Sanitary reform

“ It was, in fact, this deep sympathy, joined to his remarkable insight into the relations between effects and their causes, which led him to devote his life to the promotion of sanitary reform, when once it had become obvious to him that all effort to improve the condition of the people would be impossible until its principles were known and acted upon. ”

“ The suggested designation, namely, the Legislative, is therefore peculiarly appropriate for this, the second stage of progress in the third period of our country’s hygienic education. To legislation men pinned their faith as the most potent weapon of reform. From the first most inadequate and ineffective Factory Act of 1802 until the enactments of the last parliamentary session, each year has seen substantial additions made to the growing mass of sanitary legislation, which has become unwieldy in bulk and intensely complicated in machinery. ”

“ Some of recent growth have been allowed, for the same reason, to spring up and develop without any regard to sanitary principles or the requirements of public health. There is therefore abundant scope for further reform and in not a few cases urgent need of it. ”

“ It is the task of this hygiene not [ix] only to make sewers, but to re-make love, and to do both in the same large spirit of human fellowship, to ensure finer individual development and a larger social organization. At the one end social hygiene may be regarded as simply the extension of an elementary sanitary code; at the other end it seems to some to have in it the glorious freedom of a new religion. The majority of people, probably, will be content to admit that we have here a scheme of serious social reform which every man and woman will soon be called upon to take some share in. ”

“ Its appearance marks the first stage of social reform, which was mainly a sanitary effort to clear away the gross filth from our cities, to look after the cleansing, lighting, and policing of the streets, to create a drainage system, to improve dwellings, and in these ways to combat disease and to lower the very high death-rate. ”

“ It is scarcely necessary to say that other classifications of social reform on its more hygienic side may be put forward. Thus W.H. Allen, looking more narrowly at the sanitary side of the matter, but without confining his consideration to the nineteenth century, finds that there are always seven stages: (1) that of racial tutelage, when sanitation becomes conscious and receives the sanction of law; (2) the introduction of sanitary comfort, well-paved streets, public sewers, extensive waterworks ”

“ In prosecuting this inquiry the Association was guided by the experience of similar organizations in Great Britain, where sanitary science is now cultivated with the greatest zeal, and is yielding the richest fruits. As a preliminary step to the introduction of sanitary reforms, many of the populous towns of England made a more or less complete inspection of the homes of the people to determine their condition, and to enable them to arrive at correct conclusions as to the required remedial measures. ”

“ Yet it is easy to predict that a society committed to the abolition of infectious germs, to a higher degree of public health, and to a better standard of sanitation will not forever permit these highly communicable diseases to spread unchecked in its midst, and that a public, convinced that sanitary science, properly supported, might rid our cities of this type of disease, will at length insist upon its accomplishment. ”

“ Nobody will deny that much has already been done in the development of preventive medicine and sanitary science. It will be claimed, and with justice, that more has been done than the public is willing and prepared to accept and live up to. We know that today municipalities continue to permit the unnecessary sacrifice of lives to epidemic disease, that politics is permitted to disorganize efficient boards of health in large and small communities and to put the best material interests of family and social life into untrained hands. ”

“ To state the case concisely, the National Board of Health was not in accord with the spirit of American government, and the people rejected it. Now, what do the American people want? I will not attempt to answer this question, but will suggest that they want a general sanitary administration which is capable of steady development, and yet may be subject to such modifications as the changing conditions of our country may necessitate, a sanitary policy which can be made to expand until it will answer the public needs not only for the present but even for decades to come. ”

“ Health administration cannot rise far above the hygienic standards of those who provide the means for administering sanitary law. The tax-paying public must believe in the economy, utility, and necessity of efficient health administration. ”

“ We must not only teach the individual how to guard his life against preventable disease and accident, we must educate our communities to the need of an effective public health service to enforce sanitary regulations and otherwise guard the health and lives of their members. ”

“ I say “hopeful” because public health as an institution is rapidly growing, and its practical value is becoming more and more manifest, and sanitary science is not now nearly so far in advance of its practical application as it was even a few years ago. The possibilities of sanitation in the general advancement are being made a part of all high ideals of government, so that it is not to be wondered at that the general government should be called upon to do its share. ”

“ The passing of sanitary laws, and the granting to a certain department the power to enforce these laws, will not ensure good public health unless the public at large supports those laws intelligently, and it can only do this through State and municipal sanitary organizations. ”

“ I believe also that at the outskirts much might be accomplished by an equitable adjustment of sanitary rates, and by encouraging householders to do for themselves what no public authority can do so satisfactorily for them. ”

“ Without such protection, sanitary legislation cannot, in the words of the Royal Sanitary Commission, be ‘active and effective,’ because local officers are too dependent on their immediate employers to be thoroughly efficient. ”

“ Pecuniarily, the results of properly-applied sanitary law would be immensely successful; the cent of prevention would be more than worth the dollar of cure. It is estimated that from a half to three-fourths of the inhabitants of our principal cities are sick some time during each year of ordinary salubrity. ”

“ It is a well-known fact that the great majority of the cases of disease treated in our hospitals are induced by the bad sanitary condition of the homes of the poor, and to the direct violation, through ignorance, of the plainest hygienic laws; yet what direct steps are taken to correct this constantly-acting cause of sickness? The Health Department of New York City is expected to do little else than prevent epidemics of contagious and infectious diseases. The meagre appropriation prevents them from doing much more. ”

“ 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. ”

“ Considering all these causes, and the needless waste of life occasioned by them, I can have little doubt that as much might be done by individuals, under the influence of improved education, to lessen the mortality from chronic disease, as by sanitary legislation to stay the sources of epidemic death. ”

“ 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. ”

“ 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. ”

“ Probably if we demanded good sanitary conditions before we would supply medical goods, we would be interfering with the people. But if we were going to contribute medicines to a locality at home which allowed breeding spots for disease all over the locality, I am willing to wager that we would demand an improvement of the sanitation, and see that it was accomplished, even if we had to use some kind of force. ”

“ In the first place, the process by which the weaker are preserved consists in suppressing various conditions unfavourable to human life in general. Sanitary legislation, for example, aims at destroying the causes of many of the diseases from which our forefathers suffered. If we can suppress the smallpox, we of course save many weakly children, who would have died had they been attacked. ”

“ No better plan for sanitary government appears at the present time than one modeled upon the structure of the general government itself. Broadly stated, this sanitary policy expects of each State a sanitary autonomy whose influence should be appreciated by every individual in every hamlet, however small, in its domain. It contemplates a State pride in the development of sanitation, a self-reliance and an unwillingness to surrender functions or call for aid from the general government excepting after the clearest convictions of propriety or necessity. ”

“ No recipe has ever been found for bringing up a healthy baby on unclean, infected milk; for avoiding tuberculosis among people who are [217] compelled to work with careless consumptives in unclean air; or for making a five-story leap as safe as a fire escape. Perfect habits of health on the part of an individual will not protect him against enervation or infection resulting from inefficient enforcement of sanitary codes by city, county, state, and national authorities. ”

“ The report on the local epidemics concludes by earnestly recommending to the government—“That sanitary measures be adopted by means of which the constitution of the people may be renewed, and their longevity increased. If this recommendation be fulfilled, we may then hope to see the condition of some of the departments ameliorated, in which now the population is so degenerated that the men seem to diminish in size each time they are measured for the conscriptions.” ”

“ No branch of legislation is more really valuable than that which is occupied with the health of the people, whether it takes the form of encouraging the means by which remedies may be discovered and diffused, or of extirpating by combined efforts particular diseases, or of securing that the mass of labour in the community should as far as possible be carried on under sound sanitary conditions. ”

“ But the extension of sanitation throughout the country and [159] among the people must be a matter of time, especially if we wish to carry them with us ... (November 23) . I think that we have done all we can do at present in furtherance of sanitary improvement, and that the best plan is to leave the Local Governments to themselves to work out their own arrangements. ”

“ Of course, in sanitation, as in other phases of morals, it is not as easy to do as to know what 'twere well to do. But it is safe to say that if we were ready in this country to follow such dictates of science in sanitary measures as are of known efficiency, we could secure their birthright of long life and health to a large proportion of that forty per cent of all the people who, as statistics show, are now destined to perish from preventable infectious maladies. ”

“ Every sanitary society, every agency whose aim is to work in the interest of public health, has actively aided, and is aiding, in the propaganda for a better universal understanding of the principles of sanitation and hygiene. The individual must be educated to understand the tragic need of such a law. You cannot legislate virtue into the public conscience. ”

“ The principles now affirmed in our statute book are such as, if carried into full effect, would soon reduce to quite an insignificant amount our present very large proportions of preventable disease. It is the almost completely expressed intention of our law that all such states of property and all such modes of personal action or inaction as may be of danger to the public health, should be brought within scope of summary procedure and prevention. ”

“ 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. ”

“ This may imply—and in England it does imply—the urgent need for reform and reconstruction of local as well of central public health administration; but to attempt to separate medical from public health provision is to repeat the blunders which, despite skilled advice to the contrary, have been made on two great historic occasions.
A complete service, adequate to the needs of the community, cannot be secured by a session’s legislation. It must grow as the result of steady advance. The motto in growth might well be, “First things first.” ”