The importance of the standard of living can best be appreciated when we consider not merely of what it con sists at a given time, but the changes which it is undergo ing. The most striking indication that there has been a continuous change for the better is revealed by a study of vital statistics. This is the diminution of the death-rate : the prolongation of human life, and especially the prolongation of the period of childhood, and the con sequent better preparation for the working period of life. In the ten years between 1890 and 1900 there was, in the language of the census, " a remarkable and most satisfactory decrease in the death-rate." In what is known as the registration area,' presenting an aggregate population in 1900 of nearly 29,000,000, the death-rate declined from 19.6 per thousand in 1890 to 17.8 per thousand in 1900, notwithstanding the fact that there was a more complete record and therefore a more complete return of deaths for the census of 1900.
During the same period there was a decrease in the death-rate of nearly all European countries, closely ap proximating that given for the registration area of the United States, indicating that the improvement is not due to local or accidental causes, but to the advance of sanitary and medical science ; to a general improvement of eco nomic and social conditions or to other similar causes oper ating throughout the civilized world. The fall in the death-rate of what is now Manhattan Borough of New York City was from 26.7 to 21.3, or over 20 per cent. This decrease is attributed to the advance in medical and surgical knowledge, — especially in the line of preventive medicine ; improved sanitary surroundings and cleaner streets ; and a stricter inspection of milk and food.
In Boston the decrease was from 23.4 to 20.1, and the causes assigned were : improved water supply ; improved sewerage ; abolition of the old vault system, and the sub stitution of water-closets ; additional public parks ; and improved health regulations.
In Buffalo the death-rate decreased from 18.4 to 14.8, and from a very complete analysis of the death-rate dur ing the ten years, with tables showing deaths in each year by ages and from certain causes, it appears that the great est decrease is in the number of deaths recorded among children under five years of age, the largest percentage of decrease being among those under one year. This is attrib This area in 1890 included Connecticut, Delaware, District of Colum bia, Massachusetts, New Hampshire. New Jersey, New York, Rhode Island, and Vermont, with the cities therein, and 83 cities of 5000 or more population in other states. In the census of 1900, the area in
cluded the states named above, with the exception of Delaware, and with the addition of Maine and Michigan, and included 153 cities outside the states named, having a population of 8000 or more. The com parison, therefore, is not between identical areas.
uted to preventive and remedial agencies, summarized as follows : Control of the milk supply by licensing and supervision of milk-dealers ; inspection of outside dairies supplying milk, and the exclusion of the produce of dairies in un sanitary condition ; the enforcement of strict regulations requiring the immediate reporting of contagious disease (among which tuberculosis is included) ; inspection of infected premises, and strict quarantine during the dis ease, with complete disinfection after its termination ; obligatory vaccination of school children, free baths, pub lic and private, for bath and laundry purposes. Tenement houses and lodging-houses are repeatedly inspected, and made to comply with sanitary regulations, and other municipal improvements are made of a similar character.
The most encouraging fact about this decrease in the death-rate is that it has occurred not only in the last ten years, but that, with minor fluctuations, it has continued for over half a century, and probably much longer, wher ever registration statistics are available.
From the doctrine that there is in each community a definite standard of living, and that charitable relief is concerned, not with raising or lowering it, but rather with eliminating the obstacles which particular individuals and families have in realizing the standard, and in securing the withdrawal from the industrial class of those who are unfit for a place in it, there result certain conclusions which must not be overlooked. The first of these is that the community must provide sufficient hospital accommoda tion for the sick.
There are many kinds of diseases which can be treated effectively only in hospitals or sanatoria, for which the actual provision offered is everywhere totally inadequate. Crippled children, consumptives, and those who are of flicted by cancer, are the most conspicuous illustrations ; but it has been demonstrated that many other forms of dis ease, which have heretofore been neglected or treated only at home, can be treated more effectively in hospitals. In cases of confinement from childbirth, properly equipped maternity hospitals offer greater safety and more satis factory care than is possible even in the homes of the well-to-do, and certainly greater than can be secured, as a rule, in the tenement-houses.