Social Duties of Cities: Public Health
Charles R. Henderson
The University of Chicago
We have seen that the duties of the members of a community are the modes of conduct required by conditions of general welfare in that community. The conditions of modern city life are exceedingly complex and the duties of responsible citizens are correspondingly intricate and difficult to understand. A few general maxims about virtue and honesty are an inadequate equipment for one who would helpfully take part in helping men to better life in a huge town.
At first glance the superficial observer discovers nothing but a multitude of people scurrying in all directions, each intent on some private scheme; the general welfare is not in all his thoughts. Further reflection offers apology for this concentration of interest in self; each man must earn his living by assiduous industry or fall a burden on the city as pauper or thief. For the most part the common good is increased as every individual does the best he can for himself and is faithful to his own duty. There is so much eternal truth in the old-fashioned doctrine of individualism and liberty. Even yet there are able thinkers who believe and teach that nothing more is needed than freedom for each man to go his own way, "hoe his own row," and provide for his own wants; that the social well-being is the certain result of the sum of the enjoyment and satisfactions of all individuals; that the selfishness of millions works better than deliberate co-operation. And we admit that nothing will ever make personal initiative, energy, industry, and thrift needless. When a man depends on his neighbors to bring him material support and provide him with predigested ideas, he soon becomes a parasite and his powers fall to decay.
But individualism and liberty are words which represent only one aspect of human life; for each person is a social being, owes much to society, cannot live alone, cannot ignore the rights of others, cannot produce all the commodities he requires, cannot walk on a pavement
(358) without regard to his fellow-citizens, cannot judge his own cause fairly, cannot cure his own diseases or dress his own wounds, cannot defend himself unaided against epidemic, burglary, or riot, cannot furnish his children with schools, cannot enjoy the highest forms of art and religion. And even individual virtue—if such there be—is at its best only when enforced by social opinion, criticism, or law and encouraged by social praise and honor. " No man liveth to himself."
It is in the city that we find human solidarity in its most impressive forms, for there each citizen is enmeshed in a network of relations, influences, and obligations unknown to the isolated farmer or dweller in a village. This labyrinth of conditions can here be outlined only in a general way.
The moral ideal involved in social life presents itself .... in the three forms of institutions to be maintained, duties to be fulfilled, and a type of life to be realized. At different stages of development, and in different races of mankind, it tends to present itself more distinctly in one or other of these forms. Thus the Jews thought chiefly of Commandments, the Greeks chiefly of Virtues, and perhaps the Romans attached most importance to the maintenance of social institutions. But, in whatever form the moral life is conceived, the good citizen may be said to derive from these general conceptions of its nature the principles by which his life is guided.
Before we can know what duties grow out of urban conditions we must know what those conditions are. Hence we must make:
I. AN ANALYSIS OF THE STRUCTURE OF A CITY
I. The plan of the city streets.—No two cities are alike, as a glance at maps of New York, Philadelphia, Washington, Chicago, St. Louis, San Francisco, New Orleans, and of European cities will quickly show. The curve of a lake or ocean shore, the steep ascending hills, the narrow island, the extended marsh or plain determine the direction of growth and the arrangement of ways; while the fancy of architects and engineers, as at our national capital, seeking beauty and impressiveness, may fix the lines of streets for centuries to come.
The streets are lined with buildings for all purposes—private residences for the most part, warehouses for storage, factories, mills, mercantile establishments, parks, museums of art, public edifices for education and justice. In variety there is unity and all cities have certain essential features in common.
2. Arrangements for transportation and travel.—The street itself is made for the free movement of human beings and goods for manufacture, sale, and consumption. No individual is permitted to own and control a street; it is always public property and devoted to community uses. Whatever be the goal of the moving citizen he must reach it by walking or riding over a public way, whether at a level with the surface, or above or below it. When one leaves the door of a private home and steps upon a sidewalk he is in another world, a world of the common rule. "Keep to the right as the law directs," for law is one method of telling the individual to observe the convenience of all. On a rural highway pedestrians may safely walk; in a city the road and pavement are separated to avoid danger; vehicles have right of way on the road and pedestrians on the sidewalk. Crossings are debatable ground and when crowded are full of danger.
In cities the means of transportation are more socialized than in farming districts where each family has its own means of conveyance. Only the rich can have carriages and automobiles; most of the people use public carriages driven by electricity. These means of transportation are rarely owned by individuals, but generally by corporations, occasionally by the city. The community must make regulation to protect various interests by means of contracts in granting franchises. Private interest has never yet been adequate protection for the rights of the public; the community must guard itself with utmost vigilance and by the best methods.
3. Means of communication must be maintained for the inhabitants of a city, because industries, recreations, medical service, trade, spiritual intercourse depend on them. Hence the creation and maintenance of postal routes, telegraphs, telephones, and messenger service.
4. Standards of precision.—Through ignorance, negligence, or fraud customers may suffer loss and injury in purchase of commodities; hence the need of public scales, inspectors of weights and measures used by tradesmen, public clocks, inspection of the purity and good measure of medicines, milk, and foods. Morality of action becomes more exact with improvement in weights and measures, and mathematical precision is an ideal of conduct.
5. Protection.—On the frontier and on isolated farms each man must in some measure guard his own person, property, and family.
(360) In cities this is impossible in the same degree. For extinguishing fires we must organize trained and professional men in fire departments; for detecting and arresting criminals cities must have a police department; while general ordinances forbid selfish individuals to jeopardize the public by building with wood where stone, brick, and iron are necessary to restrict the ravages of conflagration. The whim and caprice of individual liberty are restrained in order that all may be free from danger and fear. On a farm, decaying matter left exposed may not be very offensive or dangerous, and it may even be made useful as fertilizer by covering it with earth; but in a crowded city such conduct would be deadly, for there life depends on quick removal of all organic matter. If a person pleads his right to live as he did on his farm, and to do what he pleases with his own property, he injures his neighbor and soon finds himself in the grip of the law. Streets, alleys, and courts must be lighted all night to facilitate movement and to make attacks of thieves more difficult and rare.
II. SOCIAL DUTIES IN RELATION TO PUBLIC HEALTH IN CITIES
Public health is affected by the customary conduct of individuals, by social conventions and fashions, by legal requirements enforced by public administration. Assuming that it is the duty of each citizen to refrain from injurious actions and positively to promote the conditions of physical well-being, since these belong to the primer of morality, we proceed to map out some of the main lines of conduct required by urban life. It will soon be evident that upright motives alone are not all of duty; that "hell is paved with good intentions," that virtue is a poor ghost until it takes bodily form in customs, institutions, laws, and agencies.
1. The first duty of the good citizen is to study under the best teachers the laws of hygiene and sanitation. If we cannot say that knowledge is part of duty we surely can assert that an earnest, persistent, and life-long study of the laws of health is a duty we owe ourselves, our children, and our neighbors. Ill-health undermines personal usefulness and industrial efficiency, and is transmitted in some defect to offspring; while communicable disease hurts or kills our neighbors. Disease, therefore, is no mere individual interest, but affects the welfare of the community.
Elementary instruction in anatomy, physiology, and hygiene is now generally given to children and youth in our public schools. But the knowledge acquired at so early a period is necessarily limited; its principles make slight impression on heedless youngsters who fancy they have exhaustless stores of vitality; while many important problems of public methods of guarding against disease and accidents cannot be understood until judgment has been matured by longer experience. Furthermore, only adults can proceed from such studies to associated action, and new knowledge is constantly coming to light through the investigations of scientific men in practice, in hospitals, and in laboratories.
We can here attempt nothing more than to set forth a series of topics for discussions in a class of men. The fundamental facts and principles, as well as practical maxims, should be given by physicians or cited from books. In no case should such general information as can be gathered in these ways lead one to neglect the advice of reputable physicians in illness; and for the administration of public measures specially trained medical men ought to be elected or appointed. Through all these discussions we may reverently remember the profound interest which Jesus manifested in the health and the sickness of men, and the affectionate title which Paul applied to Luke, "the beloved physician."
TOPICS IN PERSONAL HYGIENE
a) Reasons for bathing; means for taking baths; methods of bathing.
b) Diet: the constituents of food and drink; kinds of vegetable and animal foods, adaptation to age, sex, condition of health, occupation. (See chaps. iíí, iv of this series for further topics and references.)
c) Sleep, quiet, recreation; the physical need, the ways of securing what is required.
d) Physical exercise; various effects on body; adaptation to various classes of persons.
e) Clothing; materials, uses, adaptation to climate, seasons, and personal peculiarities.
f) Sexual hygiene. Secure circulars from the Society of Social Hygiene, Chicago, or Society of Moral Prophylaxis, New York. (See chapter on "Family," above.) Printed matter on this subject should not be used with children and young persons; they should be taught by parents or be taken to a high-minded
(362) physician to be instructed how to take care of themselves. None should be left to seek the coveted knowledge from unclean lips or from mercenary advertising quack doctors.
TOPICS IN PUBLIC HYGIENE AND SANITATION
With the aid of lectures by physicians, factory inspectors, commissioners of health, and books cited, the following social measures may well be discussed in church classes of adults, men or women, and co-operation with health authorities should grow out of the discussion.
a) Legal measures for preventing the adulteration of food, milk, water, and other beverages, as mentioned already in chaps. iíí and iv; inspection of grocery stores; pure-food laws; rules and work of boards or commissioners of health; control of dairies and milk stations by authorities.
b) Legal measures for keeping the air free from dust, smoke, noxious and disagreeable odors; municipal ordinances, enforced by the police and board of health.
c) Public methods of keeping the soil free from contamination, as by excessive moisture in cellars, neglect of drainage and sewers, accumulation of heaps of decaying matter, garbage, and refuse from factories; duties of commissioners of health, police, and mayors; duties of school board in relation to schools; inquiry whether the officials do their duty.
d) Agencies of the community for providing a plentiful and cheap supply of pure water, for preventing the pollution of springs, lakes, and streams; national and state laws, city ordinances. Inquire how well these agencies perform their functions.
e) The class may well study the various methods used by cities for harmless disposal of sewage and inquire as to the working of the local system.
f) What are the various methods of disposing of garbage; what is the best method; and what are the facts about the local methods?
g) In cities great care must be taken to provide public control by experts of disinfection of houses, clothing, bedding, sleeping-cars, etc.
h) It is well known that insects, as common house flies, mosquitoes, fleas, bedbugs, are the means of conveying the germs of disease, as yellow fever, malaria, typhoid fever, etc. Domestic animals, as cats and dogs, may carry the germs from house to house, and rats are guilty of homicide in a similar way, though not regarded as a pet.
i) Vaccination is ignorantly opposed by a few fanatical persons, in spite of the overwhelming evidence of its value in suppressing smallpox; and the use of antitoxin in averting or curing diphtheria is antagonized on the same grounds.
j) Quarantine methods are chiefly of interest in seaport cities and they are in the hands of national authorities; but municipal health authorities are under obligation to prevent the spread of disease by isolating houses when there is scarlet-fever or diphtheria, and posting notices of warning on the doors to protect visitors from exposure.
k) State and municipal authorities have yet before them a wide field of usefulness in which they will need the support of public opinion in discovering and preventing the diseases which are caused by occupations: air vitiated by respiration in closely packed workrooms; irritating and poisonous gases and fumes; dust-laden atmosphere, charged with deadly germs; work-places where the laborer passes quickly from extremes of heat to extreme cold, where the place is damp and dark, where the air pressure is so strong, as in tunnel construction, as to destroy or impair the organs of hearing and even heart action; occupations unfit for women or children.
This is the place for frank speech about the “Christian Science” movement in which many estimable but misguided people are interested. Catching at a half-truth, the influence of a cheerful hope and collectedness of mind on bodily states, ages ago understood by physicians and shrewd observers, these people have built up a barrier of fanaticism and obscurantism between their votaries and all the representatives of real science. To this superstition countless deaths and
untold suffering are already to be charged, because it prevented the early resort to modern scientific treatment. It is no kindness to our deluded neighbors to conceal from them our conviction that their ignorance is an enemy of public welfare and is thoroughly immoral. With
their interior motives we have nothing here to do; their conduct is vicious and their leaders should be restrained by legal process like any other quacks.
Tuberculosis is a very common disease, rarely inherited but often communicated from person to person by contact, kissing, or through the air. The germs of this disease are coughed up by the patient and after being dried are carried in dust to the lungs of others, or left on the rims of drinking cups. During recent years this lingering, impoverishing, fatal plague has been somewhat reduced by effective measures to destroy the germs.
Health depends very much on economic well-being and on intelligence and morality. For example, a working man with consumption may have good medical advice, and know that to get well he must have expensive rich food, rest, and easy life in the open air. But he
(364) feels that his family must be supported and so he works on in desperation until he can no longer lift his hand, meantime exposing his mates to infection. If, as in Germany, all working men were required by law to pay a few cents each month out of wages into a fund, and if employers were required to add a substantial sum, a fund would be created which would pay for support and medical care for all the sick; families would not have to go begging, relief societies would not be overwhelmed as now, and thousands of useful men would be restored to health and self-support. To secure such legislation intelligence on the subject must be made universal. Here we find an illustration of our principle that social duties are defined by the sum of all the elements which are necessary to the common welfare. This chapter is, therefore, incomplete in itself and should be studied in connection with all that precedes and follows.
J. F. J. Sykes, Public Health Problems.
J. A. Fairlie, Municipal Administration.
M. N. Baker, Municipal Engineering and Sanitation.
A Handbook on the Prevention of Tuberculosis, published by Charity Organization Society, New York, 1903.
S. A. Knopf, As a Disease of the Masses.
The Social Evil, Report of the Committee of Fifteen, 1901.
J. Lee, Preventive and Constructive Philanthropy.
De Forest and Veiller, The Tenement House