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establishments, that the Board recommended to the Legislature, in their sixth and seventh annual reports, that some provisions should be made by law providing for a regular inspection of all such works hereafter." The sanitary condition of the homes of the poor early attracted their attention, and in spite of "the utter indifference to the subject in the public mind," and the unwillingness of politicians to inaugurate any movement, which owing to ignorance or prejudice would incur opposition and risk their tenure of office, they at length succeeded in obtaining a charter for a company, whose object should be the building and hiring of suitable tenements for the poor." When it was found impossible to induce city councils to undertake needed reforms, the Board carried its cause directly to the source of power, the citizens in mass-meeting assembled, and were invariably sustained by the ballot. Each annual report has contained papers of great value, founded on original investigations by physicians appointed for the purpose, of subjects connected with the causation and prevention of disease, such as milk-, water- and food-supplies, trichiniasis, foot and mouth disease, river pollution, wall-paper poisoning, sewage disposal, alcoholic beverages, ventilation of school-houses, and so on. Ten thousand eight hundred of these reports are now printed for distribution each year, and in addition to this, large editions of elementary instructive papers have been sown broadcast among the people. "Such has been the written history in the barest abstract of the State Board of Health of Massachusetts. Its unrecorded work can, of course, never be given to the public. It would be impossible to estimate the actual amount of public sanitary work which has, oftentimes unconsciously, owed its origin" to its wise counsels. "In many cases hotly disputed questions of local importance have been quietly settled, and oftentimes even a threatened litigation has been avoided by an appeal to the Board, whose unbiased opinion has always been freely given when asked for." We see then that its work has been mainly one of instruction. It has thrown out its feelers into every remotest nook and hamlet of the State. It has found out who could be relied on as intelligent agents, to keep it informed as to the sanitary condition of the inhabitants, and at the same time to diffuse among them such simple and practical information as they could both readily appreciate and easily apply. It has made use of every ordinary channel for the conveyance of knowledge to the public; the secular as well as the medical press, the clergyman as well as the physician, the forum and pulpit as well as the medical society. has taken pains that the intelligence which it communicated should be at first hand-should possess the freshness, the sparkle, the enthu

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siasm, the reliability and the innate force, of personal observation made upon the spot, dealing with facts which all to whom they came could verify. And in this way it has commanded a respectful hearing for itself, and that hearing has brought conviction.

It has carefully avoided conflict with local health authorities when that was possible; and when the honesty and purity of its intentions became manifest, that generally was possible. Work that it has begun and carried to a successful issue, it has turned over, so soon as they would undertake to carry it on in good faith, to the local authorities to perpetuate. It is always ready to counsel, never hasty to interfere. And to-day, throughout the whole commonwealth, there is entire accord between the health boards, committees, and officers of every town and city, and the general board.

I do not know how I could have presented to you in any more forcible way the subject which I desired to illustrate in this paper, namely, the "End and Scope of a State Board of Health," than in this simple recital of the progress of sanitary legislation in the two most highly civilized populations of the old and the new world. Their evils are our evils, their difficulties will be our difficulties, and in the light of their experience we must meet them. It will not be out of place, however, to refer to a few of the great problems which a general sanitary establishment, sustained by the weight of the State Government, can alone successfully cope with and which must early engage its attention.

The first question which I would allude to in this view of the matter, is the harmonizing of the sanitary interests of different but contiguous or otherwise related sections. It often happens that the sanitary undertakings of one city prove to be most insanitary in their results in regard to another city. The towns and cities which line the Schuylkill, for example, each most meritoriously washes itself in that limpid stream, and so far as it alone is concerned, does well; but unhappy Philadelphia, with the typhoid virus creeping through her veins with ever-increasing malignity, shudders as she unwillingly drinks their defiled washings. Hence the necessity for the consideration in a broad, generous spirit of the difficult problem of the "pollution of rivers," and the determination of methods whereby one community may improve its own health conditions without impairing those of a neighbor. An admirable paper will be found in the Transactions of the American Public Health Association for 1875, by General Egbert L. Viele, showing how tens of thousands of dollars have been squandered in a comparatively small district of the State of New Jersey, drained by the Passaic and Hackensack Rivers, and thickly set with large towns, in the almost

vain attempt to dispose in some satisfactory way of their sewage, from the fact that there has been no intelligent concert of action among different centres of population, and hence the efforts of one have been often completely thwarted by the operations of another in the same praiseworthy direction.

Next, in an immense territory like our own, larger than that of many a nation of Europe, with its great diversity of surface and lofty mountain ranges, the question of drainage becomes one of paramount importance-in what directions the water shed shall be encouraged and in what diverted, and to what extent private corporations are to be allowed to jeopardize the health of large sections of the country by obstructing watercourses for the purposes of manufacture or navigation. Much interesting matter on this point is to be found in the reports of county societies, scattered through the volumes of the Transactions of this Society. The history of the so-called "Drowned Lands" in Orange County, New York, and Sussex County, New Jersey, as given by Prof. Cook, State Geologist, of New Jersey, before the Am. Pub. Health Association at its Baltimore Meeting, is also full of interest in this connection.

The fact that so large a portion of our State is still in a wild, uncultivated condition, gives great opportunities for sanitary engineering on a large scale, and for preventing in this way the evils which so often follow in the train of a blind and disconnected occupation and cultivation of a territory. Especially in the matter of protection of forests is interference needed here. A wise discrimination may be used in determining what forests act as natural barricades against the force of devastating winds, and should, therefore, be untouched, and what ones interfere with the proper circulation of the atmosphere, and may, therefore, with safety be removed. The agency of forests in maintaining a permanent average rainfall throughout the year and thus preventing both drought and destructive floods, cannot be gainsaid, and merits careful attention. But especially with a growing population is an opportunity offered for an immense amount of prospective sanitation to be accomplished in supervising the laying out of new towns. No town should be allowed to take the simplest corporate form, without laying before the health authorities of the State a carefully prepared plan of its hygienic provisions. Inquiry should be made into the character of the soil on which it is proposed to found it, the quality and quantity of its water supply, the width of its streets, its projected sewage, whether its lines of sewage are easy and take advantage of natural watercourses, and are adapted also to assist in the drainage of the natural surface water, its regulations in regard to habitations, as

to space allowed to each, and space allowed in each, to height of rooms and to ventilation. All these are points which should not, in our day, be left to settle themselves haphazard as emergencies arise, or as the streets of New York were originally laid out by the meanderings of meditative cows going to and from their pasture, but should, by a wise prevision, be arranged beforehand, and evils thus be easily and wholly averted, which when once they have become established, prove so difficult of remedy. The relations of the country to the city as a purveyor must also be considered. The supply of fresh vegetables and pure milk to large communities is of the utmost importance, and should be infallibly insured. The transportation of live stock for food requires to be very carefully watched and regulated, both that none but healthy and therefore wholesome meat may be exposed for sale, and that infectious and epidemic diseases may not be introduced among our native stock from other localities.

Thus it will be seen, even from this hasty and bald summary, that, entirely apart from its function as an adviser and coadjutor of established local health boards and officers, an immense amount of independent and heretofore neglected work is waiting to be entered upon by a State Board of Health, work of the utmost importance for the future as well as the present well-being of our Commonwealth.

In view of the fact that a bill for the establishment of such a board has been twice defeated in our Legislature (although at the last session it passed the Senate), I have ventured to draw up an act, which may avoid some of the features which rendered the others objectionable, and which, with the weighty indorsement of this Society, would, I trust, have a fair chance of success.

Extract from the Minutes.

"Resolved, That this Society gives its official endorsement to the proposed bill introduced at the close of the Address in Hygiene, for the creation of a State Board of Health in this Commonwealth.

"Resolved, That the Committee on State Board of Health be instructed to present it through the appropriate committee to the Legislature at its next session."

AN ACT

To create a State Board of Health, to provide for the registration of vital statistics, and to assign certain duties to local boards of health and health officers in this Commonwealth.

SECTION 1. Be it enacted by the Senate and House of Representatives of the Commonwealth of Pennsylvania in General Assembly met, and it is hereby enacted by the authority of the same, That the Governor, with the advice and consent of the Senate, shall, as soon as possible after the passage of this act, appoint six persons, five of whom shall be physicians, in the State, of good standing and of not less than ten years' professional experience, and one of whom shall be a civil engineer of not less than ten years' professional experience, who, together with the Secretary of Internal Affairs, the Superintendent of Public Instruction, and the President of the Board of Health of the City of Philadelphia, shall constitute a board of health for the State, which board shall be denominated the "State Board of Health of Pennsylvania." Of the six persons first appointed, two shall serve for two years, two for four years, and two for six years from the first day of July next following their confir mation, and the Governor shall hereafter biennially appoint, by and with the advice and consent of the Senate, two persons of the same professions as those whose terms of service have just expired, to be members of said State Board of Health, to hold their offices for six years from the first day of July next following their confirmation and until their successors are appointed, excepting the secretary, who shall continue in office as hereinafter provided; but any member may be reappointed. Any vacancy occurring in said board during a recess of the Legislature shall be filled by the Governor until the next regular session of the same.

SECTION 2. As soon as possible after the appointment of the first six persons as aforesaid, they shall meet (on the call of the Secretary of Internal Affairs) in the office of the Secretary of the Commonwealth, and shall proceed under the direction of the latter officer to determine by lot which of them shall serve for the respective terms of two, four, and six years. Immediately before entering upon the duties of the office they shall, together with the President of the Board of Health of the City of Philadelphia, take the oath pre

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