The cities showing the largest percentages of part-time workers were: San Diego, 29.2 per cent; Oakland, 26.9 per cent; San Francisco, 25.4 per cent; Los Angeles, 24.1 per cent; and Sacramento, 23.7 per cent. The average for all 12 cities combined was 20.2 per cent. The leading facts in regard to the individual cities are shown in the following table:

UNEMPLOYMENT IN 12 CITIES, AS SHOWN BY INVESTIGATION MADE DURING JUNE

It is interesting to note that the unemployment found in these 12 cities at the time the canvass was made was slightly in excess of the unemployment found in 15 cities outside of Greater New York in the East and Middle West in an investigation made during March and the first part of April, and published in May, 1915, this earlier survey covering 399,881 families having 644,358 wage earners. Of the wage earners in these families 73,800, or 11.5 per cent, were wholly unemployed, and in addition 106,652, or 16.6 per cent, were reported as having only part-time employment. The highest percentage of unemployment was found in Duluth, where 20.3 per cent of the wage earners were out of work and 17.8 per cent were working part time only. The lowest percentage of unemployment was found in Bridgeport, where only 4.3 per cent were unemployed, but 19.9 per cent of all wage workers were reported as working only part time.

The cities showing the largest percentages of part-time workers were: Wilkes-Barre, 32.3 per cent; Pittsburgh, 29 per cent; Midwaukee, 28.9 per cent; Bridgeport, 19.9 per cent; Philadelphia, 19.6 per cent; Duluth, 17.8 per cent; Toledo, 17.5 per cent; and Boston, 17.3 per cent. The percentage for all 15 cities combined was 16.6 per cent. The details for the individual cities are shown in the table immediately following:

UNEMPLOYMENT IN 15 CITIES AS SHOWN BY INVESTIGATION DURING MARCH AND

For comparison with these results, the unemployment in New York City, as ascertained in the investigation of the bureau during

February, 1915, is given as follows:

Number of families scheduled...

54,849

The figures as shown by the bureau's own investigation differ but slightly from the survey in January, 1915, made by the Metropolitan Life Insurance Co. in the families of persons holding industrial policies. The company's survey covered 155,960 families, in 37,064 of which unemployment was reported. These families contained 252,912 wage earners, and 45,421, or 18 per cent, were reported as unemployed.

OCCUPATIONAL DISEASE CLINIC OF NEW YORK CITY HEALTH DEPARTMENT.

BY ALICE HAMILTON, M. D.

We know very little about the effect of different occupations on the health of the workers. In general, of course, we know that certain substances are poisonous and therefore dangerous to handle, that exposure to great heat or to extremely humid air must be weakening, that great exertion kept up too long results in chronic fatigue, that if irritating dusts are breathed in for a long time the lungs are injured and pulmonary tuberculosis is likely to follow, but we do not know how far these factors actually affect men and women in the different industries. Yet it is most important that we should know. Think what an advance could be made in the protection of working people if we had detailed information as to the strain of each occupation on the human system.

The only way to gather such information is to carry out intensive studies, on a large scale, of people in different occupations, dealing with hundreds, or better, thousands, for conclusions based on small numbers are always open to criticism. There is no dearth of material for these studies; any one of our large cities could undertake an examination of such trades on a large scale. It is natural that the largest city, New York, should be the first to do this, and fortunate that she is doing it in such a way as to encourage other cities to follow suit, for the expense involved in the system she has adopted is not great.

About six months ago Dr. Goldwater, commissioner of health of New York City, authorized the opening of a clinic for occupational diseases, placing it under the department of communicable diseases as a division of industrial hygiene, with Dr. Louis I. Harris in direct control. There was no appropriation for this new department, but Dr. Harris has without any appropriation managed to organize a clinic in which 150 or 175 persons are examined every day by 17 to 20 physicians. He utilized a large loft in a building owned by the department of health and "begged, borrowed, or stole" furniture from the other offices or wherever it could be found. Naturally. the laboratories of the department are at his service for chemical and microscopic tests. Eight of the physicians are civil service appointees of the department of health and nine are volunteers who give their time, three hours a day, partly for the sake of the experience, partly in hope of being taken on regularly as soon as there is an appropriation. These physicians can do all the necessary work. but a very valuable addition to the clinic has been made possible through a grant by Mrs. E. II. Harriman, who pays for the services of four physicians to carry out more thorough examinations on a smaller group.

After the clinic was organized the question was how to get the people for examination, for the department has no authority to require workpeople to be examined. However, under section 146 of the Revised Sanitary Code, the bureau of food inspection is empowered to insist upon an examination of any person employed in places where food or drink is handled in order to determine whether he has any communicable disease and to withhold the permit to work in such places if examination is refused. This places at the discretion of the food-inspection department about 5,000 peddlers, 15,000 bakers, 90,000 cooks and waiters, as well as an, as yet, unascertained number of candy makers, milk dealers, butchers, and so on. The examination is made primarily to detect communicable disease, but it is possible to make a thorough search also for signs of occupational disease.

The division of industrial hygiene took up bakers first and is now in the course of examining cooks and waiters. But these trades, though they involve a menace to the health of others through possible communicable disease in the workers, are not nearly as dangerous to the workers themselves as are many others in which no such menace exists. Some way had to be found for the department to induce the workers in dangerous trades to submit to examination, for it had no authority over them. Dr. Harris selected a group of industries which involve exposure to a very irritating dust and in some processes to mercurial poisoning. These are the furriers and hatters. Where the trade was organized he worked through the unions; where it was unorganized he sent inspectors into the factories and by using tact and persuasion got employers and employees to cooperate with him. In this way he succeeded in inducing 886 workmen in these industries to come to the clinic for examination. In every instance an examination of the work place, whether restaurant or factory, dovetails into the examination of the working force. I visited the clinic toward the end of September, and the impression I gained was of a high degree of organization for effective work, resulting in a minimum of delay and fatigue to the men who are to be examined. I went over there from the department of health building and took with me a Greek waiter who was bewildered and could not find his way. There was a line of waiting men standing all the way down the block and around the corner, and as I sent my Greek to the end of the line I thought, from my experience of the usual dispensary, that the poor fellow would have to stand in line all morning and then come back again the next day. But when I left at noon the men had all filed in, been examined, and departed.

There is the usual appearance of a well-equipped clinic, fresh clean rooms, white enameled furniture, white garbed nurses and doctors, and an atmosphere of businesslike speed, but also of courtesy and consideration. The men gathered there were cooks and waiters; there were also about 30 women in a separate waiting room. These women are examined by women physicians. Food inspectors had been to hotels and restaurants, and in the course of their inspection had given out cards to 125 or 150 of the employees with instructions to report to the clinic on this particular day. Each man presented his card to one of the three department nurses, who wrote down on a history card the necessary facts concerning him, and sent him on to the examining room. Here a physician entered on the card the record of his past history and the facts concerning his present and his former occupations. Then he stripped to the waist and the physician examined him for disease of the skin or mucous membranes or organs, and noted the results on his history card. For an ordinary case this is all, the man receives his certificate, and the card goes on file. But if there is any indication of disease, especially a communicable disease, he is sent to one of the four doctors who make more intensive examinations. In the case of men handling food, what is looked for especially is tuberculosis, venereal disease, and typhoid fever, because any of these may make him a source of danger to other people. If tuberculosis is suspected, the certificate is held up till the sputum has been examined. If it is syphilis that is suspected, several spoonfuls of blood must be drawn from the vein of the arm in order to make the appropriate test. This is done so rapidly and skillfully that it causes little pain. At one time when I was a laboratory worker I needed normal blood for experimental purposes and was bled from the vein of the arm once a week for many weeks, and I can testify that it hurts very little.

The reason why typhoid fever is looked for in the histories of these men is that of late years it has been discovered that one of the most important sources of typhoid epidemics is the so-called typhoid carrier, a person who has once had typhoid fever or acquired typhoid infection through contact with a typhoid patient and who, for some cause as yet unknown, never gets rid of the bacilli as people normally do, but goes on harboring them in his body and discharging them through urine and feces. Such people ought never to be allowed to handle food for others. Now there is a blood test, the Widal test. which is used to determine typhoid fever in doubtful cases, and very often typhoid carriers respond to this test in the same way as do typhoid patients. When, therefore, any cook or waiter says that he has once had typhoid or has been in contact with a typhoid case, a few drops of blood are taken from the tip of the finger or the lobe of the ear, and the test is made.

In the case of trades that have nothing to do with the handling of food, there are other important factors. For instance, mercurial poisoning was looked for in the examination of hatters and hatters furriers, because in certain processes these men are exposed to mercury nitrate, which is used in the preparation of the fur for felting. In the study of painters, which has just begun, and which will be in full swing as soon as the slack season for painters sets in, a whole list of poisons will have to be considered; all sorts of lead compounds. turpentine, benzine and naphtha, benzol, amyl acetate-known banana oil-acetone, tar, wood alcohol, carbon bisulphide. Th examination, therefore, has to be modified a little for each trade. but the general outlines are the same for all.