Free Parks and Cam find Grounds S A_'.N FOR THE SICK AND DEBILITATED CHILDREN OF THE POOR IN CROWDED CITIES DURING THE SUMMER MONTHS. J. M. TONER, M.D. Washington, D. C. From “THE SANITARIAN,” May. 1878. A. S. BARNES AND COMPANY, New York and Chicago. FREE PARKS AND CAMPING GROUNDS, OR SANITARIUMS. For the sick and debilitated children of the jpoor of crowded cities during the summer months. J. M. TONER, M. D., WASHINGTON, D. C. The old adage to “ take care of the pence and the pounds will take care of themselves” may be aptly paraphrased; “ Take care of the infants and the adults will take care of themselves.” The philosophy that saw nothing in diseases but the evi- dences of a chastising Providence has about succumbed to the advance of the exact sciences and the light of accumulated knowledge, which enables earnest investigation to see some- thing of the law of cause and effect. Sanitary medicine is yet in its infancy. The science of the prevention of disease and the protection of life by wise and timely legislation has, in America received comparatively little consideration from the states or the general government. The principles and advantages of State Medicine, however, are beginning to win, or have won, a recognition from our law- making bodies, and its importance must give it a position of great influence in the future. Every measure that has for its end the prevention of disease, and thereby the saving of life, is worthy the most serious consideration and support of the pro- fession. The excessive mortality among children in our large cities is a sad commentary upon the habits of civilized communities and the enlightenment of the age. No man can acquit himself of the obligation to assist in arresting this evil. That nearly one-half of all deaths in our country should be of children under 72 FREE SANITARIUMS. five years of age is ■unaccountable, and I strongly suspect the result of ignorance, or worse. With the hope of doing something toward staying the tide of destruction among the innocents, the writer desires to call the attention of legitimate health guardians and the medical pro- fession to the proposition of “ Free Parks and Camping-grounds or Sanitariums, for the sick and debilitated children of large and crowded cities,” as first made by him through the North- western Medical and Surgical Journal last autumn. This article will comprehend the more important views then ex- pressed, with additional data, so as to bring the necessity of such a measure more forcibly before physicians and the public. It may be laid down as a principle that no city or country is prosperous that is not increasing in population by virtue of its birth rate: and that public health is a nation’s strength. Health is capital, and a healthy community must thrive. The State has a direct moral and pecuniary interest in the health and lives of her citizens. It is her legitimate province to make and enforce just and equitable laws, so as to protect the lives and property of the whole community, and in an especial manner is this true of her duty to the young, whose guardian she is. If the view be correct that the child belongs to the State, and conditionally, and for a limited period, to its parents, the State has a most sacred duty to perform, and should be as prompt and potential to preserve and protect the life of the youngest and humblest infant in its domain as the oldest and most distinguished citizen. To the old we may owe gratitude, but to the young are given the hopes and possibilities of a life of honor and usefulness to their race and state that is unlimited. A careful examination of the published reports of the Boards of Health of the cities of Hew York, Chicago, Philadelphia, Boston, Baltimore, and of several other cities, shows that about one-half of all deaths occurring are of children under five years of age. It is also noticeable that a large per cent, of these deaths take place during the heated term, and are attributed to cholera- infantum and other summer complaints almost peculiar to the United States. This great waste of human life in its early years of existence FREE SANITARIUMS. 73 is unnatural. Humanity demands that the cause of it be in- quired into, and as far as practicable removed. In the published reports of the Board of Health of the city of New York it appears that from 1804 to 1853, inclusive, or for fifty years, there were recorded, including the still births, 363,- 598 deaths. Of this number 177,433 were under five years of age, which is 48.79 of the whole mortality. For the years 1866 -67-68-69 and 70 the published reports give a total mortality for the city of 127,205, of which 64,182 were under five years of age, which is 50.45 percent, of the recorded deaths. In the city of Chicago, the published reports of the Board of Health show that from 1843 to 1869, inclusive, there were 63,- 538 deaths, not including still births. Of this number 32,550 were under five years of age, which is 51.24 of the total mor- tality. In the city of Philadelphia, from 1807 to 1827, inclusive, or twenty years, there were reported, including still births, 56,091 deaths. Of this number 22,329 were children under five years of age, which is 39.80 percent, of the total mortality. In the same city, from 1858 to 1870, there were reported 175,683 deaths, of which 79,016 were of children under five years of age, which is 45.54 percent, of the total mortality for the period named. In Massachusetts, the State registration reports from 1841 to 1858, inclusive, except 1849, record 248,708 deaths. Of this num her 92,567 were under five years of age; which is 37.15 percent, of the whole mortality. In the city of Boston, the Health Reports from 1811 to 1839, inclusive, show that 34,175 deaths took place. Of this number 12,913 were under five years of age; which is 37.87 percent, of the total deaths. In the same city for the five years 1868, 69, 70, 71, and 72, the reported mortality in the city, not including still births, was 31,106, of whom 13,145 were under five years of age; which is 42.22 percent, of the whole mortality. By thus reporting the mortuary reports of these large cities into groups, the increased percent, of mortality among the infant population is made more apparent. The later period, too, cor- responds to the rapid growth and consequent crowded condition 74 FREE SANITARIUMS. of the poor, and the two periods stand in the relation of cause and effect. In the city of Baltimore, in the Board of Health Reports for the years 1850 to 1860 inclusive, and the years 1862, 65, 66, and 69, a total mortality of 75,386 is given, of whom 37,070 were children under five years of age ; which is 45.54 percent, of the whole mortality for the period named. In Washington city the published Health Reports for 1849, 52, and 1858 record 2,918 deaths, of which 1,376 were of chil- dren under five years of age; which is 46.44 percent, of the total mortality. In the city of Cincinnati the Health Report for 1868 records 3,622 deaths, of which 1,691 were of children under five years of age; which is 46.68 percent, of the total mortality. In Rhode Island. The registration reports of this State for the years 1852,53, 54, 64, 65, 67, 68,70, and 71, or for nine years, record 22,943 deaths. Of this number 7,839 were of children under five years of age; which is 34.16 percent, of the whole mortality. In the city of Providence the Health Reports from 1856 to 1870 record, not including still births, 16,203 deaths. Of this number 6,230 were children under five years of age; which is 38.45 percent, of the total mortality. Dr. Edwin M. Snow, in his report for 1870, shows that there has been a gradual and steady decline in the death rate of children under five years of age to the whole mortality in Providence, from 1856, 'when it was 45.91 percent., until 1870, when it was 36.72 percent. And covering a period of 31 years the decedents in Providence were 30,167, of whom 11,965 were children, with an average per centage for children under five years for this period of 39.78. This result is wholly attributable to the enforcement of good hy- gienic regulations. In the city of St. Louis the Health Report for 1871 records 6,- 670 deaths. Of these 3,409 were of children under five years of age; which is 51.10 percent, of the whole mortality. So unconcerned have been the conservators of public health in the United States that complete files of the Reports of the Boards of Health of different cities, for any considerable length of time, are rare ; there is, however, sufficient evidence to war- FREE SANITARIUMS. 75 rant the conclusion, that more extensive data would he simply cumulative of the extent of the evil. Fortunately for our race and the country, this frightful rate of mortality among the young is not equally great in the smaller towns and in the rural districts of the United States. Indeed the healthfulness of the country as compared with the cities is in such marked contrast in this respect that instead of the percent- age of all deaths being greater under five years of age, as in crowded cities, the percentage is largely reversed; and even when the aggregate mortality of the United States is considered, the comparatively small mortality among children in the rural districts is sufficient to overcome the unfavorable percentage of cities in this respect, and presents the following results, as shown by the three last U. S. decennial census reports. Aggregate Mart. Total Mart, under 5 y'rs, Per cent of Mart, under Census. in U. S. in U. S. 5 years, in IT. 1850 323,030 133,978 38.40 1860 393,606 168,853 42.89 1870 ' 493,363 203,313 41.38 It is, therefore, fair to infer from these figures, which confirm individual experience, that there are causes operating in cities, unfavorable to the health and lives of children, that do not exist, or manifest themselves so disastrously, in the country. The causes that enfeeble or destroy human life in infancy are so manifold—constitutional, moral and unhygienic,—and are so con- stantly referred to in health reports, as to be patent to all reflect- ing minds, and to require no enumeration in this connection. That a considerable percentage of the infantile mortality of cities could be prevented under more favorable circumstances, is the settled conviction, not only of physicians, but of all persons who have given any thought to the subject. A great part of this avoidable mortality occurs in what is known as the “ heated term” (a period of special dread to parents in cities with child) en under two and a half or three years of age), comprising the months of June, July, August and Septem- ber. Whenever the thermometer rises and remains fur any con- siderable length of time above 80 deg., derangement of digestion among infants living in such an atmosphere, is very liable to oc- 76 FREE SANITARIUMS. cur. Milk and all animal substances used as food, rapidly de- teriorate in quality in high temperature, and unless great care is taken, become unfit diet for infants. An infant’s stomach is particularly susceptible, and the child by its sufferings will speed- ily show the bad effects of the least departure from pure, fresh and wholesome food or water. Persistence in the use of food that has once caused disordered digestion is sure to develop cholera infantum or some other grave form of disease. High temperature is everywhere recognized as one of the chief pro- voking causes of diseases of stomach and bowels, particularly among children under twm years of age, whether nursed at the breast or artificially fed. These diseases in their inception, are frequently mere disturbances of digestion, caused by the debility consequent on excess of heat, or by the deterioration of food, or the unsuitableness of diet. According to the weekly mortuary reports of our large cities, the diseases of this class alone are referred to as the cause of about 25 percent, of all deaths occurring during the summer months; and the mortality among children under five years of age from stomach and bowel troubles, increases the death rate in cities from one-fourth to one-half over the other months of the year. As heat seems to be the constant attendant, if not the chief cause, of the “ Summer Complaints” of children, and consequent great mortality among them, it is obviously an element to be taken into special account in studying the cause, prevention and treatment of this class of cases, and it is very desirable, as every physician knows, to provide at least for those who are actually sick, quiet apartments or homes where they can have free ven- tilation and pure air of a moderate temperature, with fresh and wholesome food. Whenever these conditions can be secured for such patients, their digestive functions are quickly restored, and the child is no longer sick. The free excursions of a day to the country or the public parks, for the poor with their sick children, recently inaugurated in the City of Yew York and in Philadelphia, will, if the exposure and fatigue is not too great for the suffering little ones, be of infinite service to them, restoring health to many a FREE SANITARIUMS. 77 languishing child, that may be thus rescued, to live and bless the promoters and benefactors of this charity. At all events, this movement has in a special manner di- rected attention to the previous condition and dangers of infant- ile life in our cities. But the measure does not go far enough. The child has to return at night to its home in the heated city, which is often a small, crowded, badly ventilated room, with furniture and clothing saturated with foul exhalations; and where it will soon lose any benefits it may have derived from the day’s airing. Beneficial, as even these excursions are ac- knowledged to be to sick children, how much more positive and substantial a result might be gained for them by a residence of a couple of months in the country, where pure air, good water and wholesome food, with out-door life, could be enjoyed until the oppressive warm season should have passed ! At first it would seem almost impossible for the poor to avail themselves of any mode of life—even if it should prove efficient for the preservation of the lives of their children—that must take the child with its mother or nurse, away from their homes and out of the city. But perhaps the first point of importance to be settled in such a question is, would a removal from the city to a healthy rural district preserve the lives of any considerable number of children who if not removed would perish ? This inquiry will be promptly answered in the affirmative by nearly every one familiar with the origin and course of infantile diseases in cities during the “ heated term.” If then the measure proposed has real merit, and gives rea- sonable promise of lessening infantile mortality in cities, it is the duty of some one to point out a feasible plan for carrying it into practice. The question may be asked, is it probable the poor would avail themselves of the means and mode of life suggested for the preservation of their children, at a nominal cost or without expense, when it would disarrange their ordinary domestic plans, and separate the wife temporarily from the husband, to whom her services in their condition of life are very essential ? The judgment of the writer is, that the parental instinct with them will always be found equal to the necessities of the 78 FREE SANITARIUMS. occasion, and ready to accept any temporary inconvenience, and to act in accordance with the best matured judgment of the medical profession that promises success, for the preservation of the lives of their children. Next comes the very important question, what kind of an institution or scheme commensurate with the wants of a large city in this regard, could be inaugurated, that is really practica- ble and worthy of the endorsement of the medical profession, and the encouragement and patronage of legislators and phil- anthropists ? A Free Park or Camping Ground, a sort of Sanitarium of one or twm thousand acres or more in extent, selected with special reference to its healthfulness—at an elevation above malaria— its accessibility, the abundance of pure water, with well shaded walks and play grounds, etc., to be improved by cheap tenements free to all who have such children, as a summer residence, would in a great measure supply this desideratum. This institution should be governed by proper and fixed rules for admission, the preservation of order and health, and be un- der the general management of a recognized Sanitarian. The park should be provided with a suitable play ground, and a gymnasium, school-houses and chapels to secure the advantages of a well regulated village home for all. Good moral influences might thus be planted and fostered in the breasts of many chil- dren that, under the guidance of Providence, would develop in them the higher and nobler instincts ofdiumanity and shed a be- nign influence over their whole lives. The rich can always leave the cities during the oppressive heats of summer, and find healthy country retreats for their chil- dren, but the poor cannot without aid. No special interest has hitherto been manifested by any city for the health of the fami- lies of this class of the community, and no boarding houses or summer resorts suited to the wants of the poor, have ever been opened, and it is very questionable if they, with their manners and style of dress, could, at present, find accommodations in any considerable number near our cities. To the question—Where could sites suitable for the purpo- ses indicated be found ? The answer is, that a search will de- FREE SANITARIUMS. 79 velop the fact that there are plenty of them sufficiently accessi- ble to all our Atlantic cities. A situation on navigable water, or on a line of railroad should be preferred. Elevation, too, is particularly desirable, as it removes at once the danger from malaria, and secures a cooler atmosphere for the greater part of the 24 hours. Every 400 feet of altitude above tide water in this region, approximates to being of the temperature to be found at sea leve1 one degree further North, It has been ascertained that the ther nmmeter falls one degree for every 280 feet of perpendiculai ascent. It is probable that the best results would be obtained for a sanitarium of this kind on some elevated ridge or mountain spur, above the line of malarial influence, where the air is pure and cool, the water good and abundant, where provisions are cheap, and where the normal temperature during the summer months does not for any considerable period of the day, range above 80 or 85 degs. It is the duty, not only of large cities, but of individual cit- ies and States and perhaps the general government, to do what- ever is possible to preserve the lives of the great army of inno- cents that are now annually sacrificed by a disregard of the laws of health, and the impecunious condition of a majority of pa- rents of the laboring class in our large American cities, who are unable to remove their children even when sick, to the country during the heated term. The proposed measure is to meet this urgent want, namely, the preservation of the lives of the children of the poor in crowd- ed cities: that each of our large cities secure one or more ex- tensive tracts of land suited to the purpose, in an elevated re- gion, and improve them in a manner suitable for Free Paries for the purposes here indicated. Special care should be taken with all the buildings and sur- rounding improvements, so as to insure free and complete ven- tilation: good surface and underground drainage should be made so as to keep the Park free from any annoyance from stag- nant water and closet deposits, slops or waste water, and to secure rapid surface drainage to the walks and play grounds after rains. The parks should be under the immediate supervision of a 80 FREE SANITARIUMS. medical and civil police, to preserve order and salubrity, and should either be so large or so numerous as never to be crowded (as that would establish the evils of city crowding); and all the improvements of the grounds should be made with a view to encourage and enable the children to be kept or to live most ot the time in the open air. The grounds should be properly laid out with shady walks and drives, and improved in every way that could conduce to health, by the erection of pavilions, cabins, cottages and board- ing houses, for the accommodation of mothers and nurses, with their sick children, during the summer months. It might and would in many cases be proper for cities to contribute meahs to send patients to the Park, and in special cases support by contributions, sick and destitute children and their mothers while there. The opening of Free Parks as summer resorts for the poor is entirely feasible, and in a humanitarian view deserving of the most serious consideration. To the statesman, the measure must present an encouraging prospect for the preservation of hu- man life, the increase of population, and national prosperity. When we consider that the U. S. census of 1870 shows that there is in the city of New York but one child under fifteen years of age to every woman between the ages of fifteen and fifty (and the same is true of our other large cities) when there ought to be three, this question assumes a still greater impor- tance. It is a fact not to be lost sight of that the decline in the pro- portion of children in the United States under fifteen years of age to the number of women between the ages of fifteen and fifty, is progressing, as is very conclusively shown by a comparison of the last five U. S. decennial census reports. The following table is made up from them. The returns from 1830 and 1810 include whites only; the others include all classes. Whole No. of Females Whole No. of children of No. of children to the bet. 15 and 50 y’rs both sexes und. 15 y’rs 1000 nubile Census of age, in U. 8. of age, in the U. 8. women. 1830 2,490,058 4,736,320 1,952 1840 8,327,016 6,201,212 1.863- 1850 5,589,732 9,629,680 T/flo 1860 7,640,663 12,734,476 1.666 1870 9,636,544 15,115,615 1,865 FREE SANITARIUMS. 81 Should the suggestion for Free Parks ever be adopted, much valuable information in the selection of the site may be had by consulting the records of the U. S. Signal Bureau as to eleva- tion, force of winds, temperature, humidity, etc.,—elements of great importance in a hygienic point of view. Such Parks should be free to all who have sick or debili- tated children, and persons while there should be permitted to live in tents or cottages, and in such style as their means and tastes might justify, so that they do not violate the laws of health or incommode their neighbors—the main purpose of the institution being to secure by a healthy rural residence the restoration to health and the preservation of the lives of the children of the poor, suffering from, or threatened by, diseases incident to, and aggravated by, the excessive heats of summer in cities. It has long been the practice of city physicians to send their young patients suffering with summer complaints to the coun- try during the “heated term,” whenever their parents can afford the expense, as almost the only means of saving their lives. The scheme of Free Parks and Camping grounds would, it is hoped, secure to the children of the poor of crowded cities dur- ing the summer nearly the same chances for life that are en- joyed by our well-to-do classes of society. Washington, D. C., March 3,1873. THE SANITARIAN. A MONTHLY JOURNAL. The purpose of this publication is to so present the results of the various inquiries which have been, and which may hereafter be made for the preservation of health and the expectations of human life, as to make them most advantageous to the public and to the medical profession. The resources of sanitary science are inexhaustible. It will be a chief object of the Sanitarian to awaken public attention to the extent of the field, and to the facts indicating how beneficently it may be cultivated. This will be done by showing the amount of ill health and mortality from preventable causes of disease; by pointing out the nature of those Causes, and the way in which they operate, by showing that such causes are remov- able ; and by exhibiting improved health, longevity and happiness as the fruits of their removal. The laws of physiology and general pathology will be kept in view, as the basis of health; and by which hygiene constitutes a department of science which the medical profession can advantageously share with the public, or apply to individuals according to circumstances. The detail of these rela- tions will involve questions of manifold significance, and many of them of the utmost importance to human health. The practical questions of State Medicine: the health of armies and navies, marine hygiene, quarantine, civic cleanliness, water supply, drainage and sewerage. Sanitary architecture : light, space, warming and ventilation. Climate and domicile: epidemic, endemic and hereditary diseases. Occupa- tion, exercise and habits, food and beverages, in all varieties of quality and quantity. In short, whatever thing, condition or circumstance is in rapport with, or antagonistic to, the most perfect culture of mind and body will be considered legitimate matter for the Sanitarian to discuss, advocate, con- demn or reject at the bar of health. Advertisements will fall under the same category, none will be admitted of even questionable character in this regard. In fulfilment of its mission, the Sanitarian asks kindly consideration and assistance from all who would aid in the protection of the most precious of gifts divine—human life. A. N. Bell, M.D., Editor. The annual subscription will be three dollars, in advance. Single num- bers, thirty cents. Communications intended for publication, books for notice, or subscrip- tions, should be addressed to THE SANITARIAN. A. S. 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