Sanitary Commission

“ The first sanitary commission was appointed at Chadwick's instigation in 1839, its immediate occasion being due to an application for his assistance by the Whitechapel authorities, who were driven to despair by an epidemical outbreak in their district. The commissioners probed the evil to its source; and their report with its startling resolutions and remedial suggestions attracted very wide attention, and it forthwith became a text-book of sanitation throughout the country. To Chadwick's directing hand in this matter may safely be ascribed the beginning of public sanitary reform. ”

“ As I have already indicated, at the commencement of the war we knew little or nothing about what was necessary to keep men in military service well,—what food, what clothing, what tents, what camps, what recreations, what everything, I may say. Now the Sanitary Commission has made searching inquiries touching every point of camp and soldier life,—gathering in facts from all quarters, and seeking to attain to some fixed sanitary principles. ”

“ Wherever the disease has prevailed in this country or in Europe, it has been because of an utter neglect and disregard of what are now known as ordinary sanitary conveniences, and the report of the Country Life Commission, although many charges were made against the conditions of living in different parts of the country, was far from telling the whole story in the matter of the shortcomings in parts of the southern states. There is, therefore, every reason why the farmer and others living in the country should be urged to make themselves comfortable with all known modern sanitary appliances. ”

“ No; if the communities have any better method than the one proposed, one that would be less expensive and equally as efficient, the commission would be very glad to hear of it. This is simply a report to the commission by the consulting sanitary engineer employed by the commission for that purpose. The commission has not formulated its conclusions, and before formulating them it desires to hear from the various communities affected by the recommendations of our consulting sanitary engineer. ”

“ The Commissioner rather rose in the estimation of the townspeople, as being a jolly good fellow, but the Mayor always thought that he had carried things a little too far for a man occupying such a dignified position.
In April, 1904, I was finally ordered to report [Pg 147] to the Commission as the chief sanitary officer for the Isthmus. Having been there, we had a very good idea of how great the difficulties would be in getting either supplies or personnel. We therefore requested the Commission to authorize our taking down a certain number of men and a certain quantity of supplies. ”

“ Court, I would beg to observe that no similar endeavour can fully succeed, except as a system—well considered beforehand, and adjusted to the various circumstances which may require its application. Uncertainties of responsibility and conflicts of jurisdiction would inevitably occasion a sacrifice of life; and therefore, before the time when Cholera is likely to become epidemic, it should be definitively settled who is to undertake this organisation. Your Commission can have no jurisdiction in the matter; and the interference of the Corporation would be only at its own option. ”

“ None but medical men can prosecute such investigations with success, or suggest the proper remedy. If such a corps of sanitary inspectors were daily patrolling their districts, visiting from house to house, searching out sanitary evils, advising and aiding the people in the adoption of preventive measures, no epidemics of smallpox, typhus, scarlet fever, or cholera would ever gain more than a transient foothold. The sanitary inspector would truly become an officer of health and would be everywhere welcome. ”

“ Do you think that body would be available for the execution of sanitary measures?—Certainly not as compared with the Board of Guardians: the Commissioners of Sewers meet only monthly, and have no medical officers and no relieving officers. The Board of Guardians meets weekly, and their officers are constantly at work, night and morning. We have not even waited for the landlords, where prompt measures appeared to be necessary for the removal of any active cause of disease. ”

“ The City Inspector’s department, which alone has the machinery for sanitary inspection and surveillance, is a gigantic imposture. Of its forty-four health wardens, whose duty it should be to make house-to-house inspections, searching out the cause The City Inspector’s
Department of disease, and using every known agency for the control and suppression of epidemics, many are liquor dealers, and all are grossly ignorant. Not one has any knowledge of medical subjects, nor dare they freely visit such diseases as smallpox, typhus, or cholera. ”

“ That for the prevention of the disease occasioned by defective ventilation, and other causes of impurity in places of work and other places where large numbers are assembled, and for the general promotion of the means necessary to prevent disease, that it would be good economy to appoint a district medical officer independent of private practice, and with the securities of special qualifications and responsibilities to initiate sanitary measures and reclaim the execution of the law. ”

“ The board has jurisdiction over all matters of public health and is composed of the following sub-departments: contagious diseases; medical inspection of schools: sanitary inspection; food inspection; inspection of milk and dairy farms; statistics; municipal laboratories; the municipal medical service. The sanitary inspection department covers the general sanitation of the dwellings, outhouses, lanes, etc. ”

“ None of the Vestries or District Boards gave any sign of making provision for those who were not paupers, although the duty of giving opportunity for isolation of infectious persons whose diseases made them dangerous to others, be they paupers or not, devolved upon them under the Sanitary Act of 1866 as the Sanitary Authorities concerned in the prevention of the extension of disease. ”

“ Without doubt the day will come when the National Board of Health will be by act of Congress, with the consent of all the States, the real superior council of public hygiene of the American Union." E. Sève, On the General Organization of Public Hygiene (Proceedings, International Sanitary Conference, 1881) . "The General Government [of the United States] can do little in the way of compulsory legislation, which might interfere with the action of the several States to control their own sanitary affairs. ”

“ The German system is dominated by the faculties of its great medical institutions and relies for its administration upon the paternal attitude of the Government. In England and the United States sanitary laws are placed under the control of special bureaus or boards of health, separate provisions for this purpose being made in the Federal and State systems, the latter also delegating to municipal corporations the powers necessary to make and enforce regulations for the protection of the public health within their jurisdictions. ”

“ As rural sanitary authorities are able under the Public Health Act 1875 to obtain almost all the powers of urban sanitary authorities, it is not considered advisable to make any distinction in the examination of the two classes of surveyors. ”

“ We want independent Medical Officers of Health—appointed by the County Council, and removable only by them—men trained up for this as a profession; we want Sanitary Inspectors, with a proper qualification, appointed with the Medical Officer's approval; we want that each Medical Officer should be informed as to all approaches of dangerous disease, and bound in his turn to supply the information for other neighbouring districts ”

“ General powers are reserved to the secretary of state, where he is satisfied that the Factory Act or law relating to public health as regards workplaces has not been carried out by any district council, to authorize a factory inspector during a period named in his order to act instead of the district council. Other general sanitary provisions administered by the government inspectors are the requirement in factories and workshops of washing conveniences where poisonous substances are used ”

“ The foregoing list is no exaggeration of the onerous duties of the town surveyor, and it seems to be a grievous mistake that this officer, whose importance in all practical sanitary [6] work cannot be over-stated (as without him no useful municipal work could go on) has been left unprotected by the Public Health Act of 1875. ”

“ That the local administrative body have power to appoint, subject to the approval of the Crown, a medical officer properly qualified to inspect and report periodically upon the sanitary condition of the town or district, to ascertain the true causes of disease and death, more especially of epidemics increasing the rates of mortality, and the circumstances which originate and maintain such diseases, and injuriously affect the public health of such town or populous district. ”

“ The Health Department in its varied work of recording the marriages, births, and deaths, preventing and caring for contagious diseases, disinfecting, sanitary inspection, and the abatement of nuisances, meat and milk inspection, employs a corps of one hundred and thirty men, besides the special summer corps of fifty physicians and the fruit-inspectors and extra disinfectors—requiring an annual appropriation of $250,000. ”

“ If the local officials are not vigilant enough, the State may step in and compel the observance of sanitary regulations.
The average citizen learns of the existence of a health regulation when he is warned that he has broken it, or perhaps is fined. ”

“ At present there is no general law in force to compel persons, who may become acquainted with the existence of an infectious disease in a dwelling-house, to give notice of the same to the Sanitary Officer....
“Surely it is more important to protect the lives of the people than to protect from loss the dealers in cattle; but until the care of public health is considered to be of more importance than the care of property, little improvement in the laws relating to health can be expected.” ”

“ In addition thereto, and now more than ever of primary importance, was the great duty of inspection—inspection of houses, and of rooms in houses, and of workshops, and often the consequent proceedings for the abatement of nuisances, or the punishment of offenders.
“House-to-house inspection,” wrote the Medical Officer of Health for Islington in 1893, “is the only efficient remedy for extensive sanitary evils. It is the life and soul of sanitary work.” ”

“ 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. ”

“ And, under the Nuisances Removal Act, the General Board of Health may be authorised, during times of epidemic disease, to issue directions and regulations for the speedy interment of the [303] dead. Both laws have remained inoperative, and are likely to remain so.
If one were starting anew—legislating for a people with unformed habits, nothing might be easier than to devise regulations of a perfect kind with regard to the sanitary management of the dead. But our case is widely different. The evils against which we have to contend are among the deepliest-rooted habits of the country. ”

“ I would simply beg to repeat, with regard to so much of the matter as lies within my own professional province, that the intelligence in question is absolutely necessary for the present progress of sanitary measures within the City; that no Health-Committee can exist for a month without it; nor can any officer, having proper respect for his character, consent to be considered responsible for the health of a population, whose illnesses he learns only from their posthumous record in the death-register. ”

“ Indeed, my experience of such matters suggests it to me as not unimportant, that, under any arrangement which may be made, the jurisdiction of Local Boards of Health should, at least in area, be conterminous with Poor Law Unions; so that those who administer sanitary affairs—affairs which are always chiefly relative to the poor—may, as far as possible, in their several districts, come into relation with single sets of Poor Law officers. ”

“ It seems not to be a movement of evasion by getting up a cry for more "government inspection," but a voluntary association of qualified men who are ready to meet the responsibilities of the task they undertake. Assuming that defective drainage is a "great enemy to public health," and that "there is a terrible absence of all supervision of sanitary arrangements," the Sanitary Assurance Association will make a careful investigation of the health-conditions of houses, and give certificates to those that are in perfect sanitary order. ”

“ Simon, in 1868, had urged the inadvisability of continuing ad hoc authorities, and had urged that, at least, sanitary should be made coterminous in area of administration with poor-law districts. His advice was not adopted, and there followed years in which sanitary authorities were allowed to subdivide areas, until the total number became 1,807 instead of 635, the number of poor-law authorities; and in which they concerned themselves chiefly with nuisances and water supplies and with inadequate provision for the prevention and treatment of infectious diseases. ”