NATURE 



73 



THURSDAY, NOVEMBER 28, 1901. 



PUBLIC HEALTH ADMINISTRATION IN 

 AMERICA. 

 Municipal Sanitation in the United States. By Chas. 

 V. Chapin, M.D., Superintendent of Health of the City 

 of Providence. Pp. viii + 970. (Providence, K.I. : 

 Snow and Farnham, The Providence Press, 1901.) 



THIS work is not a treatise on the principles of sani- 

 tation, and, in fact, these principles are rarely 

 referred to ; it is rather a compendium of sanitary prac- 

 tice in the United States of America. The author de- 

 votes but little space to an expression of his own views, 

 but his opinions whenever given are such as will meet 

 with very general approval. In the introduction he states 

 that the preparation of the present volume was primarily 

 undertaken to meet his personal needs. An investiga- 

 tion along several lines of public health work suggested 

 the utility of a comprehensive study of sanitary methods, 

 and, as a consequence, this volume was prepared, in the 

 hope that the material gathered together will prove as 

 useful to other health officers as it has to the author. 



The work is designed for American readers, but much 

 of it will prove interesting and suggestive reading to 

 those who have to do with sanitary administration in 

 this country. The points which will perhaps strike the 

 British reader most are : The e.xtent to which the sani- 

 tary law or procedure may vary in different States ; the 

 scope and stringency of certain sanitary regulations ; 

 and the frequent paucity of efficient machinery to see 

 that the law is observed. It is comparatively easy to 

 frame an almost ideal set of sanitary statutes and regu- 

 lations, but it is a very difficult matter to enforce them 

 thoroughly, and it is evident that sanitary administration 

 does not always keep pace with sanitary legislation in 

 the United States. The average of all those cities of 

 America, given in a rather long table on pp. 12S and 129 

 of the work, show the population for one inspector to be 

 about 30,000 ; but in Providence there is only one to 

 every 87,000 of population. A great many health 

 officers, we are informed, receive no compensation at 

 all, but serve their fellow-citizens simply from public 

 spirit ; thus in Minnesota in 1898, of 214 health officers, 

 83 received no pay, and one of these was in "a city of 

 5000 inhabitants." In villages, towns and cities of small 

 or moderate size, the health officer is e.xpected to do 

 nearly all the sanitary work of the community. He 

 acts as the secretary to the Board of Health, and attends 

 personally to communicable disease, attaching placards, 

 giving instructions and often doing the disinfection him- 

 self. He also investigates nuisances and often serves 

 notices for abatement. .\s a general rule, the scale of 

 pay to the health officers is very similar to that in Great 

 Britain. It is, moreover, very generally the custom in 

 cities, often of moderate size, for the health officer to be 

 entrusted with the duty of collecting and recording the 

 deaths in the population. 



In America, boards of health, which are now estab- 

 lished in all the States e.xcept Georgia, Idaho, Montana, 

 Oregon and Wyoming, are given more or less legislative 

 and executive authority in matters which experience has 

 shown they can best control, but as a rule the State 

 NO. 1674, VOL. 65] 



Board of Health is considered chiefly as an advisory 

 board. In many cases the State reserves to its State 

 Board of Health executive powers in matters of quaran- 

 tine, the control of communicable disease and diseases 

 of animals, the adulteration of food, &c. ; and the State 

 Board of Health in Massachusetts has, in addition, set 

 an example in the work of investigation which it will be 

 difficult for others to equal, and that Board's extensive 

 experiments upon water and sewage purification are 

 highly valued by sanitarians in this country. The 

 principles of local self-government in sanitary as in other 

 affairs is in the main recognised and adhered to. Out- 

 side of municipalities the sanitary organisation, usually 

 in the form of boards of health, may be established 

 either in townships or counties. Of the thirty-six States, 

 twenty have provided for a county form of sanitary 

 government, and sixteen have a township form of sanitary 

 government. 



Reference may here be made to a few matters of public 

 health administration in the United States which are of 

 special interest to British readers. The use of preservative 

 in milk or cream is altogether forbidden in some States, 

 and several State and municipal standards for milk, 

 require 35 per cent, of fat and 9 per cent, of solids non- 

 fat — a higher standard than that which obtains in this 

 country ; and in the city of New York, condensed milk 

 must contain fat to the amount of 25 per cent, of the milk 

 solids. A few States (New York, &c.) require the appli- 

 cation of the tuberculin test to cows kept in the city, and 

 many States now attempt to secure the destruction of 

 herds most affected with tubercle and to help farmers to 

 free their herds from tuberculous animals. How much 

 they have really accomplished in this direction is not 

 entirely clear, but it does not appear to be great. Con- 

 siderable opposition is experienced, and little is done save 

 on the application of the owners themselves. 



In most communities a placard or sign is put upon the 

 infected premises to notify the public of the presence of 

 infectious disease. Laws requiring the vaccination of 

 school children have been declared constitutional in 

 Indiana, Pennsylvania, New York and California ; some- 

 times it is the teacher who is required by the statute to 

 enforce the law, by excluding the unvaccinated ; more 

 often, however, it is the school board or school com- 

 mittee who are supposed to have full control of the 

 teachers. Garbage (animal and vegetable matters from 

 dwellings, shops, markets, &c.) is rarely removed less often 

 than once a week, but in Washington it is removed seven 

 times a week ; in New York, Philadelphia and some other 

 towns, six times ; and six times weekly in the summer 

 months of the year in many other instances. The dry 

 refuse (ashes and rubbish) is not usually quite so frequently 

 removed ; the work is done in New York and Brooklyn 

 six times a week, and in many cities two or three times a 

 week, but in most communities the interval between 

 removals is one week. 



There is little doubt that more than one-half of the water 

 furnished in the United States is wasted, for the per 

 capita consumption in American is twice as great as that 

 in European cities, and in the few American cities which 

 are metered the/t'r capita consumption is not one-half what 

 it is in the unmetered cities. It appears to be the experi- 

 ence in America that meters diminish waste, but do not 



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