CHAPTER XXV

SOCIAL ALLEVIATION

WHEN the security of peace and an efficient government are attained, the way lies open for the amelioration of social evils. Freedom from war and from political corruption are but the pre-conditions of social advance, which must consist in three things: the healing of existing ills, the reorganization of society to prevent the recurrence of similar ills, and the bringing of new opportunities and joys to the people. Our first step, then, is to consider social therapeutics-the palliation of present suffering, the redressing of existing wrongs; however we may seek, by radical readjustments, to strike at the roots of these evils, we must not fail to mitigate, as best we can, the lot of those who are the unfortunate victims of our still crude social organization. The detailed study of social ills and their remedies has come to be a science by itself, and a science that calls for close attention; for there is more good will than insight a field, and nothing demands more wisdom and experience than the permanent curing of social sores.

But it falls to ethics to note the general duties and opportunities, to point out the responsibility of the individual citizen for wrongs which he is not helping to right, and to direct him to the great moral causes in one or more of which an increasing number of our educated men and women are enrolling themselves. A questionnaire recently sent out by the author of this book discloses the fact that over half the college graduates of this country have given time and money to one or more of the campaigns which are being waged for social betterment.[Footnote: Some of the results of this questionnaire were published in the Independent for August 5, 1913, vol.75, p.348.] These evils which it is the duty of the State to try to remedy we shall now consider.

What is the duty of the State in regard to:

I. SICKNESS AND PREVENTABLE DEATH? Physical ills are the unavoidable lot of the human race; but by no means to the extent to which they now prevail. A very large percentage of existing sickness and infirmity could have been prevented by a timely application of such knowledge as the intelligent already possess. It is the poverty, the crowded and unsanitary living conditions, the ignorance and helplessness of the masses, that perpetuate all this unnecessary suffering, this economic waste, this drag on human efficiency and happiness. Not only from humanitarian motives, but also from regard for national prosperity and virility, it behooves the State to wage war against preventable illness and safeguard the general health.

How shocking conditions are, in view of the sanitary and medical knowledge we now possess, we are not apt to realize. It is estimated that of the three million or so who are seriously ill in this country on any average day, more than half might have been kept well by the enforcement of proper precautions; that of the 1,500,000 deaths that occur annually in the United States, nearly half could have been postponed. Tuberculosis, for example, is not a highly contagious or rapid disease; it is absolutely preventable by measures now understood, and almost always curable in its earliest stages. Yet half a million people in our country are suffering from it, and about 130,000 die of it annually. Typhoid, which could readily be as nearly eradicated as smallpox has been, claims some 30,000 victims annually. It has been estimated by various statisticians that the nation could save a billion dollars a year through postponing deaths, and at least half as much again by preventing illness that does not result fatally. Tuberculosis alone is said to cost the country half a billion annually, typhoid over three hundred million, and so on.

The cost in suffering, broken lives, and broken hearts is beyond computation.

There are many different ways in which the campaign for public health can be simultaneously waged:

(1) The enforcement of quarantine laws, vaccination, and fumigation, should be much stricter than it is in many parts of the nation. By such means the cholera, bubonic plague, and other terrible diseases have been practically kept out of the country, and smallpox has become, from one of the most dreaded scourges, an almost negligible peril. Experience shows strikingly the advantage of isolating patients suffering from contagious diseases; here at least the State, in the interest of the community as a whole, must sternly limit individual liberty. And it looks as if we were at the threshold of an era of "vaccination" for other diseases besides smallpox; typhoid is now absolutely preventable by that means, and the number of diseases amenable to prevention or mitigation by similar methods is yearly increasing. In some or all of these cases there is a slight risk to the patient, in view of which compulsory "vaccination" is in some quarters strenuously opposed.

Leaving the discussion of the principle here involved to chapter XXVIII, we may confidently say, at least, that voluntary inoculation against diseases is an increasingly valuable safeguard not only for the individual in question but for the whole community.

(2) Apart from state action, voluntary organizations formed to attack specific diseases, by spreading popular knowledge of preventive measures, and pushing legislation for their enforcement, offer much promise. The Anti-Tuberculosis League can already point to a ten per cent decline in the death rate from that plague in the decade from 1900 to 1910.[Footnote: For methods and results consult the Secretary of the National Association for the Study and Prevention of Tuberculosis, 105 East Twenty-second Street, New York City. Free literature is sent, and information furnished on request.] But while in New York City alone nearly thirty thousand fresh victims are seized by the disease every year, a voluntary organization cannot hope to cope with the situation; the power and resources of the State are needed. The congestion of population, and the lack of proper light and air, which are the greatest factors, perhaps, in the spread of the scourge, must be attacked by legislation. So typhoid must be fought not only by vaccination, but by legislation insuring a pure water supply, proper sewage disposal, and the protection of food from contamination.

Measures necessary to eradicate that pest, the house fly, must be enforced, the mosquito must be as nearly as possible exterminated, streets and yards must be kept clean, the smoke nuisance abated, the slaughtering of animals and canning of food sharply regulated, sanitary conditions enforced in homes and factories. One of the prerequisites to any marked improvement will be the "taking out of politics" of the public health service and making it an expert profession.

(3) Another service that the community must eventually, in its own interests, provide, is free medical attendance, by really competent physicians, wherever there is need. Without referring to the suffering and anxiety spared, the expense of this service will far more than be saved the State in the prevention of illness and premature death. The most careful medical inspection of school children, including attention by experts to eyes, ears, and teeth, is of utmost importance; all sorts of ills can thus be averted which the parents are too ignorant or careless to forestall.[Footnote: Consult the literature of the American School Hygiene Association (Secretary T. A. Storey, College of the City of New York). L. D. Cruickshank, School Clinics at Home and Abroad. Outlook, vol.84, p.662.] It is earnestly to be hoped that the present chaos of medical education and practice will be soon reduced to a better order; that practitioners who prefer manipulation or mental healing, for example, will, instead of forming separate and antagonistic schools, unite their insight and experience with the main stream of scientific therapeutic effort.

The quacks who delude and murder hordes of ignorant victims must be, so far as is practicable, severely punished; and adequate physiological and medical education should be required for all practicing healers, whatever methods they may then choose to employ.

(4) Besides free medical attendance, the State must pro- vide free hospitals for the sick, nurses for the poor, asylums for those who are incapacitated by infirmity from self-support. The care and treatment of the feeble-minded, the insane, the deaf, the blind, the crippled, should always be in the hands of experts; and, so far as possible, work that they can do must be provided. With the enforcement of the measures we have enumerated, the need of such institutions will become much less; but at present they are inadequate in number and equipment, too often managed by incompetent officials, and not always free from scandal. [Footnote: Cf. C. R, Henderson, Social Spirit in America, chap. XV.]

(5) Most important of all, perhaps, is the work that must be done to save the babies. Approximately a third of the babies born in this country die before they are four years old; half or two thirds of these could be saved. Wonderful results in baby saving have followed strict control of the milk supply and the banishing of the fly. Besides this, mothers must in some way be given instruction in the very difficult and complicated art of rearing infants; for many of the deaths are due to simple ignorance.[Footnote: For methods and results in baby-saving, consult the Secretary of the National Association for the Study and Prevention of Infant Mortality, 1211 Cathedral Street, Baltimore, Maryland. Also Outlook, vol.101, p.190. J. S. Gibbon, Infant Welfare Centers.] Poverty, the necessity of self- support on the part of mothers, also plays a large part; we shall consider in chapter xxx the possibility of state care of mothers during the infancy of their children. II. Poverty and inadequate living conditions? If human illness can be in large measure averted by state action, poverty can be practically abolished. The poor we have always had with us, indeed; but we need not forever have them.

There is no excuse for our tolerance of the suffering and degradation of the submerged classes; the causes of this wretchedness are in the main removable. The initial cost will be great, but in the long run the saving to the community will be enormous. Individual effort can only achieve a superficial and temporary relief; and even the two or three hundred charity organization societies in the country are impotent, for lack of funds and of power, to stem the forces that make for poverty. To dole out charity to this family and to that is unhappily necessary in our present crude social situation; but it is not a solution. It not only runs the continual risk of encouraging shiftlessness and dependence, but it does not go to the root of the matter. There will always be inequalities in wealth and room for personal gifts from the more to the less fortunate; but the State must not be content with such patching and palliating, but must strike at the roots of the evil. We will consider the chief causes of poverty and their cure.

(1) The cause that bulks largest is the inadequate wages of a considerable portion of the lowest class. It is obviously impossible to support the average family of five in decency, not to say in health, efficiency, or comfort, with an income of, say, less than a thousand dollars a year, as prices go at time of writing (1914). Yet great numbers of families at present have to exist somehow upon less, even much less. Five million adult male workers in this country receive less than six hundred dollars a year for their work.[Footnote: Cf. Professor Fairchild's comments in Forum, vol. 52, p. 49 (July, 1914).] Even when mothers work who ought to be at home tending the children, even when children work who ought to be in school, the total income is often miserably inadequate. Yet there is ample wealth in the country, if it were better distributed, to pay a living wage to every laborer. By some one of the means which we shall presently discuss, the State must see that all laborers are well enough paid to enable them, while they work, to support in comfort a moderate family.

(2) Involuntary unemployment is the next source of poverty. This is due to many causes: the periodic depressions and failures of industries; the introduction of new machinery, throwing out whole classes of laborers; the enormous influx of immigrants and consequent congestion in the cities of unskilled labor; lack of education, or natural stupidity, which render some men too incompetent to retain positions. Ignorance can be overcome by proper compulsory education laws; all but the actually feeble-minded (who must be cared for in institutions) can, by skillful attention, be taught proficiency in some trade. And with a more widespread education the work that requires no skill can be left to the hopelessly stupid. The congestion of labor in the cities [Footnote: In February, 1914, there were reported to be 350,000 men out of work in New York City (Outlook, March 14, 1914).] can be largely remedied by free state employment bureaus which shall serve as distributing agencies; there is almost always work enough and to spare in some parts of the country, and usually not far away. But more than this is necessary; the State must see that work is offered every man who is able to work.

All sorts of public works need unskilled laborers in every city of the country; there is digging to be done, shoveling and sweeping and carting. There are roads to be built, rivers to be dredged, parks to be graded, buildings to be erected, a thousand things to be done. It will be quite feasible, when wages are generally adequate, for the cities, by general agreement, to offer work to all applicants at a wage so low as not to attract men away from other employments, and yet to enable them to support their families decently. The low wages given will save the city much money directly, as well as saving it the care of the indigent. But it will be a feasible plan only when the city's jobs cease to be used as a means of vote-buying by politicians and are offered where they are needed.[Footnote: 1 See W. H. Beveridge, Unemployment. J. A. Hobson, The Problem of the Unemployed. Alden and Hayward, The Unemployable and the Unemployed. C. S. Loch, Methods of Social Advance, chap. IX. Quarterly Journal of Economics, vol.8, pp.168, 453, 499. Review of Reviews, vol.9, pp.29, 179. Charities Review, vol.3, pp.221, 323. Independent, vol.77, p.363. National Municipal Review, vol.3, p.366.

The unemployment which is the result of laziness must be cured by compulsory work as in farmcolonies, which have been successful in Europe. Cf. Edmond Kelly, The Elimination of the Tramp.]

(3) The third important cause of poverty is sickness and the death of wage earners. Here the way is clear. When the State has taken the measures we have enumerated for the public health, when it provides competent doctors and nurses, and bears the cost of illness, we shall have only the loss of wages during the illness or after the death of wage earners to consider. And here some form of universal insurance will probably be the solution; this is preferable to state care of dependents, as it carries no taint of charity. This solves every problem but the delicate one, which must be entrusted to expert diagnosticians, of determining to work is caused by physical weakness or mere laziness.

(4) The fourth great cause of poverty, drink, can and must be abolished in the near future, by the means already considered.

(5) There remain three personal causes which need be the only permanently troublesome factors- -laziness, self-indulgence, and the incontinence which results in over- large families. The laziness which prefers chronic inactivity to work is not normal to human nature, and will be largely banished by education, the improvement of health, and the improvement of the conditions and hours of labor. The obstinate cases of unwillingness to work must be cured by compulsory labor in farm colonies or on public works; most such cases respond to intelligent treatment and cease to be troublesome when some physical or moral twist has been remedied. The waste of income in self-indulgence of one form or other is more difficult to deal with; but the law can justly forbid the wage-earner from squandering upon himself money needed by wife and children, and direct that a due proportion of his wages be paid directly to the wife. If neither father nor mother will use their money for the proper welfare of the children, the State must take the children from them though that step should only be a last and desperate resort.

Finally, there is the tendency, unfortunately most prevalent among the lowest classes, to have more children than can be decently cared for. To some extent this evil can be remedied by the dissemination of information concerning proper methods of preventing conception [Footnote: There is, however, a danger in the general dissemination of such information- the danger of increasing prostitution by lessening one of the chief deterrents there from.]; to some extent by moral training to self-control and a sense of responsibility. Or the State may undertake the countenance large families; if this is done (see chapter xxx), steps must of course be taken to prevent the marrying of the unfit-or, at least, their breeding. With our rapidly decreasing birth rate, and the spread of education, which will do away with "lower" classes and fit every one in some decent degree to be a parent, this will probably be the ultimate solution. With the disappearance of poverty, the miserable living conditions of so large a proportion of our population will automatically improve. But much should be done directly by the State to prevent such housing conditions as make for physical or moral degeneration.

We are far behind Europe in housing-legislation, and conditions in most of our cities are going from bad to worse. There is, however, no need whatever of unsanitary housing; it is merely the selfishness of owners and the apathy of the public that permits its existence. The crowding-which in New York City runs up to some thirteen hundred per acre-can be stopped by simple legislation. The lack of proper light or ventilation, of proper water supply, plumbing, or sewerage, of proper removal of ashes, garbage, or rubbish, is inexcusable. The results of living in the dark, foul-aired, unsanitary tenements of our slums are: a great increase in sickness and premature death; a stunting of growth, physical and mental, and an increase in numbers of backward and delinquent children; the spread of vicious and criminal habits through the lack of privacy and contagion of close contact with the vicious.

We are breeding in our slums a degenerate race,-boys who grow up used to vice, and girls that drift naturally into prostitution; we are allowing disease to spread from them, through the children that go to the public schools, the shop-girls we buy from in the stores, the servants that enter our houses, the men we rub elbows with on the street or in the street-cars. Very salutary are the laws that require the name of the owner to be placed on all buildings; shame before the public may wring improvements from many a landlord who now takes profits from tenements unfit for habitation. But it ought not to be left to the conscience of the individual owner; the State must exercise its primary right to forbid the crowding of tenants into houses which do not afford sanitary quarters and permit a decent degree of privacy.