A Health Census of 
Chelsea Neighborhood 
14th to 42d Streets 
5th Avenue to the Hudson River 
New York City 
Community Sickness Survey 
Conducted by the 
Metropolitan Life Insurance Company . M, V 
> »» 
and the 
Chelsea Neighborhood Association 
Metropolitan Life Insurance Company 
New York 
1917 CHELSEA HEALTH CENSUS* 
Fifth Community Sickness Survey 
Health conditions have been for several years the subject 
of serious consideration in the Chelsea neighborhood, 14th to 
42d Streets, 5th Avenue to the Hudson River, New York City. 
Various public and philanthropic agencies in the district have 
approached the problem from numerous angles. The Chelsea 
Neighborhood Association through its health committee, has 
devoted considerable time and energy to constructive and 
preventive health measures. This committee of the Neighbor- 
hood Association, Dr. B. H. Lewinski-Corwin, Chairman, in 
the early part of April, 1917, approached the Metropolitan Life 
Insurance Company with the suggestion that the Company, 
through its agents in Chelsea, make a health census of the 
neighborhood, similar to those previously conducted in Roches- 
ter, Boston and in other places, so as to establish the basis for 
a constructive health programme in the future. The Company 
agreed to undertake the work with the cooperation of the 
Neighborhood Association, the census to be taken during the 
two weeks following April 23d. 
Local Conditions. 
Before entering into the details of the census and its findings, 
it may be well briefly to touch upon general conditions in the 
Chelsea neighborhood as related to public health. 
Chelsea contains about 180,000 residents. The district 
presents all the problems of a good-sized city. It contains 
some desirable residential areas, separated from a considerably 
larger number of congested poorer sections; its thoroughfares 
are devoted to offices, small shops and to some of the largest 
manufacturing plants in the country. Many of the residents 
*The census was made under the direction of Dr. Lee K. Frankel, Third Vice-President 
of the Metropolitan Life Insurance Company. Dr. Louis I. Dublin, Statistician of that 
Company, and Dr. E. H. Lewinski-Corwin, Chairman of the Health Committee of the 
Chelsea Neighborhood Association. Mr. Edward H. Pfeiffer, Secretary of the Neighbor- 
hood Association, assisted in planning the census and in preparing the report. 
1 are native-born Americans, who have lived in Chelsea for 
several generations, and hark back to Irish, English or Ger- 
man stock. A large number of Italians, Greeks, French, 
Spaniards and Poles are also to be found in the district. 
Chelsea contains some 125 civic and social agencies- 
churches, hospitals, day nurseries, schools, milk stations, 
settlements, libraries, public baths, playgrounds, social clubs 
and the like-and a Neighborhood Association with over five 
hundred members, representing the broader mutual interests 
of residents, business men and property owners. It is one 
of the oldest sections of the city, rich in historic memories and 
fine houses of a former period. It has the finest docks in the 
city, the Pennsylvania Railroad Terminal, Chelsea Park and 
several smaller recreation spaces, and the well-known London 
Terrace and Chelsea Cottages. 
Yet with all these facilities the district has its serious 
problems. It had a death rate* in 1915 of 19.28 per 1,000, and 
an infant mortality rate of 121.4 per 1,000 births. The atten- 
tion of philanthropic agencies has been for many years chiefly 
riveted upon the Fast Side, and it is therefore not to be wondered 
at that conditions among the West Side poor are often most 
deplorable. As will be pointed out later, the section needs 
better and more modem public school buildings, added recrea- 
tional facilities for young and old and, more especially, improved 
housing for many of its people. 
Chelsea Neighborhood Association. 
In 1913 a small group of Chelsea people formed the Chelsea 
Neighborhood Association "to make Chelsea a better place 
to live and work in." From modest beginnings the Association 
has grown to a membership of over five hundred, and the 
breadth of its scope is indicated by the fact that the Association 
has standing committees on health, housing, schools, recreation, 
employment, policing and immigration. The Association is a 
neighborhood clearing house for Chelsea's agencies and has 
during the past four years interested itself in nearly every 
type of problem known to social or civic workers. 
*On the basis of a population of about 140,000 people in the New York City Health 
Department sanitary areas wholly included in Chelsea neighborhood. 
2 The Neighborhood Association's request to the Metropolitan 
Life Insurance Company for a Chelsea health census met with 
a hearty response from the Company. Its Third Vice-President, 
Dr. Lee K. Frankel, and Statistician, Dr. Louis I. Dublin, 
immediately conferred with the Neighborhood Association to 
plan the survey. Mr. T. W. Ridgway, Superintendent of the 
Company's Chelsea district, with his forty agents, on April 23d 
began taking Chelsea's health census, after the Association had 
paved the way by a thorough publicity campaign. 
Publicity Campaign. 
During the week preceding the health census the Neighbor- 
hood Association distributed throughout Chelsea 10,000 4-page 
folders, "Chelsea's Chance." The folder emphasized the fact 
that the census aimed to multiply the advantages of living in 
the neighborhood. This was found to be a tactful and effective 
method of neighborhood advertising. These folders were left 
directly with families or distributed through churches, libraries, 
schools, milk stations, clinics and other agencies. The folder 
briefly urged the neighbors to cooperate by answering all 
questions to the best of their ability, requested neighbors to 
report to the Association at any time any health menaces 
and gave a list of all health agencies in the district, which might 
be kept for handy reference. 
In addition, fifteen Chelsea motion picture theatres ran 
slides announcing the census to their audiences, the slides 
being accompanied by an original cartoon drawn by the well- 
known artist, Hy. Mayer. 
A vigorous publicity campaign through the English and 
foreign language press was also made, and articles appeared in 
numerous leading magazines and other publications. 
Dr. Hermann M. Biggs, New York State Commissioner of 
Health, issued a statement saying, "I think this admirable 
plan should be of great value not only to Chelsea, but also to 
other portions of the city, where Chelsea's example ought to be 
followed," and Health Commissioner Dr. Haven Emerson of 
New York City, declared that, "The Department of Health 
welcomes cooperation of this sort. Only by first ascertaining 
what are the health conditions in a community can we 
undertake effective corrective measures." 
3 Clergymen announced the plan for the census to their 
Chelsea congregations, and Chelsea business concerns told then- 
employees of the undertaking. 
Principal Findings of the Census. 
The same general methods of inquiry were pursued in 
taking the Chelsea health census as were followed by the 
Metropolitan Life Insurance Company in its health enumera- 
tions of other representative communities in the United States. 
The inquiry form contained the usual items to which was 
added a special housing query to ascertain the number of 
persons per room. 
The completed schedules were sent to the Home Office for 
the preparation of the necessary statistical tables and these 
are offered in the following discussion. 
In all, 5,983 families were reached by the agents, and in 
these families the health status of 24,043 persons was ascer- 
tained. There were 356 sick persons enumerated, or at a rate 
of 14.8 per 1,000 registered. 
Among 21,700 white persons, 318 were found to be sick or 
at a rate of 14.7 per 1,000. Colored persons were enumerated 
in 2,343 instances, among whom there were 38 sick persons, 
or at a rate of 16.2 per 1,000. Sickness involving disability 
for work was discovered in 331 cases, or at a rate of 13.8 per 
1,000; among the group of white persons, 295 cases involving 
disability for work were discovered, and among colored persons 
36 cases. These correspond to rates of 13.6 and 15.4 per 
1,000 respectively. 
Extent of Disability. 
The number of cases of sickness showing physical disability 
for work constituted 93.0% of the total registered. Persons 
bed-fast at home were counted in 73 cases, or 20.5% of the 
total. Persons sick in hospital were found in 56 cases, or 15.7% 
of the total cases of sickness. Ambulant cases unable to work 
were discovered in 202 cases, or 56.7% of the total illnesses 
registered. Of the latter, 32 were receiving dispensary treat- 
ment; this constituted 9.0% of the total cases of sickness. 
The sicknesses involving no disability to work amounted to 
only 25 in the entire survey, or 7.0% of the total sickness 
registered. It must be remembered that the agents were 
4 istructed not to register trivial diseases and injuries, but only 
such as involved physical disability for work or which were 
irious enough to be of economic significance. 
The sickness statistics of this Chelsea health census were 
classified also according to sex and by age periods. Among 
11,373 males at all ages, 169 cases of sickness involving disa- 
bility for work were discovered. This constituted a rate of 14.9 
per 1,000 registered. The sickness rate for males was least 
in the ages under 15 years, 8.3 per 1,000, and highest in the age 
period 55 and over, 61.1 per 1,000. 
Among 12,670 females there were 162 cases of sickness 
liscovered where the patient was disabled for work. This is 
equivalent to a rate of 12.8 per 1,000 registered. The sickness 
-ate was again least for those under 15 years of age and greatest 
for the age period 55 years and over. These figures however 
when arranged according to sex and by age period for each 
sex are based upon too few cases to warrant any final con- 
clusions on the sickness rate according to these categories in 
Chelsea neighborhood. Yet there is close enough correspond- 
ence between the statistical results, when thus arranged, and 
the material previously developed by the Metropolitan Life 
Insurance Company's other sickness surveys, to justify the 
conclusion that the sickness statistics of this survey are based 
upon trustworthy original data. 
Sickness by Sex and by Age Period. 
Diseases and Conditions Discovered in the Survey. 
The cases of communicable disease, for instance, were 
tabulated in detail, showing the name, address, sex and age 
of patient and disease, and this information was given to the 
New York City Department of Health as an auxiliary check 
upon the reporting of communicable disease in Chelsea. The 
Health Department informed the Association that most of the 
cases of contagious diseases thus reported were known to the 
Health Department and that the diagnoses given by the 
families to the visiting agents were correct. 
By far the greatest number of cases for any particular 
disease or condition were reported for rheumatism, of which 
there were recorded 51 cases. "Rheumatism" is very fre- 
quently a diagnosis of obscure conditions, simulating rheumatic 
5 disease, on the part of the laity as well as of physicians. By 
this term is covered a multitude of ailments. 
Accidents and injuries were next in importance with 39 
cases, of which 16 were specified as fractures, 4 as injuries due 
to falling, and 19 as unspecified accidents and injuries. Pneu- 
monia was registered in 16 cases, diseases of the stomach in 
13 cases, diseases of the kidneys in 11 cases, and paralysis 
(unspecified cause), likewise, in 11 cases. The sequelae of 
infantile paralysis were recorded in 2 instances. 
There were only 12 cases of pulmonary tuberculosis recorded, 
and 4 cases of other types of tuberculosis, but there were 4 cases 
of "lung trouble" of which 2 were of over a year's duration, 
6 cases of bronchitis of which 2 were over two year's duration, 
3 cases of pleurisy of which 1 was of a year's standing, a case 
of "run down," and some other similar designations of con- 
ditions which led one to suspect that they were probably 
pulmonary tuberculosis. Should allowance be made for these 
suspicious cases, and even if they were entered as tuberculosis, 
the total amount of the disease discovered in the survey was 
comparatively very small. This was probably due to the fact 
that many cases of the first and second stages were either 
unrecognized or if known to the family were not given to the 
agents. According to the records of the Health Department 
there were 285 new cases of tuberculosis reported in Chelsea 
for the first quarter of 1917. This gives a gauge of the preva- 
lence of this disease in Chelsea. The health survey agents 
presumably reached only those cases of tuberculosis which were 
in the last stage of the disease and were totally unable to work 
or to conceal their malady. 
The principal facts of these aspects of the health census 
are shown in the table on opposite page. 
Character of Medical Service. 
Out of the total cases of sickness registered, 255, or 71.6%, 
had medical attendance of one kind or another. In 166 cases, or 
65.1% of the total having any kind of medical service, a private 
physician was employed; hospitals were caring for 56 cases, 
or 22.0% of the total showing medical service. Thirty-three 
cases out of the total showing attendance of a physician were 
being treated at dispensaries. This latter number constituted 
12.9% of the total with any kind of medical attendance specified. 
6 Table 1. 
Number of Cases of Specified Diseases and Conditions. Total 
Sick Persons, Chelsea Neighborhood Census, New 
York City. Classified by Age Period. 
DISEASE OR CONDITION 
All Ages 
Under 
15 
15 to 34 
35 to 54 
55 and 
Over 
All diseases and conditions 
356 
61 
83 
123 
89 
Malaria 
2 
2 
Measles 
1 
i 
Scarlet fever 
3 
3 
Diphtheria and croup 
4 
4 
Influenza 
7 
4 
3 
Dysentery 
1 
i 
Mumps . 
1 
i 
Septicemia 
5 
3 
2 
Tuberculosis of the lungs 
12 
6 
6 
Tuberculosis other than pulmonary type. 
4 
1 
2 
1 
Cancer-all forms 
9 
2 
Tumor 
1 
1 
Rheumatism 
51 
7 
20 
24 
Diabetes 
3 
1 
2 
Anemia 
2 
2 
Locomotor ataxia 
1 
i 
"Spinal trouble" 
4 
3 
1 
Sequelae of "infantile paralysis" 
2 
2 
Apoplexy 
3 
i 
2 
Paralysis-unspecified 
11 
*1 
6 
4 
Insanity 
4 
3 
1 
Epilepsy 
1 
1 
Neuritis 
3 
3 
"Rundown" 
1 
1 
" Nervousness " 
6 
i 
i 
4 
Feebleminded 
4 
1 
2 
1 
Blind 
7 
1 
1 
5 
Other diseases of the eyes 
3 
2 
1 
Diseases of the ears 
2 
2 
Heart diseases 
9 
2 
4 
2 
1 
Arterio-sclerosis 
3 
1 
2 
Varicose ulcers 
3 
1 
2 
Disease of lymphatic system 
2 
2 
Hemorrhage 
2 
i 
i 
" Colds" 
4 
i 
1 
2 
"Nose trouble" 
2 
1 
i 
Bronchitis 
6 
2 
3 
1 
Pneumonia 
16 
5 
3 
6 
2 
Pleurisy 
3 
1 
1 
1 
Asthma 
7 
1 
3 
3 
"Lung trouble" 
4 
1 
1 
1 
1 
Tonsillitis 
8 
5 
2 
1 
Tonsillar abscess 
1 
1 
Diseases of stomach 
13 
3 
4 
3 
3 
Herniae 
3 
1 
2 
Gall stones 
3 
1 
1 
1 
Diseases of liver 
5 
2 
3 
Diseases of kidneys 
11 
1 
i 
s' 
4 
"Miscarriage" 
1 
1 
Maternity cases 
3 
3 
Diseases of the skin 
5 
i 
2 
i 
1 
Traumatism by fall 
4 
2 
2 
Fractures-cause unspecified 
16 
2 
3 
10 
1 
Other and unspecified accidents and injuries . . 
19 
3 
5 
9 
2 
Dropsy 
3 
2 
1 
Crippled, lame 
8 
2 
3 
2 
1 
"Sore leg" 
3 
1 
2 
"Operation" 
3 
1 
i 
1 
Other and unspecified diseases 
35 
7 
u 
7 
10 
♦Probably sequel of "infantile paralysis." 
7 Hospital Care of Sickness in Chelsea. 
As Chelsea has only two general hospitals within its bounda- 
ries, a goodly number of cases made use of these two institutions. 
Nineteen went to the New York Hospital and 4 to the French 
Hospital. The remainder went to the hospitals outside of the 
district. Bellevue Hospital accommodated 21 and presumably 
these were surgical cases and people acutely ill. Two chronic 
cases went to the hospital on Blackwell's Island. It is rather 
surprising that the hospitals in the near vicinity of Chelsea, 
such as the Polyclinic and St. Vincent's, received no more than 
2 cases each, while 2 cases went to the Knickerbocker Hospital 
on 135th Street, 1 to Mount Sinai, 1 to Hudson Street Hospital 
and 1 to the Post-Graduate Hospital. Two cases of insanity 
were taken to the Manhattan State Hospital and 1 to Central 
Islip. St. Mary's Hospital for Children was availed of in only 
one instance. Two cases of tuberculosis went to Sea View 
Hospital, 1 to Seton Hospital and 1 to an unspecified sana- 
torium. Two cases went to Willard Parker Hospital for the 
treatment of contagious diseases. 
The scattering of patients among the hospitals is probably 
a normal distribution of cases among institutions in a city 
like New York, where, with the stupendous hospital problem 
to be dealt with, there is no regulative machinery of any kind 
in existence. 
The surprisingly small number of dispensary cases, namely, 
33 in all out of a total of 255 seeking medical advice, is probably 
due to the nature of the survey which emphasized only cases of 
serious illness. 
Duration of Cases of Sickness. 
The agents who enumerated the sicknesses in this health 
census inquired also for the duration of sickness up to the date 
of enumeration. The 356 cases were distributed according 
to the duration of the sickness up to the date of the inquiry 
and the tabulated facts are shown in the table on opposite page. 
Out of the total number of cases with duration of sickness 
specified, 30, or 9.0% were sick less than one week. Only 
16.5% were sick for less than two weeks, and 42.0% for less 
than two months. The duration of . illness of the majority of 
the cases discovered (54.9%) was over three months. There are 
evidently many chronic types of illness, particularly among 
the males, for while 41.6% of women were ill for a period longer 
8 Duration of Sickness-Chelsea Health Census Cases-Total Sick 
Persons. 
Table; 2. 
DURATION OF SICKNESS 
TOTAL 
Males 
Females 
Number 
PerCent* 
Number 
Per Cent. 
Number 
Per Cent. 
All durations 
356 
100.0 
186 
100.0 
170 
100.0 
1 day 
2 
.6 
2 
1.2 
Over 1 day, under 1 week.... 
28 
8.4 
12 
7.0 
16 
9.9 
1 week, under 2 weeks 
25 
7.5 
11 
6.4 
14 
8.7 
2 weeks, under 3 weeks 
23 
6.9 
8 
4.7 
15 
9.3 
3 weeks, under 1 month 
30 
9.0 
16 
9.3 
14 
8.7 
ifmonth, under 2 months.... 
32 
9.6 
17 
9.9 
15 
9.3 
2 months, under 3 months. . . 
10 
3.0 
5 
2.9 
5 
3.1 
3'months, under 6 months. . . 
37 
11.1 
22 
12.8 
15 
9.3 
6 months, under 1 year 
33 
9.9 
18 
10.5 
15 
9.3 
1 year, under 3 years 
48 
14.4 
25 
14.5 
23 
14.3 
3 years and over 
65 
19.5 
36 
20.9 
29 
18.0 
Unspecified 
23 
14 
9 
♦Duration of sickness specified. 
than six months, 45.9% of men suffered from protracted mala- 
dies. Sixty-five cases, or 19.5% of the total with duration 
of illness specified were sick three years or more. 
Prevention of Chronic Disabling Sickness. 
Through the census 7 cases of blindness and 9 cases of 
heart disease were found. The Neighborhood Association had 
special visits made upon all these persons and each set of con- 
ditions was carefully investigated. Among the 7 cases of 
blindness, 5 were found to be already in touch with the New 
York Association for the Blind, one case was in need of aid 
and one case had evidently moved without leaving the new 
address and so could not be relocated. Of the 9 cardiac cases, 
2 were under hospital care, 6 were in the care of private 
physicians and 1 had moved out of the city since the taking 
of the census. It is doubtful whether the 51 cases of 
"rheumatism" have ever received any instruction in personal 
hygiene or in dietetics. No data are at hand as to whether 
those discovered sick had made any provision for meeting 
the economic contingencies arising from sickness. 
Housing. 
In the health survey was included an item as to the number 
of rooms occupied by the families visited, with a view to 
discovering if there was any correlation between housing and 
9 health. At the outset it was considered doubtful whether 
this inquiry would bear fruitful results, and the investigation 
entirely sustained these doubts. It was not possible to establish 
any correlation between sickness and housing. Much interesting 
information, however, as to the housing conditions in the 
district was obtained. It was found that 25.0% of the families 
lived in three-room apartments, 38.6% in four-room apart- 
ments and 14.7% in five-room apartments. In other words, 
close to 80% of the families lived in apartments having from 
3 to 5 rooms. In examining the table, one may be surprised 
to see that there are such a large number of single persons 
living in apartments, consisting of 3, 4 and 5 rooms, but 
these are probably persons who were boarding with families 
occupying as many rooms. It is also possible that those 
classified in the first line of the table were in some cases the 
ordinary life insurance policy-holders of the Company, and 
these were of higher economic status. 
The table shows that there is an appreciable amount of 
over-crowding in the district. For instance, there were 242 
families with 4 persons each living in 3 rooms, 118 families of 
5 living in 3 rooms, 60 families of 6 living in 3 rooms, 33 families 
of 7 living in 3 rooms and 9 cases of families of 8 living in^3 
rooms. Similarly, there were 194 families of 6 living in 4 rooms, 
90 families of 7 living in 4 rooms, 48 of 8 living in 4 rooms, 
34 of 9 living in 4 rooms, and 11 of more than 10 living in 4 
rooms. 
The Tenement House Department also has supplied the 
Association with some interesting data relative to housing 
conditions in Chelsea. The neighborhood contains 3,210 
tenements, 3,167 of which are "old law" houses. Of these, 
273 are rear tenements, built behind houses fronting on the 
street. The Department reports that 63 tenements contain 
462 dark rooms against which orders are pending. Yard 
toilets in the rear of tenements are found in 599 houses, the 
total number of fixtures being 1,920. 
Chelsea Sewer System. 
Since local health conditions are often seriously affected 
by sewer facilities, the Association has inquired into that 
subject, and the Bureau of Sewers of the City has supplied the 
facts relative to Chelsea's system. Since sewerage is a matter 
10 Table 3. 
Housing Statistics of Chelsea Neighborhood. Number and Percentage of Families of Specified Size Occupying Apartments 
of Indicated Number of Rooms. 
Number of 
All Apartments 
1 Room 
2 Rooms 
3 Rooms 
4 Rooms 
5 Rooms 
6 Rooms 
7 Rooms and Over 
Unknown 
Family 
Number 
Per Cent. 
Number [Per Cent. 
Number 
Per Cent. 
Number 
Per Cent. 
Number 
Per Cent. 
Number 
Per Cent. 
Number 
Per Cent. 
Number 
Per Cent. 
Number 
Per Cent. 
1 
543 
100.0 
276 
50 
8 
111 
20.4 
82 
15.1 
40 
7.4 
13 
2.4 
2 
.4 
19 
3.5 
2 
1,347 
100.0 
56 
4 
2 
134 
9.9 
540 
40.1 
443 
32.9 
93 
6.9 
33 
2.4 
ii 
.8 
37 
2.7 
3 
1,347 
100.0 
10 
7 
45 
3.3 
410 
30.4 
591 
43.9 
201 
14.9 
43 
3.2 
li 
.8 
36 
2.7 
4 
1,097 
100.0 
5 
5 
20 
1.8 
242 
22.1 
537 
49.0 
192 
17.5 
48 
4.4 
21 
1.9 
32 
2.9 
5 
706 
100.0 
13 
1.8 
118 
16.7 
322 
45.6 
167 
23.7 
50 
7.1 
16 
2.3 
20 
2.8 
6 
425 
100.0 
2 
.5 
60 
14.1 
194 
45.6 
94 
22.1 
32 
7.5 
31 
7.3 
12 
2.8 
7 
244 
100.0 
4 
1.6 
33 
13.5 
90 
36.9 
57 
23.4 
30 
12.3 
19 
7.8 
11 
4.5 
8 
122 
100.0 
1 
.8 
9 
7.4 
48 
39.3 
35 
28.7 
15 
12.3 
12 
9.8 
2 
1.6 
9 
110 
100.0 
2 
1.8 
34 
30.9 
18 
16.4 
45 
40.9 
8 
7.3 
3 
2.7 
10 and over 
42 
100.0 
2 
4.8 
11 
26.2 
10 
23.8 
9 
21.4 
8 
19.0 
2 
4.8 
All families 
5,983 
100.0 
347 
5 
.8 
330 
5.5 
1,498 
25.0 
2,310 
38.6 
880 
14.7 
307 
5.1 
137 
2.3 
174 
2.9 
11 which lies with the local improvement boards and steps for 
better facilities cannot be initiated by the City, this is almost 
entirely a neighborhood problem. 
The Bureau of Sewers reports that the greater part of the 
original sewer system was built from 1840 to 1860, although 
many minor branches were built subsequently. Many of 
these older sewers are in very poor condition, due both to their 
age and to inferior materials in use at the time they were built. 
When the sewage reaches the waterfront it is carried in 
wooden barrels out to the end of a pier where it is discharged 
into the river without treatment of any kind. This practice has 
caused the accumulation of banks of sewage sludge along the 
waterfront and results in unsightly and perhaps unhealthful con- 
ditions at the sewer outlet. In certain locations the odors from 
this accumulation had been such as to cause serious complaints. 
Days Lost by Wage-Earners Because of Sickness. 
As in the other sickness surveys conducted by the Metro- 
politan Life Insurance Company among the wage-earning 
part of the population in representative American communities, 
approximately 1.5% of the population enumerated was found 
to be seriously sick. For the group of males aged 15 years or 
more the sickness rate involving disability for work was 17.6 
per 1,000 registered. This leads to the conclusion for Chelsea 
neighborhood that between 5 and 6 days are lost each year by 
adult wage-earners on account of serious sickness. The period 
in previous surveys was somewhat longer. 
Results. 
Important results of the census cannot be expected within so 
short a time, yet a number of interesting developments growing 
out of the health survey are worthy of mention here. 
The agents' of the Metropolitan Life Insurance Company 
did much useful work in the survey, noting cases of extreme 
poverty, unemployment and need of fresh air relief as well as 
of sickness. When the census was completed, all such cases 
were referred to the Chelsea Neighborhood Association, which 
in cooperation with other Chelsea agencies tried to solve each 
family's distressing problems. 
Cases of poverty were handled through the Charity Organiza- 
tion Society, Chelsea and Lowell branches; the Association for 
Improving the Condition of the Poor; the St. Vincent de Paul 
12 Society and neighborhood churches. Unemployment cases 
were handled through the Neighborhood Association's own 
employment bureau and fresh-air relief cases through the 
Association's special fresh-air committee. Some of the children 
found ill and in need of special summer attention were referred 
to the Hudson Guild, a Chelsea neighborhood settlement, for 
intensive treatment during the hot months along the lines of 
nourishment, recreation and physical training. 
Requests were received during the census, from organiza- 
tions devoted to work with the blind, crippled and deaf, for any 
information relative to their field which the census may have 
brought to light, and similar data was sought by agencies 
interested in housing conditions. The Neighborhood Asso- 
ciation in all cases made available to the several organizations 
the desired information. It is certain that as a result of this 
cooperative work Chelsea will reap many benefits. 
Cases of sickness were referred to the City Health Depart- 
ment's several bureaus and wherever further attention was 
needed proper steps were taken. 
The census revealed the need and special value of a neigh- 
borhood association as a center for a district's social and civic 
activities, especially along health lines. The practical results 
already achieved by the Neighborhood Association in Chelsea 
clearly indicate that other communities throughout the country 
may materially profit by organizing neighborhood associations 
and thus enable their citizens to participate in local move- 
ments for health and civic betterment. 
Since the Neighborhood Association is more than likely to 
follow out in great measure the programme outlined below, 
the Chelsea neighborhood may be sure to gain much lasting 
and constructive good from its health census. Furthermore, 
it is confidently hoped that other municipalities will see the 
advantages of neighborhood association work in a programme 
of civic betterment. 
Conclusions and Plans. 
The health survey has afforded an approximate indication 
of the prevalence of illness in Chelsea. The census showed 
almost 15 cases of serious illness per 1,000 people, and on the 
assumption that this rate applies throughout the year, there 
are estimated to be over 2,700 cases of serious sickness in 
Chelsea district all the time. A minor part of the illness is 
13 due to the acute contagious diseases, such as measles, scarlet 
fever and diphtheria. Much of it is due to degenerative 
diseases of the heart, blood vessels and kidneys, while some 
is due to tuberculosis and typhoid fever. 
A great deal of sickness is unavoidable, but a good proportion 
can be prevented either directly by the exercise of proper care 
by individuals or indirectly by closer observance of definite 
rules of public hygiene. Efficient public health administration 
on the part of the City authorities is, of course, an indispensable 
community measure. 
Through its Health Department the City is spending over 
$3,000,000 annually to protect the health of its citizens and 
is accomplishing appreciable results. It is, however, handi- 
capped in reaching a still higher degree of efficiency by the 
lack of cooperation on the part of the average man and woman, 
who are careless in their habits of life and behavior toward 
others. Promiscuous spitting in street cars and unprotected 
sneezing and coughing are responsible for many cases of tuber- 
culosis, pneumonia and other diseases of like nature, which 
are spread from man to man. 
The neighborhood is the first link in general community 
action for better health. Among neighbors, health matters 
can and are being discussed more freely and intimately than 
among any other large group of people. The findings in the 
Chelsea health survey lead to the conclusion that an educational 
campaign should be begun among the neighbors to promote 
a better knowledge of health rules and to inculcate the principles 
of wholesome community living. 
The Association proposes to enlarge its health committee 
so that it will include representatives from every important 
social agency in the district, from every hospital, dispensary 
and nursing organization working within the neighborhood 
boundaries. Through such an enlarged and representative 
committee it would seem possible to keep in touch with the 
existing agencies doing health work in the district and to give 
advice to neighbors on various matters of personal and collective 
interest. The Association will probably endeavor to raise 
funds to enable it to employ a qualified nurse who would be 
in constant touch with all the agencies of the district, who will 
act as the executive officer of the health committee and who 
will advise at all times with neighbors desiring instruction and 
guidance. 
14 Thanks to the health census, the Association now possesses 
information about the district, which can be enlarged gradually, 
so that in time it will have a considerable grasp upon the living 
and working conditions of the people in Chelsea. The Associa- 
tion's members aim to be in direct neighborly relations with all 
whom they know personally. The Association will also en- 
deavor to keep in constant touch with the Health Department 
by assisting medical inspectors, nurses and other agents of the 
Department in their numerous activities and by keeping them 
informed of local health conditions. Infractions of the sani- 
tary code, which the neighbors may report to the Association, 
and which the Association may be unable to rectify itself 
promptly by neighborly persuasion, will be reported to the 
Department of Health. 
The Association will keep in touch with the Street Cleaning 
Department to see that its work is done thoroughly and ex- 
peditiously and will help that Department as well as the 
neighborhood by calling the attention of the neighbors to the 
value of a clean neighborhood, free from litter, rubbish, dirt 
and garbage, in which flies and disease germs thrive abundantly. 
Similarly, the Association plans to cooperate with the Tenement 
House Department, and to report to the Commissioner all 
cases of neglect by inspectors and will also keep that Depart- 
ment informed of menaces to life and health which come to 
its attention. In this connection it will be well to remind the 
neighbors constantly that dark rooms, overcrowding and 
stagnant air are powerful allies of tuberculosis and other 
diseases. The Association will endeavor to work with the 
Police Department in curbing immorality and crime in the 
district, and will continually impress upon Chelsea's people 
the dire individual and social effects of venereal diseases, 
alcohol, and habit-forming drugs, such as morphine, cocain 
and heroin. The Association will take steps to improve the 
neighborhood's sewerage system. 
Working with the various public health, civic and philan- 
thropic agencies of the district, as w'ell as with those of the 
city, the Association hopes to be able to advise the neighbors 
authoritatively and accurately as to where to secure the best 
advice whenever they or their families develop sickness or 
meet with any difficulties. Many neighbors, who were reached 
through the health census, require hospital or convalescent 
care. They are being put in touch with the proper agencies. 
15 Many Chelsea children need attention to assure proper nourish- 
ment and some the opportunity to spend the summer in the 
open air outside the city. The Neighborhood Association is 
addressing itself to these needs. 
Some children of the district are feeble-minded and should 
not be allowed to be misused by other children and by incon- 
siderate adults. They should be placed in institutions estab- 
lished by the City or State for this purpose. 
Many of the sick, who were visited in the district, could 
derive more benefit from instruction as to diet and the rudiments 
of health than from medication. The Association will endeavor 
to persuade the dispensaries in the neighborhood to print 
circulars of instruction and to distribute them to sick neighbors 
who apply for medical advice, the circulars to deal with proper 
dietetics for the sick as well as for the well. Steps will also be 
taken to disseminate information as to the value of various 
foods and as to the economics of food consumption, a matter 
of primary importance in the present national crisis. 
Mothers of sick babies, who cannot afford the services of 
private physicians, will be urged to bring their children to the 
baby welfare stations maintained by the Department of Health. 
Measures will be provided to help the blind, the deaf and the 
crippled of the neighborhood to obtain vocational education 
and secure adequate employment. 
The health census revealed many conditions calling for 
relief. By a programme such as above outlined, the Associa- 
tion hopes to improve conditions considerably. 
It is hoped that the findings of this survey and the remedial 
measures proposed by the Chelsea Neighborhood Association 
will Serve as an indication to other communities throughout 
the country of what can be accomplished through neighborly 
interest and activity. The Metropolitan Life Insurance 
Company has cooperated in this work and has made the results 
available with this end in view. The experiment can be re- 
peated generally and profitably by other cities and by wards 
within the cities. An increase in our intensive knowledge of 
local health and social conditions will result, and higher 
community health standards will inevitably follow such a 
programme. 
16