tried in every direction. There is every hope that America may yet learn by her failures and evolve a system of government that shall be her pride rather than her shame. Our National Government has worked far better than our state and local government, but even that can be further freed from the pull of improper motives, made much more efficient and responsive to the general will. We are in a peculiar degree on trial to show what popular government can accomplish. The Old World looks to us with distrust, but with hope. And though the solution of our political problem involves many technical matters, it has deep underlying moral bearings, and affects profoundly the success of every great moral campaign.

R. C. Brooks, Corruption in American Politics and Life. L. Steffens, The Shame of the Cities. J. Bryce, The Hindrances to Good Government. W. E. Weyl, The New Democracy, chaps. VIII, IX. Jane Addams, Democracy and Social Ethics, chap. v. A. T. Hadley, Standards of Public Morality, chaps. IV, v. T. Roosevelt, American Ideals. C. R. Henderson, The Social Spirit in America, chap. XI. Edmond Kelly, Evolution and Effort, chap. IX. W. H. Taft, Four Aspects of Civic Duty. E. Root, The Citizen's Part in Government. D. F. Wilcox, Government by All the People. L. S. Rowe, Problems of City Government. H. E. Deming, The Government of American Cities. Publications of the National Municipal League (703 North American Building, Philadelphia). Political Science Quarterly, vol. 18, p. 188; vol. 19, p. 673; vol. 24, p. 1.

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 afield, 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. 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

1 Some of the results of this questionnaire were published in the Independent for August 5, 1913, vol. 75, p. 348.

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 AntiTuberculosis League can already point to a ten per cent decline in the death-rate from that plague in the decade from 1900 to 1910. 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

1 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.