We have seen in earlier chapters that the various communicable diseases may be controlled, if proper steps are taken to prevent their spread. Good sanitary regulations, and their vigorous enforcement, are necessary in order that this may be accomplished. The food that comes into the city or town, and the stores where it is handled and sold, must be inspected. The homes and factories where people live and work, and the streets, yards, and open places must be supervised to see that there are no conditions likely to cause disease. The public must be educated as to the causes of disease and taught how diseases of all kinds may be avoided. The statistics of births, deaths, and cases of communicable disease must be carefully kept and analyzed, so that the whole public health campaign may be properly directed. These things are the duties of the Board of Health of the city or town, and of the state, and of the United States Public Health Service at Washington.
The Control of Communicable Diseases.One of the most important duties of the Board of Health is the control of communicable diseases.
In order that this may be accomplished, all cases of communicable disease should be promptly reported, so that the Board of Health may send an inspector to see that the case is properly isolated during its course, and that the necessary cleansing or disinfection is carried out afterward.
In diphtheria, it is the business of the health authorities to see that the sick person and carriers in the family are given antitoxin; and in smallpox and typhoid fever, they must see that all persons who have been exposed are protected by vaccination.
Whenever there is an increase in the number of cases of any disease, the Board of Health attempts to discover the cause and takes the necessary steps to prevent the further spread of the germs, by purifying water or milk, by isolating
infected individuals, by destroying insect carriers, or by whatever other measures are required.
The Health Laboratory.In order to carry on its work, the Board of Health must have not only trained medical experts, but also a properly equipped laboratory.
In this laboratory, samples from the throat and samples of blood and other body fluids are examined to see whether suspected cases are really diphtheria, tuberculosis, malaria, typhoid fever, or whatever the disease may be. In the four diseases mentioned, and in many more, the bacteriologist, with his microscope and growths or cultures of bacteria, is the one to give final judgment as to the nature of a doubtful case. Diphtheria and typhoid carriers can be detected only in this way-by the fact that the bacteriologist actually finds the disease germs in throat or discharges. In diphtheria, the end of the isolation period is usually fixed by the disappearance of diphtheria germs from the throat, as shown by laboratory tests.
In the larger city and state laboratories, various sera and vaccines are prepared for free distribution to the public. Diphtheria antitoxin, and smallpox and typhoid vaccines, with other preparations of the same sort, should be available for all, whether they are able to pay or not. The purity of these preparations should, moreover, be guaranteed by the Board of Health.
It is also the duty of the Board of Health laboratory to examine samples of water, milk, foods, and drugs, so as to determine their quality by chemical and bacteriological tests.
Supervision of Food Supplies.The Board of Health must assure itself by inspections, as well as by laboratory examinations, of the purity of the public water supply and of the milk and food supplies of the city or town.
Its representatives inspect the land near the river, lake, or reservoir from which the water supply comes, to make sure that there is no danger of pollution by sewage. They watch the operation of the filter or disinfecting plant by which the public water supply is purified, and see that it works efficiently.
Another of their duties is the inspection of the dairies which supply milk, to see that the stables and milk houses are clean, that the cows and milkers are healthy, and that the milk is properly iced and cared for in transportation to the city. The inspectors carefully oversee the working of the pasteurizing plants, to make sure that all the milk is really heated as it should be.
The representatives of the Board of Health inspect the stores, restaurants, and other places where food is handled, and assure themselves that conditions are cleanly, and that sick people are not employed in the preparation of the food. They inspect the food itself to see that no infected or spoiled food of any kind is sold, not only because it is unhealthful to eat such food, but because no dealer has the right to take people’s money for food that is not clean and wholesome.
In many cities and states, the Boards of Health also attend to the detection of food and drug fraudsadulteration, the use of misleading labels on foods, and the use of preservatives which may be injurious to health. It is particularly important that medicines should be of the right strength, for if they are too weak they will not give the effect the doctor wants, or if too strong they may do serious harm. The examination of foods for fraud is chiefly important to protect the pocketbook of the consumer and enable him, when purchasing food, to get as good quality as he pays for.
Inspection of General Sanitary Conditions.Another group of inspectors deals with the general sanitation of the city or town, with the conditions which may breed disease, or which create offensive nuisances.
Much of the work of these sanitary inspectors has to do with the prevention of bad smells, from glue factories and other offensive industries, with the cleaning up of dirty backyards, and with the removal of conditions that are objectionable to the eye or to the nose.
The most important activities of the sanitary inspectors are those which deal with the disposal of human wastes and with conditions that favor the breeding of insect carriers of disease. Carelessly-built outside toilets, overflowing cesspools, and open drains are very real dangers, and whatever is done to remedy these conditions is an aid to public health. The treatment of mosquito-breeding pools, and the removal of filth in which flies may breed, may also directly and effectively prevent disease.
The inspection of tenements to see that there is light and air for those who live in them, that fire escapes are provided and are kept clear, that toilet facilities are adequate, and that the building is decent and clean; the inspection of factories to see that machinery is safe, that the workers are protected against harmful dusts and poisons used in their work, and that the workrooms are properly ventilated and lightedthese are special types of inspection which must be carried out by some public authority. Sometimes they are under the care of the Board of Health, but more often, perhaps, there is a special department created for these purposes, such as a Tenement House Department or a Bureau of Labor.
Educational Activities of the Board of Health.Probably the two most important health problems are infant mortality and tuberculosis. In dealing with these questions and with many others, the Board of Health must use educational methods rather than legal force.
We have seen in preceding chapters that tuberculosis can best be controlled by teaching people how to live healthy lives, so as to build up their vital resistance, and that infant mortality must be controlled chiefly by teaching mothers how to care for their babies. So the Board of Health provides clinics and dispensaries, where medical advice and treatment can be given to those suffering from tuberculosis, and sends nurses into the homes to find the early cases and to teach how to check the progress of the disease. It supports the Infant Welfare Stations, where the mothers may bring their babies to get instruction as to feeding and care.
In many fields of work, the health authorities need the help of the individual citizen. Progressive health departments, therefore, publish monthly or weekly bulletins, be-sides special circulars of information for the public. They supply the newspapers with carefully prepared news of the latest discoveries, and of the facts people ought to know in order to keep themselves and their families well. They prepare exhibits for the public, and send out lecturers to speak at schools and churches, and before various clubs and civic organizations.
Health workers will not be satisfied until the whole community is organized into a great united army for the prevention of preventable disease.
The Public Health Nurse.One of the most recent and most important of the activities of the Board of Health is
the employment of public health nurses, not to take care of the sick but to help people to keep well by teaching them the principles of hygiene.
The first person to see what a future there was for such health nursing was the great Englishwoman, Florence Nightingale (1820-1910). It is said that, when a child, her favorite game was to bandage and nurse her dolls, and that her first living patient was an injured shepherd dog. When she grew up, she kept her love of animals and combined it with a passion for helping suffering men and women. She became a pioneer in organizing hospitals and in developing the work of nursing. Then came the Crimean War in 1854-1855. There was no proper preparation for caring for the wounded at the front. Florence Nightingale was called upon for help and went out to the Crimea, where she soon had 10,000 men in the hospitals under her care. She organized these hospitals so successfully that the death rate was cut to one twentieth part of what it was before.
Florence Nightingale thought of nursing as including much more than the sick nursing done in a hospital. She saw, as few people did in those days, that fresh air, light, warmth, cleanliness, quiet, and diet were the chief factors in keeping health, as well as in re-covering from sickness. After the war was over, she urged, at every opportunity, the value of health nursing, or education by nurses in the principles of hygiene. The Infant Welfare nurse, the school nurse, and the tuberculosis nurse are employed by the Board of Health to-day largely as an indirect result of the teachings of Florence Nightingale.
Results of the Public Health Campaign.The campaign against preventable disease really began only after the discoveries as to the relations between microbes and disease, made by Pasteur and his followers between 1880 and 1890.
Since that time, the results obtained in many cities and countries have given clear proof of the value and the importance of progressive sanitary measures.
The success of public health work in any community is measured by its vital statistics, or the records of deaths and cases of disease, from various causes and at different ages, compared with the actual population. In this book we can consider only the simplest of all methods of measuring sanitary conditionsthe general death rate.
The general death rate is the ratio of the total number of deaths from all causes in a year to the number of people in the city, town, or state, reduced to a basis of 1000. For instance, if in a city of 10,000 people there are 150 deaths in a given year, the general death rate would be 15 per 1000.
Fig. 136 shows what has happened to the general death rate in New York City since 187o. The death rate fell from 26 in 1888 to 14 in 1913, or, in other words, decreased by 46 per cent in twenty-five years. There are to-day about 20o deaths every twenty-four hours in New York City. If the death rate of twenty-five years ago had continued, there would be 370. Similar reductions in the death rate have followed in many other cities and states where vigorous campaigns have been made against preventable disease.
The health departments of New York City and of New York State have taken as their motto the statement:
Public health is purchasable. Within natural limitations, a community can determine its own death rate.
It is a bold saying but a true one. If you remember it as you grow up, you will do all you can to make your city and your state secure a low death rate by setting in operation all the machinery necessary for the prevention of preventable disease.
QUESTIONS FOR DISCUSSION AND REVIEW
1. What are some of the matters which come under the control of the Board of Health?
2. How is the spread of communicable diseases prevented? What is the duty of the Board of Health when a case of communicable disease is reported?
3. If a man were quarantined for a light attack of some disease, and decided to go out to business before the danger of infection was over, would he be a good citizen? Could he be punished?
4. Where there is doubt as to whether a patient has diphtheria or only a sore throat, what does the Board of Health do in order to find out the truth?
5. In a case of diphtheria, what precautions are taken with those who have been exposed? In typhoid fever? How is the isolation period for diphtheria determined?
6. Why is it considered necessary to inspect all food supplies?
7. How does the Board of Health supervise the water sup-ply? The milk supply?
8. Why is it necessary to examine the milkers in dairies, as well as the cows? Why does the Board of Health oversee pasteurizing plants?
9. The Sanitary Code of New York City requires that all foods exposed for sale must be covered. Why?
10. There has been a movement requiring medical inspection of cooks in restaurants. Explain.
11. What would be the work of a government inspector in each of the following departments: (a) factory inspection, (b) tenement inspection, (c) general sanitary inspection?
12. What did we find was the advantage in educating the public in the care and prevention of tuberculosis?
13. How is the method of educating the public used to save the lives of babies?
14. How does the visiting nurse help in carrying out this work?
15. Have you a nurse in your school? What are her duties?
16. Who was Florence Nightingale and why is she famous?
17. Which is the finer kind of work, the nursing of the sick
or the prevention of sickness? Defend your opinion.
18. Why is the work of the Board of Health much more effective now than it was before the days of Pasteur?
19. How is the success of public health work measured?
20. What is meant by the general death rate? Why has the death rate fallen in the past twenty-five years?
21. Find out the death rate in your city or town. Is it a low rate?
22. What is the health motto of New York City? Do you believe in it? What can each person do to help make it true?