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The complications to the pulmonary condition, if any.
The previous work history, particularly since the onset

of the disease.

The intelligence and probable cooperation of the patient.
The patient's home conditions, so far as they can be

learned.

On the basis of these seven points, each person referred
for placement should be placed, according to work capacity,
in one of the following groups. The jobs should be chosen
not only in accordance with this work-capacity classifica-
tion, but with the principles outlined covering suitable and
unsuitable jobs.

The suggested classification is:

Maximum Capacity. Those able to do a normal day's
"selected" work. That is, eight hours' office work, or nine
hours' shop work, up to twelve hours' inactive work.

Limited Capacity. Those able to do part-time "selected"
work.

A. Six hours under ordinary conditions.

B. Four hours under ordinary conditions.

C. Four hours' work, seated, done during the daytime and
in a work place near the home.

Minimum Capacity. Those able to work in specially super-
vised surroundings only, that is, in a sheltered work shop, or
sanatorium. This may also include home work provided the
patient does not have to call for and deliver the product.

Each patient should be studied by his own physician and
his individual work capacity described in terms which the
placement worker can understand before a job is procured
for him. The classification is suggested in order to make
this possible it is somewhat similar to the one already in
use in the heart clinics.

We believe that through this the placement worker can
interpret the physician's estimate of the patient's work-
tolerance; and also that the physician in making recom-
mendation for these patients, should describe them not only
in terms of the classification of disease, but also add to it
the work capacity and thereby a great advantage would be
gained in the suitable placement and the intelligent advise-
ment of the tuberculous case.





READY FOR RECREATION 1306 READY TOR RECREATION I32G

Courtesy of the American Child Health Association





HYGIEISE LESSOIH 1306



HYCIEME LEJ/DN 1326



August 15 September 15, 1927



THE SURREY



545



Fifty-three Experiment Stations!

By HAVEN EMERSON, M.D.

CAN we afford it? Don't we really care to follow
science? Does experience stop at state boundaries?
Do tubercle bacilli behave as inconsistently as people?

In the eighty pages of State Health Department Super-
vision in the Control of Tuberculosis, Robert E. Plunkett,
M.D., Director, Division of Tuberculosis of the New York
State Department of Health puts us on parade, state, terri-
tory, and district, laughing when he is not weeping at our
irrational and incompetent performances. At least he shows
what a ludicrous matter is much of the statistical record
keeping, how uneven is the work to find and heal the tuber-
culous, how trifling has been the advance through these
twenty-five years of wordy warfare under the aegis of the
double bar cross.

The National Tuberculosis Association publishes this
pamphlet. Go! get it! you tuberculosis executives, visiting
nurses, local associations for health. Read, ponder, and per-
haps even act, on the scourge of facts given by your state
departments of health, and assembled fairly so that all may
read and understand.

How can we act as if we had arrived, in the social or
civic sense, or continue blithely in a maze of make-beli'eve
when even in the best equipped, richest, least illiterate, most
law abiding of states we find that almost one half of all
tuberculous patients who die were not reported at all or
only after death ? In the name of all the barn-doors-closed-
after-horses'-exits what are we as a people thinking about?
Would the underwriters make any trouble for a city if 45
per cent of the fires were allowed to burn themselves out?
Yet almost a quarter of all the cases of tuberculosis reported
by the death certificate were never even acknowledged to
the Health Officer, in New York State's population, even
after the patient's death.

While the amiable optimists of Framingham declare there
are ten cases of detectable tuberculosis for every death per
annum, and the hypercritical Allan Krause proves that five
active cases can be found for each annual death from this
disease, and while the very lowest common or garden
health officer ratio is accepted as three cases per death per
annum, there are only two states which have reached even
this last lowest goal, and only five more states in which
from two to three cases of tuberculosis have been reported
for each death registered from this disease. In only twenty-
six of the states or territories were there as many patients
with tuberculosis reported as there were deaths from the
disease. Talk about ostriches, their middle initials must
have been M. D.

And even when tuberculosis is reasonably well reported
as in Kansas and Maryland we find that rarely are as many
as 20 per cent of them discovered in the incipient stage of
the disease. Furthermore each year shows a smaller rather




MEDICAL IM/PECTION 1306




than a larger per cent of all reported cases, classified as in
the incipient stage. Almost uniformly each year in New
York State over 30 per cent of all reported cases of tuber-
culosis are found to be in the advanced stage of the disease
at the time of the report.

Baldly stated it is certainly not by virtue of an intelligent,
consistent, uniform public health control that tuberculosis
has diminished as a cause of death. While prosperity lasts
tuberculosis is certain to continue its fall to a subordinate
place among the first ten causes of death. Dr. Plunkett's
study is heavy with implications, and offers incentive to
modesty on the part of health officers and tuberculosis
associations.



MEDICAL EXAMINATIDh 1336



BOSTON has opened still another Health Unit, the fourth
in her public health plan, and the third under the cooperation
of the George Robert White Fund. Four years ago the
Boston Health League and allied interests urged and secured
the application of the income of the George Robert White
Fund to the development of Health Units. This Fund given
by a public spirited business man totals several million dollars.
Its income is to be applied to "works of public utility and
beauty for the use and enjoyment of the inhabitants of the
city of Boston." The first Unit was constructed in the North
End; the second in East Boston; the third in South Boston.
It is one of the terms of this gift that all public utilities
created under the Fund shall be maintained by the city out of
public funds. It is the practice therefore in the establishment
of the Health Units for the city to conduct them through its
department of health. The same architects have had charge
of the development from the beginning, so that this third unit
combines all of the advantages and seeks to eliminate the few
disadvantages thus far discovered in previous construction. No
expense has been spared to make the building and its equip-
ment adequate to the proposed uses, yet there is no unnecessary
adornment to be found. The x-ray, dental and other equipment
in this last unit cost some $35,000. In the building are housed
branch offices of the Overseers of the Public Welfare, the
Family Welfare Society, the Catholic Charitable Bureau, the
Boston Provident Association, the Jewish District Service, the
Community Health Association, and other private incorporated
charitable enterprises, in addition to the city Department of
Health. Jointly the group conduct a series of clinics drawing
the public schools closely into cooperation.

WHAT twenty years has meant in the movement for child
health is suggested in the silhouettes on this and the facing
page, taken from the charts prepared for the last annual
meeting, of the American Child Health Association. Stiff
gymnastics are giving place to free play; cut and dried book
lessons to actual practice in the habits that make for health
and growth ; while the expansion of routine medical examina-
tions to include the education of the mother and follow-up by
the nurse helps to make them more than a matter of formality
and statistics by setting in motion the desire and the means to
correct the physical defects which they disclose. In twenty
years the infant deathrate of this country has been cut by more
than 50 per cent and the general expectation of life lengthened
by ten years, but the number of mothers who die in childbirth
in the United States continues higher than most of the rest of
the civilized world and even shows a slight increase in rate.
For reproductions oi these drawings and graphs in chart or
slide form write the American Child Health Association, 370
Seventh Avenue, New York City.



COMMUNITIES



Lions 5 Libraries



By MAI A. CLINEDINST



A"ie fall term opens in the little red brick country
school houses of York County, Pennsylvania,
hundreds of boys and girls will be looking for-
ward to the books which the Lions' Club of
York brings them each month during the school
year. Realizing that the elementary grades give the best
opportunity for guiding children toward good reading, the
Club appointed a committee in 1925 to look into the library
plans outlined by the Lions' International the previous year.
Examination of this project led to the discovery that it was
not practical for York, owing to the limited facilities of the
town library, but after conferences with the writer it was
found possible to extend to the isolated schools of the county
the system of small circulat-
ing libraries which had been
started in the public schools
of the town some years
earlier.

By this plan collections of
twenty carefully chosen
books are sent to the schools
and left there for a month
in the charge of the teacher.
The books are issued at
least once a week for read-
ing at home or in spare
moments at school, so that
each child has an oppor-
tunity to choose several in
turn, and often to read all
of them. The books are
housed in substantial wood-
en boxes equipped with
hinges, locks and handles,
which serve as an open
bookshelf in the classroom
and as a closed container in
transportation. A list of the
contents, an itinerary of
transfer dates from school-
room to schoolroom, and a simple charging outfit are en-
closed with each traveling library. The boxes are circulated
by volunteers from the Lions' Club, who make themselves re-
sponsible for their distribution on the allotted dates and thus
keep in personal touch with the children and their reading.

A report blank is sent out every month from the Club to
record the circulation of books in the individual rooms and
is returned to the Club. Little time or energy on the part
of the teacher is required. In some instances one of the
older pupils has charge of the library hour. At the close of
the school year the libraries are returned to the Lions' Club
for inventory. Books and boxes are examined for repairs.




Woodcut by Herbert Pullinger from The Woodcut of Today, London Studio
The District School



Wornout books must be discarded, plans for the coming year
are discussed and additional books are bought and catalogued.
At the start a survey of rural schools was made with the
approval of the county school superintendent to determine
which schools were most in need of aid, and the teachers of
these schools were invited to a meeting at the Lions' Club
at which instructions as to methods of charging and distri-
bution were given. The library committee of the Lions,
aided by the women's auxiliary and the public school libra-
rian, prepared and catalogued the books and arranged them
in the traveling boxes, which had been made by two Boy
Scouts, sons of *wo members of the Lions' Club. The first
year there were twelve collections of twenty books each,

selected from a list of stand-
ard titles submitted by the
writer. The average cost was
$30 for each box of twenty
books, not including the con-
struction of the boxes. The
third month of operation
showed 1,032 readings of
the 240 books, an average
of five readers to a book and
an excellent testimonial of
the children's appreciation.
Last year there were 30
boxes or a total of 600
books in circulation over
four different routes lead-
ing from York, and the esti-
mated readings during the
school year showed a total
of at least 30,000, and this
fall the number of boxes
and books is to be doubled.
The Lions' Club of York
recognizes the traveling li-
braries as its major activity
and budgets an appropriate
sum each year for main-
tenance and development of the service.

Discussions and dramatizations of the books in the class-
rooms show that they are carefully read. Interest moreover
is not confined to the children alone, for parents and older
brothers and sisters eagerly anticipate the arrival of a travel-
ing library. One little girl who was reading Joanna Spyri's
Heidi at home was asked by her mother, who was illiterate,
to "read her the pictures." Not satisfied by pictures alone, she
then asked the child to read the book aloud and the next day
sent her to school with the question, "Where is Switzerland ?"
In the isolated roads of York County, Pa., new worlds are
being opened to the imagination, new interests established.



546









New Towns for Old



By GEDDES SMITH



THE wily peddler in the story of Aladdin's lamp,
who went up and down the streets of Baghdad
crying "New lamps for old," was trying to get
the better of his customers. He knew that a very
special virtue lay in the old lamp which he hoped
to take in trade a magical power for which no amount of
shiny new brass could compensate.

But since his day the cadence of his cry has been borrowed
hundreds of times by reformers who have persistently turned
the phrase inside out. New lands for old, new creeds for
old, new thoughts for old, they have cried, and they have
sincerely believed that the new thing they offered was so
much the better that the wise man would hurry to his
doorstep to make the exchange.

John Nolen uses the phrase in this sense as the title of
his suggestive and encouraging book on town planning
(New Towns for Old, by John Nolen. Marshall Jones Co.
177 pp. Price $3.00 postpaid of The Survey), but he gives
himself away on the jacket for he has allowed his publishers
to decorate it with a drawing of a perfectly good Gothic
church designed by that arch-revenant Ralph Adams Cram
a draft of the old vintage if there ever was one. The fact
seems to be that Mr. Nolen is in love with his old towns,
and for that very reason creates new ones a paradox which
gives me the text for some comment on the new towns in
his book and some others.

What are the virtues of an old town? What comes to
mind when we hear reference to Old Lyme, or old York,
or old Nuremberg? In my mind the picture is of some-
thing established, gracious, lived-in picturesque, but not
deliberately so. Old places grew to be the way they are.
Why are they now beautiful ? For one thing, because they
were built for use by the builders, not for exploitation by
realtors. They had to be livable because they were designed
for daily wear and tear. There was a singleness of motive
in their construction which, coupled with something solid
and cohesive in the culture of which they were an ex-
pression, gave them esthetic integrity.

More than this, as Mr. Nolen points out in one of his
introductory chapters, the old town of the New England
species was characterized in many instances by a shrewd
adaptation to its site, by a natural and inevitable civic
center, and by a matter-of-fact road system leading where
people wanted to go, instead of criss-crossing in the arbitrary
fashion of Philadelphia or the New York of 1811. Mr.
Nolen is neither so eloquent nor so emphatic in his praise
of the Puritan village as Lewis Mumford in Sticks and
Stones, but both agree that it worked. Even Boston's
maligned streets, Mr. Nolen points out, were intelligent in
their original intention and still provide "a strikingly de-
sirable basis of natural growth to work upon."

From the virtues of the old town it is an easy step to
Mr. Nolen's summary of the essentials of a new town the
sort of new town in which he is interested, not the sort
that is devised merely to pay a smashing profit to the pro-
moter and to lure the home-buyer with smart promises of



cfi


c/>



"appreciation" in the value of his purchase. Mr. Nolen
suggests four essentials:

1. The new town or city should have the right location,
the right site geographically. This is a matter of primary im^
portance, and is related closely to national, state and regions^
planning. . . .

2. The local plan for a town should be based upon topo-
graphical conditions, and be worked out in right relation to
railroads, main highways, water frontages or other controlling
natural features. . . .

3. The character of the new town should be rightly con^;
ceived with reference to its purpose and the use of the land. . . ."

4. The probable size of a town must have some considera^' ;
tion; otherwise the fundamental planning, th parts not easily
changed, cannot be satisfactorily determined. . . . The uncon-
trolled growth of cities is the problem that gives gravest con-i\
cern today. . . .

It is amusing, by the way, to note how closely the New ^
England villages of Mr. Mumford's panegyric fit these 2
principles. He makes much, in the opening chapter of ~<J)
Sticks and Stones, of their adjustment of plan to site and ; .
function, and points out how the town that had grown to
the full limit of convenience and orderly administration
solved the problem of increasing population by simply
spilling over into a new settlement an excellent precedent,
in miniature, for the process that Mr. Nolen now foresees:

There is a limit to the size of cities. What this limit is may
be open to discussion, it is true, but human capacity to organize
and govern, or at any rate the law of diminishing advantages
in cities in proportion to cost (like the law of diminishing re-
turns in agriculture) will sooner or later fix a limitation to
the size of existing cities and compel new populations to estab-
lish settlements elsewhere.

But it would be unfair to Mr. Nolen to imply that he
is a propagandist. He is rather the technician who has
thought through his problem, who recognizes the sharp
limitations of replanning in existing cities, and who turns
with more enthusiasm to the alternative the creation of
new ones. While he is careful to point out that "both solu-
tions must be employed to the full and both must go on
concurrently," he finds in the community less need for con-
servatism in planning, more hope of really contributing to
human well-being.

FROM this point of view he presents a number of his
own projects new towns with old virtues, some of
them; others old towns renewed. The two that best il-
lustrate his "reasons of major importance for building new
communities" first, "to take care of territories that are
from time to time opened up for settlement," and second
"to meet modern requirements and standards by new plan-
ning" are, respectively, Kingsport, Tennessee, and Marie-
mont, Ohio.

Kingsport, as presented here, sounds like a Utopia of
enlightened self-interest. A straggling farm village in 1915,
it had grown ten-fold by the end of the war. It was created
by a railroad which penetrated territory rich in undeveloped
mineral and other resources, and which needed business.
A favorable site inviting economic possibilities, and com-



547



548



T II E S U R T E Y



August 15 September 15, 1927



petent team-work seem to have interacted to produce a well-
planned and efficient manufacturing city. Ten large con-
cerns united in the Kingsport Improvement Corporation,
which secured a sound fundamental plan and which makes
decent housing available on reasonable terms to both white
and colored workers. Their joint paternalism, with the
city-manager government as a partner, has gone so far as
to provide group insurance for the entire population. Here
is a peculiarly American variant of the garden city, with
the element of joint control and continuity of development
supplied not by a cooperative corporation but by a group of
employers who recognize the mutuality of their interests
and the economic value of good living conditions. Mr.
Nolen, naturally, writes as a planner and not as a sociologist ;
it would be interesting to know how life is actually lived in
Kingsport ; what differences appear be-
tween the atmosphere of a ten-company
town and a one-company town ; what has
been the effect of wage and price changes
since the war.

Mariemont, briefly described in The
Survey when it was first projected (see
The Survey, March 15, 1923), came into
being because Mrs. Mary M. Emery of
Cincinnati was interested in good housing
for workers. It is not, however, philan-
thropic; the project is organized on a
commercial basis with the expectation
that it will pay something like two per
cent on the investment. Mariemont lies
ten miles from the center of Cincinnati,
and has been laid out with careful regard
for the nature of the ground a rolling
plateau bordered on one side by the sharp
bluffs that drop to the shore of the Little
Miami River. Planned for a population of not more than
10,000, it had already attracted about 1,400 people when I
saw it six months ago. At completion it is to house not
more than six or seven families to the acre. At present it is
a white-collar-and-professional suburb, with houses selling
at from nine to twenty-five thousand dollars. Later, when
the Mariemont Company has found just the right sort of
factories, with steady employment and good wages for
skilled and semi-skilled workers, it will have its own in-
dustrial section with lower-priced but still decent and com-
fortable housing.

Since Forest Hills Gardens was built we have learned
that a planned town need not look like a picture-book:
Mariemont was parcelled out among a number of architects
and shows plenty of variety in building materials and
architectural treatment. There are no radical experiments
in house-design, although such devices as the stub-end road,
more familiar abroad than here, are used. The charm of
the place, which like most new developments still looks
rather like a seven-year-old with two or three front teeth
missing, is in its informality and scale. The business block
already erected is ingratiating rather than impressive; the
church and school are not too grand ; the winding streets
are livable.

The Mariemont Company is holding business sites for its
own exploitation and has written zoning and building re-
strictions, effective until 1975, into its deeds of sale. But
there is no effort to control resale, or to prevent over-
crowding in the existing apartments. One wonders what




will happen to this oasis when Cincinnati grows out and
enfolds it.

Mr. Nolen escapes some embarrassment, perhaps, in
limiting his text to a discussion of his own work. But I,
for one, regret that he did not go further afield and evaluate
some of our other new towns Longview, Washington, for
example. This, "the most talked about city in America,"
as the company's booklets have it, was farm-land until 1922.
By 1926 it claimed a population of 11,600, and it is headed
for 50,000 and up. Fifty miles from the mouth of the
Columbia River, on deep water, and fifty miles nearer the
sea than Portland, it intends to make a vigorous bid for
the trade and manufacture of the Douglas fir country.
The Long-Bell Lumber Company bought 14,000 acres of
land as its site, employed Hare and Hare, with the late
George E. Kessler as consultant, to plan
it, and is now engaged in promoting it on
a grand scale.

There is no question as to the magni-
tude of the physical achievement which
Longview represents. It is competently
and handsomely planned for an im-
portant future, and I am assured that it
already has an abundance of clubs and
civic organizations and an enjoyable
social life. But when one tries to find out
just what manner of new town this is,
there are curious anomalies.

I paid a hurried visit to Longview a
year ago and find myself still puzzled by
it. I arrived at night, and was driven
magnificent distances to a brilliantly
lighted and smartly appointed hotel.
The clerk was affable. The bellboy
literally ran down the corridor with my
bag. The waitress, whose footsteps echoed through the
empty dining-room, took my order with a jaunty "all
righty." The welcome was almost too eager. From the



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