there expressly affirmed. We follow and apply the decision there made." Discrimination. One feature of the ordinance upheld in the Adams Case, supra, distinguishes it from all of the other cases decided up to the present time. The ordinance there under consideration applied only to dairy cattle kept outside the territorial limits of the city, and its validity was sustained against the contention that there was a discrimination as between such cattle and those kept within the city. The court held that because the city had full power and authority to regulate all kinds of live stock within the city by means of its health regulations, and that it had by that means actually enacted and was enforcing very stringent regulations as to its milch cattle, it was justified in making the classification to which objection had been made. Adams v. Milwaukee was affirmed in 228 U. S. 572, 57 L. ed. 33 Sup. Ct. Rep. 610, with special reference to the point as well as to that of requiring the destruction of milk without a judicial hearing. Conclusion. The conclusion necessarily drawn from all the cases decided up to the present time is that, generally speaking, a city has, by virtue of the police power, authority to enact valid legislation prescribing sanitary regulations of all animals kept within its limit, including milch cattle, and to enforce the same by penalty. or otherwise; that it has the further power to refuse permission for the sale of milk unless the owner of the cattle from which it comes voluntarily permits inspection by city officials and conforms to its sanitary regulations; that it has the power to prescribe or name the particular test to be applied to the animals for the purpose of detecting disease, so long as the designated test is supported by competent scientific authority and recognized by legislative bodies; and, if the holding in Adams v. Milwaukee is sound, it may regulate the milch cattle within its limits by an ordinance regulating animals generally, and those without its limits by another ordinance by virtue of its power to refuse a license to sell milk within its limits. Of course it must be understood that, because of different state Constitutions, legislation, and charters, some cities are able to do what is forbidden to others, but under the usual grant of power to protect the health of the inhabitants, the city may be said to possess these powers in the absence of unusual restrictions. Because of the importance of such legislation, the courts have been inclined to uphold every fair and honest attempt to protect the health and lives of the people in this way, and the decided tendency of modern times is toward more liberal construction, so that it would seem that there is no cause to fear an encroachment by the courts upon the legislative power of the city. John At McCracken Sanitation and Religion. As a result of the triumph of sense and sanitation, the death rate has been wonderfully diminished everywhere, plagues and epidemics have about lost their terror, and it devolves upon the young man of to-day to still further carry on the work of the fathers until germ and microbes shall acknowledge the hand of the master of science. In the American pulpit, preachers are preaching the gospel of soap and water, and deaths due to want of sanitary precautions are no longer dwelt upon in funeral sermons as results of national sin or as "inscrutable Providence," and both religious press and pulpit carry to every household just ideals of sanitary precautions and hygienic living.—Joseph A. McCullough of the Greenville (S. C.) Bar. The Federal Children's Bureau Some Aspects of its Present Work BY JULIA C. LATHROP Chief of the Children's Bureau [ED. NOTE-This article consists of extracts from a paper read by Miss Lathrop at Minneapolis, on June 19 1913, before the American Medical Association, and here presented by her permission.] T HE Children's Bureau is the result of efforts lasting for ten years to secure a provision by which the general government should create a special agency devoted to the interests of the children of the nation, with methods of investigation and publication analogous to those through which the various bureaus of the Department of Agriculture have vastly increased the productiveness of the soil and the welfare of farmers. In these efforts many organizations and individuals joined,-notably the National Child Labor Committee, various settlements and women's clubs, societies, and associations engaged in the active work of caring for children and protecting the public health. So that the bureau went into operation with a remarkable backing of public interest and good will. Duties of Bureau. The Children's Bureau was established by act of Congress on April 9, 1912, although it did not go into operation until August 23 of the same year, when the appropriation for its maintenance became available. The statute defines its duties thus: "The said bureau shall investigate and report to said department upon all matters pertaining to the welfare of children and child life among all classes of our people, and shall especially investigate the questions of infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents, and diseases of children, employ ment, legislation affecting children in the several states and territories. . . . The chief of said bureau may, from time to time, publish the results of these investigations in such manner and to such extent as may be prescribed by the Secretary of Commerce and Labor" (now Secretary of Labor). For the discharge of these duties, the statute provides a staff of fifteen persons and an annual appropriation of about $30,000. It is apparent that this is a bureau of investigation and publicity, and although it is directed to investigate "all matters," that direction is to be interpreted with relation to other existing bureaus, notably those of the Census, Education, and Public Health, which have to do with certain aspects of the care of children and with which this bureau naturally co-operates. It is obviously intended that the Children's Bureau shall occupy the field popularly described as that of "child welfare," which must be based upon census enumerations, and must touch upon the social, economic, and moral aspects of both education and health. Infant Mortality. The law itself mentions infant mortality as the first subject to be undertaken, and it is certainly reasonable that the government should consider first of all this subject, the wastage of human life at the beginning. If the census authorities are right in estimating that at least 300,000 babies, or one out of every eight born, died last year before any one of them had lived a twelvemonth,―if,of all the funerals in America, one in every five is that of a child less than a year old, and if, as you tell us, at least touched side of the health problem today is not in our congested cities, with all their acknowledged unwholesomeness of life, but in rural and village life, upon whose wholesomeness we have confidently depended to reinforce our cities. half of these deaths are preventable by that for all England, which is 105. It methods that you as sanitarians have as-is startling indeed to find that the uncertained and placed at our disposal,then the American public cannot disregard the call to action, nor can we ignore the larger implications of social welfare presented by the statement of Newsholme: "Infant mortality is the most sensitive index we possess of social welfare. If babies were well born and well cared for, their mortality would be negligible. The infant death rate measures the intelligence, health, and right living of fathers and mothers, the standards of morals and sanitation of communities and governments, the efficiency of physicians, nurses, health officers, and educators." Again, we are challenged Photo by Doubleday Page Syndicate, N. Y. by the report of the New York Special Public Health Commission, just issued, which shows for that state that, since 1902, the rural and village death rate has slowly risen; that it began to exceed the urban death rate in 1909; and that "since that date the divergence between the two in favor of the urban death rate, has steadily increased." The report of the Commission continues: "The work of this Commission may be said to be, to ascertain how the rural and village death rate can be made to follow the urban death rate in its downward course." It is safe to say that the improvement in urban health is in large measure due to the new attention paid to saving infant life. This is shown by the improvement in the infant death rate of London, which, in the last ten years, has been reduced from 160 to 103; so that to-day the London infant death rate is lower than On the other hand, it is deeply significant that the most favorable record of infant mortality is that of New Zealand, where the figure was 68 in 1910,a country whose newness, equality of opportunity, wholesome climate, and high level of intelligence, combine to give favoring conditions, but only such conditions as this country should also afford. Partly because the limited appropriations forbade the bureau's undertaking extensive inquiries for the present, and partly because the great cities of this country have already under way many successful civic and volunteer activities for reducing infant mortality,while the necessity for such work, being less obvious in smaller communities, is not yet thoroughly recognized, it was determined to undertake a series of studies into infant mortality in small industrial centers and rural communities as our first field work. Our inquiry does not assume to be a medical inquiry, nor even one based upon the records of deaths. It is rather an inquiry into the social, industrial, and economic conditions surrounding the children born in a given town within a given year, and is an effort to trace every child so born either through that year, or as much of that year as he survives. It was necessary, in conducting an in quiry thus based upon the birth records, to choose localities within the registration area. Johnstown, Pennsylvania, was selected because its size, situation in a registration state, and general industrial characteristics, made it a suitable beginning. The schedule follows the child through the first year of life in his family surroundings, and in addition embraces a survey of the reproductive history of the mother. It is necessarily intricate. and perhaps annoying to the person who must answer the questions. The inquiry was launched with some anxiety as to how the agents would be received. The field agents were, of course, necessarily women. The law states that "no official or agent or representative of said bureau shall, over the objection of the head of the family, enter any house used exclusively as a family residence." The instructions to the agents were, in addition to this, that they should enter no home without the good will of the woman at the head of the family, and for two reasons: First, because the humbler the home, the greater its need that the government should recognize its dignity; and because, further, without the good will of the woman at the head of it, no schedule could be prepared which would be worth writing. down. It was doubtless an aid in securing the co-operation of the mothers that the schedule was arranged so that the name and address appeared on a perforated slip, which was removed in the mother's presence, thus assuring her that the schedule was returned to the office without a name upon it, and that the government only desired the facts, without any tinge of personality. Fifteen hundred and fifty-eight schedules were secured. It is interesting to note that there were two refusals. It is obvious that such an inquiry is absolutely democratic; and it must follow the history of every baby wherever born, if born within the given year. The agents found everywhere a cordial reception. Whether among the foreignborn women, who must be visited with an interpreter, or in the American quarter of the town, the mothers responded to the request of the government that they co-operate in an effort to learn how to safeguard their own and their neighbors' babies' lives. The state board of health sent, for distribution in the foreign quarters, circulars in various languages on the care of babies. The American mothers took our agents to task because the government had no instructions in English for them, complaining of the confusion of doctrine among doctors, nurses, neighbors, and relatives. Such an inquiry should bring out an invaluable by-product of public attention, and this is shown in the present instance by the interest of the health department, the press, the women's clubs, and the clergy; by renewed public activity in such matters as the disposal of garbage; and by the request of the city that the Department of Agriculture make a thorough examination of the milk supply. This examination is now (June, 1913) under way. Publications. There are various aspects of the present work of the bureau which I will not discuss here, but I may briefly mention that the bureau has now in preparation a series of pamphlets on the care of children, beginning with one upon prenatal care; that it has ready for the press the first instalment of material which will appear as a statistical handbook, embodying the figures of the last United States. Census relating to children, rearranged for convenient use by those interested in the welfare of children. I wish to mention particularly certain. activities closely related to the inquiry into infant mortality. There will issue from the press within a few days the first of a series of annual bulletins on baby-saving campaigns, entitled "A Preliminary Report on What American Cities are Doing to Prevent Infant Mortality." So far as its resources permit, the bureau desires to place itself at the service of localities undertaking inquiries on the same lines which it is pursuing, and to co-operate in such a manner as to make the material of greatest possible advantage. T BY J. E. CRICHTON, M. D. Commissioner of Health, Seattle, Wash. HERE is a triumvirate in comparison with which all the nations, likely to engage in war, if plunged into desperate combat with all of the modern instruments to kill, maim, and destroy, would seem and would be in fact insignificant when measured in terms of destruction to life, hope, and happiness, and this great power is the triumvirate composed of tuberculosis, alcohol, and syphilis. In speaking of the cost of these three diseases to the world, and the important position which they occupy in public health matters, it is not my intention to discuss their ravages and results only, but also the influence which one has upon the other, and finally to speak of these three utterly unnecessary conditions or diseases as that thing which makes the most savage war mere child's play, which consumes rich treasuries in a day, and the influence of which has devastated this earth in so many, many ways. The power of this triumvirate is so diversified in public health matters, its ramifications into the life history of individuals, of peoples, and nations have been so great, that, when we examine into the facts and conditions as they actually exist, we stand aghast and stupefied at the results which we see. When referring to the effects of alcohol, as we discuss these diseases and their relation towards each other, it is our intention to treat substantially the matter from the physical standpoint, and only to point out the debasing influence of alcohol upon the moral man sufficiently to show that to a certain degree it is responsible for a considerable amount of venereal infection which exists in this and other countries where it is used in unreasonable quantities. In considering this trinity of power as a public health issue, we must examine into and understand the physical, mental, and moral conditions produced in those who are victims and those who for succeeding generations may suffer the consequences. All great health departments have for ages fought the usual communicable and preventable diseases. The Seattle Department of Health is now leading the way into new and possibly richer fields. We will then hew strictly to facts and speak only of those things which are actually proven. Alcoholism. Statistics prepared by the government in Switzerland, embracing a period between 1892 and 1906 from actual individual examination, show that of those dying from diseases of circulation 23 per cent of deaths were due to alcohol; from digestive diseases, 43 per cent; from certain liver involvements, 91 per cent; from pneumonia, 30 per cent; and from kidney diseases 25 per cent. These percentages of deaths ran through the period of life between the ages of forty and fifty, or during the time when men are in their prime. The general death rate in pneumonia is, in immoderate drinkers, 53 per cent, as against 18 per cent, in total abstainers. The statistics of infant mortality show that in 1,551 ordinary families, dead children were born to the mothers in 13 per cent of all cases. In 1,833 families, where the parents were rather hard drinkers, the rate of dead children was 23 per cent, in heavy drinking parents, out of 2,461 families, 32 per cent of the children were born dead. To show the effects of drunkenness in Massachusetts, in 1911, there were 148,666 arrests, of which 93,965 were for drunkenness or something like 63 per cent of the entire number. This fact is brought out because jail and prison life |