fresh air, not only would the problem of disease in the community be largely solved, but the expense of government would be greatly decreased. Because of the failure of the family and of the individual citizen to do their part, the community, through its government, enacts ordinances to compel people to keep their premises clean and their drains in proper condition. Ordinances usually exist to prevent the filthy and dangerous practice of spitting in public places. This practice is one of the most effective means of spreading some of the worst diseases, such as tuberculosis or consumption, and the ordinances to prevent it are among the most important enacted by our city governments. Unfortunately they are also among those most seldom enforced and most often violated. Here is one of the cases where constant and concerted action on the part of all cleanly and well-informed persons is necessary to secure the enforcement of the law.

Street

Every city has its street-cleaning department, which does not always do its work as well as it should. In large cities it consists of an army of men, with horses and wagons and suitable machinery for sweeping cleaning and cleansing the streets and alleys. These men and smoke inspection are under the supervision of a board or a commissioner, acting under the authority of the government (see chapter XXII). There are also smoke inspectors, whose work is important in keeping the atmosphere pure. If the stoking of the furnaces in factories and large buildings is done properly, the smoke nuisance can be greatly lessened. There are smoke consumers which aid in the consumption of the smoke that is otherwise poured out of the chimneys over the community; but the expense and trouble of putting them in prevents many men from doing so. The community should insist, however, that the smoke

nuisance be removed as far as possible, not only because it is detrimental to health, but also because it mars the beauty of the city.

Of great importance in large cities is the system of parks provided for the recreation of the people. In small towns

Parks and

play

grounds

parks are not of such great importance from the standpoint of health; but in crowded cities every breathing place, where fresh, pure air and grass and trees can be found and enjoyed by the people, is of untold value. One of the best of the charitable works in large cities is that by which thousands of poor children are sent to the country or the seashore, or to "fresh-air farms," during the summer months. This is doing much to lessen the death rate and the sickness in the crowded tenement districts. In the rapid growth of American cities not enough care has been taken to provide for parks. Provision should be made in all growing cities to leave spaces that may be converted into beautiful and refreshing parks as need arises. In some cities playgrounds are being established and provided with tennis courts, ball grounds, and gymnastic appaThe opening of school yards as playgrounds during vacation periods is a good practice that is growing.

ratus.

Cities have hospitals, some supported by private organizations, such as churches, and some supported at public Hospitals; expense. The public hospitals are under the quarantine charge of physicians, surgeons, and nurses paid out of the public treasury. Precautions are taken against the spread of contagious diseases. The government has the right to declare a quarantine against a home, or even against a whole section of the city; this means that, in case of the existence of a contagious disease, the occupants of the dwelling or of the section of the city may be prevented from leaving it, and others prevented from

entering it. Physicians are required by law to report contagious disease to the health officers, who placard the house, proclaiming the existence of the disease. Persons in whose homes such diseases exist may be prevented from going about their ordinary business, and the children from going to school. Physicians sometimes grow careless about reporting such cases of sickness, and families, thinking solely of their own convenience, often try to conceal the presence of contagious disease in their homes. This is not good citizenship. Such families endanger the health of others. Much is being done in some of our cities to prevent the spread of disease by a systematic medical inspection in the schools.

When an

Just as an individual, or a family, is dependent for health on other individuals and families in the neighborhood, so also a community is more or less dependent on other communities for its health. This is especially true in these days when the means of communication are so fully developed and when traveling is so common. Contagious diseases spread rapidly from town to town, and not infrequently cover large districts at the same time. epidemic of smallpox breaks out in one city, it is likely to appear in other cities, and even in the country districts. Any ship that enters our harbors may bring with it diseases from the slums of Europe or of Asia. When a factory pollutes the stream that runs by it with refuse, it threatens the health, not only of the immediate community in which it is situated, but also of other communities farther down the stream. When Chicago turned its sewage into the drainage canal, and thence into the Illinois and Mississippi rivers, cities and towns for many miles along these streams became very much alarmed, and St. Louis, which derives

Dependence of one community another for

upon

health