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facilities and to extend their scope, so as to assure the handicapped of minimum educational opportunities with which they had to dispense in earlier days.18 Vocational education is a relatively recent function of State education, and its course of development has been strongly influenced by Federal grants-in-aid under the Smith-Hughes Act of 1917. However, in 1906, more than a decade before the enactment of the Federal law, Massachusetts had established a State commission on industrial education to superintend the creation and maintenance of industrial schools for which State aid was made available in modest amounts. Other agencies were established in New York in 1909, in Wisconsin in 1911, and in the 5 States of Connecticut, Indiana, New Jersey, Pennsylvania, and Virginia in 1913, making a total of 10 States by 1917. The effect of the SmithHughes Act of that year was to universalize the pattern.1
The concept of free public education for all the members of society was early in origin, but it was only gradually that the public schools have evolved into comprehensive State systems ranging from minimum attendance in the common schools through the high schools to the apex of the State university, and includ ing as well the provision of special facilities for the education of the handicapped and the extension of State aid to underprivileged areas for educational purposes. The validity of educational standards is generally appreciated, but much remains to be done in realizing them to a fuller degree among various classes and areas of the State.
Health.-Both the drama and the effectiveness of human resources conservation are illustrated in the rise of the public-health movement. The horrible plagues and epidemics of bygone days have passed. The life expectation of man has been increased, while the death rates from particular diseases have greatly declined. In the case of tuberculosis alone the death rate has dropped from 200 per hundred thousand in 1920 to less than 60 in 1933.20 The achievement of public health becomes all the more remarkable when it is recalled that during the same period which witnessed so much progress in improving the people's health, the country became urbanized, concentrating the Nation's population in the big cities. The growth of cities raised such problems in relation to the life and death of the modern community as the maintenance of an adequate sanitary water supply and waste disposal. The record of public health is convincing evidence of what the State can do if, when challenged, there are both the oppor tunity and the will to invoke the aid of modern science and technology in the service of humanity.
Public health is also unique in another respect-in the exercise of wide legal powers by the State, for in no other field of governmental activity are such sweeping powers over persons and property so drastically administered in the interests of the great community, with the usual concurrence of the courts. But it would be error indeed to leave the impression that all is well with the people's health, for the conditions of certain underprivileged areas and classes may threaten to take as heavy tolls as once did cholera and the yellow fever. The responsibility of the modern State for the health of its citizenry is continuous and ever challenging.
During colonial times governmental activities were comparatively little con cerned with health, the promotion of which was regarded as an individual, or at best a local, problem that sporadically appeared in the form of epidemics. In 1631 Virginia provided for the collection of vital statistics and in 1639 undertook to regulate the practice of medicine, but so were many other trades and professions subject to regulation. Public notification of smallpox outbreaks was required in Rhode Island in 1721; but when attempts were made at health administration
18 Knight, op. cit., pp. 578-583.
19 See Monthly Labor Review, July, 1931, p. 6.
* Huntington, cp. cit., p. 568. See also The Problems of a Changing Population, pp. 166–74.
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as a regular governmental function they were promptly abandoned without any fair trial. For example, the Massachusetts maritime quarantine of 1648 was repealed in the following year, and when a similar regulation was reenacted in 1669 it was forthwith disallowed by the Privy Council in England as too stringent an interference with commercial shipping."
The promotion of public health was incorporated into governmental organization first on the local level, starting with the Baltimore Board of Health in 1793. In 1797 Massachusetts passed a State-wide enabling act for the establishment of local health boards to make the necessary regulations "for the public health and safety respecting nuisances, sources of filth, and causes of sickness." Many localities, however, established their health boards on the authority of special charters or legislation, and, in fact, more health boards were established in this manner than under the general enabling laws whose enactment was relatively slow until after the Civil War. Ordinarily, local health authorities were estab lished prior to the creation of a State health authority, but in 13 States, State and local health authorities were established simultaneously and in 5 States the State authority preceding local organizations.22
The problems of sanitation, which were particularly aggravated in the seaport towns, called for a unit of health administration that could exercise control over larger areas and during continuous periods of time. It is a paradox that "the greatest scourges of the Nation-smallpox, yellow fever, and choleraproved also the best instruments in hastening the day of sanitary organization." The first State health authority in the United States (established by Louisiana in 1855) was “in reality a quarantine board called into being by the yellow fever epidemic." The prototype of the modern State health authority is more com monly ascribed to the Massachusetts board of 1869 which was established to "make sanitary investigations and inquiries in respect to the people, the causes of disease, and especially of epidemics and the sources of mortality and the effects of localities, employments, conditions, and circumstances, on the public health.” 23 Other States were quick to follow the Massachusetts example. By 1890 central health authorities had been established in 34 States, and by 1907 the pattern was made complete for all the States. (See fig. 7.) An important factor in this growth of State health activities was the establishment of a National Board of Health in 1879 to "obtain information upon all matters affecting the public health, to advise the several Departments of the Government, the execu tives of the several States, and the Commissioners of the District of Columbia, on all questions submitted by them, or whenever in the opinion of the board such advice may tend to the preservation and improvement of the public." The National Board of Health was also authorized to "report a plan for a national public health organization, which plan shall be prepared after consultation with the principal sanitary organizations and the sanitarians of the several States of the United States, special attention being given to the subject of quarantine, both maritime and inland, and especially as to regulations which should be established between State and local systems of quarantine and a national quarantine system." Committees of eminent experts on yellow fever
21 J. A. Tobey, Public Health Law (1926), p. 10.
12 See J. W. Kerr and A. Moll, Organization, Powers and Duties of Health Authorities (U. S. Public Health Bulletin No. 54, 1912), pp. 8-11; Mass. Laws 1792-1800, p. 794.
23 Mass. Laws 1869, c. 42 0; Kerr and Moll, op. cit. Puerto Rico is reported to have established a health agency (i. e. a quarantine authority) in 1788, but it appears to have been short-lived, and in 1898 a new health agency was created. Ibid. In 1806 there was established for Philadelphia a health board to function throughout its metropolitan area. See Paul Studenski, The Government of Metropolitan Areas in the United States (1930), p. 257.
An interesting forerunner of the Massachusetts State Board of Health of 1869 was the temporary sanitary commission of 1850, the chairman of which was Lemuel Shattuck. The report of the commission submitted 50 recommendations, includ ing the following: "17 * * in laying out new towns and villages, and in extending those already laid out, ample provision be made for a supply, in purity and abundance, of light, air, and water; for drainage and sewerage, for paving and for cleanliness * * * 21 that wide streets be laid out, and ornamented with trees 38 tenements for the better accommodation of the poor be erected in cities and villages * ** 41 * • meas ures be taken to prevent, as far as practicable, the smoke nuisance." The report is reprinted in George C. Whipple, State Sanitation (1917), pp. 239-367.
were assembled, financial aid was made available to the States for research purposes, and special surveys of particular areas were made.24
Some of the State health authorities (especially those limited to quarantine activities) suffered serious relapses in activity; but with the passing of the quarantine and epidemic phase of the public-health movement―i. e., compulsory suppression of disease by isolation instead of prevention and treatment-and the emergence of sanitary engineering and preventive medicine on a large scale in the nineties, public health has been put on a permanent basis in the State governments.
With the growth of knowledge and the development of specialized branches of health service, such as epidemiology, vital statistics, sanitary engineering, and public-health laboratory service, the work of the health department became more rational. For a time, however, the activities relating to disease control to a large extent were centered around special diseases, such as tuberculosis, venereal diseases, malaria, typhoid fever, diphtheria, and hookworm disease. During the past 10 years there has been a tendency to broaden and balance the work, with a view to applying all available knowledge regarding disease prevention. 25
Child hygiene and rural health are among the more recent problems that the State health departments have begun to cope with in their effort at raising the health standards of the State. In 1912 the Louisiana State Health Department organized a division of child hygiene, and in 1914 a division of child hygiene was established by law in the New York State Health Department. In the course of the next 3 years 10 other States acted, and in 1919 alone 20 States took steps to provide for some child hygiene organization, largely as a result of the "Children's Year" sponsored by the United States Children's Bureau. By 1921 when the Sheppard-Towner Act made available Federal aid for maternity and infancy hygiene, special child-health units had been organized in all but 10 States, which then rapidly fell into line, completing the administrative pattern in 1925. In 1929 Federal aid was withdrawn, only to be reincorporated in fuller form by the Social Security Act of 1935.26
Rural-health work was, like most governmental activities in the field of human resources, local in origin, deriving from the work of Jefferson County in Kentucky in 1908, Guilford County in North Carolina and Yakima County in Washington in 1911. State aid for rural health first became available in 1916 when North Carolina appropriated $400, while in 1917 the United States Public Health Service was authorized to expend modest amounts for demonstration purposes. By 1933 rural-health agencies had been organized in 38 States, in 2 of which the entire health costs were borne by the State, while in 32 others the State contributed some aid (which increased from less than one-half of 1 percent in 1916 to approximately 20 percent in 1933). The principal development of State aid for rural health took place in the decade 1916 to 1925 when 27 States acted to provide assistance. From studies made by the United States Public Health Service it appears that larger proportions of the rural population are served by full-time health organization in the South than elsewhere, in part because of the assistance of the Rockefeller Foundation which has made direct grants to rural-health authorities since 1916.27
24 20 Stat. 484; repealed in 1893 (27 Stat. 449). See R. D. Leigh, Federal Health Administration in the United States (1927), pp. 479-481.
26 J. A. Ferrell, Health Departments of the States and Provinces of the United States and Canada (U. S. Public Health Bulletin, No. 184, 1936), pp. 50-51.
26 M. P. Ravenel, A Half Century of Public Health (1921), pp. 318-319; 42 Stat. 135; and U. S. Children's Bureau, Pub. No. 203 (1931).
27 The growth of State aid for rural health after the pioneer action of North Carolina in 1916 was as follows: 1917, Loui siana, South Carolina, and Virginia; 1918, Mississippi; 1919, Alabama, Georgia, Kentucky, Tennessee, and Texas; 1920, Kansas and Ohio; 1921, Maryland and West Virginia; 1922, California, Illinois, Iowa, Missouri, and Oregon; 1923, Indiana and South Dakota; 1924, Oklahoma, Pennsylvania, and Utah; 1925, Arkansas, New Mexico, and Wyoming; 1926, New York; 1927, Delaware; 1928, Michigan and Montana; 1929, Idaho; 1930, Arizona; 1931, Florida. In Delaware and Pennsylvania the program is entirely State supported. In four States the program is entirely local: Colorado (1925), Massachusetts (1927), Minnesota (1923), and Washington (1911). No rural health activities were reported for Connecticut, Maine, and North Dakota. See J. A. Ferrell and P. A. Mead, History of County Health Organizations in the United States, 1908-33 (U.S. Public Health Bulletin, No. 222, 1936).
The conservation of the people's health has proceded from the defense of organized society against the terrible scourges of epidemics to the rise of Statewide sanitation and recent concerted efforts at improving the health of underprivileged classes and areas of the State.28
Labor.-"Labor legislation in the United States as in England began with the regulation of child labor." The first American labor law was passed by Massachusetts in 1836 forbidding the employment of any child under 15 years of age in any manufacturing establishment unless he had attended school for at least 3 months during the preceding year. In 1842 the number of hours that a child could work were limited to 10, while in 1848 Pennsylvania set a flat minimum age of 12 years. But the general progress of child-labor legislation, not to speak of the enforcement thereof, was very slow. By 1879 only 7 States had fixed a minimum age below which no child could work, and only 12 States had set maximum hours beyond which no child could work. According to Commons' History of Labor in the United States, the "typical child-labor law" of 1900 remained "limited in scope to children employed in manufacturing; set a minimum age of 12 years; fixed maximum hours at 10 per day; contained some sketchy requirements as to school attendance and literacy; and accepted the affidavit of the parent as proof that the child had reached the legal minimum age.
The trend has since been to develop child-labor standards by extending the age upward and the hours downward to bear some relationship to the amount of work safely undertaken, increasing the coverage of the legislation to include most occupations and to exclude entirely certain hazardous or unhealthy occupations, relating the labor provisions to minimum educational standards, and employing administrative techniques that will effectively preclude parent-employer circumvention of the law,30
The policy of limiting the hours of work in the interests of higher labor standards has been applied to persons other than children by the declaratory working. day legislation (1847), regulation of hours on public-works projects (1853), women legislation (1863), and legislative regulation of hours on railroads (1892), and in mining (1896). The declaratory working day legislation raised no problem of enforcement, for agreement among the parties automatically operated to make the legislation inapplicable; the law merely provided that in the absence of agreement 10 hours' work constituted the working day. The regulation of hours of work for women, on the other hand, raised difficult problems of enforcement as well as of constitutional law, and consequently spread slowly among the States. By 1896 only 13 States had passed laws, 8 States were added in the period 18961908, while the greatest progress seems to have been made in the period 1909–17 when 19 States adopted laws for the first time. However, only 2 States passed laws in the period 1918-32. The more recent tendency is to reenforce the statu tory prohibition by effective enforcement devices, extend the coverage of the law, and further raise the labor standards by administrative order.
The hours of work for men were first protected on public work projects, but the policy was slow in getting under way and by the early 1930's had been adopted by only slightly more than half the States. Between 1853 when the first law was passed by New York and 1890 only 4 other States had acted; between 1891 and 1910, 17 additional States passed laws, but then the trend slowed down again, and by 1931 the total number of States was 27. Limitation of hours on railroads was later in getting underway (1892) but rapidly gained momentum, with 18 States acting in the decade of 1901-10, and Congress
18 See H. A. Millis, Sickness and Insurance (1937) and the Committee on the Costs of Medical Care, Medical Care for the American People (1932).
19 Elizabeth Brandeis. Labor Legislation (vol. III of Commons et al., History of Labor in the United States, 1935), pp. 403-405. See generally the forthcoming volumes by H. A. Millis and R. Montgomery on Labor's Progress and Some Basic Problems and Labor's Risks and Social Insurance, parts of which were made available to the author in manuscript form through the courtesy of Robert Burns, research assistant at the University of Chicago.
80 Ibid., p. 406.