A Highly Important Matter.—Nothing among all the activities of modern government is more important than the care of the public health. Its importance cannot be measured in dollars and cents or in figures of any kind. The health of the individual is the greatest of all factors in personal efficiency; no man, woman, or child can do the best work in any field of activity if hampered by disease, however slight. The health of the community is likewise essential to its progress and prosperity. Health protection, accordingly, is not a matter which can safely be left to everyone’s discretion. Some people would realize the necessity of safeguarding themselves and their families against disease; but others would not, and their neglect would entail danger to the whole community. Some people would know how to avoid ill-health, so far as it can be avoided; but others would not possess this knowledge and would suffer for lack of it.^[251] A man’s religious or political belief may be his own personal concern; but his ideas of cleanliness and disease prevention are not. People who lay themselves open to disease constitute a danger to all those around them. In earlier days, when the population was scattered and not brought into contact the need for social control of the public health was less imperative. Today, when millions of people live in crowded cities where they come hourly into contact with one another the safeguarding of the public health constitutes a governmental task of the first importance and magnitude.

Old and New Ideas Concerning Health Protection.—No science has made greater progress during the past hundred years than the science of preventive medicine. In early times all diseases were looked upon as due to the same cause, namely, the anger of the gods for some misdoing on the part of the individual or the community.^[252] The usual course, when a pestilence came upon the people, was to go through ceremonies and offer sacrifices in order that this anger might be appeased.

Great plagues swept over Europe almost unchecked for a thousand years. In every community there were healers and medicine-men, who claimed to possess magic arts in dealing with all human ailments but, as a grim truth, nobody had the remotest idea as to what brought these epidemics, or how they were spread, or what might be done to prevent them. It is said that the Black Death in the fourteenth century carried off one-third of all the people in England. Whole towns were swept out of existence. Knowledge concerning the nature of disease and the methods of preventing it developed very slowly for many centuries, because many superstitions had to be broken down, and only within quite modern times did health protection reach the stage where it could properly be called a science.

Health protection did not attain a scientific basis, in fact, until the germ theory of disease was worked out and accepted. This theory, which is simple enough in its elementary principles, completely reconstructed the ideas of the human race concerning the causes and methods of preventing bodily ailments. It provided a complete explanation for many things which had been looked upon as utter mysteries. The wonder is that the world spent so many centuries in discovering it. Even in the days of the Roman Empire intelligent men suspected that there was some connection between filth and pestilence; but just what this connection was they never were able to trace out satisfactorily, nor did anyone manage to do it for more than fifteen hundred years after them.^[253] How long it has sometimes taken the world to move from one step in knowledge to the next!

The Causes of Disease and Infection.—The germ theory of disease may be concisely stated in this way: Innumerable small organisms (known as microbes, bacteria, bacilli, or germs) exist in the air, and in or upon nearly all substances. These organisms or germs are so small that they are invisible to the eye unless a powerful microscope is used. They are so small that thousands of them can assemble on the head of a pin or in the smallest drop of water. |Harmless bacteria.| Most of them are harmless; and some of them render useful service. Without the aid of these little organisms we could not make cheese or vinegar. On the other hand nearly all organic decay, of whatever sort, is caused by the action of bacteria. When apples rot, or milk grows sour, or butter becomes rancid, it is all due to bacterial action. Bacteria multiply with extraordinary rapidity wherever the temperature and other conditions are favorable; most species increase by division, that is, one micro-organism divides itself into two, these two into four, and so on by geometrical progression. As successive divisions often take place within a few hours it is easy to see how a very few germs today may number millions tomorrow. Under the microscope most of the different species can be identified, for they assume varying shapes and display a variety of characteristics.

But although most of these diminutive organisms are harmless, many of them are what scientists call pathogenic germs, in other words, they are a menace to health when they gain access to the human body. The human body, in fact, is the most favorable environment for these disease-bearing bacilli, and most of them can live but a short time outside of it. Access may be gained in various ways, but principally through the food and drink we consume, or through the bites of germ-carrying insects. The bacteria, when they gain lodgment in the tissues of the body, often multiply with great rapidity, creating poisonous substances, and thus increase the normal bodily temperature—a condition which we speak of as fever. When the body is strong and vigorous, it can sometimes overcome and throw off the effects of this bacterial action, for the human blood, under normal conditions, possesses powers of resistance to pathogenic germs; but when people are frail or exhausted, this power of resistance is greatly diminished and the bacilli are enabled to gain the upper hand.

Water-Borne Diseases—Typhoid Fever.—One way in which pathogenic bacilli gain access to the human body and produce disease may be illustrated by the case of typhoid fever. Fifty years ago this disease was one of the most common in all countries; today it has been almost entirely eradicated in civilized lands. Both armies in the Civil War lost thousands of men through its ravages, but in the American army during the World War there were only a few cases. Accurate knowledge of the way in which typhoid is transmitted has given mankind an almost complete mastery over this scourge of many centuries.

Typhoid is caused by a germ which is most commonly found in polluted water, but sometimes makes its way into milk through the use of water in washing cans and utensils. It does not come from bad ventilation, sewer gas, ash piles, or exposure to cold, as some people imagine. The typhoid bacilli, being taken into the stomach with water, milk, or any other contaminated nourishment, find their way into the intestines and cause inflammation there, thus producing a fevered condition. If the sewage from hospitals and homes where there are typhoid patients is not carefully guarded, it gets into lakes, rivers, or wells, polluting them and spreading the disease. The elimination of typhoid is, therefore, very largely a problem of protecting the water supply against contact with human sewage. This is one reason why progressive communities are giving so much attention and spending so much money upon modern methods of sewage disposal and upon the rigorous protection of their public water supplies. An epidemic of typhoid is always the outcome of somebody’s ignorance or neglect. It has been suggested, with a good deal of force, that for every such epidemic somebody ought to be put in jail.

Insect-Borne Diseases.—Another way in which disease-bearing bacilli obtain access to the human blood is through the bites of insects. |The scourge of yellow fever.| Fifty years ago yellow fever was the great scourge of all tropical countries. When the French built a railway across the Isthmus of Panama in 1885 it is said that the work cost one life for every tie in the road, so great were the ravages of yellow fever among the laborers. But the United States, twenty-odd years later, succeeded in digging a canal across the Isthmus without the loss of a single life from this disease. Under Spanish rule, Cuba was never free from yellow fever; the island has been free from it since the Americans cleaned it up.

The change has been brought about by the discovery that the germs of yellow fever are carried by a certain species of mosquito which transmits the infection from a diseased person to others. The cleaning-up of stagnant pools in which the mosquitoes breed, and the careful screening of doors and windows has practically eliminated the disease wherever these measures have been taken. Substantially the same thing is true of the disease known as malaria so far as causes and remedies are concerned. Typhus, a fever which has long been the pestilence of backward countries, is transmitted from person to person by the common body-louse or “cootie”. Cities, armies, and even whole countries have been set free from this plague by delousing operations, that is by the wholesale disinfection of clothing and persons.^[254] Bubonic plague, the Black Death of the Middle Ages, which has swept over Asia and portions of Europe so many times, is transmitted by rat fleas. Other diseases besides yellow fever, typhus, and bubonic are known to be spread by insects, and still others are believed to be. The common house-fly is undoubtedly a carrier of typhoid germs from filth and sewage to the water, milk, and food supplies in homes and stores. The world would be far better off if the whole category of disease-carrying insects, mosquitoes, lice, fleas, and flies, could be made as extinct as the dodo.

The Wide Range of Disease and Causes.—Not all diseases, of course, are caused by polluted food and drink or by the transmission of insect-borne bacilli. Some are undoubtedly caused by pathogenic germs whose methods of infection we do not yet know. There are various theories as to what carried influenza from one end of the world to the other during 1918 but none of them satisfactorily explain all that happened. The epidemic in one case broke out upon a sailing ship, far off at sea, six weeks after it had left port. So disease still has its mysteries, yet unsolved. |Things which cause and spread disease.| We know, however, that many ailments are either directly caused or are facilitated by poor nourishment, bad ventilation, lack of cleanliness, physical exhaustion, and lax attention to personal hygiene. Some are due also, in whole or in part, to certain forms or conditions of work, and are commonly known as occupational or industrial diseases. Such, for example, is lead poisoning in paint factories; such also is the illness which often overcomes men working in tunnels and other places where compressed air is used. The spread of tuberculosis, the great white plague of today, is undoubtedly due in some measure to dust and bad ventilation. The relations between diseases and occupations have not received careful study until recent years, but it is believed that we shall ultimately find the causes of many human ailments in the conditions under which some forms of industry are carried on.

Hygiene of Factories and Workshops.—Because of the unsanitary conditions which have been found by investigation to exist in workshops and factories, particularly in the large cities, various states have made laws and regulations to protect the health of employees in such establishments. Some trades, such as the making of poisonous phosphorous matches, have been prohibited altogether. Others, by reason of their danger to the health of the workers, have been subjected to strict regulation. The “sweat-shops” or tenement rooms in which women and children formerly worked long hours for a mere pittance, crowded together with almost no ventilation—these industrial dungeons have been legislated out of existence almost everywhere. Workshops and factories must now be commodious, well-lighted, clean, and properly ventilated. Adequate sanitary equipment must be provided. It is the duty of the state factory inspectors to see that all these requirements are fulfilled.

The Prevention of Disease—Individual Precautions.—Without the co-operation of individuals no government can maintain a high standard of health among the people. All that the public authorities may do will prove inadequate unless individuals themselves, young and old, understand and observe the means of disease-prevention. |Physical fitness.| Physical fitness is one of the greatest blessings any man or woman can have, and it is largely the product of strict attention to the upbuilding of the body in early years. Theodore Roosevelt was a frail, sickly lad in his boyhood days. He realized, as he explains in his autobiography, that he could never make a marked success in life without building up his physical vigor, so he set about doing it, and by the time he had reached full manhood he was a model of physical ruggedness. How did he manage it? Regular habits, out-of-door life, prompt attention to minor ailments, a zest for every form of wholesome sport,—these things transformed a weakly youth into the sturdiest man that ever sat in the presidential chair.

There is no need to lay down any definite rules as to how the young men and women of America may gain and maintain a high standard of health and bodily vigor. Common sense will suggest most of them. The besetting sin of youth is its prodigality, the wasting of strength that should be saved for years to come, and the failure to realize that an individual’s health at the age of forty or fifty depends very largely upon what use is made of health opportunities during the years from fifteen to twenty-five. The glory of a young man is his strength; he does not usually let his mind run ahead to the day when he will be neither young nor strong. No investment that young people can make will pay higher dividends than that which is represented by the time, the thought, and the care spent upon the task of keeping well in early years.

The Prevention of Communicable Diseases: Quarantine and Disinfection.—First among the measures taken by the public authorities to prevent the spread of communicable diseases are the quarantine regulations which are enforced at all the seaports under the authority of the national government. Day and night throughout the year, the health officers stand guard at these ports to see that no disease-bearing persons are permitted to land. Vessels leaving foreign harbors for the United States must secure a bill-of-health from the American consul before they sail; and the first person who goes on board an incoming vessel after it takes on its pilot is the quarantine officer. This official permits no passengers to be landed until he has made sure that there are no persons afflicted with communicable disease aboard. If there are any such cases, the passengers are held until the danger is past. The various states and cities also maintain systems of health-inspection and quarantine. Certain diseases (including tuberculosis, smallpox, typhoid, scarlet fever, pneumonia, whooping cough, diphtheria, measles, mumps, and so forth) must be promptly reported to the local health authorities. The local health regulations require that in case of the more readily communicable diseases the house be placarded. In extreme cases, the patients may be removed to an isolation hospital.

After the illness has terminated, the regulations usually provide that the premises shall be disinfected under the supervision of an official from the health department. Every state, as well as every city and town, maintains general regulations relating to quarantine and disinfection, these being enforced by the state health authorities. For the most part, however, this work is supervisory, the detailed enforcement of the rules being left to the health officers of the various communities, although in the case of epidemics, involving several municipalities, the state health authorities usually assume direct control. Similarly, when epidemics spread or threaten to spread from one state to another, the national health authorities step in.^[255]

Vaccination and Inoculation.—The practice of vaccinating and inoculating healthy persons as a safeguard against disease has been used for more than a century. Vaccination consists in introducing vaccine into the blood of a healthy person, usually by making an abrasion of the skin. The vaccine is obtained from health laboratories, where it is produced from the blood of artificially-infected cattle. Inoculation of the human blood is also widely used nowadays in order to prevent or to mitigate diphtheria, typhoid, pneumonia, and rabies. All members of the American expeditionary forces during the World War were given the anti-typhoid inoculation. It consisted of injecting into the blood a quantity of dead or greatly-weakened typhoid bacilli. They were not sufficient to produce the disease but they were enough to set the resisting-powers of the blood in motion so that the latter would be fully developed to meet a real infection if it should come.

Vaccination against smallpox is compulsory in several of the states and in many communities, although there is a good deal of objection to it among certain sections of the people. If smallpox were completely wiped off the face of the earth there would be no need for universal vaccination; but so long as numerous cases exist, as they still do in many countries, compulsory vaccination is likely to prove a justifiable measure of public safety.

Milk Inspection.—Among all the foods of humanity, milk is probably the most important. It is the chief nutrition of children until they reach school age, and sometimes even longer. It forms a large factor in the diet of invalids. Even in the daily fare of robust adults, it is an item of no small importance. Yet no article of everyday commerce is more easily contaminated, and in the case of no other article are the results of pollution likely to be so serious. For when the germs of disease get into milk, they multiply with appalling rapidity and they go directly into the diet of those who have the least power to withstand infection, the children and invalids of the community.

From its source on the farms milk passes through several hands before reaching the consumer, and at each of these points may be contaminated. Careless milking, the storing of milk in unsanitary places or in unclean utensils, the lack of adequate precautions in transporting or delivering the milk—any of these things may result in pollution. Strict rules and frequent inspection help to safeguard the milk supply at the source and during its journey to the consumer, but the problem of careful inspection is rendered difficult by the fact that the milk supplies of large cities are now drawn from a wide area outside the municipal limits. New York City, for example, obtains its supply of nearly two million quarts per day from about forty-five thousand farms scattered throughout eight different states.

It is easy to appreciate the difficulties involved in the supervision of the milk supply under such conditions. Nevertheless, this supervision is being carried on in all large communities and it has resulted in a marked lowering of the infant death rate. Infant mortality and the milk supply are closely related, in fact it can fairly be said that the rate of the one depends in a large measure upon the purity of the other. The establishment of milk-distribution stations in large cities has been of considerable value in enabling the people of the crowded sections to obtain pure milk at reasonable prices.

The Inspection of Food.—The marketing of impure or adulterated food is everywhere forbidden by the laws and the health regulations, but until comparatively recent years these rules were not always strictly enforced. One reason for this is to be found in the fact that many articles of food are subjects of interstate commerce, produced in one state to be sold in another, and hence are not easily made amenable to local control. |The Food and Drugs Act, 1906.| In 1906, however, Congress passed a comprehensive law known as the Food and Drugs Act, by the terms of which the national government assumed the duty of eliminating impure food from general commerce. This act prohibited the adulteration of food and drugs; it made provision for the inspection of meats at the great packing plants; it required that all packages of food and drugs shall be branded correctly and that when artificial preservatives are used, the label shall state the fact. All impure, adulterated, or wrongly-branded articles are excluded from interstate commerce under the provisions of this law.

The supervision of the national government does not extend, however, to articles of food which are produced, distributed, and sold within the territory of a single state. As regards such articles, the task of protecting the public against impurity and adulteration rests with the state and local health officers. These officers perform their work by frequent inspection at places where food is produced and sold. Makers and vendors of impure or adulterated foods are prosecuted in the ordinary courts.

The Drug Evil.—The indiscriminate and unchecked sale of narcotic drugs (morphine, opium, etc.) in past years led to serious evils. Persons who regularly use any of these narcotic drugs become slaves to the habit; they are unable to get along without daily use of them, and in the end become physical wrecks. The drug habit became, a few years ago, such a widespread public evil that the national government took the manufacture and sale of these narcotics under its own supervision. Such drugs cannot now be bought or sold except under strict regulations which involve the written request of a qualified physician. Nevertheless a good deal of trade in narcotics is still carried on through illicit channels.

Prohibition of the Liquor Traffic.—The relation of the liquor traffic to the public health is a matter upon which men have not entirely agreed; but it is a well-recognized fact that the general use of intoxicating liquors led in many cases to poverty, and poverty in turn brought under-nourishment and disease in its train. The action of the states in adopting the Eighteenth Amendment, by which the manufacture, transportation, and sale of all intoxicants is forbidden, may therefore be looked upon as a step which, in the long run, will conduce to the betterment of the public health. The excessive use of alcohol impaired the physical vigor of many thousands among the population and rendered them less capable of resisting disease. The statistics of hospitals during the period that has intervened since prohibition went into effect show that, from a health standpoint, the Eighteenth Amendment has had a beneficial effect.

Waste Disposal and Sewerage.—Every community produces each day a large amount of waste which must be collected and disposed of in a sanitary manner if the interests of the public health are to be fully protected. Some of this waste contains little or no element of danger—ashes, waste paper, and rubbish of all sorts, for example. The removal of this material is a matter of public convenience rather than of public health protection. As a rule it is drawn away and either used for filling marsh land or incinerated. |Garbage.| Another form of waste is garbage, which includes the discarded material from markets, bakeries, hotels, restaurants, and private dwellings. This garbage decomposes quickly and must be gathered at frequent intervals. In some communities the garbage is disposed of by incineration; in others it is sold to farmers for feeding swine; a few cities utilize it in reduction plants, where the grease and oil is extracted for commercial use.

Sewage, which includes both surface water and the liquid waste from places of human abode, is by far the most dangerous waste of all. Although it is more than ninety-nine per cent water, every ounce contains the possibility of spreading disease. |Older methods of disposal.| This effluvia, which passes through the sewers and drains, was at one time everywhere disposed of by turning it into the ocean, lakes, or rivers. Even yet many cities of the United States get rid of their sewage in that way. The method is not objectionable in the case of ocean discharge, provided the outfall sewer is carried a sufficient distance from the shore, although even in such cases some of the sewage may be borne landward by the incoming tides to pollute the shellfish beds and the beaches. The sewage of many cities along the Great Lakes is discharged into these extensive bodies of fresh water where the amount of dilution is so great that no serious harm results, provided no water for human consumption is drawn from the immediate neighborhood of the discharge points. The time will doubtless come, however, when the increasing volume of sewage will compel these cities to adopt other methods of disposal. The discharge of untreated sewage into rivers and small streams is now generally regarded as a public nuisance, and the abandonment of the practice is being required by the laws wherever practicable. Many cities, however, yet resort to this method.

Modern, scientific methods of sewage disposal have taken several different forms. A common plan is to conduct the sewage into huge reservoirs, basins, or tanks, where the solids are allowed to settle and form a sludge while the liquid is run off into the ocean or a lake or a river. The settling process is sometimes hastened by the use of chemicals. This does not free the waterways from danger but it is a good deal less objectionable than the practice of turning untreated sewage into them. Some cities pump the sewage upon filter beds (tracts of land which have been dug out and filled with slag or other porous substances). A few use their sewage for the irrigation of dry farming lands. No particular plan of sewage disposal can be regarded as the best under all circumstances. Local conditions differ from one community to another, and each case requires special study. Ordinarily a large town or city will produce nearly two hundred gallons of sewage per day for every man, woman, and child in its population. This means an enormous total in the course of a year and the problem of handling it safely, without excessive expense, is often a difficult one. It may well be repeated, however, that so far as the public health is concerned, sewage is the most dangerous substance known to man, and its safe disposal is one of the most important problems of the government in every civilized community.

The Protection of the Public Water Supply.—The great importance of an adequate and safe water supply is something which hardly requires a long argument. In the rural districts and in small villages the neighboring wells and springs may be utilized, but in large communities, especially those having numerous industries, a public supply must be provided. |How much water is needed?| It is customarily figured that large towns and cities require approximately and on the average one hundred gallons of water per capita every day in the year. Half-a-ton of water per day per person! What is done with it all? Not all of it, of course, is used for human consumption. By far the greater part is utilized for public, industrial, and general sanitary purposes. Sprinkling parks and lawns, putting out fires, flushing sewers—all these activities require large amounts of water. Factories, laundries, railroads, and other such establishments make heavy demands on the total supply. So does the modern sanitary equipment which is now being installed almost everywhere in hotels, stores, and houses. The amount of water required for human consumption is very small compared with the quantities used in these other ways.

The first essential of a satisfactory water supply, therefore, is that it be adequate, which means that large cities must often go a long distance in order to obtain water in sufficient quantities. |Sources of supply.| New York City derives a large part of its water from the Catskill Mountains; Los Angeles brings its entire supply from the Sierra Nevadas, more than two hundred and fifty miles away.^[256] Many other cities obtain their water close at hand: Chicago, for example, draws from Lake Michigan, and Cleveland from Lake Erie. Adequacy, however, is not the only consideration. For use in the industries, water must be clear in color and not too hard. When it is turbid or hard, it has to be clarified and softened by storage and the use of chemicals. The relative purity of the water, its freedom from pollution, is the most important consideration of all.

There are various ways of making sure that water is fit for human consumption. One way is to secure the supply from a source which is by nature free from pollution, from deep-driven wells or from mountain lakes which are above the level of probable contamination. Water supplies drawn from very large bodies of water, like the Great Lakes, are normally safe enough if the intake is set far out from shore, because the diluting power of these vast water areas is sufficient to render harmless even a considerable amount of pollution by sewage discharge. Where a water supply of sufficient natural purity cannot be had within reasonable distance the only safe plan is to subject the water to such length of storage, or to such mechanical or chemical treatment as will ensure its fitness for use. The storage of water in a reservoir, exposed to the light and air, will render it safe, under normal conditions. The length of time required for this purpose will depend, of course, upon the quality of the water which is put into the reservoir. A period of three months is ordinarily regarded as sufficient where the raw water has not been badly contaminated. The mechanical treatment of water is commonly known as filtration, and there are several forms of public water-filtration plants now in use by American cities. The simplest is the system of slow sand filters in which the water is treated by allowing it to percolate slowly through a bed of sand and crushed stone, thereby becoming rid of noxious bacteria. A more complicated method involves the use of rapid sand filters in which the raw water is forced through filterbeds of crushed stone under pressure.^[257]

Smoke Abatement.—Pure air is another essential to the maintenance of the public health. Rural parts of the country encounter no difficulty on this score, but the larger cities are now finding it necessary to protect the air which their citizens have to breathe. In these days of smoke-belching industry, the very atmosphere of the large city is laden with a menace to health and cleanliness. An investigation made in New York some years ago disclosed the fact that sulphur dioxide (a poisonous gas) was being discharged into the air by the smokestacks and chimneys of the city at an appalling rate. The elementary student of chemistry can well testify that SO₂ is not a substance that human beings thrive upon. And apart from the menace to health there is the heavy damage done by soot-laden atmosphere to the furnishings of houses and the contents of shops. Hence the agitation in the large cities for an abatement of this smoke nuisance and the establishment of regulations which now, in many places, require the use of mechanical smoke consumers by all large industries. The enforcement of this requirement is not at all difficult, because any violation is visible to the naked eye.

The Housing of the People.—By the homes of a town or city you may judge its people. The proper housing of the population has a close relation to many things, but to none is this relation closer than to the public health. When the people are herded together in tenements, with dark and narrow hallways, with rooms badly ventilated and often without sunlight, we have a fertile soil for the spread of tuberculosis. More than ten thousand persons die each year in the tenement districts of New York City from the Great White Plague alone. The children who grow up in congested quarters, moreover, go out into the world handicapped in both body and soul. Their powers of resistance to disease are often seriously impaired by the crowding, poor ventilation, and lack of proper sanitary arrangements. An investigation of housing conditions made in New York City over twenty years ago led to the enactment of a comprehensive Tenement House Law (1901) in order to prevent overcrowding, and the main provisions of this law have since been copied by most of the larger cities of the country.^[258]

In some European cities, notably Glasgow and London, many municipal tenements have been erected. Crowded slums have been demolished and model houses, each accommodating one or more families, have been erected in their place by the use of public money. These tenements are then rented to workers at reasonable rates. This plan has not yet been tried on any large scale in the United States nor would it be likely to prove very satisfactory so long as city administration, in all its branches, is conducted so wastefully as it is in America today. During the World War, however, the federal government built many hundreds of workmen’s dwellings in different parts of the country, particularly in the neighborhood of the great shipbuilding plants. After the war they were sold to private buyers.

It is often urged that instead of building model tenements in crowded sections, the authorities of large cities ought to promote the growth of suburbs by giving them good transportation facilities, and by promptly supplying these suburban districts with sewers, water supply, gas, electricity, and paved roads. People who go to the suburbs not only have more room, but they are much more likely in the course of time, to own their homes. |The importance of owning a home.| Home-owning is a practice which ought to be encouraged, not only for reasons of health and recreation, but to steady the political temper of the people as well. The man who owns a piece of the earth’s surface, with a house on it that he calls his home, is not often a believer in violence or revolution. A great deal of honest sentiment clusters about the American home, but very little can ever attach to three or four rooms in a tenement house.

Other Measures of Public Health Protection.—The foregoing list does not exhaust the various measures taken by the authorities of the nation, state, and city for the protection of the public health. The laws and regulations which now prohibit the use of public drinking-cups on trains, in schools, and in other public places may be mentioned. The common cup has been, in the past, an active spreader of infection. Its use ought to be forbidden everywhere. Measures for the elimination of mosquitoes and house-flies have been taken by all the more progressive states and cities with aid at many points from the national government. The statement has been made, upon what seems to be good authority, that mosquitoes, flies, and other insect pests are directly or indirectly responsible for a hundred thousand deaths in the United States every year. Whatever their number, these deaths are preventable, because a diligent campaign will suffice to banish both flies and mosquitoes from any part of the country. The medical inspection of children in the schools is another health measure of great importance. In many of the larger cities this inspection includes all school children, of whatever age, and is made at frequent intervals. It permits the early detection of symptoms and thus allows remedies to be applied promptly. It has done a great deal to protect the schools against the frequent outbreak of epidemics.

How Health Measures are Enforced.—The duty of enforcing measures for the protection of the public health rests first of all upon the local health officers. |Local boards of health.| The laws of most states now require that a board of health or some similar authority shall be maintained in every township, village, town, and city. One of the members of this board of health must usually be a physician. In large towns and cities a qualified health officer, who is always a physician, is employed on part time or full time. The local boards of health and the health officers have charge of quarantine and disinfection, the inspection of food and milk, and the enforcement of sanitary regulations. They also grant permits for the maintenance of slaughter-houses and other establishments which have a direct or indirect relation to the public health.

In practically all the states, moreover, there is a State Department of Health. This department is usually under the supervision of a State Board of Health, but in a few states a single health commissioner has been placed in charge. The powers and duties of these state departments vary a good deal throughout the country, but in a general way they assist the local health authorities, especially when an epidemic threatens to spread beyond local control. A good deal of their work is advisory in character.

The United States Public Health Service was established in 1912, although health work had been carried on by the national government through other agencies prior to that date. It is, rather strangely, a bureau of the Treasury Department. The Public Health Service has charge of the port quarantine system; its assistance may be obtained by the states at any time in coping with epidemics; and it maintains well-equipped research laboratories for the study of all questions affecting the public health. It is believed by many physicians that the work of this bureau is so important that it ought to be made a regular department of the national administration with a member of the cabinet at its head.^[259]

Education and the Public Health.—The basis of successful public health work is the education of people in hygiene and sanitation. If the people can be brought to realize the transcendent importance of the work, their co-operation will be given cheerfully. Where the health regulations are now disobeyed it is largely because their value to the individual, as well as to the community, has not been made clear. An effective method of educating the public is by means of health exhibits which demonstrate, with the aid of pictures, especially motion pictures, the value of proper hygienic conditions in the workshop and the home. But the ultimate education of the whole people in this field, as in all others, must be primarily the work of the schools. It is easier to teach hygiene and sanitation to children than to grown-ups. Adults have acquired habits of life and attitudes of mind which are hard to alter. Hence the education of children in all that relates to clean living, wholesome food, modern sanitation, and the avoidance of disease should be part of the regular work in schools throughout the country. Upon this will depend, in no small degree, the future physical well-being of the nation.

H. G. James, Municipal Functions, pp. 68-92;

Hollis Godfrey, The Health of the City, especially pp. 1-29;

W. H. Allen, Civics and Health, pp. 3-32;

Cyclopedia of American Government, see under Health, Contagious Diseases, Quarantine, Tenement House Regulation, etc.;

W. B. Munro, Principles and Methods of Municipal Administration, pp. 122-166 (Water Supply); pp. 167-210 (Sewerage and Sanitation);

H. B. Wood, Sanitation Practically Applied, especially pp. 205-232 (Pure Foods); pp. 233-277 (Clean Milk);

Irving Fisher and L. B. Fisk, How to Live, pp. 119-168;

Walter Camp, Keeping Fit All the Way, pp. 3-41;

Charles Baskerville, Municipal Chemistry, pp. 1-19;

Milton J. Rosenau, Preventive Medicine and Hygiene, pp. 716-745;

W. T. Sedgwick, Principles of Sanitary Science and the Public Health, pp. 89-107;

E. B. Hoag and L. M. Terman, Health Work in the Schools, pp. 133-191.

1. How can the spread of communicable diseases be prevented? Are the vital statistics of your community carefully and promptly compiled? The local health authorities,—who are they and what are their functions? What control is exercised over the agencies which spread disease? Examine the status of each in your own community. References: Milton J. Rosenau, Preventive Medicine and Hygiene, pp. 134-158; H. B. Wood, Sanitation Practically Applied, pp. 66-152; Woods Hutchinson, Preventable Diseases, pp. 83-122; Hollis Godfrey, The Health of the City, pp. 158-193; G. C. Whipple, State Sanitation, Vol. I, pp. 88-112; see also the United States Public Health Service, Reprints on the Notifiable Diseases, and the reports of the state and local Boards of Health.

2. Public water supplies. References: W. B. Munro, Principles and Methods of Municipal Administration, pp. 122-166; H. G. James, Municipal Functions, pp. 217-227; H. B. Wood, Sanitation Practically Applied, pp. 278-337; Allen Hazen, Clean Water and How to Get It, 2d ed., pp. 73-99; Charles Baskerville, Municipal Chemistry, pp. 33-89; F. E. Turneaure and H. L. Russell, Public Water Supplies, pp. 141-172.

3. Modern methods of sewage disposal. References: W. B. Munro, Principles and Methods of Municipal Administration, pp. 183-210; H. G. James, Municipal Functions, pp. 227-237; H. B. Wood, Sanitation Practically Applied, pp. 338-378; John A. Fairlie, Municipal Administration, pp. 245-255; Charles Baskerville, Municipal Chemistry, pp. 276-299; W. P. Capes and J. D. Carpenter, Municipal Housecleaning, pp. 33-89; G. W. Fuller, Sewage Disposal, pp. 175-183; Leonard Metcalf and H. P. Eddy, American Sewerage Practice, Vol. II, pp. 78-127; A. P. Folwell, Sewerage, pp. 300-332; L. P. Kinnicut, C. A. E. Winslow, and A. W. Pratt, Sewage Disposal, pp. 204-232.

4. The milk question. References: Charles Baskerville, Municipal Chemistry, pp. 90-118; H. B. Wood, Sanitation Practically Applied, pp. 233-277; Hollis Godfrey, The Health of the City, pp. 30-57; M. J. Rosenau, The Milk Question, pp. 1-22; J. S. MacNutt, The Modern Milk Problem, pp. 1-30; H. N. Parker, City Milk Supply, pp. 28-90; G. C. Whipple, Typhoid Fever, pp. 41-91.

5. Housing in its relation to public health. References: Hollis Godfrey, The Health of the City, pp. 302-345; F. C. Howe, The Modern City and Its Problems, pp. 273-288; Jacob A. Riis, How the Other Half Lives, pp. 7-27; Lawrence Veiller, Housing Reform, pp. 3-46.