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The German gymnastic centers

The Bohemian turners

The Danish folk schools

The Italian Community Theater and Art centers

The English sports fields and church recreation centers

3. Recreation Centers in the United States

The great forward movement between 1906 and 1912

Railroad system centers, like Santa Fe

Great corporation units like the Standard Oil Center at
Whiting, Indiana

Mercantile centers, like Wanamaker's, Philadelphia, and
Curtis Publishing Company, Philadelphia

Neighborhood social centers

Park field house centers

School centers

Settlement house centers like Hull-House, Chicago, and
Hiram House, Cleveland

Church centers

The town rural centers, like Brimfield, Illinois

Memorial recreation centers, like the McCormack center,
Peoria, Illinois

Small town recreation centers serving the whole com-
munity Community Arts Center as at Santa Barbara

4. Factors to be Considered in Establishing a Neighborhood

Recreational Center



Type of neighborhood :

average
Racial type and tendencies



industrial, suburban, college,



Flow of population
Zoning requirements affecting future
Existing volunteer agencies
Existing public agents
Commercial recreation

5. Specific Problems

Problems of land and structures, size, location, and type

of center

Problems of administration
Size and character of board
Is the center to be an independent unit or part of a city

wide plan?
Is the service for an entire neighborhood and for all

ages, both sexes, and different races?

6. Business Administration
Where are the offices located?
What records kept, and why?

How long are current records kept together, and how
cared for? in the nature of permanent transfer

What general type of filing system is used? card index,
loose leaf, fixed books, fire proof containers

Board and committee records

Complete records of property, easily accessible

Down to date inventory

Acceptable publicity records

Monthly budget check off

Service and attendance records

Triplicate method of handling orders and supplies

7. Program

Arranged democratically in plan and in administration
Gives the family opportunities to play together as a unit
Brings those of marriageable age together in wholesome

contact

Does not over-emphasize separation of boys from girls
Built up on normal interests, not superimposed
Ample opportunity for initiative and self expression
Both intensive and extensive



Where to Write for More Information



General Sources:

1. The Playground and Recreation Association of America,
315 Fourth Avenue, New York, N. Y.

2. Recreation Department, Russell Sage Foundation, 130
East zznd Street, New York, N. Y.

3. Bureau of Education, Government Printing Office, Wash-
ington, D. C. (School Centers)

4. U. S. Department of Agriculture, Government Printing
Office, Washington, D. C. (Rural Centers)

5. "The Rural Community Building," by Robert H. Moulton.
The Rotarian, September, 1922

6. "Planning and Construction of Community Type Build-
ings," by Lewis E. Jallade. The Playground, February,
1924

7. "Floor Plans of Community Buildings," by Guy Lowell,
Board of Home Missions of the Presbyterian Church in
the United States of America, 156 Fifth Avenue, New
York, N. Y.

Local Sources:

1. Brimfield, Illinois Brimfield Recreation Center

2. Bryn Mawr, Pennsylvania Recreation Center



3. Chicago, Illinois Hull-House Recreation Center (Neva
Boyd)

4. Cleveland, Ohio Hiram House Recreation Center
(George Bellamy)

5. LaSalle, Illinois LaSalle-Ogelsby Center (Board of Edu-
cation)

6. Oxnard, California Recreation Center (Fred Hokin, Ex-
ecutive Secretary, Community Service)

7. Philadelphia, Penn. Municipal Recreation Centers (Wil-
liam D. Champlin, Supt. of Recreation, City Hall)

8. Salt Lake City, Utah Recreation Centers in Salt Lake
City (Charlotte Stewart, Supt. of Recreation, 112 City
and County Building)

9. San Francisco, Calif. Recreation Centers (Lois M. Wil-
liams, Executive Secretary, Community Service Recrea-
tion League, 941 Phelan Bldg.)

10. Santa Barbara, Calif. Recreation Center (Bertha G.
Rice, Executive Secretary)

11. Seattle, Washington Municipal Neighborhood Recreation
Centers (Ben Evans, Supt. of Playgrounds, Park Dept.,
City Hall)

12. Winnetka, Illinois Community House.



330



HEALTH



The Cost of Medical Care



By HAVEN EMERSON, M.D.



THE spirit of the recent conference in Washington
on the economic factors affecting the organization
of medicine is tersely put in Lincoln's words so
appropriately used as introduction to the program :
"If we could first know where we are, and whither
we are tending, we could better judge what to do and how
to do it." The inability of people to pay the cost of mod-
ern scientific medicine was thrown down as a challenge to
start discussion. There followed a sketch of the maladjust-
ments from which the disorganization of medicine suffers,
and as a suitable third side of the triangle came descriptions
of recent attempts to provide more adequate medical service.
With his well-known mastery of sources of information
and sledge-hammer concentration of facts, Louis I. Dublin
related the assembled records and estimates of medical costs.
The Bureau of Labor Statistics says $60 per family per year.
Detroit's family welfare agency finds workmen's families
pay $80. The Metropolitan Life Insurance Company itself
found that its employes paid $80 or more a year. So it is
estimated that of the $70,000,000,000 of our national in-
come from all sources, from $3,000,000,000 to $4,000,000,-
ooo is spent on illnesses, including payments to physicians,
dentists, hospitals, nurses and druggists. Apparently phy-
sicians get half of this payment ; dentists about 20 per cent ;
druggists and instrument makers another 16 per cent for
medicines, dressings, and various appliances; hospitals 7 per
cent ; nurses 5 per cent.

Baffling problems in diagnoses, long illnesses, operative
and surgical costs, face the patient and family with incal-
culable expenses often threatening financial catastrophe.
Hence the great increase in dispensary care, until now 10
per cent of the treatment of the sick is in dispensaries
throughout the country. No one at present is making a foot-



path through the
which threatens
much of a .very
ance. This uni-
experience of
a staggering load,
preventable and
itely better
Leo Wolman




economic morass
to submerge
precious inherit-
versal intimate
sickness becomes
much of which is
could be infin-
distributed.
came still closer
to the problem of relative costs when he showed that 67
per cent of our population have family incomes of $1,450
a year or less, and only 6 per cent have incomes of $2,900
or more. And again he finds that 90 per cent of us have
annual incomes of less than $2,000, and even after the in-
crease of total national income of 36 per cent in the years
1921-1926, the median income in 1926 had increased only
2O per cent since 1918, and at present is somewhere be-
tween $1,350 and $1,400 a year.

Are we ready to trust any government of any state or



city in this country with the collection and expenditure of
$80 of our money each year for our benefit in sickness? Re-
member our fantastic excursion into medical care and com-
pensation by which we are paying through the Veterans'
Bureau about $570,000,000 this year to help a fraction of
the 5,000,000 men who were under arms in the World War
and this in an administration with economy as its slogan.
Dr. C. C. Pierce, speaking with the authority of the
United States Public Health Service, pushed home the argu-
ment for revision of our present methods by telling us that
more than a third of all sickness is entirely unattended, and'
that but 38 per cent of us have any kind of dental care.
He sees among the unsolvable problems of today that of
bringing the ben- e fits of periodic

health examina- ImlljWidSi^N. t'ns to people of

Michael M. |Pyii^fr|ly'jllli) | Davis urged the
importance of re- fr^^Y^rOT Iatin g the in-
comes to the U \\j \A1 amount of sick-
ness. The lower Jf _-^*vL *Q-, t ' le ' ncome tnc
more the sickness, &^~* ^^ -^ * almost universal-
ly. He finds that about a quarter of all the families of
the country have serious illness within a year, for which they
must pay between one and five hundred dollars. While for
75 per cent of us the annual cost of sickness is low and quite
bearable, for the other quarter of the nation's families, it
is heavy. Among the questions he wants answered is : What
can a family of moderate means get in the way of prevention
and care of sickness for $40 or $80? Not only inadequate
income, but inadequate medical service is found to be at
fault, and itself to be a cause of unnecessary sickness by
omission or commission. Relative values in medical care
may be expressed personally in terms of family distress or
catastrophe.

THERE followed a discussion of the manifestations of
maladjustment in medical practice, illustrated by in-
adequacy of personnel and financial support for preventive
agencies, both official and voluntary; shortage and inacces-
sibility of physicians and equipment for the care of the sick
in private practice; expensive employment of inferior types
of treatment; unfairness to the individual family practi-
tioner of the present distribution of payment for special and
operative services ; insufficient interest and information of
physicians in private practice in the resources of preventive
medicine.

In enlarging upon these maladjustments, Dr. W. C.
Rappleye told of the distribution of recent medical grad-
uates: 40 per cent or more go directly into the specialties;
75 per cent locate in communities of 10,000 or more, and
half in cities with populations over 50,000. He finds that
1 6 per cent of physicians are in whole-time salaried posi-



331



332



THE SU R V E Y



June 15, 1927



tions and 18 per cent more receive salaries for part-time
professional work. Then he pictured the changes to he
wrought in the next thirty years by the shifting ratios be-
tween physicians and the population they serve. With 4,000
physicians completing their professional training each year
at about 28 years of age, we shall see the lowest level in
ratio of physicians to population at present rates of na-
tional growth in the year 1945, when there will be one
physician to 1,400 people, while at present there is one to
800 a provision we shall not again reach until 1960.

Is medical care provided at present for any considerable
community with adequacy? And if so, at what cost? For
the answers there came testimony from colleges and schools,
from shoe factory towns and mining centers. Drs. John
Sundwall and William Darrach told of the health fees from
$i to $40 per student gathered by the administration of
state universities and private boarding schools to provide
elaborate protective and treatment services for young people
and their teachers. Drs. A. J. Lanza and Daniel C. O'Neill
brought first-hand records from, the industrial field. If the
consumer pays two and one-half cents in the price of each



pair of shoes for the provision of medical care of the factory
hand and his family with good results, who is to arrange
for the treatment of the consumer at large, or can he self-
organize for his own benefit? Industrial medicine offers a
wide scale of benefits at from $2 to $25 per employe per
annum and has not reached perfection at either level.

Finally we were all brought up standing by the sturdy
challenge of Edward T. Devine who thought it dangerous
to demonstrate the inadequacy of medical care without a
plan to offer for the redistribution of wealth. He warned
us that neglect, injustice and suffering will follow any
fragmentary dealing with sickness care and prevention.

To clear ourselves of the honest opinion of many that we
are retarded socially, backward in organization and infantile
in our civilization as compared with contemporary western
European nations, at least in the serious consideration of
sickness and its bearing upon our economic progress, a five-
year committee was forthwith created under the leadership
of Dr. Ray Lyman Wilbur, from whom we may expect
thorough and honest searching and declaration of facts, so
that we may know "what to do and how to do it."



Against Bears, Beetles and Bacteria



HARDY perennial among the objections to the
extension of work for the public health is the
charge that when effective it preserves the un-
fit members of society, who might die young
in the natural course of events, and that by
giving them a chance to live and propagate their kind, it
lowers the efficiency and the resistance of the whole human
race. Recently, within twenty-four hours, two resounding
slaps at that pessimistic philosophy were struck by scholars
with the highest qualifications to speak for their respective
fields: by the addresses at Yale University by Sir George
Newman, chief medical officer of the British Ministry of
Health, technician for the Empire through a score of min-
istries ; and the paper read by Professor Herbert S. Jennings
of Johns Hopkins University before the annual meeting of
the National Tuberculosis Association at Indianapolis, mar-
shalling the evidence of the biologist as to the compatibility
or incompatibility of health progress and race progress. Be-
cause of their profound bearing on all public health work,
these papers are here abstracted in some detail.

Popular fallacies to the contrary, Sir George Newman
asserted, the work of Darwin

changed the whole method of man's rational approach to his
problems, whatever they were. . . . Man learned in an orderly
way to apply his powers to the solution of his problems. He
found that struggle with pestilence must be organ-
ized and not left to casual and empirical
efforts; it must be positive
and constructive and must find
its strength in the resistant
body of man. Disease is being
steadily controlled, life is pro-
longed and the personal and
social capacity of the individual
is being enlarged. Probably at
no time in the long history of
civilization has there been a
brighter prospect of the health
and contentment opening be-
fore the individual citizen.




Man, as Professor Jennings reminded the Indianapolis
meeting, is only following the law of all living creatures
in endeavoring to select the conditions which form a part
of life:

All organisms are forced to defend themselves in manifold
ways against other organisms that seek to destroy them; against
bears, beetles, bacteria. All organisms must protect them-
selves against the injurious forces of nature; against heat and
cold, and wind and wet; against starvation and repletion;
against unfit food and drink; against bumps, bruises and
broken bones ; against plagues and poisons. From amoeba
through the oyster up to man, life is a struggle for exist-
ence; there is a mere commonplace. If any organism ceased
this struggle, ceased to select its environment, ceased to pro-
tect itself, its kind would become extinct in a generation.

But are there limitations that must be placed on this pro-
tective struggle? Are there paradoxical situations at which
success in the struggle makes for degeneration and destruction,
instead of for the survival and prosperity which are its direct
objective? Are there methods of protection, of defense, which
organisms must not employ; methods that overshoot them-
selves and fall on the other side? May the struggle for exist-
ence be waged too efficiently, so that its indirect results turn
against and destroy those directly reached?

Such are the general biological questions that underlie the
criticism, the forebodings of evil, directed upon public health
work. Are there junctures at which man must adopt, in oppo-
sition to his practice for the last 20,000,000 years, in opposition
to his most masterful and clamorous impulses, the maxims,
resist not evil, resist not death? How shall we
know these junctures? What is their na-
ture? And specifically, does
the activity of the social
worker, the public health offi-
cer, fall in this class?

Modern work in genetics
with banana flies, for ex-
ample shows junctures at
which the indiscriminate pro-
tection of survival and prop-
agation may tend toward de-
Silhouette by Anna Schirmer generation. Experimental biol-



June 15, 1927



THE SURREY



ogy shows that at the beginning any organism is a com-
plex thing, composed of a great number of separable sub-
stances called genes. If some of these sets of genes are de-
fective, the individual will be defective in certain respects.
"If the thyroid secretion is defective, either from poor genes
or poor nutrition, the individual fails to develop normally ;
it becomes that pitiful, half-formed thing, a cretin, an
idiot." Our present knowledge of chemistry can cancel or
correct some undesirable things in the store of genes; can
feed the cretin, for example, with the thyroid hormone
which will make him a human being. The defect is rem-
edied for the individual but not for his descendants.
life may be made as comfortable and pleasant as lies within
the power of present science but he must not be allowed
to pass on known defects to future generations. The only
remedy from the point of view of the race is to stop the
propagation of persons who bear defective genes, widening
our knowledge so that we may recognize not only the ob-
viously defective persons, but the tenfold greater number of
the apparently normal who also may bear defective chile

The public health worker must take this fact seriously; a
burden of responsibility is placed on him; he must become
genetically minded, eugenically minded. If he promotes, in
fhe congenially defective propagation as well as surviva his
work does indeed tend toward a measure of racial .degenera-
tion But it is the propagation, not the survival, that
central point. ... The difficulties of ending the careers of
Scdve gene, by preventing propagation of their bearers are
a nothing" compared with the hopeless proposal to allow de-
fective individuals to waste away and die unaided. . . . Tech
nically, the great difficulty lies in the fact that the : great major-
ity of defective genes are stored in normal indiv.duals, and
that recognition of these storehouses is not yet possible. B,
fore that can be done, genetics must advance far beyond
present point.

Is there reason to hold that public health work is indeed
preserving individuals with defective genes?

There can be little doubt that, other things being equal,

some genetic constitutions are more readily attacked by plague,

by smallpox, by typhoid, by pneumonia, by tubercu lo. .than

are others Certain combinations of genes are more I

me off victorious in a struggle with a wildcat; or to survive



rasuc cases the essential question is this: If the
environmental agent-whether disease, weather, or wild 1
" nT controlled, are the individuals thereby saved undesir-
able unfit in other respects, to be citizens of the world. . . .
The' victims of smallpox, yellow fever .hookworm .malaria , o
sunstroke frostbite, lions are they individuals with suet

~

L,



333

chemicals, excluding others. Protective coverings become in
other animals more and more efficient the skin, hair, feathers,
the heavy shell of the oyster, the armor plates of dinosaur and
armadillo. Microscopic enemies that penetrate these defenses
find the body fluids charged with destruction. Elaborate in-
ternal mechanisms are developed for keeping the temperature
high and uniform. Strength of body, quickness, agility, the
development of claws and teeth these seize the advantage by
transforming the defensive into an offensive. Acuteness of
senses, cunning, inventiveness, supplement all these methods.
Cooperative action registers an enormous advance. Shelter,
clothes, are found or devised; fire taken into service; food cul-
tivated; weapons invented; machines produced; the properties
of substances tested; new ones compounded. Some organisms
proceed to that systematic elaboration of methods for dis-
covery and application of knowledge that we call scientific re-
search; the most powerful aid yet devised for bringing the
environment under control.

Hygiene, medicine, the arts of public health these things
are but later terms in the long series that begins where amoeba
takes in certain substances and rejects others. Cessation
of this process of adapting ourselves to the conditions is un-
necessary, undesirable, impossible.

School Clearing Houses

By L. A. CRAIGHAN, R.N.

WE are learning a gteat deal at the present time about
the segregation of school children on the basis of
mental capacity but the public has not yet discovered the
need for a temporary segregation of children on the 1
of physical capacity.

Dr. Josephine Baker and others estimate that 2 pei
of our school children have organic heart disease,
of children returning to school after acute illness have r
conditions that could be corrected by a proper school prc
gram of rest. These children are at once lost in the c
and are subjected to the same mental and physical stn
the normal child. Routine temporary segregation c
valescent children into special classes where they could be
kept under observation would prevent many a disasl
haps another 5 per cent of our school children have spmal
curvature, flat foot, or other minor deformity t
eres with health; 5 per cent have, or have ^.tuberculous
disease of the lungs; and 25 per cent are .offering

In every ichooi building one room should be set apart
for a special health class of mentally normal children
this class should be placed the nervous the malnourished t
cardiacs (for temporary observation) and every chil
turning to school after acute communicable disease. A *

Tnic at the school and a nurse for medical *>"*
would give most of these children the superv.s.on needed to
restore them to normal physical condition.

The health classes would serve as clearmg houses froni
which the salvaged children would return to regular work,
nd the Prlem cases could be transferred to preventonums
to a special central school for intensive health work. Such



wh e ic e h V t e h d e "tracking "gent has been' controlled. * nc, B -
ground, in man, for holding that all differences in ger
rlpf^rf-Jvpnpss in one or the other. .

J55K=ra -



dayhan the



EDUCATION



Labor's Laboratory School

By NELLIE M. SEEDS

Wood-cuts by pupils of Manumit School



IN the foothills of the Berkshire Mountains, sixty-six
miles north of New York City, labor is trying out a
new venture in the field of experimental education.
Manumit School, as it is called, was founded two
years and a half ago by William and Helen Fincke,
who contributed to the enterprise their fertile and well-
stocked dairy farm of 177 acres. The present buildings
consist of an old colonial farmhouse with its barns and out-
houses, one small cottage which is used as a dormitory, two
small shacks used as a carpenter and print shop, an arts
and crafts shop, a gymnasium and boy's dormitory, and a
director's home. A tumbling trout stream furnishes oppor-
tunity for swimming and youthful experiments in the art
of navigation. In the summer the hillsides and broad fields
can be used for crops; in the winter they can be used for
coasting and skiing, the temporary ice pond for skating.
Milking, caring for the horses, pigs, cattle and chickens,
ploughing, planting, harvesting, and truck gardening com-
plete the circle of projects in which the children are free
to engage.

Manumit School is controlled and directed by the Man-
umit Associates, a voluntary group of men and women
actively identified with the labor movement or with educa-
tional institutions or projects. The school has been endorsed
by a large number of trade unions and labor federations
and individuals prominent in the labor movement. Its
thirty-eight children represent nineteen different trades, with
a few whose parents are not connected with any trade union.
Manumit School by no means represents a separatist
movement. Its children represent a true cross section of
life. Most educational experiments that have been success-
ful attribute their success to the fact that they start with a
picked group. Manumit hopes to show the feasibility of the
new education methods with a representative public school
group, under conditions
which are attainable for the
average public school parent.
If it succeeds in so doing, it
can offer a direct contribu-
tion to the whole public
school system. For as the
laboratory school for the



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