained. 6. Recently built schools follow improved standards: a. Windows are ample, reaching within six inches of the ceiling. b. Decorations of the classrooms were good, the walls above the blackboards were tinted a soft green and the ceilings light yellow, reflecting the sunlight. c. The blackboards in the lower grades were built within reach of the children. d. Each classroom had its own cloakroom, with a low seat built along the wall. e. Cabinets built flush with the wall in the classroom ex- tended into the cloakroom. These cabinets provided am- ple storeroom for teachers' records and class material. f. The doors leading to the yards were opened by self re- leasing fire exit latches. g. The toilet rooms were ample, were provided with light and cleanliness was made easy. 7. In the eight school buildings seen the aisles and floors were clean. a. Floors were oiled. b. Sweeping compound was used. c. In four buildings seen on a Saturday morning the chalk boards underneath the blackboards were cleaned, although the boys' high school showed evidence that more adequate janitor service was needed. 25 II. WEAKNESSES IN THE PRESENT ADMINISTRATION. 1. A reasonable limit of risk for fire or panic is greatly ex- ceeded in some school buildings. a. In the second floor of the East Atlanta School are three classrooms. The whole floor is divided in two by a par- tition running lengthwise. To the left of this partition is a large classroom with 60 desks and a narrow hallway in which the stairs leading to the first floor are located. The right half of the floor is divided by a cross partition into two rooms, the children in the inner room passing through the other in order to reach the stairway. From 120 to 150 children occupy these three classrooms. The teacher in the largest room has her desk in a corner op- posite the exit. To get out, the 60 children in the big room must pass through a door measuring exactly three feet wide. Issuing from this door they collide with the children coming from the other two rooms whose only exit is a door, three feet wide and opening directly on the head of the stairs. The stairway is 4 feet 3 inches wide and descends after a double turn to the hallway below into which doors from the classrooms on the first floor open. The final exit into the open air is through a double door 6 feet wide. On the first floor doors are cut through the rear walls di- rectly into the classrooms. This is an old frame build- ing with no fire escapes. The classrooms are heated with coal stoves. 2. Playgrounds were either not at all provided or if space was provided, were not kept in condition for use. a. The boys coming out of the high school during recesses congregated on the streets. Many were sitting on the curb stones eating their lunches. b. The Highland and Edgewood Schools were situated on spacious grounds but the soil consisted of yellow clay with no top dressing or covering that permitted children to play on them. 3. All school yards are closed to the children after 2 P. M. ir- respective of the need for playgrounds or recreation centers. a. In disregarding the need for playgrounds the school board 26 is blind to the fact that one of the serious problems of a large growing city is to supervise and direct the outdoor activities of the children whose homes do not provide spacious yards and are too young to be employed. 4. The absence of wall maps, globes and other educational equipment was noticeable although the survey for these things was hurried. a. In the boys high school where every room was examined there was found only one map of the United States and one globe. b. In the two new schools mentioned there were but two or three maps in the whole building. 5. No schools were used to serve their neighborhoods in any other capacity than to teach the children in the morning. a. The Highland and Edgewood schools have no artificial lights. Their auditoriums were not equipped with seats. b. All schools are closed shortly after 2 P. M. The capital investment in them lies idle during half of the day. c. The splendid opportunities that a school building offers for social centre work are lost. Cities such as Rochester, New York City, Milwaukee, St. Paul, Minneapolis, Boston and innumerable smaller cities of less importance than Atlanta are opening their school buildings to the youths and grown people for instruction and recreation with not- able beneficial results not only upon health and morals but also upon interest in school work itself. 6. Unnecessary neglect of sanitary conditions was shown in many school toilets. a. In the Inman Park School the boys' toilet is located in the basement. The single gas jet lighting this room is placed in the centre and gives very poor light to the closed-in toilets. At the visit during a school session, one of the six seats provided was very dirty and the bowls of all of them were filled with execretion. There was no running water in the hoppers, due it was explained, to temporarily defective plumbing. b. In the boys' high school three toilets were visited in. the afternoon after school session was closed. In the base- ment toilet there are 8 seats, each enclosed in a booth. The light comes from a small rear window which lights 2 booths and 2 gas jets in the centre of the room. The end booths are dark. All the seats were dirty and the seats and floor covered with water. Some of this water was the accumulation of the condensation formed on the heavy water pipes extending the entire length of the rear 27 wall and right above the seats. The color and odor of the water indicated, however, that not all come from this source. The toilet room also contained a separate urinal and 3 sinks with running water. The toilets and the first and second floors are exact counter- parts of the one in the basement and the uncleanliness the same, except that no water was found on the floor in the second floor toilet. Across the hall from the toilet on the first floor was another, apparently used by the office force. This contained one commodious booth, the seat of which was thoroughly clean, as well as the entire room. c. No toilet paper was in evidence in any one of these places and only in few of the booths seen in other schools except in the office toilet, which had toilet paper and towels. The superintendent of buildings stated that janitors were in- structed to provide paper. Scraps of newspapers in the bowls of one room indicated that none had been provided that morning. d. In no school seen were towels provided for the drying of hands after washing. The roll paper toweling has been found both adequate and economical in many other cities. e. In the East Atlanta School the toilets consist of two sur- face privies, in the rear of the school yard, more than 100 feet distant from the school building, properly screened. The privies are dilapidated frame shanties, 5 feet wide and 8 feet long. In the boys' privy is a seat with 3 holes and in one corner an "L" shaped urinal, emptying itself into the receptacle under the nearest hole. The seat showed evidences of the muddy feet of the boys and traces of water. No traces of dry excreta were seen except on the lower edge of one of the openings. On the seat a roll of toilet paper was placed. The visit was made on Saturday morning before the janitor had cleaned up. Underneath two of the openings were iron receptacles, about 12 inches square and 10 inches deep with handles turning outward. In each of these there was noticeable remnants of both solid and fluid matter. Between the upper edge of the receptacles and the seat there was an opening of two or three inches that would give free ac- cess to flies, etc. Under the third opening was a round garbage can with cubic contents about three times as large as one of the others into which the urinal drained. Between the privy and the rear fence is enough space for a man to empty the receptacles. Upon inquiry from the 28 janitor it was ascertained that the cans are emptied and replaced without any attempt of carefully cleaning them. No facilities for such cleaning have been provided. Attached to the door was a serviceable and apparently new lock. The door, however, was open ; it is not probable that it is kept locked at night. The girls' privy consists of two compartments, the larger containing a seat with three openings, provided with lids and hinges. The seat as well as the floor was clean and toilet paper provided. The other compartment was re- served for the use of teachers. f. In the Faith Street School the toilet facilities resemble those in the Inman Street School, except that the recepta- cles in which the drainage from the urinal flowed was three-fourths full. It was standing, uncovered, on the bare ground and outside of the privy, the pipe leading from the urinal extended over a foot beyond the wall. These receptacles had been emptied the preceding day ac- cording to the janitor and would not again be emptied until the following Wednesday. If the water collected one school day would fill this can to three-fourths of its capacity, it would undoubtedly overflow before the next emptying. The janitor stated that this can frequently was overflowing and that the urine soaked into the soil. g. The lack of proper lighting of toilets is an inexcusable offense against decency. At a slight expense the school board could long ago have removed the moral and physi- cal contamination that must result from conditions here described. That surface privies should be permitted on school grounds may cqnceivably be condoned on grounds of the expense of sewer connections, but it is doubtful if a great city like Atlanta can afford to save a relatively trifling expense at so great a possible cost in health and comfort and morals. h. The superintendent of schools took special pains to call the investigator's attention to these unsanitary conditions and declared that he had been unable to make the authori- ties remove them. i. The drinking arrangements in all but the most recently erected school buildings practically necessitate the use of common cups. (1) In the East Atlanta and the Faith Street schools the only supply of water was obtained in the yard. In the first a water pipe rose from the ground about three feet and had one faucet at its end. The overflow drained into the ground. In the second two water pipes, each 29 with four faucets, furnished the supply. The overflow ran into troughs and through a drain pipe into the ad- jacent lot. No arrangements were made for the keep- ing of individual cups. At slight expense of inverting faucets a crude but satisfactory "fountain" can be de- vised. (2) In many schools the children have to go to the toilet rooms with their cups, if they have any, to obtain drinking water. (3) In two of the newest schools seen bubbling water fountains were provided. 30 III. DEFECTS IN THE ADMINISTRATIVE RECORDS. 1. No census of the number and names of children of school age is taken. a. No true basis for the distribution of state school funds can now be given. b. Atlanta can not know the number of new school buildings needed to care for the unschooled. c. Atlanta can not gauge the moment when her illiterate and uncared for school population has grown into undue proportions. 2. Records of school attendance are inadequate. The city superintendent does not know a. How many classrooms have more than 50 children. b. The ages of the children in the various grades. c. The regularity of attendance in each school. 3. No one can now tell a. Whether ill-assorted ages are found in the same grade. b. What proportion of children need more than one year to complete the grade. c. At what ages children drop out of school. d. The reasons why children drop out of school or why they do not attend regularly. e. How many children fail. f . Why they fail. g. How much of this failure could under present conditions be avoided by more effective checking of classroom work, etc. 4. The weekly school reports which now give the number of pupils enrolled, the number belonging, the number of pu- pils absent, number of absences and the average attendance and also information as to tardiness of pupils and teachers, do not help as they should. a. As these reports do not give any cumulative totals they can not without prohibitive effort show the trend of at- tendance. b. They do not enable the principal to compare school with school. 31 5. Principals are compelled to confine their teaching to ad- vanced subjects in the upper grades because of alleged short- age of teachers in these grades. As a consequence the prin- cipal is unable a. To do teaching where it will do the most good, i. e., in the classrooms of weak teachers of all grades who need special help and guidance. 6. Adequate records of teachers' efficiency are not kept. a. The investigator was informed that principals did not systematically record their observation of teachers in their schools. b. The only records in the possession of the city superin- tendent were his own notes made in a pocket memoran- dum book, of his visits to classrooms, too meagre for 532 teachers under his supervision. 7. The public is not kept informed as to school facts and school needs. a. Not having current records which show needs and effi- ciency, the schools can not give these facts currently to the public. b. An annual report published January, 1912, covers the school years 1903-1911 i. e., for eight years no annual report was published for Atlanta's greatest public service. 32 TENTATIVE CONSTRUCTIVE SUGGESTIONS FOR COR- RECTING CONDITIONS NOTED IN ATLANTA'S SCHOOLS DURING SHORT FIELD SURVEY. 1. That possible danger from fire be immediately reduced by a. Installing fire escapes where necessary. b. Putting in extra doors. c. Having all doors open out. d. Widening doors. e. Widening corridors and stairways. 2. That sanitary conditions be immediately improved by a. Lighting all toilets sufficiently. b. By enlisting the co-operation of the janitors and giving them such definite instruction that dirty seats, bowls and floors would be impossible, foul odors would be banished; detached closets would be kept fly-proof; urine containers would be emptied daily. c. Supplying toilet paper in each toilet. d. Supplying paper towels in each toilet and primary room e. Supplying bubbling fountains in all the schools, or at least individual drinking cups with dust proof cabinets. f. Instructing teachers, children and pupils how to secure sufficient ventilation from the windows. g. Installing humidifying apparatus where necessary. 3. That "continuous record" cards for each pupil be provided at once so that superintendent, principal and teacher may easily learn and use the important facts about a. Average and its causes. b. Dropping out and its causes. c. Non-promotion and its causes. d. Physical defects and their treatment. e. Mental defects and their treatment. f. Why, from what grades and at what ages and in what numbers children drop out of school. g. Why, in what grades, at what ages and in what numbers children repeat grades. 4. That financial uniform records recommended by the United States Bureau, with modifications to serve your local schools, 33 be introduced at once, so that the board of education and the public may have currently available information as to Per capita costs of instruction in the different subjects, through different schools and in the system as a wheter 5. That a school census be taken at once with the co-operation of the superintendent, principals, teachers and pupils which will bring out : a. How many children there are in Atlanta of school age. b. How many between the ages of 12 and 13 are at work. c. What, if any, additional evening classes or courses are needed. d. Which, if any employers would be glad to permit em- ployees under 18 to attend "continuation schools" in the day time at hours arranged with school authorities. 6. That later a study be made to ascertain. a. What children of 12 to 18 are working at b. What their wages are. c. What their educational equipment is. d. What effect length of schooling seems to have on wages and rate of increase in wages. e. What the chief fields are uncovered by the school course as seen by employers, and f. Deficiencies as seen by employees. 7. That further, the quality of classroom instruction be or- ganized to determine whether a. The methods used by the teachers are effective in im- parting to the child the education that the course of study and probable future work call for. b. Whether through wrong methods there is a waste of teachers' and pupils' time. c. Whether it would be more economical to demand higher qualifications of teachers than to permit this waste to continue. 8. That detailed budget estimates be prepared by the board of education each year based on accurate records of cost and attendance for each kind of school and each kind of special work, school population, shift in population, etc., and that these estimates be given publicity through budget hearings, parents' meetings and the public press. 9. That at least one more assistant be given the superinten- dent to enable him to make continuous tests of the classroom efficiency of the teachers. 10. That confining the teaching of principals to upper grades 34 only, be discontinued at once, so that such time as is given be centered on classes and grades where there is greatest weakness. 11. That the board of education arrange for a study of the teaching of domestic and mechanic arts in other cities, with the idea of extending the teaching of these subjects in At- lanta schools. 12. That school playgrounds be put in a condition for use by following present minimum standards of playground equip* ment to be found in available publications, such as The Play- ground, i. e. by a. Surfacing them properly. b. Properly equipping them with teeters, the giant stride, etc. c. Interesting children in making apparatus such as parallel bars, standards for trapezes and jumping, etc. 13. That adequate play space be provided immediately sur- rounding or in the immediate neighborhood of every school. 14. That proper leadership and supervision for play be pro- vided not only during vacation time but during play hours in school time. 15. That a complete list of necessary educational equipment he made by the superintendent by referendum to all princi- pals and teachers and by special conference with a commit- tee of principals and teachers and that funds be provided forthwith to make up the present shortage in maps, globes, etc. 16. That immediate steps be taken looking to the wider use of school plant by a. Equipping all school auditoriums not now provided with seats. b. By placing artificial lights in all schools. c. By starting evening classes in all subjects and in all neigh- borhoods where there is a demand. d. By keeping playgrounds open every school day from 2 P. M. until dark, all day Saturday and during vacations. 17. That steps be taken to enlist approximately 100% of the community's outside civic interest in solving Atlanta's edu- cational problems by a. Throwing open the school buildings to parent-teachers' meetings, meetings of civic clubs, debating clubs and even social clubs with the idea that centering social life in school buildings will tend to center social interest in school problems. 35 b. By calling a conference of all civic organizations and all possible co-operative agencies to outline a plan of effective continuous co-operation between outside bodies and the board of education. c. By making available to the press both advance informa- tion about matters to come before board meetings and re- ports on such meetings. d. By giving to the press summaries of monthly reports such as will be possible if suggestions here given are adopted as to records, sanitary improvements, etc. e. By publishing an annual summary without fail but just before the beginning of each year rather than the middle or toward the end of the school year when it is too late to interest either teachers, officers or public in the superin- tendent's suggestions. 18. That pending an analysis of the present course of study which will ascertain its adaptability to the differences of mental and physical equipment of children, a special study be immediately made to learn the effectiveness of curriculum and teaching in preparing for citizenship that includes a. Ability to make use of important channels of informa- tion, as newspapers, libraries, etc. b. Ideals of personal and municipal hygiene. c. Intelligent choice of occupation. d. Understanding of civics as applied to local, state and na- tional government. 19. That in selecting board members steps be now taken to secure the substitution of selection at large for selection from wards. > 20. That the six following questions be used in testing indi- viduals considered for the school board: a. Are they interested in the success of the public school ? b. Do they know reasonably well the local conditions which the public school is supposed to express and the local needs which the public school is supposed to meet? c. Are they in the habit of basing judgment upon facts? d. Are they in the habit of working from first hand infor- mation instead of hearsay ? e. Can they use effectively such sources of information as school records, reports of state and national bureaus of education, the valuable discussions of school methods and advance steps in educational journals? f. Are they capable of managing any other business where the number of subordinates, patrons and days spent equals 36 the number of subordinates, patrons and days spent of Atlanta's school system. 21. That the chamber of commerce help the whole citizenship of Atlanta take and maintain the position that no one is qualified to act as school trustee. a. Who would be obviously unfit for councilman or sinking fund commissioner. b. Who thinks he has eyes enough to see or ears enough to hear for himself without studying records all he needs to know about school work. c. Who despises records of work done and of needs unmet which unfitness is apt to call "mere statistics." d. Who thinks that 20% of Atlanta's children are predes- tined to fail each term. e. Who has contempt for the public, and thinks it can never understand the intricacies of school management. f . Who in intellect or strength of character is inferior to teachers and principals. g. Who has never had experience in applying efficiency tests to subordinates and to his own results. 37 , w 9 <> 2 QQ H 1 5 1 4 I l^ PQ o ' H si 'S C3 g S ^ H 20) 43 t-; _^ o -*" 1 03 C3 CO(M 00 rH rH rH N rH rH CO W C r 3^ ^ 1 1 1 1 i 1 g O v. .v,v.>.v.x.v.v.-v.v.v.^^>v.-> >_^ 6-'ww3-w. '.'. ^*- CO W S 38 I -M oS .9 OS CO 2 - % g 1^11 o "S " g".2 o i!^ b g i 1 ^^ 3 2 w ^ o a llc^ (V^ Q^ C^ 0) *^ S S-i OJ ""* ^ c ^ S o rH O .2 i -> *H fi _^ t, * S fill! 1 CO rH 1 rH 1 1 1