Board of health

“ Congress passed an act to prevent the introduction of contagious or infectious diseases into the United States, requiring the national board of health to co-operate with, and, so far as it lawfully might, aid, state and municipal boards of health to that end. The act appropriated $500,000, or so much thereof as might be necessary, to meet the expenses incurred in carrying out its provisions, and to be disbursed by the secretary of the treasury on estimates made by the national board of health, and approved by him. ”

“ But in smaller communities, while health departments or health officers usually exist, the organization has for the most part been very ineffective. The people themselves have not been sufficiently aroused to their needs and to methods of meeting them. New York and Massachusetts are among the most progressive states in this matter. Each local community in these states (town, village, or small city) has its board of health and health officer ”

“ Most rural townships have a local board of health and health officer, who is charged with reporting births and deaths and with the enforcement of quarantines against contagious diseases, but it is notorious that these local health officials are rarely efficient or take any leadership in the betterment of public health. Ordinarily the health officer receives little if any pay, and is a resident physician who is not inclined to antagonize his own clients when the enforcement of health regulations would meet their opposition. ”

“ Students of rural health problems are now fairly agreed that the only means of securing efficient administration of public health regulations in rural communities is by the employment of a full time county health officer, working under a county board of health, who will have the same general duties as the health officers in our cities. Local health officers would be retained, but their work would be under the supervision of the county health officer and would have the benefit not only of his support and encouragement, but also of his superior technical training. ”

“ The Health Department is usurping the powers of the Legislature, which it has no authority to do. The law plainly states what the physician shall report and the Board of Health has no power to require additional matters. ”

“ Since the establishment of the Board of Health, in March, 1866, strenuous efforts have been made by that body to remedy the most glaring defects in the tenant-houses. Nothing could bear better evidence of the good results effected by the wise sanitary measures they have adopted than the saving in our mortality rates during the last year. It has been asserted that "our present code of health laws are better than those of any other city on this planet;" ”

“ This has always been the greatest difficulty in preventing the spread of infectious diseases—how to let other people know. So about fifty or sixty years ago, people got together and decided that the best thing to do was to appoint an officer known as a Health Officer, or a committee known as a Board of Health, in each town and in each county, whose business it should be to find out cases of infectious disease, and to warn other people against them. ”

“ Of course the community must take hold of the problem, through a Board of Health, or Health Officer, appointed for the purpose; and this is why questions of health are coming to play such an important part in legislation, and even in politics. ”

“ Before my first enlistment in the service of public health, others had fought this great cause with rare courage and devotion; establishing its main principles in a manner to require no corroboration, and to admit little immediate increase. The true patriarchs of the cause in this country are the present working members of the General Board of Health. The constitution of my city appointment is quite independent of this Board ”

“ When all is peace and happiness—when the hospitals are empty of patients—when the weather is fine and people are dying at the usual rate—it matters little whether the world at large takes a deep interest in the work of the Board of Health. The public knows that somewhere, somehow, someway, there exists a Board of Health composed of highly trained medical experts. They also appreciate from past experiences that these watchful gentlemen “know their job” and that no ordinary microbe can hope to move from Warsaw to Chicago without prompt interference on the part of the delousing squad. ”

“ One of the provisions of the Bill was, as I have before stated, that every district Poor Law medical officer should be the health officer of his district, and that his reports of insanitary conditions should be sent to the Board of Guardians, many members of which Board would be found to be the principal offenders against sanitary requirements. ”

“ While this work was proceeding the organizations devoting their energies to control of infectious disease, inspection, and administration had been far from idle. The State Board of Health had three sanitary engineers and two physicians, trained in public health work, in the city before the waters receded. The city Board of Health was one of the first in the field, and the medical corps of the Ohio National Guard promptly took up the work. ”

“ One danger in New York City is that the board of education, like the board of health, when compelled to choose between so-called standard, necessary, traditional duty and school hygiene, will sacrifice the latter. The school authorities, without any more funds and without physicians and nurses, could already have made, had they desired, eye tests and breathing tests sufficiently accurate to detect the majority of children needing attention. ”

“ Our tardiness in establishing a national board of health that shall do this great educational work is due in part to the fact that American sanitarians have frequently chosen to do things when they should have chosen to get things done. ”

“ Whether inspectors, examiners, and nurses shall be directed by the board of education or the board of health is a question that it is impossible to decide without knowledge of local conditions. So far as state and county organizations are concerned, it is clear that whatever the boards of health may do, it will be necessary for state and county superintendents of education to equip themselves with the machinery above recommended. ”

“ For example, the measures to be adopted in a purely rural community would not be practicable or desirable in a large metropolitan area, nor would the measures desirable and feasible at the beginning or end of an epidemic be found those best adapted for the intervening period. The committee has found it impossible, therefore, to lay down any rules for the guidance of all health officials alike in preventive measures. The most it has been able to do has been to state certain general principles that in its judgment should underlie administrative measures for the prevention of influenza. ”

“ The state reports of vital statistics have not been accurate; therefore in many states we have the anomalous situation of an aggressive veterinary board arousing the farmer and the consumer of milk to the necessity of protecting the health of cattle, and an inactive, uninformed state board of health failing to protect the health of the farmer and the consumer.
Vital statistics presume efficient health administration. An inefficient health officer will not take the initiative in gathering health statistics. ”

“ Constant vigilance alone can give security, and it is a small price to pay if the community is compelled to bear even the whole expense of such a health official. Community health is [147] often intrusted to the town fathers or a district board with little interest in the matter; on the other hand, the agent of a State board is not always a local resident, and is liable to overlook local conditions. It is desirable that the health official be an individual of good training, familiar with the locality, and with ample authority, for in this way only can safety be reasonably secure. ”

“ The board has all the powers of the secretary of state under the Public Health Act 1848, and the numerous subsequent acts relating to sanitary matters and the government of sanitary districts; together with all the powers and duties of the privy council under the acts relating to the prevention of epidemic disease and to vaccination. ”

“ The Committee are of opinion that the extent of accidental infection is greatly exaggerated in the public mind, but a few cases occasionally occur, and the Committee recommend that there should be better provision of public conveniences, especially for women, and the U-shaped closet-seat should be adopted. ”

“ Some prosperous American communities hold human life so cheaply that they maintain no public health service at all. Others—and there are many of them—have a mere skeleton service. The citizens imagine that if they appoint a health board consisting of doctors, all will be well with them. The suggestion that the board be provided with money to carry on its functions would be regarded as wanton extravagance. ”

“ PROPOSED NATIONAL BOARD OF PUBLIC HEALTH, CONTROLLED BY ONE SCHOOL OF DOCTORS, CONDEMNED A typical instance of the dangerous tendency of the medical profession to extend its power over the people is shown in the recent scheme of the proposed National Department of Public Health, to be composed chiefly of doctors of one sect, with a head doctor having a seat in the President’s Cabinet. ”

“ A staff of nurses to assist medical examiners to give children practical demonstrations in cleanliness, to teach mothers the care of children both at their homes and in mothers' meetings, to enlist the coöperation of family physician and neighborhood facilities, such as hospitals, dispensaries and relief agencies, magistrates' courts and probation officers,—all to be under the control of the board of education or the board of health. ”

“ Personally, I have no first-hand knowledge as to whether the disease is so prevalent in the community as to demand urgent measures, but there is an opinion among women social workers and medical practitioners, whom I have consulted, that something should be done, and they are in favour of compulsion under the Act, provided its administration is satisfactory. ”

“ It is conceivable that one physician working from nine to five would accomplish more than six physicians working the alleged three hours a day. So imperative are the demands of school hygiene that it seems probable that in New York and in other large cities school physicians, whether paid by the board of health or the board of education, must be expected to be at the service of school children, subject to the call of school officers, during as many [301] hours of the day as teachers themselves must give. ”

“ They urged on all parents and educational, philanthropic, and religious organizations the pressing necessity for a sustained campaign, in co-operation with the medical profession, in order to inculcate in the community higher ideals of personal hygiene and health. ”

“ Nursing assistants, volunteers, etc., should be used wherever possible in homes and institutions, under expert supervision, after classification and assignment on a basis of minimum standards as to fitness, and such intensive training in the care of influenza and pneumonia patients as may be feasible.
3. From the standpoint of the patient, home treatment is to be advocated, if medical, nursing, disease preventive and other facilities are adequate. ”

“ Whatever sanitary laws may be passed, and whatever success may be attained in dealing with bodily disease, there can be no true health if the soul of the nation remains corrupt. If this inquiry should serve to remove some of the popular ignorance regarding venereal disease, and to quicken the public conscience so that appropriate steps may be taken to deal with this dreadful scourge, the Committee feel that their labours will not have been in vain. ”

“ This laid down the important principle that there should be an unofficial majority. For a time the secretary also acted as sanitary superintendent, but, the duties increasing to such an extent that he was unable to devote sufficient attention to outdoor matters, a Medical Officer of Health was appointed. In consequence of the decision of the Legislative Council that in the event of a vacancy occurring the Medical Officer should occupy a seat on the Sanitary Board, all the unofficial save one resigned. ”

“ In general, one man is better than three to execute, although three may be better than one to legislate. Where small communities do not wish to have the entire state sanitary code rigidly administered, they can adopt New York's method of a legislative board of three members, headed by an executive, whose business it is to act, not talk ”

“ Members of the board shall have expertise, knowledge and experience in the areas of consumer advocacy, management, finance, labor and health care, and to the extent possible shall represent the geographic and ethnic diversity of the state. A majority of the board members must consist of individuals who do not receive or have not received within the past two years more than 50 percent of the individual's income or the income of the individual's family from the health care industry or the health insurance industry. ”

“ The clinics should be made more available by being open continuously. Every effort should be made to secure privacy. A specially trained nurse should be in attendance at women's clinics, and women doctors should be secured where possible.
The Committee recommend that provision be made at the clinics for prompt preventive treatment of those who have exposed themselves to infection.
Lady patrols should be appointed in other centres to perform the kind of work that is being carried on in Christchurch. ”