THE PLAGUE IN ITS STRONGHOLD

TUBERCULOSIS IN THE NEW YORK TENEMENT

By ERNEST POOLE

"We must care for the consumptive in the right place, in the right way, and at the right time, until he is cured: instead of, as now, in the wrong place, in the wrong way, at the wrong time, until he is dead."—J. II. Pryor.

THE PLAGUE IN ITS STRONGHOLD

THE PRAYER OF THE TENEMENT

“BREATH—breath—give me breath!” A Yiddish whisper, on a night in April, 1903, from the heart of the New York Ghetto.

At 18 Clinton Street, back in the rear tenement, a young Roumanian Jew lay dying of consumption. l had come in with a Jewish doctor. With every breath I felt the heavy, foul odor from poverty, ignorance, filth, disease. In this room ten feet square six people lay on the floor packed close, rubbing the heavy sleep from tired eyes and staring at us dumbly. Two small windows gave them air, from a noisome court—a pit twenty feet across and five floors deep. The other room was only a closet six feet by seven, with a grated window high up opening on an air-shaft eighteen inches wide. And in that closet four more were sleeping, three on a bed, one in a cradle.

“Breath—breath—give me breath!” The man's disease was infectious; and yet for two long weeks he had lain here dying.From his soiled bed he could touch the one table, where the two families ate; the cooking stove was but six feet from him; the cupboard, over his pillow; he could even reach one of the cradle!., where his baby girl lay staring frightened at his strange position: for his wasted body was too feeble to rise; too choked, too tortured, to lie down. His young wife held him up while the sleepers stared silently on, and that Yiddish whisper came over and over again, but now with a new and more fearful meaning: “Breath—breath—breath! Or kill me; oh, kill me!”

Two years ago this man had come to America—one of the four hundred and eighty-eight thousand in 1901. He came young and well and hopeful, with his wife and their baby son. Two more had been born since then. It was to be a new country, a new home. a fresh start, a land to breathe in. “Breath—breath—give me breath!” He had breathed no air here but the close, heavy air of the sweat-shop, from six in the morning until ten at night. Sometimes—he whispered—he worked on until eleven. He was not alone. In New York to-day and to-night are over fifty thousand like him working. And late in the night when he left the feverish labor, at the hour when other homes are sleeping, he had come in through the foul court and had sunk into restless sleep in the dark closet six feet by seven. There are three hundred and sixty-one thousand such closets in the city. And this was his “home.”

“Luft—giebt mir luft.” He spoke only Yiddish. The new country had given the Plague before the language. For the sweat-shop and the closet had made him weak; his weakened body could make no tight; the Plague came in and fed swiftly. Still on through the winter he had worked over the machine in the sweat-shop, infecting the garments he sewed—feverish, tired, fearful—to buy food and coal, to keep his “home” alive. And now, on this last day of life, ten times he had whispered to his brother, begging him to care for the wife and the three

little children.

The struggle now is ended. The home is scattered. The smothered whisper is forever hushed. “Breath—breath—give me breath!” It speaks the appeal of thousands.

THE GREATEST OF PLAGUES: AN UNNECESSARY EVIL

This Plague Consumption is to be stamped out once for all. It has hung upon the earth for thousands of years. It has killed not millions but billions of men, women, and children; more than all wars and plagues the world over. And now of the seventy millions in our country, seven millions must inevitably die of this scourge unless the present ratio be brought down. Each year it kills over a hundred thousand of our men and women, and most of these are cut off in the very prime of life. To women between twenty and forty-five it brings one-third of all deaths; to men between thirty and forty-five it brings thirty-two per cent. Most startling of all—to young men between twenty and twenty-nine it brings no less than thirty-six per cent of deaths from all causes. It is a Plague in disguise. Its ravages are insidious, slow. They have never yet roused a people to great, sweeping action. The Black Plague in London is ever remembered with horror. It lived one year; it killed fifty thousand. The Plague Consumption kills this year in Europe over a million; and this has been going on not for one year but for centuries. It is the Plague of all plagues—both in age and in power,—insidious, steady, unceasing.

It can be stamped out. Its workings are no longer hidden. We know now that consumption is not produced by direct heredity-the tendency alone is inherited. It is produced by infection from living germs, coughed up, millions in a day. Ignorance lets these millions live, spat out on walls and floors and pavements, to float later in the air and so spread the infection. Darkness, foul air, and filth keep these millions alive. Sunlight has killed them in fifteen minutes; in dark tenement halls they are known to have lived two years. Darkness, foul air, ignorance, drink—these weaken men, women, and children, and so make them ready for infection. Then the germs, if breathed in, may bring pulmonary tuberculosis—consumption; or if swallowed, tuberculosis of the stomach or the intestines; or if brought in contact with a wound, tuberculosis of the skin or of the joints. These latter forms are most common in little children. They bring but one-fourth of all deaths from the Plague. Tuberculosis of the lungs is the one great form of the Plague to be fought above all others. It can be stamped out.

In New York City a strong beginning has already been made. While the population has vastly increased in the last twenty years, the number of deaths from this cause has remained about the same. Far greater effort, however, is now called for. Dr. Hermann M. Biggs, Medical Officer of the Department of Health, has recently said: “The measures now in force are quite inadequate as compared to the importance and magnitude of the problem. The sanitary authorities, however enthusiastic and efficient, and the medical profession, however influential and numerous, cannot grapple with this problem unless they have the hearty support of the people.” And he adds: “I believe that tuberculosis may be practically stamped out.'” This is said from years of wide experience. It is supported by science the world over. Experience everywhere has shown just what must be done. The time is ripe for the people to act on a tremendous scale. Not hundreds, not thousands, but tens of thousands are to be saved for New York City alone in these next ten years. They are to be saved by attacking this Plague in its stronghold.

THE STRONGHOLD OF THE PLAGUE

Its stronghold is the tenement. Statistics prove this the world over. They show in New York State that in cities of over twenty-five thousand—now swiftly absorbing young men from the country, so making the problem still more appalling—the death-rate from consumption is over twice the rate in smaller towns and villages. In the city it is worst of all in the tenements. In New York City to-day there are at least twenty thousand in the tenements who are suffering in some stage of this disease. It is here among the crowded poor that the Plague feeds fat on ignorance and poverty, in dark halls, foul rooms, dark closets. It is here that it shatters the home as it has shattered homes among us all. Here it fastens on thedbread-winner, eating up the small savings, lingering on for months and even years, so making the greatest of human powers—Love—only a means of infection and death. It is from here that sweat-shop garments and wares of all kinds go out infected to all classes of people. It is here that unceasing danger lies for the whole community.

“THE LUNG BLOCK”

“The Lung Block” has well earned its name. It is bounded by the streets Cherry, Catharine, Hamilton, Market. It is close to the East River—to open air. It should be wholesome. For a month I worked through it with the help of those who know it best. I went through with health and tenement inspectors, as a settlement visitor one week, as a “fresh-air man” the next. I use this one block as a centre, not to prove, but to image what has already been proved all through the civilized world, to image the three great evils we must fight in the tenement. These evils are Congestion, Dissipation, Infection.

That the Plague spreads with congestion has long been proved beyond the shadow of a doubt. It spreads even faster than the crowd pours in. So it is in the block we have taken. lt stands in one of the most congested wards of the most crowded city in the world, and this Seventh Ward is steadily, swiftly packing closer. Between 1890 and 1900, the density of its already crowded population increased no less than sixty-five per cent. Now it holds four hundred and seventy-eight humans to an acre. The Lung Block alone holds nearly four thousand, not to mention dogs, cats, parrots and one weakened old monkey. Of the humans, some four hundred are babies.

It is a block packed close with huge grimy tenements; these tenements are honeycombed with rooms; these rooms are homes for people. To squeeze in more homes, light and air are slowly shut out. Halls, courts, air-shafts, are all left cramped and deep and sunless.

It is a block of a thousand homes. Through halls, in rooms, on stairways, in courts, in shafts, and out on fire-escapes, arc sprinkled the four hundred babies. At the age of two they are found alone in the street, already imbibing its deep, muddy wisdom. So this muddy street overflows into the home. It is hard for the home to keep wholesome and pure. Things and people—good and bad—have only partitions between them.

In a block so congested the Plague spreads swiftly. In the past nine years alone, this block has reported two hundred and sixty-five cases. From doctors, druggists, and all others who know, I gathered that this is but half the true number.

In a block so congested dissipation comes easy. Foul air, darkness, wretched surroundings-these work on the home by day and by night. Here a thousand homes struggle on, while hundreds yield and sink and so pollute the others. So come squalid homes and wretched meals. So comes the humorous, shattered old chap who told me, “I aint never sober but when I gits out of bed.” So come hundreds of others, men and women, young and old; drunk, bestial, vile, forever steadily sinking. “Hard drinking triples susceptibility to consumption.” This is seen most of all in the Irish; hence among the Irish the death-rate from the Plague is twice that of any other white nationality. The Jews, with their strict habits, their dietary laws, and a certain standard of cleanliness enforced by a rigid religion, show the lowest death-rate of all, though this is rising as they become tenementized. At present, the Lung Rlock has only Jews on the Market Street end, and among them we found hardly a case of consumption. The body of the block is packed with Irish and Italians, and a sprinkling of twelve other peoples. All these image best the dissipation, the shattered vitality which eats into savings, starves the home, then gives the Plague easy entrance, and makes it a constant danger to all in the family.

I give here but a few brief tales among many. In a tenement old, vile, infected, one of the worst on the block, an Italian lived some two years back. He had a wife and three little children. They lived in one room and a closet. They lived on four dollars a week. To make a home wholesome here means unceasing struggle. His wife gave up and took to drink. The man struggled on. He worked hard to support his babies, but it was a wretched home to come to at night. Even the neighbors said so. The house was infected, and against its infection the home gave no protection, but only wretched food, wretchedly cooked, for the tired man and his little children. The man took the Plague. He worked on. Friends tried to make him stop. “No! Me die not yet at all! Me gotta bringa de grub to ma chiI’.” This feeling is as old as the hills. He struggled on. One afternoon he had a hemorrhage at work, and was brought home on a shutter. The “home” broke up. I could find but one more item. The baby girl died last year of the Plague—tubercular meningitis—over on Randall's Island.

Not far off lives a German family, a mother and five girls, the oldest sixteen, the youngest four. The father drank, took the Plague, and died. The mother took it from him. Of the hundred and thirteen dollars life insurance, she spent ninety dollars on his funeral. Then the starving began. The girl of sixteen lived three months on bread and tea alone, working each day at four dollars a week in a factory, pushing a heavy treadle from six in the morning until seven at night. She had worked so since she was twelve. “She aint never seen the country,” said her little sister, who loved her. She went to night school always. She said she “meant to be somebody.” She took the Plague in the winter, when coal had gone up, when the sleepless nights grew freezing cold. It was a brave fight, but it is over. I had her examined. She is hopeless. She knows now what the cough means when it shakes her thin, hollow chest; and her eyes, when the others are not looking, have that pitiful, hunted look which young eyes must ever have when suddenly meeting death. She had “meant to be somebody”; but her father drank.

Other vice is thick in the neighborhood. Among its victims, with no health, no love, no aid behind them, the Plague makes fearful havoc. “Not worth the bother,” “I know a dozen but they aint worth helping”—so I was told again and again when seeking for patients whom country air might cure. Near by, on South Street, stands a house of ill-fame with a tiny attic overhead, reached by a ladder. In this place a consumptive, a woman, lay three months cursing life and waiting for death. Just before the end, she was brought down the ladder one night like a spectre into the brothel, and so out into the ambulance. Thousands like her have been sick of this Plague in New York. How many have infected their patrons?

In one terrible house on the block lived a woman of ill-fame who had the Plague and struggled on—as a midwife—for a year.

But in this block the good outnumber the bad eight to one. In my month of work I met some of the kindliest good people that ever lived. Hundreds of homes are doing their best; and yet even these homes cannot be wholesome. The innocent suffer. I will give only one brief tale.

It is a story of love-Irish love. They had been lovers for forty years, ever since the wedding back in the sixties. Even now their tender devotion was the talk of the block. They were poor and had one room with a closet in a house called “The Bucket.” In this house of homes the saloon below has for convenience a side door opening into the hall. In nine years the house has reported fourteen cases of the Plague. The real number must be over twenty. Foul air, darkness, ignorance, drink—all are common here. But our old couple drank not a drop, and their rooms, I am told, were neat as wax-useless cleanliness, when halls and stairways are all foul, infected, and black as night. The old wife took the Plague. For one long year she lay growing steadily weaker. By day the young people came often to sing and sew in the room with their cheery old friend. By night, her husband, a watchman on the dock, was away from six until seven the next morning. He was sixty-five and could get no other work. When friends spoke of the hospital, both the old people broke down completely. It was never mentioned again. She kept so cheerful always that he began hoping she might get well. He even thought so one cold night just after Christmas, as he ate his supper while she lay in the closet behind. She kissed him good-night and was left alone. In the morning at seven he came back. Then the woman next door heard a low, shaking cry. She found the old man sobbing by the bedside. For his wife was dead.

A “Lung Block” Resident.

A “Little Mother” and her Baby in the Corner of their Only Playground.

So the sober and the drunken, the pure and the foul, the well and the sick, are all packed close and mingle. So lungs are made ready for the Plague.

So, too, death overflows in the tenements. We have seen how congestion helps to bring drink. We have seen how both together make blood grow thin and lungs grow weak. To the lungs so weakened, congestion now brings constant exposure. By the most careful scientific proof we know that the Plague can lodge for years in tenements. When these infected tenements are crowded and dark and filthy; when winter keeps thousands packed close inside; then they can make appalling records of suffering and death. Of the two hundred and sixty-five cases reported on the block, one hundred and four came from the six old tenements alone.

There is one called “The Ink Pot.” It has front and rear tenements five floors high, with a foul narrow court between. Here live one hundred and forty people. Twenty-three are babies. Here I found one man sick with the Plague in the front house, two more in the rear—and one of these had a young wife and four children. Here the Plague lives in darkness and filth—filth in halls, over walls and floors, in sinks and closets. Here in nine years alone twenty-six cases have been reported. How many besides these were kept secret? And behind these nine years—how many cases more?

Rooms here have held death ready and waiting for years. Up on the third floor, looking down into the court, is a room with two little closets behind it. In one of these a blind Scotchman slept and took the Plague in '94. His wife and his fifteen-year-old son both drank, and the home grew squalid as the tenement itself. He died in the hospital. Only a few months later the Plague fastened again. Slowly his little daughter grew used to the fever, the coughing, the long, sleepless nights. The foul court was her only outlook. At last she, too, died. The mother and son then moved away. But in this room the germs lived on. They might all have been killed in a day by sunlight: they can live two years in darkness. Here in darkness they lived, on grimy walls, in dusty nooks, on dirty floors. Then one year later, in October, a Jew rented this same room. He was taken and died in the summer. The room was rented again in the autumn by a German and his wife. She had the Plague already, and died. Then an Irish family came in. The father was a hard, steady worker, and loved his children. The home this time was winning the fight. But six months later he took the Plague. He died in 1901. This is only the record of one room in seven years. In the rear house is another Plague room—on the ground floor to the right of the low, narrow entrance. Here, in '96, lived an old Irish hat-maker, with his wife, his small daughter, his two sons. He was housekeeper. He took the Plague, worked a year or more there on his hats, then died. The cough came on his wife soon after. She suffered long, weary months, only to see at the end her young daughter begin the same suffering. The mother died. The home was shattered. The girl was taken away by her aunt, and soon followed her mother. The two sons died of the same disease, spreading it out into other tenements. So by this room one whole family was blotted out. This is not all. When the next housekeeper came to this same room with his wife both were strong and well. The man took the Plague in '99. He still fought for We when all knew he was hopeless; he still lived on when he could not rise, could barely speak, but only lie alone in one of these closet bedrooms. There are no fewer than twenty such rooms in this rear house—windowless, six feet by eight. That winter of 1900 brought the memorable blizzard. While it was raging, a settlement visitor came to this room, and found the water-pipe burst, the room flooded. The plucky little wife had carried her husband upstairs on her back. A few days later his struggle was ended. The wife is still here.

Infection comes not only from the room, but as well from halls and stairways. An old Italian, a hopeless victim, sits out on the steps in front, all day long in the sun while the children play around him, and all through the evening with men and women beside him. His cough never stops. The halls behind and above arc grimy, offensive, hung heavy with cobwebs, and these cobwebs are always black. The stairways in the rear house are low and narrow, uneven, and thick with dust piled up in every nook and corner. This dust is virulent with disease. Through the years a score of consumptives have lived here, groping their way each night up the stairways, stopping on the landings to catch their breath and cough, and so spread the infection. But for light trickling through grimy panels in doors, these halls are forever dark. It is in halls like these that the germs can live two years or longer. It is with halls like those outside that one clean room cannot bring safety.

This house is a danger not only to those who live in it. From here the Plague is constantly spreading out all over the city-to rich and poor alike. To show this danger, I give the few tales recorded here from the many in the past.

In this rear house lived once an Italian family. They, too, had little children, and so were ambitious, and gained a name with employers for always doing good work. Their work was sewing men's garments to be sold later in large clothing stores. The work was all done in their rooms. By working fourteen hours they could make sixty cents each. In early winter the man gave out. His weakened body could resist no longer the ceaseless infection. He took the Plague. He kept on working. The air was close and heavy. The windows were never open, for in freezing weather fresh air costs coal. His disease for months was constantly infecting the garments he worked on. He worked until the very end.

On the floor above, the right-hand room in the rear has one closet bedroom six feet by seven. An Irish boy of seventeen died there of the Plague in '96. Soon after, a man of forty-three moved in. He slept in the same closet. One year later I find him reported. His disease was slow. He kept on for two years with his work. His work was handling fish in the market.

In the basement lived another man who made hats. He died of the Plague, and soon after the basement became a pickle factory. So it is to-day.

In the front house, high up in the sloping roof, are the small dormer windows of an attic. An Italian woman, already sick with the Plague, moved in some years back, with a wild, carousing crowd of companions. Three weeks of this brought the end, and she was taken off in the ambulance. The attic is now offensive beyond words. It is packed with some twenty Italians—men and boys, one slight girl of sixteen, and a baby. The men bring in sheepskin rugs and by some process here make them snowy white, to be sold up-town from house to house, where they bring good prices. So the Plague spreads.

PLAGUE SPOTS IN OTHER CROWDED QUARTERS

This is infection for but nine years in one tenement. Not here aIone, but from every crowded quarter, these stories roll up with a terrible force. I give briefly the stories of three Plague rooms. Up on West Eighteenth Street is one room in a rotten old wooden tenement. For years it has held the same dust in its corners, the same grime on its ceilings, the same filth on its walls. Sanitation here is unspeakable. The Plague entered by chance a few years back. It was no chance that made it stay. Since then in this one room there have been five deaths from the Plague among those who, one by one, have come here to live, who have been weakened by its foulness, then infected by its germs.

Near by, on Fifteenth Street, are two rooms in a basement. These are damp and close and old with disease. The bedroom is wholly dark. Here the Plague came ill three years back. A man died. liis family moved out. An Irish family came next, in the winter—” all strong and well,” the dispensary doctor said. But human beings to keep strong need more than a foul, damp basement. Bodies grow weak; and if then the germs are breathed in they may lodge and spread with appalling swiftness. The husband took the Plague.  In two months he died. The family, now weak and sickly, moved out to go on charity. A stout German moved in with his wife. Six months later he took the same disease. They moved away. An Irish widow came next. She was the strongest of them all. The four little children were lively as crickets. Soon they began to change; their mother began to cough. Now she is dead and they are scattered.

The third “home” is but a few blocks away. The family moved in some three years back. They were American—a young man of thirty, his wife, and five small children. One year later he had taken the Plague and died. His wife slept in the same back-room. She died of the Plague six months later. Her old father and mother went there to care for the children. He slept in the same back-room. He died of the plague in 1902. His son came to help support the others. He slept in the same back-room. Two months ago he died of the same disease. Of these cases not one was reported as consumption. The room has not once been disinfected. The same dirt, the same grime, the same germs are undisturbed. The old grandmother is there now with the children.

THE SERVANTS OF THE SLAYER: DARKNESS, FOUL AIR, IGNORANCE

So in these Plague strongholds infection is aided by darkness and foul air. Of these two evils—darkness and foul air there are many causes.

One cause is the air-shaft. Through the city are thousands of tenements with air-shafts less than five by five. Rooms opening on these are technically “dark.” Add these to the rooms wholly dark, and we have in New York three hundred and sixty-one thousand. On the Lung Rlock alone are four hundred. The Tenement House Department is ordering the landlords all over the city to open up one side of each dark closet, so making a huge window into the room they belong to, that more light and air may thus come in. There are three hundred and sixty-one thousand to be changed. Meanwhile the worst Plague strongholds on the block all have these rooms and these air-shafts. Shafts like these are no places to breathe in; as one old Irishman said: “They do for wan mouthful of air”—but no more. The sunlight never enters.

I know a winsome little chap five years old, and his name is Yutzi Romeo. Two years back his father came over from Sicily, and eight months ago he sent for the little wife to come and bring Yutzi. I found them in a rear tenement on Hamilton Street, one where the Plague has made a fearful record. They lived on four dollars a week, in a room and a bedroom closet. Their front room looks into a court five floors deep—a court so narrow that a short iron bridge connects the two roofs above it. The closet looks on an air-shaft. This shaft is two feet wide by fifty deep; foul with garbage, decayed refuse, old clothes, and filth. The dark closet has a window high up, small and grated, that the people across the shaft may not crawl in. What a place for a little child to be sick in! Here night after night through the winter, while the man worked in the other room on sweat-shop garments, the little mother had sat up listening to the cough that grew deeper and more choking, watching the fever grow worse, the little body grow thin; frightened more each night as the neighbors told her of the Plague and what it could do. She, too, was ignorant. She bought a cheap print of the Madonna, set it up in the dark closet, and prayed as even ignorant mothers can. She had tried two Italian doctors. I tried two more. “Consumption—hopeless,” said both. Then we went up-town to a great specialist on lungs—and kindness. He said at last:' “Malaria and bronchitis—will almost surely develop tuberculosis in such surroundings, but now his case is hopeful.” So the chance was seized, and one of the thousands was taken in time.

There are hundreds of other shafts as foul, hundreds of other little children as tender, hundreds of other mothers who love but do not know.

A second cause of foul air is that thousands of tenements have no skylights. All the hot, fetid air from the halls, the stairs, and the open rooms below rises up, finds no way out, and settles in the hall and rooms above. Time and again, going with the tenement inspector, I felt a breath of bad air as we reached the top hallway. This complaint, "no skylight," was sent in for almost every house on the block where the Plague has its stronghold.

I remember one of the worst, another old house on Hamilton Street, with eleven cases recorded in nine years. I went in one night at six o'clock. Outside was broad daylight. I climbed five dark flights, felt the heavy, foul air of that cramped top hallway, and, groping my way to a door, I knocked and entered. A young Irishman of twenty-five lay fevered, smothered, breathing hard, in a tiny room stifling hot. His was an advanced case of the Plague. Close beside his lounge, on a soiled pillow on a chair, lay his baby girl five months old, with eyes wide and frightened, sick with pneumonia and the measles. The doctor who kept the drug store had come up once to see her. The wife, a thin, pale girl of twenty-three, was out office cleaning. She would come back at eight o'clock, worn out, to cook and clean and nurse. Two children on their floor had died that week of the measles. They had not been reported. The man kept the windows all shut for fear of his baby. So they lay side by side—white, weak, fighting for every breath. And every breath held the germs of the Plague.

Below, on the ground floor, lay a man of twenty-nine, a hopeless case, a beast from drink and worse. His room was a pen of tilth, its foul, infected air mingled with that of the equally infected halls and stairways, and this air rose up to the father and his child. So it is with thousands.

There are many other causes of darkness and foul air. All these I can show best by a story of a case in “The Bucket.” In the fourth floor rear lived an Italian and his wife, with five small children. The dark man was a hard worker, from daylight until long after dark, sewing neckties. He took the Plague in a tenement nearby, which is called “The Morgue” because in the past fifteen years it has held twenty-eight cases of the Plague. They left this place and moved up-town, but could not bear the expense and so came down to this tenement on Cherry Street. The man was sick three years, still working when he could—infecting the ties he worked on. At last he stopped and went to the hospital, but soon left and came “home” to die. It is this love of wife and children that brings thousands of deaths from the Plague in the tenements. The man died in the spring of 1902. But he died too late.

This family of eight had lived in three rooms. One was a dark closet, windowless; next came the kitchen, also dark; and third, the “best room,” crowded with old plush furniture, with two windows looking into the court behind. Here the children lived with the father, while he slowly died.

Here the air was forever foul. From their windows the court looks like a deep pit; brick walls rise up on all four sides. It is crowded below with school sinks, and these we found unspeakably filthy, with three weazened little chaps playing hide-and-seek between them. The ground floor of the house is a pork shop, where huge cauldrons of pork fat boil day and night. Even from the roof above we noticed the sickening odor. Inspecting the cellar we found a strange odor of gas. The floor as usual was damp, uneven earth. A huge sewer main ran along one side. In this we found three gaps the size of your fist, and two rents, one eighteen inches long; hence the odor, which mingled with the other odors in the pit outside.

This air came in the front room, through the dark kitchen, into the closet behind. In this closet, seven feet by nine, slept four of the smaller children. Rosalie was a gentle little girl of seven. At night she slept in this closet. By day she watched three still younger brothers and sisters while her mother was out scrubbing. You could see her grow paler each day, so I am told by a friend from the settlement near. It was then her father came home to die.

That was a terrible month. The mother never let the four younger children go down to the street below, where you can see men and women drunk at any hour, where, on the one block, on this one side of the street alone, are eight saloons and several houses of ill-fame. So they used to play most often in the hallways. These we found so dark that it took the inspector's lamp to show up the filth on floors and stairs, the broken plaster, the grimy streaks and patches on walls and ceilings, the ideal dark hall where germs live two years and longer.

“It is in Halls Like These that the Germs Can Live Two Years or Longer.”

An Air-shaft Six Feet Long, Twelve Inches Wide, and Six Floors Deep.

“Halls, Courts, Air-shafts, are all Left Cramped and Deep and Sunless.”

There are Over 361,000 Such Dark Rooms in the City.

The father died. The Italians spend every cent on their funerals. So it was here. Then came even closer living-and then the hot weather. The four brick sides of their pit grew too hot to cool off at night. All night you could hear the coughing from two consumptives on the floor just below.

“The Bucket” grew terribly thirsty; noises grew louder and more prolonged. Foul air arose from the cellar, the pit, the halls, the closet. Rosalie took the Plague in one of its most loathsome forms—intestinal tuberculosis. She sank swiftly. A visiting nurse was summoned, and found the child lying on two chairs near the two open windows. “She was a pitiful sight, only skin over bone.” She could barely take medicine. She could not even turn over unless you helped her. So the weeks bragged on while the foul air steamed up. In the end of August Rosalie died.

THE WARFARE AGAINST THE PLAGUE

Congestion, Dissipation, Infection! The war against them will be fought on two lines, Prevention and Cure.

Prevention is slow. Foul air, darkness, and ignorance—these must be steadily changed for fresh air, cleanliness, knowledge, and light. It means years of unceasing work ahead: unceasing work by the new Tenement House Department which in one year has made such a splendid beginning; unceasing support of this work by the people of New York; unceasing appropriations; unceasing belief that to save thousands of human lives is cheap at any cost. It means millions of dollars to be spent in new parks, in playgrounds, in public baths. It means big-hearted brotherhood. It means self-defence.

Cure need not be slow. Those sick of the Plague must now be treated “at the right time, in the right place, in the right way, till they 're cured”—not as before, “at the wrong time, in the wrong place, in the wrong way, till they 're dead.”

ln Germany every laborer and servant is obliged by law to become insured against sickness, accidents, and old age, the companies being controlled by the government. Hence, as soon as the Plague's first symptoms appear, men are quick to find relief at one of the many sanatoria. There, in 1897 and 1898, eighty-two thousand insured men and women were treated, and of these seventy-one per cent left with strength and hope won back. So they have now learned to hope; and so by going in time arc lastingly cured. Here in America men wait on until unable to work, then sec a doctor, and at last are reported hopeless. The cry, “The hopeless report, the hopeful don't!” comes from all the men and women who are striving to push this tremendous campaign. I give now the reasons for this cry.

FACTS TO BE FACED IN NEW YORK

They don't report in time because the places of cure are not yet inspiring trust and hope. Go to-night through this same block. You will find no one sick. They must know you first. What is your business there, how can you help? In my week as “fresh-air man” I found many cases before unseen—because I could help. The city has even now room for but a few hundred consumptives. It is well known that most of the cases it takes are already hopeless. True, a few are cured, for a right beginning has already been made. On the East River islands are city hospital camp:i which arc doing excellent work. At Seton Hospital a few more are cured each year. This is just the beginning.

It must take time and widespread endeavor to kill the vague superstitions that have grown up between the tenements and the city hospital. “The black bottle” I have heard of again and again as containing a fatal drug, which the doctors are believed to give when tired of free patients. So thousands are afraid and don't report.

They don't report in time because thousands feel that the Phguc is absolutely fatal. On the Lung Block two hundred and sixty-five have been sick; hardly one has been cured. Those sick feel the Plague fastening slowly. Many make up their minds to die, and wait, working.

In the house where Rosalie died I found a brave little woman working, waiting with her daughter eight years old. They have a room looking into that same foul pit; a dark kitchen behind it, where the gas was lit when I went in at noon; and behind, wholly dark, a bedroom. In this room her mother died of the Plague eighteen months back. Her father and brother both died of the Plague in a house quite as bad a few doors up the street. Her husband was already stricken. He drank. He had left her. His mother and father, his sister and two brothers, had all died of the Plague over on Hamilton Street. And now in the last five years her two babies had died from another form of the same disease. “What 's the use? What's the use?” While her mother was sick she was working through the summer in a factory from 7.30 in the morning until 10.30 at night. I have seen such places in summer. A hasty swallow at noon and six o'clock; between, only desperate haste. “The steam was the worst,” she told me; “it was awful-awful-awful!” The few hours at night were by the sick mother. In a few months her weakened lungs, too, were infected. The Plague fed with terrible swiftness. In eight months she lost eighty-five pounds—but still, worked on. At last, too weak for the factory, she worked from seven until nine and again from five until eight, at office cleaning. So we found her and had her examined. The doctor said there was still a chance. And because the girl of eight was pale and delicate, we offered to send both for three months to the country, where medical care could be given. But she said: “It 's got to come anyway, an' we 'd get homesick for the block, so I guess we'll stay.”

“It 's got to come!”—this is the belief of thousands. This belief can only be destroyed by hundreds of cures to be begun in 1903.

They don't report in time because hundreds are insured in small companies, and this insurance is all lost to the patient's family if his disease be reported as consumption. It is for this cause that thousands have died of the Plague, begging their doctors to call it pneumonia or bronchitis. Doctors, too, are human, and the immediate needs of their patients obscure the importance of accurate records. So thousands have died in years past and the records, startling as they are, have not yet told the whole story.

They don’t report in time because they want to live to-day, not after six months of tedious, doubtful recovery. This is most true of the lrish. To-day is worth a score of to-morrows. Just here the quack steps in with his “Sure Cure for Consumption.” I know one drug store on Catharine Street where the druggist counted from memory eighteen who had come to him regularly for these patent cures. These cures contain alcohol, which brings relief to-day but relapse to-morrow. Their written promises are vastly more attractive than the vague hopes held out by the doctors.

The druggist told me of one tall, genial young Irishman, barely twenty years old, who came every week for three months in the winter, growing steadily more emaciated, his eyes more hopeless, his jokes more feeble, his smile more forced. At last he disappeared. So it has been with not hundreds but thousands here in the city who have spent their small earnings, their small hope, in these cheap deceptions, have lost faith in all medical aid, and so despairing have died.

One reason why the Plague makes such slow progress among the Jews is their constant effort to cure it in the right way-by fresh air, by right and abundant food. I know of one family with five small children where every cent was scraped and saved from the push-cart earnings in the Ghetto to send the father back to Germany to a sanatorium there. This happens, I am told, with hundreds in our Ghetto.

Up on Second Avenue lives a Polish widow. She has two babies, two and three years old, and she has taken the Plague. She is only an ignorant mother. Being ignorant, she cannot

see the danger, nor the use of carbolic acid. Being a mother, she sleeps with them, feeds them, loves them. To leave the wretched small room, the unchecked fever, the aching weariness of sleepless nights, to leave all this-and the babies-she has twice refused. And up on East Sixteenth Street there lives a Russian sick of the Plague. All day and long into the night he sat sewing garments in the one small room. His little daughter of twelve worked with him. Now she, too, has taken the Plague. Again and again have friends tried to give her these summer months in the country. But her father is sick and alone. So she, too, stayed on—and now she is dying.

They don't report in time because-and this last reason is strongest of all-they won't give up. Life in the tenements is bright and full of color if only you keep up. Lose your grip, and things seem to pile up in a day and bury you under. All who watch the tenements will tell you this. “Don't lose your grip!” is the motto. Charity experts agree that here in America the dread of going on charity is generally greater than in any other country of the earth. And so they fight on, because plucky, and because they have seen their Plague-stricken friends go to the hospitals only to die. They keep clear and won't believe in time. They fight on blindly. I remember case after case of brave, unceasing effort, of kindness, devotion, and death. Most of it is blind for all the reasons I have given, and because there is hardly a case that can be cured without large expense of money.

I am glad to tell of one case where the unaided struggle was won, in a rotten old tenement on Cherry Street. Husband and wife, Danish, they had lived on the block for sixteen years. The man was pronounced hopeless last December. Then his wife took charge. Years ago, as a nurse in the English army, she had fought day and night the fearful cholera plague in India. She was iron-strong in mind and body and soul. For three days, she told me, she “talked the Plague right out of him.” First—all doctors were fools! Second—he was a coward! Third—he must get well! She had sent to Denmark for a wonderful herb which her old mother had used, and for some Danish sweet oil. She brought out now every cent of her savings. Milk and eggs, meat soups and oil—all these were given constantly. He was moved to a lounge right under the open windows. He was never left alone. The Plague was talked out, oiled out, herbed out. Perhaps the milk and eggs and the unceasing devotion did it. He gained twenty pounds, and is now again out working—ten hours a day cleaning out manholes.

This success is but one among thousands of failures. Across the street, in “The Barracks,” a woman told me that for weeks she had been kept awake in her closet bedroom by an unending cough that came through the thin partition beside her. It was some time until I found the one who coughed, because she worked all day. She was a German widow whose husband died of the Plague last year. She has three children, one a baby in the day nursery. She comes home only late at night. At first she was afraid to be examined, and it was only through the kindness of the doctor at the mission near by that this strong fear was overcome. The woman had the Plague in the very beginning stage. She might easily be cured. She was told she might take her baby and youngest boy to the country to be boarded free all summer. The boy of fourteen was to be kept with friends until she came back in the fall. She refused. She thought work was too rare to be given up; what if she could find no other work in the fall and so go on charity? Anyway, she wasn't yet sick. She would work on, she said, until she got sick in bed, and then she would think of being cured. No arguments from visitor, doctor, or friends could change this decision. “Keep your grip!” It is the motto of America.

WHAT THE SITUATION DEMANDS

The right time, the right place, the right way, are all demanded. The sick will never report at the right time until they believe they can be healed; until they know we have the right ways and the right places to cure them. These right places must now be made.

Millions must be spent—because thousands of human lives will not be saved for less. Most doctors agree that every consumptive should be taken outside the city to sanatoria. All doctors agree that there are thousands in the most wretched of our tenements who cannot possibly be cured in their present foul surroundings. As one has said: “It is open air, and open air all the time, that counts.” He adds: “The Plague is not cured by quacks, by patent medicines, nostrums, or other secret remedies; but solely and exclusively by scientific and judicial use of fresh air, sunshine, water, abundant and good food; milk, eggs, meat, vegetables, fruit; and by the help of certain medical substances when these hygienic and dietetic means do not suffice in themselves to combat the disease.”

The farm cure plain and simple is not enough. A friend of mine sent one young Russian to a farm last March to be cured by Nature. The Plague was only beginning. The time was right; the place was wrong. At the end of a month a series of letters began, of which I quote bits that tell the whole story: “i am improving very nice—i aint coughing no more—i am getting fat—i sleep good and i have a good appetite to eat—i gained sixteen pounds-the country doctor here says the only thing i Need is plenty of exercise work all day plowing and planting on the farm—so i do. when i earn enough i will bring my wife and baby—it is a regular paradise—i will live here always—the faivers you have done to me will never be forgotten.” Two weeks later: “you write me not to work hard. you no as long as i am harnest up i must pull—my wife and baby are here and feel good—i will answer your questions—i cough again bad—appetite no good—sleep no good—sweatenights no—fever yes.” Ten days later: “i am coughing something terrible werst i ever did." He died.

He should not have died! And now others like him must live. We must have the right places; where not in summer alone but all through the winter the sick may have the right use of fresh air and sunshine; where the right food may be given in abundance; where doctors will not advise “heavy plowing all day”; but where the right doctors and nurses will ever watch and heal.

Millions must be spent because it is sound common-sense, because these few millions will save to the city countless millions more. Dr. Biggs of the Health Department has estimated that the total loss to Kew York City alone from this Plague is at least twenty-three millions of dollars a year, and that the loss to the United States must be over three hundred and thirty millions. Why? The Plague attacks young men most of all. The average cost to society of a man's bringing up is fifteen hundred dollars. This loan he returns by the labor of his manhood. Multiply this by the thousands of young men who die each year of the Plague in New York alone. To this loss you must add millions more for the care and expense they require from families or friends or the city, in their lingering illness. It costs each patient several hundred dollars to die. And add still more. For, as was recently said, the Plague, because so lingering and hence so costly, because it attacks most often the breadwinner of the family, is “a cause of poverty out of all proportion to its importance as a cause of death.” Wives and children are forced on charity lists.

And so each year the expense rolls up into the millions. We are told that five millions wisely used now for great sanatoria, for more dispensaries and diet stations, for more inspectors, would save countless millions to be lost year after year in the future.

What has been spent before has been mostly useless. Four per cent of the tenement consumptives have gone to hospitals—most of them to die, and for lack of room many have gone into the wards with other patients. This four per cent has cost the city five hundred thousand a year without proportionate result. “Treble this sum,” says Dr. Knopf, “and thousands of lives may be saved annually.” Not only will these lives be saved; they will cease to be a menace to others.

The old treatment in the hospitals was as costly as it was useless. In one recent year seventeen hundred and fifty died in the public hospitals of the city. Careful calculation shows that these, if treated in sanatoria, would have cost the city four dollars a week less for each patient. It is the same among children. The need for seaside sanatoria for little children whom the Plague has attacked in other forms—this need is appalling. In such places thousands like Rosalie might have been cured. On the coasts of Germany. France, Italy, Holland, thousands of lives have so been saved. Over here, our Plague-stricken children, if cared for at all, are kept in city hospitals at an expense for greater, with suffering far worse.

“The Stairways in the Rear House are Low And Narrow, Uneven, And Thick With Dust Piled In Every Nook And Corner.”

A Group of “Lung Block” Children.

Millions must be spenot because hundreds of thousands from every class in the city are in constant danger. As Dr. Knopf has said, the patient up and about, attending often to his usual work, but expectorating indiscriminately everywhere from ignorance or carelessness, is the most dangerous of all consumptives. You have heard stories of how the sick struggle on. In laundry, cigar factory, cook shop, fish market; as waiter, as midwife; in scores of callings they have worked on and coughed and worked on still. infecting their fellows and the products of their labor. Of these the sweat-shop work is most dangerous, most potent to spread the Plague to all classes. It is an open fact that most tailors from every class put their work out to be done in the sweat-shop or in the tenement home. The home itself becomes then a sweat-shop.

In a row of fifteen old houses on Cherry Street I found thirty-one little children and eighty-seven women sewing on garments. The garments they sewed were almost all to be worn by young children-the kind you buy in our clothing stores. This row of fifteen houses included the five most deadly Plague strongholds on the block.

This home work shows most clearly what is true in some degree in all other trades—that the Plague-stricken poor must work on to the very end. You have had stories enough. I will add but a scene taken from the written records of a visiting nurse.

The man was dying down in the Ghetto. His cough kept on day and night. It was January. Coal was high. The room at night grew freezing cold. The Plague grew worse. He worked on in bed. He had but one blanket. He used the coats and trousers to cover him. Now consider our tense, rushing, strained city life; remember the scores of your own friends whose vitality is now at the lowest ebb; and then think of the constant danger to them from a Plague whose victims keep on working, who are constantly in the streets, the cars, and all public places. We all use the products of their work. Only be human and think of these hundreds of thousands, rich and poor alike, in constant danger. Thousands of these will inevitably be taken with the Plague this year, as thousands were taken last year and before. It is for next year, the next, and the next, that I appeal.

Millions must be spent-because we are human. It is my last word. It holds all the rest. I once heard a little chap uptown on his knees at night whispering, “Give us this day our daily bread.” He stopped and asked, “How many is us?” From a visiting nurse I heard of another. He was four years old, in a tenement room, and dying. The Plague had gone all through his weak little body. The eyes were blind. And each night, when her half-hour visit was ended, he used to grope for her hand to hold it just a moment, that it might help him bear the long night. This baby might have been saved. He is one cost of delay. The weak groping hand seemed to ask the same question, "How many is us?" And this is the answer:

"I was an hungered and ye gave me meat: I was thirsty, and ye gave me drink: I was a stranger, and ye took me in: naked, and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came unto me [....] Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me."