CHAPTER XXI

THE STATE-Continued

HEALTH, CHARITIES AND CORRECTION

Health and the State. The germ theory has greatly broadened and enlarged the usefulness of the State. So long as people believed that disease was a "humor" in the blood, to be cured by drugs, there was little to be done except to wait until a malady appeared and then cure it. But with the germ theory there has come a new idea and a new department of medical work-that of detecting and destroying the disease bacillus. With this change we have passed from the remedial to the preventive policy. But prevention is a gigantic task which far exceeds the resources of the individual; it means community action. We now expect our State governments to establish a healthful environment for all classes and to keep our streets, offices and schools as free from unsafe conditions as possible. This means that State activity in health affairs is multiplied one hundred fold. While the germ theory is a discovery of medical science, its effects upon government are most striking.

The progress of science now urges our States and cities to conduct thorough and exhaustive investigations of all forms of disease; To maintain laboratories of hygiene;

To establish a systematic medical inspection of schools and other public institutions;

To enforce vaccination;

To inspect tenements, factories, sweatshops, etc.;

To disinfect dwellings;

To establish sanatoriums for consumptives, open air and recreation grounds for all classes;

And to maintain a reasonable standard of purity in foods and drugs and accomplish scores of other tasks, all directed towards the one great aim of providing a sanitary environment. Most of these new duties have fallen upon the local governments, and these bodies are supervised by a central State office. Another result of the germ theory has been the determination of the people to make public health a matter of general, not purely local, concern. The active passage and interchange of persons and goods between all parts of the commonwealth has made it imperative that some central authority be established to watch over the physical welfare of the entire State. Such a plan has been successfully adopted by most of the commonwealths.

The State Board.-The central body is fast becoming the strong

est single force in the fight for a higher health standard. It is usually composed of six to ten members appointed by the Governor, the majority being physicians. Its duties and powers are:

Suppression of epidemics and widespread contagious diseases; for this purpose an emergency fund of several thousand dollars is placed at the disposal of the Board;

Investigation of diseases and their causes;

Vital Statistics;

Power to act as a local board of health in those districts where no local board exists;

Power to assist and encourage the existing local boards.

As the State Board usually meets only at certain periods or in case of emergency, its continuous work is assigned to a paid secretary who devotes all of his time to such duties. Under the direction of the board and its secretary is a corps of special agents, chemists, inspectors and local district physicians. The board also maintains a central laboratory in which its chemists conduct analyses and investigations, while the inspectors examine on the spot and report to the board any local conditions which the board directs.

New Problems of Health Administration.-Prominent among the questions confronting the State authorities are:

(a) The creation of pure water supplies;
(b) Purity of foods, beverages and drugs;

(c) The campaign against tuberculosis;

(d) The important administrative question-what shall be the powers of the central authority?

(a) The Water Supply.-Every large town and city in the United States either has already before it or is about to face the problem of pure drinking water. The universal nature of the demand has raised this question to the front rank. The problem is a peculiarly difficult one because of the rapid increase of small towns and cities which require a municipal supply but cannot afford an expensive plant. Again, the sources of pollution in the supply of any town are usually beyond the limits of the town itself and are not subject to its jurisdiction or control. This in itself is enough to warrant State supervision and protection. The central State authorities are now trying to stop the widespread practice of emptying sewage into streams which form the necessary source of supply for other communities. With the exception of Massachusetts, none of the States enforce vigorously and effectively the laws prohibiting this custom-an administrative weakness which costs the lives of thousands each year. The laws of Massachusetts not only forbid pollution of water-supply streams and ponds, whether through sewage or otherwise, but they also authorize the officials of any town, city or of any water or ice company to bring a complaint before the State board, setting forth the cause of such pollution. The board, after a public hearing, may order the causes removed. As no appropriation le for this purpose, however, the State board is obliged to

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make its regulations and rely upon local boards for their enforcement.

These provisions give the Massachusetts board some means of protecting the water supplies of the State against the more open sources of impurity, but it is in its advisory capacity that the board exerts a more typical influence. No town is authorized to provide for a new water supply or sewerage system without first consulting the State Board of Health. Since in Massachusetts most of the plans for local sewerage and water supply require the authorization of the State legislature, the latter body would usually refuse to allow a change which did not meet with the approval of the State board.1

1 The Massachusetts Act of 1886 and 1888 "To Protect the Purity of Inland Waters," etc., provides as follows:

An Act to Protect the Purity of Inland Waters, and to Require Consultation with the State Board of Health Regarding the Establishment of Systems of Water-supply, Drainage and Sewerage.

Sec. 1. The state board of health shall have the general oversight and care of all inland waters, and shall be furnished with maps, plans and documents suitable for this purpose, and records of all its doings in relation thereto shall be kept. It may employ such engineers and clerks and other assistants as it may deem necessary; provided, that no contracts or other acts which involve the payment of money from the treasury of the Commonwealth shall be made or done without an appropriation expressly made therefor by the general court. It shall annually on or before the tenth day of January report to the general court its doings in the preceding year, and at the same time submit estimates of the sums required to meet the expenses of said board in relation to the care and oversight of inland waters for the ensuing year, and it shall also recommend legislation and suitable plans for such systems of main sewers as it may deem necessary for the preservation of the public health, and for the purification and prevention of the pollution of the ponds, streams and inland waters of the Commonwealth.

Sec. 2. Said board shall from time to time, as it may deem expedient, cause examinations of the said waters to be made for the purpose of ascertaining whether the same are adapted for use as sources of domestic water-supplies or are in a condition likely to impair the interests of the public or persons lawfully using the same, or imperil the public health. It shall recommend measures for prevention of the pollution of such waters, and for the removal of substances and causes of every kind which may be liable to cause pollution thereof, in order to protect and develop the rights and property of the commonwealth therein and to protect the public health. It shall have authority to conduct experiments to determine the best practicable methods of purification of drainage and sewage and disposal of the same. For the purposes aforesaid it may employ such expert assistance as may be necessary.

Sec. 3. It shall from time to time consult with and advise the authorities of cities and towns, or with corporations, firms or individuals, either already having or intending to introduce systems of water-supply, drainage or sewerage, as to the most appropriate source of disposing of their drainage or sewerage, having regard to the present and prospective needs and interest of other cities, towns, corporations, firms or individuals which may be affected thereby. It shall also from time to time consult with and advise persons or corporations engaged or intending to engage in any manufacturing or other business, drainage or sewage which may tend to cause the pollution of any inland waters, as to the best practicable method of preventing such pollution by the interception, disposal or purification of such drainage or sewage; provided, that no person shall be compelled to bear the expense of such consultation or advice, or of experiments made

In Pennsylvania, where conditions of highly developed manufactures and dense population also prevail, the State board of health has for years advocated the establishment of a force of "river wardens" under the direction of the board, to police the water supply of the entire State; but the recommendations of the Board have thus far been ignored by the legislature. This appears to be the only permanent, satisfactory solution of the problem since pollution becomes every year more extensive and dangerous.

(b) Food Inspection.-The use of fraudulent or harmful food adulterants and preservatives has become a question of deep popular interest as we saw in considering the National power to regulate commerce. Unfortunately the practice has not been confined to luxuries and delicacies. Since it is the poor especially who demand a cheap diet, adulteration and harmful preservatives are most prevalent in the ordinary necessities of the table, such as meat, salt, sugar, milk, butter, flour, meal, canned and preserved fruits and vegetables. Every manufactured article of common food and drink is now extensively adulterated. It will also be apparent that the evil falls heavily upon that class which is least able to protect itself. In view of such conditions, the National Government has adopted the law of 1906 already described and the States have begun to enact similar measures. The laws now in force are of two general kinds: First, those aimed to prevent fraud, though permitting the sale of harmless substitutes if plainly marked; and second, those intended to eliminate injurious adulteration and preservatives, of all kinds.

Under the first class of laws, for example, are those regulating the manufacture and sale of oleomargarine. This substance is not considered harmful; it is claimed to be cleaner than butter and is certainly much cheaper. The sale of oleomargarine as butter, having reached a point where it threatened to displace the genuine article, the various farmers' associations of the country began an active crusade against the new product. In response to this movement several States provided that oleomargarine must be sold as such. Dealers were required to be licensed, the packages to be plainly marked, and the use of coloring matter to imitate butter for the purposes of this act. All such authorities, corporations, firms and individuals are hereby required to give notice to said board of their intentions in the premises, and to submit for its advice outlines of their proposed plans or schemes in relation to water-supply and disposal of drainage and sewage, and all petitions to the legislature for authority to introduce a system of water-supply, drainage or sewerage shall be accompanied by a copy of the recommendation and advice of the said board thereon. Said board shall bring to the notice of the attorney-general all instances which may come to its knowledge of omission to comply with existing laws, respecting the pollution of water-supplies and inland waters, and shall annually report to the legislature any specific cases not covered by the provisions of existing laws, which in its opinion call for further legislation. Sec. 4. In this act the term "drainage" refers to rainfall, surface and subsoil water only, and "sewage" refers to domestic and manufacturing filth and

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was in some cases prohibited. Here the objection is not to the sale of the article in question, but to the fraud perpetrated when this article is artificially colored and sold as butter.1

Weights and Measures.-The Departments of Weights and Measures of many of the States are now awakening to their possibilities and are issuing illustrated pamphlets for housewives which contain valuable material on methods of reducing the cost of living and show what service the State may offer in this new field. The pamphlets give practical suggestions as to the kinds of scales to be used; the methods of avoiding short weight; the great advantage of buying in bulk rather than in package; the ordinary methods used by dishonest dealers and manufacturers to conceal weights and the immediate bearing which the whole problem has upon the family's outlay for provisions. The pamphlets are prepared in a popular style and are replete with pointed hints.

Many of the State laws also require that the presence of certain dangerous drugs in a food or beverage or in a medicine must be stated on the label. These laws so far as they affect products brought from other States are subject to the general food and

1 The same applies to manufactured vinegars, etc., many of which are harmless preparations such as diluted acetic acid, but their sale as vinegar can no more be permitted than can other forms of fraud.

2 The following example is taken from the Washington State publication: DO YOU KNOW

That a Department of Weights and Measures for the State of Washington was created by the 1913 legislature?

That every city of the first class and every county in the State are to have a sealer of Weights and Measures?

That the county auditor is ex-officio sealer in his county?

That it is the duty of the sealer to protect the honest dealer and the general public in the matter of honest weights and measures?

That much depends upon you, Mr. or Mrs. Consumer, whether full weight and measure goes into the homes in Washington?

That a careful study of this booklet will make you a valuable assistant to the Department of Weights and Measures?

That every household should have an accurate scale and set of liquid measures that have been tested?

That your city or county sealer, or the State Department of Weights and Measures at Olympia, Wash., will test and certify your scales and measures free of charge for you?

That many cans and packages presumably containing a certain amount are far short of that amount?

That in buying some package goods, which since the passage of the pure food law have been gradually reduced in size, you are paying a high price for paper wrappings and tin?

That when dry commodities are sold in liquid capacity measures you are losing about 15 per cent?

That there are approximately 24,000,000 pounds of butter consumed in the State of Washington each year, and that a shortage of one ounce in each pound would mean a loss of approximately $450,000.00 per year?

That in the City of Seattle the department seized and confiscated over 4,000 short measure milk bottles in the first two years of its existence, and that the shortage on these bottles alone more than equals the operating expense of the department?