PUBLIC HEALTH AND SANITATION
_The purpose of this chapter is to point out what things endanger
the public health and what means are taken to safeguard the people
against them._
[Sidenote: Health and efficiency.]
=A Highly Important Matter.=—Nothing among all the activities of modern
government is more important than the care of the public health. Its
importance cannot be measured in dollars and cents or in figures of any
kind. The health of the individual is the greatest of all factors in
personal efficiency; no man, woman, or child can do the best work in any
field of activity if hampered by disease, however slight. The health of
the community is likewise essential to its progress and prosperity.
Health protection, accordingly, is not a matter which can safely be left
to everyone’s discretion. Some people would realize the necessity of
safeguarding themselves and their families against disease; but others
would not, and their neglect would entail danger to the whole community.
Some people would know how to avoid ill-health, so far as it can be
avoided; but others would not possess this knowledge and would suffer
for lack of it.[251] A man’s religious or political belief may be his
own personal concern; but his ideas of cleanliness and disease
prevention are not. People who lay themselves open to disease constitute
a danger to all those around them. In earlier days, when the population
was scattered and not brought into contact the need for social control
of the public health was less imperative. Today, when millions of people
live in crowded cities where they come hourly into contact with one
another the safeguarding of the public health constitutes a governmental
task of the first importance and magnitude.
=Old and New Ideas Concerning Health Protection.=—No science has made
greater progress during the past hundred years than the science of
preventive medicine. In early times all diseases were looked upon as due
to the same cause, namely, the anger of the gods for some misdoing on
the part of the individual or the community.[252] The usual course, when
a pestilence came upon the people, was to go through ceremonies and
offer sacrifices in order that this anger might be appeased.
[Sidenote: The great plagues of olden days.]
Great plagues swept over Europe almost unchecked for a thousand years.
In every community there were healers and medicine-men, who claimed to
possess magic arts in dealing with all human ailments but, as a grim
truth, nobody had the remotest idea as to what brought these epidemics,
or how they were spread, or what might be done to prevent them. It is
said that the Black Death in the fourteenth century carried off
one-third of all the people in England. Whole towns were swept out of
existence. Knowledge concerning the nature of disease and the methods of
preventing it developed very slowly for many centuries, because many
superstitions had to be broken down, and only within quite modern times
did health protection reach the stage where it could properly be called
a science.
[Sidenote: The germ theory of disease.]
Health protection did not attain a scientific basis, in fact, until the
germ theory of disease was worked out and accepted. This theory, which
is simple enough in its elementary principles, completely reconstructed
the ideas of the human race concerning the causes and methods of
preventing bodily ailments. It provided a complete explanation for many
things which had been looked upon as utter mysteries. The wonder is that
the world spent so many centuries in discovering it. Even in the days of
the Roman Empire intelligent men suspected that there was some
connection between filth and pestilence; but just what this connection
was they never were able to trace out satisfactorily, nor did anyone
manage to do it for more than fifteen hundred years after them.[253] How
long it has sometimes taken the world to move from one step in knowledge
to the next!
[Sidenote: Explanation of this theory.]
=The Causes of Disease and Infection.=—The germ theory of disease may be
concisely stated in this way: Innumerable small organisms (known as
microbes, bacteria, bacilli, or germs) exist in the air, and in or upon
nearly all substances. These organisms or germs are so small that they
are invisible to the eye unless a powerful microscope is used. They are
so small that thousands of them can assemble on the head of a pin or in
the smallest drop of water. [Sidenote: Harmless bacteria.] Most of them
are harmless; and some of them render useful service. Without the aid of
these little organisms we could not make cheese or vinegar. On the other
hand nearly all organic decay, of whatever sort, is caused by the action
of bacteria. When apples rot, or milk grows sour, or butter becomes
rancid, it is all due to bacterial action. Bacteria multiply with
extraordinary rapidity wherever the temperature and other conditions are
favorable; most species increase by division, that is, one
micro-organism divides itself into two, these two into four, and so on
by geometrical progression. As successive divisions often take place
within a few hours it is easy to see how a very few germs today may
number millions tomorrow. Under the microscope most of the different
species can be identified, for they assume varying shapes and display a
variety of characteristics.
[Sidenote: Harmful bacteria.]
But although most of these diminutive organisms are harmless, many of
them are what scientists call _pathogenic_ germs, in other words, they
are a menace to health when they gain access to the human body. The
human body, in fact, is the most favorable environment for these
disease-bearing bacilli, and most of them can live but a short time
outside of it. Access may be gained in various ways, but principally
through the food and drink we consume, or through the bites of
germ-carrying insects. The bacteria, when they gain lodgment in the
tissues of the body, often multiply with great rapidity, creating
poisonous substances, and thus increase the normal bodily temperature—a
condition which we speak of as fever. When the body is strong and
vigorous, it can sometimes overcome and throw off the effects of this
bacterial action, for the human blood, under normal conditions,
possesses powers of resistance to pathogenic germs; but when people are
frail or exhausted, this power of resistance is greatly diminished and
the bacilli are enabled to gain the upper hand.
=Water-Borne Diseases—Typhoid Fever.=—One way in which pathogenic
bacilli gain access to the human body and produce disease may be
illustrated by the case of typhoid fever. Fifty years ago this disease
was one of the most common in all countries; today it has been almost
entirely eradicated in civilized lands. Both armies in the Civil War
lost thousands of men through its ravages, but in the American army
during the World War there were only a few cases. Accurate knowledge of
the way in which typhoid is transmitted has given mankind an almost
complete mastery over this scourge of many centuries.
[Sidenote: The causes of typhoid and the remedies.]
Typhoid is caused by a germ which is most commonly found in polluted
water, but sometimes makes its way into milk through the use of water in
washing cans and utensils. It does not come from bad ventilation, sewer
gas, ash piles, or exposure to cold, as some people imagine. The typhoid
bacilli, being taken into the stomach with water, milk, or any other
contaminated nourishment, find their way into the intestines and cause
inflammation there, thus producing a fevered condition. If the sewage
from hospitals and homes where there are typhoid patients is not
carefully guarded, it gets into lakes, rivers, or wells, polluting them
and spreading the disease. The elimination of typhoid is, therefore,
very largely a problem of protecting the water supply against contact
with human sewage. This is one reason why progressive communities are
giving so much attention and spending so much money upon modern methods
of sewage disposal and upon the rigorous protection of their public
water supplies. An epidemic of typhoid is always the outcome of
somebody’s ignorance or neglect. It has been suggested, with a good deal
of force, that for every such epidemic somebody ought to be put in jail.
=Insect-Borne Diseases.=—Another way in which disease-bearing bacilli
obtain access to the human blood is through the bites of insects.
[Sidenote: The scourge of yellow fever.] Fifty years ago yellow fever
was the great scourge of all tropical countries. When the French built a
railway across the Isthmus of Panama in 1885 it is said that the work
cost one life for every tie in the road, so great were the ravages of
yellow fever among the laborers. But the United States, twenty-odd years
later, succeeded in digging a canal across the Isthmus without the loss
of a single life from this disease. Under Spanish rule, Cuba was never
free from yellow fever; the island has been free from it since the
Americans cleaned it up.
[Sidenote: The war upon insects.]
The change has been brought about by the discovery that the germs of
yellow fever are carried by a certain species of mosquito which
transmits the infection from a diseased person to others. The
cleaning-up of stagnant pools in which the mosquitoes breed, and the
careful screening of doors and windows has practically eliminated the
disease wherever these measures have been taken. Substantially the same
thing is true of the disease known as malaria so far as causes and
remedies are concerned. Typhus, a fever which has long been the
pestilence of backward countries, is transmitted from person to person
by the common body-louse or “cootie”. Cities, armies, and even whole
countries have been set free from this plague by delousing operations,
that is by the wholesale disinfection of clothing and persons.[254]
Bubonic plague, the Black Death of the Middle Ages, which has swept over
Asia and portions of Europe so many times, is transmitted by rat fleas.
Other diseases besides yellow fever, typhus, and bubonic are known to be
spread by insects, and still others are believed to be. The common
house-fly is undoubtedly a carrier of typhoid germs from filth and
sewage to the water, milk, and food supplies in homes and stores. The
world would be far better off if the whole category of disease-carrying
insects, mosquitoes, lice, fleas, and flies, could be made as extinct as
the dodo.
=The Wide Range of Disease and Causes.=—Not all diseases, of course, are
caused by polluted food and drink or by the transmission of insect-borne
bacilli. Some are undoubtedly caused by pathogenic germs whose methods
of infection we do not yet know. There are various theories as to what
carried influenza from one end of the world to the other during 1918 but
none of them satisfactorily explain all that happened. The epidemic in
one case broke out upon a sailing ship, far off at sea, six weeks after
it had left port. So disease still has its mysteries, yet unsolved.
[Sidenote: Things which cause and spread disease.] We know, however,
that many ailments are either directly caused or are facilitated by poor
nourishment, bad ventilation, lack of cleanliness, physical exhaustion,
and lax attention to personal hygiene. Some are due also, in whole or in
part, to certain forms or conditions of work, and are commonly known as
occupational or industrial diseases. Such, for example, is lead
poisoning in paint factories; such also is the illness which often
overcomes men working in tunnels and other places where compressed air
is used. The spread of tuberculosis, the great white plague of today, is
undoubtedly due in some measure to dust and bad ventilation. The
relations between diseases and occupations have not received careful
study until recent years, but it is believed that we shall ultimately
find the causes of many human ailments in the conditions under which
some forms of industry are carried on.
[Sidenote: Industry and ill health.]
=Hygiene of Factories and Workshops.=—Because of the unsanitary
conditions which have been found by investigation to exist in workshops
and factories, particularly in the large cities, various states have
made laws and regulations to protect the health of employees in such
establishments. Some trades, such as the making of poisonous phosphorous
matches, have been prohibited altogether. Others, by reason of their
danger to the health of the workers, have been subjected to strict
regulation. The “sweat-shops” or tenement rooms in which women and
children formerly worked long hours for a mere pittance, crowded
together with almost no ventilation—these industrial dungeons have been
legislated out of existence almost everywhere. Workshops and factories
must now be commodious, well-lighted, clean, and properly ventilated.
Adequate sanitary equipment must be provided. It is the duty of the
state factory inspectors to see that all these requirements are
fulfilled.
=The Prevention of Disease—Individual Precautions.=—Without the
co-operation of individuals no government can maintain a high standard
of health among the people. All that the public authorities may do will
prove inadequate unless individuals themselves, young and old,
understand and observe the means of disease-prevention. [Sidenote:
Physical fitness.] Physical fitness is one of the greatest blessings any
man or woman can have, and it is largely the product of strict attention
to the upbuilding of the body in early years. Theodore Roosevelt was a
frail, sickly lad in his boyhood days. He realized, as he explains in
his autobiography, that he could never make a marked success in life
without building up his physical vigor, so he set about doing it, and by
the time he had reached full manhood he was a model of physical
ruggedness. How did he manage it? Regular habits, out-of-door life,
prompt attention to minor ailments, a zest for every form of wholesome
sport,—these things transformed a weakly youth into the sturdiest man
that ever sat in the presidential chair.
There is no need to lay down any definite rules as to how the young men
and women of America may gain and maintain a high standard of health and
bodily vigor. Common sense will suggest most of them. The besetting sin
of youth is its prodigality, the wasting of strength that should be
saved for years to come, and the failure to realize that an individual’s
health at the age of forty or fifty depends very largely upon what use
is made of health opportunities during the years from fifteen to
twenty-five. The glory of a young man is his strength; he does not
usually let his mind run ahead to the day when he will be neither young
nor strong. No investment that young people can make will pay higher
dividends than that which is represented by the time, the thought, and
the care spent upon the task of keeping well in early years.
[Sidenote: Quarantine.]
=The Prevention of Communicable Diseases: Quarantine and
Disinfection.=—First among the measures taken by the public authorities
to prevent the spread of communicable diseases are the quarantine
regulations which are enforced at all the seaports under the authority
of the national government. Day and night throughout the year, the
health officers stand guard at these ports to see that no
disease-bearing persons are permitted to land. Vessels leaving foreign
harbors for the United States must secure a bill-of-health from the
American consul before they sail; and the first person who goes on board
an incoming vessel after it takes on its pilot is the quarantine
officer. This official permits no passengers to be landed until he has
made sure that there are no persons afflicted with communicable disease
aboard. If there are any such cases, the passengers are held until the
danger is past. The various states and cities also maintain systems of
health-inspection and quarantine. Certain diseases (including
tuberculosis, smallpox, typhoid, scarlet fever, pneumonia, whooping
cough, diphtheria, measles, mumps, and so forth) must be promptly
reported to the local health authorities. The local health regulations
require that in case of the more readily communicable diseases the house
be placarded. In extreme cases, the patients may be removed to an
isolation hospital.
[Sidenote: Disinfection.]
After the illness has terminated, the regulations usually provide that
the premises shall be disinfected under the supervision of an official
from the health department. Every state, as well as every city and town,
maintains general regulations relating to quarantine and disinfection,
these being enforced by the state health authorities. For the most part,
however, this work is supervisory, the detailed enforcement of the rules
being left to the health officers of the various communities, although
in the case of epidemics, involving several municipalities, the state
health authorities usually assume direct control. Similarly, when
epidemics spread or threaten to spread from one state to another, the
national health authorities step in.[255]
=Vaccination and Inoculation.=—The practice of vaccinating and
inoculating healthy persons as a safeguard against disease has been used
for more than a century. Vaccination consists in introducing vaccine
into the blood of a healthy person, usually by making an abrasion of the
skin. The vaccine is obtained from health laboratories, where it is
produced from the blood of artificially-infected cattle. Inoculation of
the human blood is also widely used nowadays in order to prevent or to
mitigate diphtheria, typhoid, pneumonia, and rabies. All members of the
American expeditionary forces during the World War were given the
anti-typhoid inoculation. It consisted of injecting into the blood a
quantity of dead or greatly-weakened typhoid bacilli. They were not
sufficient to produce the disease but they were enough to set the
resisting-powers of the blood in motion so that the latter would be
fully developed to meet a real infection if it should come.
[Sidenote: Should vaccination be compulsory?]
Vaccination against smallpox is compulsory in several of the states and
in many communities, although there is a good deal of objection to it
among certain sections of the people. If smallpox were completely wiped
off the face of the earth there would be no need for universal
vaccination; but so long as numerous cases exist, as they still do in
many countries, compulsory vaccination is likely to prove a justifiable
measure of public safety.
[Sidenote: Importance of the milk supply.]
=Milk Inspection.=—Among all the foods of humanity, milk is probably the
most important. It is the chief nutrition of children until they reach
school age, and sometimes even longer. It forms a large factor in the
diet of invalids. Even in the daily fare of robust adults, it is an item
of no small importance. Yet no article of everyday commerce is more
easily contaminated, and in the case of no other article are the results
of pollution likely to be so serious. For when the germs of disease get
into milk, they multiply with appalling rapidity and they go directly
into the diet of those who have the least power to withstand infection,
the children and invalids of the community.
[Sidenote: The danger of pollution.]
From its source on the farms milk passes through several hands before
reaching the consumer, and at each of these points may be contaminated.
Careless milking, the storing of milk in unsanitary places or in unclean
utensils, the lack of adequate precautions in transporting or delivering
the milk—any of these things may result in pollution. Strict rules and
frequent inspection help to safeguard the milk supply at the source and
during its journey to the consumer, but the problem of careful
inspection is rendered difficult by the fact that the milk supplies of
large cities are now drawn from a wide area outside the municipal
limits. New York City, for example, obtains its supply of nearly two
million quarts per day from about forty-five thousand farms scattered
throughout eight different states.
[Sidenote: Milk and the infant death rate.]
It is easy to appreciate the difficulties involved in the supervision of
the milk supply under such conditions. Nevertheless, this supervision is
being carried on in all large communities and it has resulted in a
marked lowering of the infant death rate. Infant mortality and the milk
supply are closely related, in fact it can fairly be said that the rate
of the one depends in a large measure upon the purity of the other. The
establishment of milk-distribution stations in large cities has been of
considerable value in enabling the people of the crowded sections to
obtain pure milk at reasonable prices.
=The Inspection of Food.=—The marketing of impure or adulterated food is
everywhere forbidden by the laws and the health regulations, but until
comparatively recent years these rules were not always strictly
enforced. One reason for this is to be found in the fact that many
articles of food are subjects of interstate commerce, produced in one
state to be sold in another, and hence are not easily made amenable to
local control. [Sidenote: The Food and Drugs Act, 1906.] In 1906,
however, Congress passed a comprehensive law known as the Food and Drugs
Act, by the terms of which the national government assumed the duty of
eliminating impure food from general commerce. This act prohibited the
adulteration of food and drugs; it made provision for the inspection of
meats at the great packing plants; it required that all packages of food
and drugs shall be branded correctly and that when artificial
preservatives are used, the label shall state the fact. All impure,
adulterated, or wrongly-branded articles are excluded from interstate
commerce under the provisions of this law.
[Sidenote: State inspection of food.]
The supervision of the national government does not extend, however, to
articles of food which are produced, distributed, and sold within the
territory of a single state. As regards such articles, the task of
protecting the public against impurity and adulteration rests with the
state and local health officers. These officers perform their work by
frequent inspection at places where food is produced and sold. Makers
and vendors of impure or adulterated foods are prosecuted in the
ordinary courts.
=The Drug Evil.=—The indiscriminate and unchecked sale of narcotic drugs
(morphine, opium, etc.) in past years led to serious evils. Persons who
regularly use any of these narcotic drugs become slaves to the habit;
they are unable to get along without daily use of them, and in the end
become physical wrecks. The drug habit became, a few years ago, such a
widespread public evil that the national government took the manufacture
and sale of these narcotics under its own supervision. Such drugs cannot
now be bought or sold except under strict regulations which involve the
written request of a qualified physician. Nevertheless a good deal of
trade in narcotics is still carried on through illicit channels.
[Sidenote: Prohibition as a health measure.]
=Prohibition of the Liquor Traffic.=—The relation of the liquor traffic
to the public health is a matter upon which men have not entirely
agreed; but it is a well-recognized fact that the general use of
intoxicating liquors led in many cases to poverty, and poverty in turn
brought under-nourishment and disease in its train. The action of the
states in adopting the Eighteenth Amendment, by which the manufacture,
transportation, and sale of all intoxicants is forbidden, may therefore
be looked upon as a step which, in the long run, will conduce to the
betterment of the public health. The excessive use of alcohol impaired
the physical vigor of many thousands among the population and rendered
them less capable of resisting disease. The statistics of hospitals
during the period that has intervened since prohibition went into effect
show that, from a health standpoint, the Eighteenth Amendment has had a
beneficial effect.
=Waste Disposal and Sewerage.=—Every community produces each day a large
amount of waste which must be collected and disposed of in a sanitary
manner if the interests of the public health are to be fully protected.
Some of this waste contains little or no element of danger—ashes, waste
paper, and rubbish of all sorts, for example. The removal of this
material is a matter of public convenience rather than of public health
protection. As a rule it is drawn away and either used for filling marsh
land or incinerated. [Sidenote: Garbage.] Another form of waste is
garbage, which includes the discarded material from markets, bakeries,
hotels, restaurants, and private dwellings. This garbage decomposes
quickly and must be gathered at frequent intervals. In some communities
the garbage is disposed of by incineration; in others it is sold to
farmers for feeding swine; a few cities utilize it in reduction plants,
where the grease and oil is extracted for commercial use.
[Sidenote: Sewage.]
Sewage, which includes both surface water and the liquid waste from
places of human abode, is by far the most dangerous waste of all.
Although it is more than ninety-nine per cent water, every ounce
contains the possibility of spreading disease. [Sidenote: Older methods
of disposal.] This effluvia, which passes through the sewers and drains,
was at one time everywhere disposed of by turning it into the ocean,
lakes, or rivers. Even yet many cities of the United States get rid of
their sewage in that way. The method is not objectionable in the case of
ocean discharge, provided the outfall sewer is carried a sufficient
distance from the shore, although even in such cases some of the sewage
may be borne landward by the incoming tides to pollute the shellfish
beds and the beaches. The sewage of many cities along the Great Lakes is
discharged into these extensive bodies of fresh water where the amount
of dilution is so great that no serious harm results, provided no water
for human consumption is drawn from the immediate neighborhood of the
discharge points. The time will doubtless come, however, when the
increasing volume of sewage will compel these cities to adopt other
methods of disposal. The discharge of untreated sewage into rivers and
small streams is now generally regarded as a public nuisance, and the
abandonment of the practice is being required by the laws wherever
practicable. Many cities, however, yet resort to this method.
[Sidenote: Modern sewage systems.]
Modern, scientific methods of sewage disposal have taken several
different forms. A common plan is to conduct the sewage into huge
reservoirs, basins, or tanks, where the solids are allowed to settle and
form a sludge while the liquid is run off into the ocean or a lake or a
river. The settling process is sometimes hastened by the use of
chemicals. This does not free the waterways from danger but it is a good
deal less objectionable than the practice of turning untreated sewage
into them. Some cities pump the sewage upon filter beds (tracts of land
which have been dug out and filled with slag or other porous
substances). A few use their sewage for the irrigation of dry farming
lands. No particular plan of sewage disposal can be regarded as the best
under all circumstances. Local conditions differ from one community to
another, and each case requires special study. Ordinarily a large town
or city will produce nearly two hundred gallons of sewage per day for
every man, woman, and child in its population. This means an enormous
total in the course of a year and the problem of handling it safely,
without excessive expense, is often a difficult one. It may well be
repeated, however, that so far as the public health is concerned, sewage
is the most dangerous substance known to man, and its safe disposal is
one of the most important problems of the government in every civilized
community.
=The Protection of the Public Water Supply.=—The great importance of an
adequate and safe water supply is something which hardly requires a long
argument. In the rural districts and in small villages the neighboring
wells and springs may be utilized, but in large communities, especially
those having numerous industries, a public supply must be provided.
[Sidenote: How much water is needed?] It is customarily figured that
large towns and cities require approximately and on the average one
hundred gallons of water per capita every day in the year. Half-a-ton of
water per day per person! What is done with it all? Not all of it, of
course, is used for human consumption. By far the greater part is
utilized for public, industrial, and general sanitary purposes.
Sprinkling parks and lawns, putting out fires, flushing sewers—all these
activities require large amounts of water. Factories, laundries,
railroads, and other such establishments make heavy demands on the total
supply. So does the modern sanitary equipment which is now being
installed almost everywhere in hotels, stores, and houses. The amount of
water required for human consumption is very small compared with the
quantities used in these other ways.
The first essential of a satisfactory water supply, therefore, is that
it be adequate, which means that large cities must often go a long
distance in order to obtain water in sufficient quantities. [Sidenote:
Sources of supply.] New York City derives a large part of its water from
the Catskill Mountains; Los Angeles brings its entire supply from the
Sierra Nevadas, more than two hundred and fifty miles away.[256] Many
other cities obtain their water close at hand: Chicago, for example,
draws from Lake Michigan, and Cleveland from Lake Erie. Adequacy,
however, is not the only consideration. For use in the industries, water
must be clear in color and not too hard. When it is turbid or hard, it
has to be clarified and softened by storage and the use of chemicals.
The relative purity of the water, its freedom from pollution, is the
most important consideration of all.
[Sidenote: The treatment of water for human use.]
There are various ways of making sure that water is fit for human
consumption. One way is to secure the supply from a source which is by
nature free from pollution, from deep-driven wells or from mountain
lakes which are above the level of probable contamination. Water
supplies drawn from very large bodies of water, like the Great Lakes,
are normally safe enough if the intake is set far out from shore,
because the diluting power of these vast water areas is sufficient to
render harmless even a considerable amount of pollution by sewage
discharge. Where a water supply of sufficient natural purity cannot be
had within reasonable distance the only safe plan is to subject the
water to such length of storage, or to such mechanical or chemical
treatment as will ensure its fitness for use. The storage of water in a
reservoir, exposed to the light and air, will render it safe, under
normal conditions. The length of time required for this purpose will
depend, of course, upon the quality of the water which is put into the
reservoir. A period of three months is ordinarily regarded as sufficient
where the raw water has not been badly contaminated. The mechanical
treatment of water is commonly known as filtration, and there are
several forms of public water-filtration plants now in use by American
cities. The simplest is the system of slow sand filters in which the
water is treated by allowing it to percolate slowly through a bed of
sand and crushed stone, thereby becoming rid of noxious bacteria. A more
complicated method involves the use of rapid sand filters in which the
raw water is forced through filterbeds of crushed stone under
pressure.[257]
=Smoke Abatement.=—Pure air is another essential to the maintenance of
the public health. Rural parts of the country encounter no difficulty on
this score, but the larger cities are now finding it necessary to
protect the air which their citizens have to breathe. In these days of
smoke-belching industry, the very atmosphere of the large city is laden
with a menace to health and cleanliness. An investigation made in New
York some years ago disclosed the fact that sulphur dioxide (a poisonous
gas) was being discharged into the air by the smokestacks and chimneys
of the city at an appalling rate. The elementary student of chemistry
can well testify that SO_{2} is not a substance that human beings thrive
upon. And apart from the menace to health there is the heavy damage done
by soot-laden atmosphere to the furnishings of houses and the contents
of shops. Hence the agitation in the large cities for an abatement of
this smoke nuisance and the establishment of regulations which now, in
many places, require the use of mechanical smoke consumers by all large
industries. The enforcement of this requirement is not at all difficult,
because any violation is visible to the naked eye.
[Sidenote: Overcrowding and disease.]
=The Housing of the People.=—By the homes of a town or city you may
judge its people. The proper housing of the population has a close
relation to many things, but to none is this relation closer than to the
public health. When the people are herded together in tenements, with
dark and narrow hallways, with rooms badly ventilated and often without
sunlight, we have a fertile soil for the spread of tuberculosis. More
than ten thousand persons die each year in the tenement districts of New
York City from the Great White Plague alone. The children who grow up in
congested quarters, moreover, go out into the world handicapped in both
body and soul. Their powers of resistance to disease are often seriously
impaired by the crowding, poor ventilation, and lack of proper sanitary
arrangements. An investigation of housing conditions made in New York
City over twenty years ago led to the enactment of a comprehensive
Tenement House Law (1901) in order to prevent overcrowding, and the main
provisions of this law have since been copied by most of the larger
cities of the country.[258]
[Sidenote: Housing experiments abroad.]
In some European cities, notably Glasgow and London, many municipal
tenements have been erected. Crowded slums have been demolished and
model houses, each accommodating one or more families, have been erected
in their place by the use of public money. These tenements are then
rented to workers at reasonable rates. This plan has not yet been tried
on any large scale in the United States nor would it be likely to prove
very satisfactory so long as city administration, in all its branches,
is conducted so wastefully as it is in America today. During the World
War, however, the federal government built many hundreds of workmen’s
dwellings in different parts of the country, particularly in the
neighborhood of the great shipbuilding plants. After the war they were
sold to private buyers.
It is often urged that instead of building model tenements in crowded
sections, the authorities of large cities ought to promote the growth of
suburbs by giving them good transportation facilities, and by promptly
supplying these suburban districts with sewers, water supply, gas,
electricity, and paved roads. People who go to the suburbs not only have
more room, but they are much more likely in the course of time, to own
their homes. [Sidenote: The importance of owning a home.] Home-owning is
a practice which ought to be encouraged, not only for reasons of health
and recreation, but to steady the political temper of the people as
well. The man who owns a piece of the earth’s surface, with a house on
it that he calls his home, is not often a believer in violence or
revolution. A great deal of honest sentiment clusters about the American
home, but very little can ever attach to three or four rooms in a
tenement house.
=Other Measures of Public Health Protection.=—The foregoing list does
not exhaust the various measures taken by the authorities of the nation,
state, and city for the protection of the public health. The laws and
regulations which now prohibit the use of public drinking-cups on
trains, in schools, and in other public places may be mentioned. The
common cup has been, in the past, an active spreader of infection. Its
use ought to be forbidden everywhere. Measures for the elimination of
mosquitoes and house-flies have been taken by all the more progressive
states and cities with aid at many points from the national government.
The statement has been made, upon what seems to be good authority, that
mosquitoes, flies, and other insect pests are directly or indirectly
responsible for a hundred thousand deaths in the United States every
year. Whatever their number, these deaths are preventable, because a
diligent campaign will suffice to banish both flies and mosquitoes from
any part of the country. The medical inspection of children in the
schools is another health measure of great importance. In many of the
larger cities this inspection includes all school children, of whatever
age, and is made at frequent intervals. It permits the early detection
of symptoms and thus allows remedies to be applied promptly. It has done
a great deal to protect the schools against the frequent outbreak of
epidemics.
=How Health Measures are Enforced.=—The duty of enforcing measures for
the protection of the public health rests first of all upon the local
health officers. [Sidenote: Local boards of health.] The laws of most
states now require that a board of health or some similar authority
shall be maintained in every township, village, town, and city. One of
the members of this board of health must usually be a physician. In
large towns and cities a qualified health officer, who is always a
physician, is employed on part time or full time. The local boards of
health and the health officers have charge of quarantine and
disinfection, the inspection of food and milk, and the enforcement of
sanitary regulations. They also grant permits for the maintenance of
slaughter-houses and other establishments which have a direct or
indirect relation to the public health.
[Sidenote: State health officers.]
In practically all the states, moreover, there is a State Department of
Health. This department is usually under the supervision of a State
Board of Health, but in a few states a single health commissioner has
been placed in charge. The powers and duties of these state departments
vary a good deal throughout the country, but in a general way they
assist the local health authorities, especially when an epidemic
threatens to spread beyond local control. A good deal of their work is
advisory in character.
[Sidenote: The United States Public Health Service]
The United States Public Health Service was established in 1912,
although health work had been carried on by the national government
through other agencies prior to that date. It is, rather strangely, a
bureau of the Treasury Department. The Public Health Service has charge
of the port quarantine system; its assistance may be obtained by the
states at any time in coping with epidemics; and it maintains
well-equipped research laboratories for the study of all questions
affecting the public health. It is believed by many physicians that the
work of this bureau is so important that it ought to be made a regular
department of the national administration with a member of the cabinet
at its head.[259]
[Sidenote: What the schools can do.]
=Education and the Public Health.=—The basis of successful public health
work is the education of people in hygiene and sanitation. If the people
can be brought to realize the transcendent importance of the work, their
co-operation will be given cheerfully. Where the health regulations are
now disobeyed it is largely because their value to the individual, as
well as to the community, has not been made clear. An effective method
of educating the public is by means of health exhibits which
demonstrate, with the aid of pictures, especially motion pictures, the
value of proper hygienic conditions in the workshop and the home. But
the ultimate education of the whole people in this field, as in all
others, must be primarily the work of the schools. It is easier to teach
hygiene and sanitation to children than to grown-ups. Adults have
acquired habits of life and attitudes of mind which are hard to alter.
Hence the education of children in all that relates to clean living,
wholesome food, modern sanitation, and the avoidance of disease should
be part of the regular work in schools throughout the country. Upon this
will depend, in no small degree, the future physical well-being of the
nation.
General References
H. G. JAMES, _Municipal Functions_, pp. 68-92;
HOLLIS GODFREY, _The Health of the City_, especially pp. 1-29;
W. H. ALLEN, _Civics and Health_, pp. 3-32;
_Cyclopedia of American Government_, see under _Health_, _Contagious
Diseases_, _Quarantine_, _Tenement House Regulation_, etc.;
W. B. MUNRO, _Principles and Methods of Municipal Administration_, pp.
122-166 (Water Supply); pp. 167-210 (Sewerage and Sanitation);
H. B. WOOD, _Sanitation Practically Applied_, especially pp. 205-232
(Pure Foods); pp. 233-277 (Clean Milk);
IRVING FISHER and L. B. FISK, _How to Live_, pp. 119-168;
WALTER CAMP, _Keeping Fit All the Way_, pp. 3-41;
CHARLES BASKERVILLE, _Municipal Chemistry_, pp. 1-19;
MILTON J. ROSENAU, _Preventive Medicine and Hygiene_, pp. 716-745;
W. T. SEDGWICK, _Principles of Sanitary Science and the Public Health_,
pp. 89-107;
E. B. HOAG and L. M. TERMAN, _Health Work in the Schools_, pp. 133-191.
Group Problems
=1. How can the spread of communicable diseases be prevented?= Are the
vital statistics of your community carefully and promptly compiled? The
local health authorities,—who are they and what are their functions?
What control is exercised over the agencies which spread disease?
Examine the status of each in your own community. =References=: MILTON
J. ROSENAU, _Preventive Medicine and Hygiene_, pp. 134-158; H. B. WOOD,
_Sanitation Practically Applied_, pp. 66-152; WOODS HUTCHINSON,
_Preventable Diseases_, pp. 83-122; HOLLIS GODFREY, _The Health of the
City_, pp. 158-193; G. C. WHIPPLE, _State Sanitation_, Vol. I, pp.
88-112; see also the United States Public Health Service, _Reprints on
the Notifiable Diseases_, and the reports of the state and local Boards
of Health.
=2. Public water supplies.= =References=: W. B. MUNRO, _Principles and
Methods of Municipal Administration_, pp. 122-166; H. G. JAMES,
_Municipal Functions_, pp. 217-227; H. B. WOOD, _Sanitation Practically
Applied_, pp. 278-337; ALLEN HAZEN, _Clean Water and How to Get It_, 2d
ed., pp. 73-99; CHARLES BASKERVILLE, _Municipal Chemistry_, pp. 33-89;
F. E. TURNEAURE and H. L. RUSSELL, _Public Water Supplies_, pp. 141-172.
=3. Modern methods of sewage disposal.= =References=: W. B. MUNRO,
_Principles and Methods of Municipal Administration_, pp. 183-210; H. G.
JAMES, _Municipal Functions_, pp. 227-237; H. B. WOOD, _Sanitation
Practically Applied_, pp. 338-378; JOHN A. FAIRLIE, _Municipal
Administration_, pp. 245-255; CHARLES BASKERVILLE, _Municipal
Chemistry_, pp. 276-299; W. P. CAPES and J. D. CARPENTER, _Municipal
Housecleaning_, pp. 33-89; G. W. FULLER, _Sewage Disposal_, pp. 175-183;
LEONARD METCALF and H. P. EDDY, _American Sewerage Practice_, Vol. II,
pp. 78-127; A. P. FOLWELL, _Sewerage_, pp. 300-332; L. P. KINNICUT, C.
A. E. WINSLOW, and A. W. PRATT, _Sewage Disposal_, pp. 204-232.
=4. The milk question.= =References=: CHARLES BASKERVILLE, _Municipal
Chemistry_, pp. 90-118; H. B. WOOD, _Sanitation Practically Applied_,
pp. 233-277; HOLLIS GODFREY, _The Health of the City_, pp. 30-57; M. J.
ROSENAU, _The Milk Question_, pp. 1-22; J. S. MACNUTT, _The Modern Milk
Problem_, pp. 1-30; H. N. PARKER, _City Milk Supply_, pp. 28-90; G. C.
WHIPPLE, _Typhoid Fever_, pp. 41-91.
=5. Housing in its relation to public health.= =References=: HOLLIS
GODFREY, _The Health of the City_, pp. 302-345; F. C. HOWE, _The Modern
City and Its Problems_, pp. 273-288; JACOB A. RIIS, _How the Other Half
Lives_, pp. 7-27; LAWRENCE VEILLER, _Housing Reform_, pp. 3-46.
Short Studies
1. =The germ theory of disease.= C. V. CHAPIN, _The Sources and Modes of
Infection_, pp. 1-38; C. B. MORREY, _The Fundamentals of Bacteriology_,
pp. 18-31.
2. =Typhoid fever.= Illinois State Board of Health, _Typhoid Fever: Its
Cause, Prevention, and Suppression_, pp. 2-17.
3. =Insects and disease.= H. B. WOOD, _Sanitation Practically Applied_,
pp. 420-444.
4. =Vital statistics.= _Ibid._, pp. 25-65; G. C. WHIPPLE, _Vital
Statistics_, pp. 308-337.
5. =Sources of water supply.= W. B. MUNRO, _Principles and Methods of
Municipal Administration_, pp. 122-142.
6. =The disposal of garbage.= _Ibid._, pp. 167-183.
7. =The inspection of food.= H. B. WOOD, _Sanitation Practically
Applied_, pp. 205-232.
8. =The smoke nuisance.= HOLLIS GODFREY, _The Health of the City_, pp.
1-8. (See also United States Bureau of Mines, _Bulletin_, No. 49.)
9. =Tenement-house reform.= C. A. BEARD, _American City Government_, pp.
287-310.
10. =Municipal housing abroad.= HOLLIS GODFREY, _The Health of the
City_, pp. 263-301; F. C. HOWE, _The Modern City and Its Problems_, pp.
284-304.
11. =The work of local health authorities.= MOSES N. BAKER, _Municipal
Engineering and Sanitation_, pp. 248-258; HENRY BRUÈRE, _The New City
Government_, pp. 401-413.
12. =Health and education.= H. B. WOOD, _Sanitation Practically
Applied_, pp. 445-462; F. W. BURKS and J. D. BURKS, _Health and the
School_, pp. 73-102; E. B. HOAG and L. M. TERMAN, _Health Work in the
Schools_, pp. 1-35.
Questions
1. From your reading of history and literature give some examples of the
way diseases were dealt with in the olden days.
2. What are bacilli? Make a list of the things, beneficial, harmless,
and harmful which are due to their activities.
3. Explain the various ways in which disease may be communicated. How
are the following measures related to the control of communicable
diseases: (_a_) quarantine; (_b_) the draining of marshes; (_c_) the
removal of filth; (_d_) the extermination of rats; (_e_) the enforcement
of regulations to prevent overcrowding in tenements?
4. What are vital statistics and what is their value? How are they
compiled and by what means may they be improved?
5. Explain what is meant by vaccination. By inoculation. Give some
evidence to prove that both have been effective.
6. Why is milk inspection of supreme importance? In what various ways
may milk become infected? Why should milk be kept in a cool place?
7. Do you understand the following terms: adulteration; artificial
preservatives; misbranding; ptomaine; narcotics?
8. Name the various wastes which the community produces each day and
explain how each may be safely disposed of.
9. In what ways may water be treated so as to make it safe for human
consumption?
10. Why and in what way is it necessary to regulate the housing of the
people in large cities?
11. What are the duties of the local board of health in your community?
The state department of health?
12. Ought hygiene to be a compulsory study in the public high schools?
Topics for Debate
1. Vaccination should be made compulsory throughout the United States.
2. American cities should construct and maintain municipal tenements.
3. Free medical attendance should be provided at the public expense for
all who cannot afford to pay for it.
-----
Footnote 251:
Measures for the promotion and protection of the public health have a
marked effect upon the death rate. Fifty years ago it was not at all
uncommon to find, in American cities and towns, an annual death rate
of thirty persons per thousand of population. Today this rate has
everywhere been cut in two. Even in large centers of population like
New York and Chicago the annual death rate, in normal years, is now
below fifteen per thousand. This means, of course, that the average
duration of life, taking the population as a whole, has been
lengthened. The lowered death rate has probably added seven or eight
additional years to the average life-span. It is easy to see what an
enormous gain this has meant to the productive power of the country.
Footnote 252:
Recall, for example, the passage in Homer’s _Iliad_, where the sun god
in anger raised his terrible bow and with every twang of the
bow-string sent men to their death by pestilence.
Footnote 253:
It was the same with many other things. The Romans, for example, used
seals with which to stamp impressions on documents and coins. That is
the essence of printing. Yet the world did not learn the next
important step, how to print books, for a thousand years.
Footnote 254:
During the earlier years of the World War, before the armies of the
Central Powers overran Serbia, that country was stricken with typhus
from one end to the other. The Allied countries equipped a great
sanitary expedition which went through the land and virtually
disinfected the entire population. Trains of box cars were fitted up
as bathing and delousing plants, with hot water and steam from the
locomotive. These trains went along from village to village, stopping
at each long enough to put the inhabitants, one by one, through the
scrubbing process and their clothing through the steam vat.
Footnote 255:
In order that measures for preventing the spread of disease may be
effective, they must be based upon a well-organized and accurate
system of vital statistics. These statistics include figures relating
to births, deaths, and illness. They are compiled in the offices of
the health authorities from the reports sent in by physicians. These
reports, to be of real value, must not only be accurate but prompt. By
means of these statistics the health authorities can sense the
beginnings of an epidemic, can often determine its source or cause,
and can immediately set the machinery in motion to ensure its control.
When one physician reports a case of typhoid this may not be of great
significance; but if a dozen cases are reported on the same day, the
necessity of an immediate investigation into the water and milk
supplies becomes apparent.
Footnote 256:
The city of Glasgow obtains its supply of pure water from Loch
Katrine, immortalized in _The Lady of the Lake_.
Footnote 257:
The choice between the two kinds of filtration depends upon local
conditions. Where the raw water is excessively turbid or bad-colored,
the rapid sand filter is more commonly used. The chemical treatment of
water involves the use of chlorinated lime (better known as bleaching
powder) or some other chemical disinfectant which kills the noxious
bacteria. Only small quantities are required in proportion to the
volume of water used. Chemical treatment is not commonly used except
in emergencies; it is not regarded as a satisfactory permanent plan of
water treatment.
Footnote 258:
These housing regulations now provide, as a rule, that houses designed
to accommodate more than two families shall not occupy more than
two-thirds of the lots upon which they are built, the remaining space
being left for light and air. They also require that such houses shall
not be of highly inflammable construction, that they be provided with
lighted hallways, that sanitary equipment be installed, and that no
rooms be used for ordinary living purposes unless they have one or
more windows. A further provision in some of these tenement-house laws
is that houses may be condemned as unsanitary if they contain less
than so many cubic feet of air space for each person living in them.
This last provision is difficult to enforce except by frequent
inspection, yet it is very important because no matter how well a
house may be constructed, there will be a danger to the public health
if it is seriously overcrowded.
Footnote 259:
At the Peace Conference in 1919 the protection of the public health
throughout the world was considered so important that provision for it
was included in the Covenant of the League of Nations (see p. 638).