It is a great pity that we Americans have taken so long to learn that laws do not enforce themselves, that even good motives and good intentions in the best of officials do not insure good deeds. Thousands of lives are being lost every year, millions of days taken from industry and wasted by unnecessary sickness, millions of dollars spent on curing disease, the working life of the nation shortened, the hours of enjoyment curtailed, because we have not seen the great gap between health laws and health-law enforcement. In our municipal, state, and national politics we have made the same mistake of concentrating our attention upon the morals and pretensions of candidates and officials instead of judging government by what government does. Gains of men and progress of law are useful to mankind only when converted into deeds that make men freer in the enjoyment of health and earning power. In protecting health, as in reforming government, an ounce of efficient achievement is worth infinitely more than a moral explosion. One month of routine—unpicturesque, unexciting efficiency—will accomplish more than a scandal or catastrophe. Such routine is possible only when special machinery is constantly at work, comparing work done with work expected, health practice with health ideals. Where such machinery does not yet exist, volunteers, civic leagues, boys' brigades, etc., can easily prove the need for it by filling out an improvised score card for the school building, railroad station, business streets, "well-to-do" and poor resident streets, such as follows:

Table V

Score Card for Citizen Use

 PerfectAllow
Schoolhouse  
Well ventilated, 20; badly, 0-10  20...
Cleaned regularly, 20; irregularly, 0-10  20...
Feather duster prohibited, 10  10...
No dry sweeping, 10  10...
Has adequate play space, 10; inadequate, 0-5  10...
Has clean drinking water, 10  10...
Has clean outbuildings and toilet, 20: unclean, 0-10  20...
 100 
Church and Sunday School  
Well ventilated, 20; badly, 0-10  20...
Heat evenly distributed, 20; unevenly, 0-10  20...
Cleaned regularly, 20; irregularly, 0-10  20...
Without carpets, 20  20...
Without plush seats, 20  20...
 100 
Streets  
Sewerage underground, 20; surface, 0-10  20...
No pools neglected, 10  10...
No garbage piled up, 10  10...
Swept regularly, 20; irregularly, 0-10  20...
Sprinkled and flushed, 10  10...
Has baskets for refuse, 10  10...
All districts equally cleaned, 20; unequally, 0-10  20...
 100 

Until recently the most reliable test of health rights not enforced was the number of cases of preventable, communicable, contagious, infectious, transmissible diseases, such as smallpox, typhoid fever, yellow fever, scarlet fever, diphtheria, measles, whooping cough. By noticing streets and houses where these diseases occurred, students learned a century ago that the darker and more congested the street the greater the prevalence of fevers and the greater the chance that one attacked would die. The well-to-do remove from their houses and their streets the dirt, the decomposed garbage, and stagnant pools from which fevers seem to spring. It was because fevers and congestion go together that laws were made to protect the well-to-do, the comfortable, and the clean against the slum. It is true to-day that if you study your city and stick a pin in the map, street for street, where infection is known to exist, you will find the number steadily increase as you go from uncongested to congested streets and houses, from districts of high rent to districts of low rent. Because it is easier to learn the number of persons who have measles and diphtheria and smallpox than it is to learn the incomes and living conditions prejudicial to health, and because our laws grant protection against communicable diseases to a child in whatever district he may be born, the record of cases of communicable diseases has heretofore been the best test of health rights unenforced. Even in country schools it would make a good lesson in hygiene and civics to have the children keep a record of absences on account of transmissible disease, and then follow up the record with a search for conditions that gave the disease a good chance.