Our Health Boards and Their Powers
As a nation, we have no comprehensive health organization. The crying need for one I shall point out in a future article. Our only Federal guardianship is vested in the United States Public Health and Marine Hospital Service, which, by some mystery of governmental construction, got itself placed in the Treasury Department, where it certainly does not belong. It is, with the exception of a few ancient political appointees now relegated to unimportant posts, a highly trained and efficient body of hygienists and medical men, the best of whom have also qualified as diplomats in trying crises. Any germ-beleaguered city may call upon this Service for aid. It is a sort of flying squadron of sanitative defence. When yellow fever broke out in New Orleans, it was the M. H. S. men who, working quietly and inconspicuously with the local volunteers, mapped out the campaign which rid the city of the scourge. In the San Francisco panic eight years ago, when bubonic plague beset the city, it was the Marine Hospital Service which restored confidence: and a Service man has been there ever since as the city's chief adviser. The Federal "surgeons," as they are called, may be in St. Louis helping to check smallpox, or in Seattle, blocking the spread of a plague epidemic, or in Mobile, Alabama, fighting to prevent the establishment of an unnecessary and injurious quarantine against the city by outsiders, because of a few cases of yellow jack; and all the while the Service is studying and planning a mighty "Kriegspiel" against the endemic diseases in their respective strongholds—malaria, typhoid, tuberculosis, and the other needless destroyers of life which we have always with us. In the Marine Hospital Service is the germ of a mighty force for national betterment.
DR. CHARLES HARRINGTON
SECRETARY OF THE MASSACHUSETTS STATE BOARD OF HEALTH, WHICH, BY THE DISTRIBUTION OF VACCINE AND ANTITOXIN ALONE, HAS SAVED THE STATE $210,000
Of the State boards, perhaps a fourth may be regarded as actively efficient. The rest are honorary and ornamental. Undoubtedly a majority would be ready and willing to perform the services for which they are not (as a rule) paid anything; but they lack any appropriation upon which to work. South Carolina, for example, has an excellent State board. Its president, Dr. Robert Wilson, is an able and public-spirited physician of the highest standing; an earnest student of conditions, and eager for the sanitary betterment of his State. But when he and his board undertook to get one thousand dollars from the legislature to demonstrate the feasibility of enforcing the pure food law and of turning away the decayed meat for which the State is a dumping-ground, they were blandly informed that there was no money available for that purpose. It was in South Carolina, by the way, that a medical politician who served on the public health committee of the legislature addressed this question to a body of physicians who had come there to appeal for certain sanitary reforms: "What do you want of laws to prevent folks being sick? Ain't that the way you make your livin'?" Which is, I fear, typical of the kind of physicians that go into politics and get into our legislatures, where, unhappily, they are usually assigned to the public health committees.
DR. THOMAS DARLINGTON
COMMISSIONER OF HEALTH FOR NEW YORK CITY, WHICH HAS THE MOST THOROUGHLY ORGANIZED CITY HEALTH DEPARTMENT IN THE UNITED STATES
Under the State boards, in the well-organized States, are the county boards and officers, who report to the State boards and may call upon the latter for advice or help in time of epidemic or danger.
In certain circumstances the State officials may arbitrarily take charge. This is done in Indiana, in Maryland, in Pennsylvania, and in Massachusetts. The last State not only grants extraordinary powers to its health executive, Dr. Charles Harrington, but it appropriated last year for the work the considerable sum of $136,000. By the issuance alone of vaccine and antitoxin, the Board saved to the citizens of the State $210,000, or $74,000 more than the total appropriation for all the varied work of the institution. Some vague idea of the economy in lives which it achieves may be gained from the established fact that death results in only sixteen out of every thousand cases of diphtheria, when the antitoxin is given on or before the second day of the illness; 110, when given on the third day; and 210 when the inoculation is performed later. The old death rate from diphtheria, before antitoxin was discovered, ranged from 35 to 50 per cent. of those stricken.
DR. CHARLES V. CHAPIN
SUPERINTENDENT OF HEALTH IN PROVIDENCE, RHODE ISLAND, ONE OF THE CITIES WHICH HAS BEEN FOREMOST IN PROSECUTING PHYSICIANS FOR FAILURE TO GIVE NOTICE OF INFECTIOUS DISEASE
Finally, there are the city bureaus, with powers vested, as a rule, in a medical man designated as "health officer," "agent," or "superintendent." What Massachusetts is to the State boards, New York City is to the local boards, but with even greater powers. Under the charter it has full power to make a sanitary code. Matters ranging from flat wheels on the Metropolitan Street Railway Company's antiquated cars, to soft coal smoke belched forth from factory chimneys, are subject to control by the New York City Department of Health. The Essex Street resident who keeps a pig in the cellar, and the Riverside Drive house-holder who pounds his piano at 1 a.m. to the detriment of his neighbor's slumber, are alike amenable to the metropolis' hired doctors.
The province of the city, State, and Federal health organization is broad. "Control over all matters affecting the public health" is a comprehensive term. "All the powers not already given to the school committees," observed a Massachusetts judge, "are now ceded to the Boards of Health." In theory, then, almost unlimited powers are vested in the authorities. But how carefully they must be exercised in order not to excite public jealousy and suspicion, every city health official well knows. More serious than interference and opposition, however, is the lack of any general equipment. At the very outset the loosely allied army of the public health finds itself lacking in the primal weapon of the campaign; comprehensive vital statistics.