THE WORK OF BOARDS OF HEALTH 235 



the state. In the United States the management of the internal affairs 

 of each separate state is left, for the most part, to the state concerned. 

 Municipal charters are obtained from the state governments and in 

 these charters the power to regulate conditions affecting public health 

 are specifically granted. Cities and towns thus owe responsibility to 

 the state governments and are answerable to them to a greater or less 

 extent, depending upon local circumstances. In Massachusetts local 

 boards of health are comparatively independent of the state authority, 

 while in New York the state department of health is a central body to 

 which the local boards of health are closely tributary. 



State health authorities are in no case responsible or answerable to 

 the general government. There is no national board of health. 



In the management of health matters the smallest unit of respon- 

 sibility is a municipal health officer or municipal board of health; the 

 largest the state health officer or board of health. Whether municipal 

 or state, the functions of health authorities are very much the same. 

 The main differences arise from the differences in area over which the 

 authorities are required to exercise supervision. Local boards have 

 charge of the conditions which occur in the several localities in a state ; 

 they take cognizance of individual houses and of persons. The ultimate 

 units over which state boards exercise jurisdiction are municipalities. 



It is the first duty of all health boards to collect vital statistics, to 

 collate them in tabular form, and to interpret these data so as to show 

 the state of the public health. Local boards of health collect reports of 

 deaths and of contagious and other diseases from physicians, interpret 

 these data, for the benefit of the districts in which they apply, and 

 then forward them to the state authorities. The state authorities so 

 obtain a knowledge of the health in various sections of the state and are 

 so enabled to judge the relative healthfulness of the different localities. 

 An excessive prevalence of disease in one place can thus be promptly 

 detected. 



The methods of collecting vital statistics are often unsatisfactory 

 and the results frequently deceptive. It may be remarked in passing 

 that vital statistics are to-day available for only a part of the people 

 of the United States, except during years when this government makes 

 a census enumeration. The census returns are themselves unsatisfac- 

 tory. In this respect the United States government is behind nearly 

 every civilized country in Europe. The fault lies with our municipal 

 and state governments. 



In interpreting death rates careful account must be taken of the 

 marriage and birth rates, total population, migrations of population, 

 and other factors ; and it would be well for boards of health to eharsre 

 themselves with collating as well as collecting these vital statistics, in a 

 more intelligent manner. 



