Report to the Governor by the Superintendent of Public Health

              •
REPORT TO TH1~ GOVERNOR
BY
'rE:Bi SUPli:RnTT]:~JDE1JT OF PUBLIC HEALTH.
The Arizona B<.1ard of Health was created by i.'l,n act of the
Legisla,ture dated March 19, 1.903» and al thO'LLgh a. Superintendent
of Pv,:blic Health was n,pp<linted in aecordance therewith and
most of the countiel3 proceeded to oq;sanlze thetr boarda ot'
Ta are no records to show
that prior to 1Jarch, 190?, ~1.ny reports werB rnMfJ to
Terri to.rial :Board of He th. In this lat t;f;; r mon J Dr. J. VI.
Coleman was app()int~d SUIJerintendent of Public Heb,lth to
succeed Dr. Wm. Duffield. ",he vit statistics of the territo
date fr'J.rtl the f at 01' April, 190'1. The effect oftbe laxi ty
0:1' the previous ad1'1.:i.nistration is shovrn by the almost constant
increase in the returns births and deaths since the
Territ. al SU'p~~rintendent of Public Heal th began to re 1"8
the quarh~rly reports from count,y officers. 1'TOt only have
the physicd.ans thrc.l"i.lglH:.lu.t the territory have re!:iiponded to their
pleas a VH:~Y "Chat deserved a trib"ltte to t.r.le~r public spiri t ~
Phoenix» Tucson an.a Pr~scott bur.ial or rernay ~U permits prior
to burial '::Ir n:moval are not 1:'8 q,uired and as <:it re
requicing trle iesuance of cart icates of death cannot be
enforced.
V'ITAL S:1'ATISTltJS
In. 0 rder to obt compll;; te rBturns of the deaths in
territory» it is essential that the prl:H:;ent system of re-port
to county officers abolished a,-n.d
enacted. The county system reporting \lital atath,t
Union a.nd
I
exception, has proved a failure. Requjxing an undertaker in
Bisbee to send to Douglla-a for the buria,l or removal 'permi t
that 'Would enable him to bury the body of a person dead in the
former city W(HJld involve a de1lEt:Y and inc omrenience that is
unjust ,and unnecessa,!'Y$ And jret the bur:i.a.l :8ermit is abso..
lutely essential, not only f~ the accurate recording of
deF.t. hs for statistic.,.,,81 :purposes but tn order to prevent the
burial of those who ha;ve died as the result of some un19,wM
act.
1J0nplete returns of aLl the deaths is the very fou.nda...
tion of efficient public health work. Without them, offici als
are unable to properly est.imate the in:rportainc e of the va,rioue
diseases and the value of the means applied to their
amelioration or eradication. They far m the only means of
checking back to di scover whether or not the birth;;, a1 dean..
tagious diseflJ3es are be :repo ad as they should1>le 0
The necessity. of reporting contagi'7.ms disea,ses is
apparent to everyone tmd yet pressure is constantly brought
to bear on physicians to make exceptions in particu::U~.r
cas es and it is to be regretted that they soYnetimes yield.
If the patient happens to die, no certificate of death is
led and no one is the wi ser, tb,ough some other farot I;, :may
wonder whete their child contracted dipththeria or scarlet
f,ever or other dlsease a,s the case may be. Under an enforcea­b119
and ent'orced l::i,w, phystcians would not dare t:.;ke chanCElS
and where all alike fea,red detection, th,ere 'would not be the
fear of losing cases whicb. is the determining factor in nearly
every instance of ~vasion.
The "model h'tw" r erred to is the one that has been
drafted by the Division of Vital ~tatistics of the census
::aureau working in oonjunction wi C011'lTIlit,tees of the Ameri...
can Medical Asso(~i lon, The Amerioa,n Pub]i c Health Assoc
tion and Confer~:;;nce ;:;ta,te and ProV' Board of
I
Health. It has received the a.prrov'?l of these bodies~ the
endvrs~i:ment of Congress a,nd Of' the Cornmi tteees on Uniform
Legislation of' the America7t Bar Associa.tion. It is not in­tended
tha,t it 'be adopted in precisely the same form t in
every ODe of the states and territories, but that it be adapt-ea
to the local conditions> Without, however, viol8.ting a.ny
of ita essent. ial reguireme nte .4-tdfle-a, .nQtseej}1wi~e ·at
HIla time···'to·····conaiderthe ..·r:egis1;ration·ofbi:rth,siWh'6",diffi..
c-uitties of' obta.ining oomplete registra.tion of births are so
much greater that probably any kind of a,lawwo'Jldf'a,il to ob-tain
it in this territory.
To quote i"rom the circular of the Census :Bureau (Divi..
occurence,
"All deaths must be regiS'.l'Lered immediately after their
occurence in the ,i uri. sdict ion where they occur (city or other
primary cUvii:iion). By ~ttg.!!-~e regi.I!.!:TJ!!iop is me~:tntt re...
gistration before interment ~r removal of the body.
1*2 Certifica.te of Death S1121)1d be requJred.
"'l'he primary recordof death .should cO!1sist of a c~rti­of
presor1'bed for fi, including. as ar'dnimum require ..
1';\.11 the da.ta necessary for the mortalit'T statistics of
United ~tates Census.
fica.
men
the
"32JlF,j...a 1 or r...e. mo"l[51). p.ermits arJL.E!s~~M~al to the enforce­ment
of the law •
....""'------~--
"No dead body should be removed from the place of death, in­tered,
cremated or otherwise dtsposed of, unless such action
is a.uthorized by a burial or removal permit based on a sat..
isfactory certificate of death and signed by the local re­gistrar.
"4~:!.J_ql.en~.. 1oc~.1 r!g,:l,5tra.~Ee neg~s5arl' __
"'there should be an efficient local registrar in each
cityw town or other political di5trict~ whose duty it should
be to reoeive and a.pprove oertificates of death a.nd to issue
[)U!'lal or removal permit. s for' a,ll dea,ths tb occur in his
jurisdiction. He 5hould be prpper1y compensated, a,nd should
be required to enforce the lat,Vl in his district under penalty
fo r negl ect •
"5. The responSibility fo~ reporting deaths to the 10-
cal r~gistrar should be fixed.
"'She reapon~ibility :for obta, iningand f:i.l ing the or':Lgi­11.&
1 record of deaths with the registrar shouldbe fixed byb
the lavi. The best reenlta a.r'e obt:\\:i ned.) when this duty is 1m­PQ:
l&ed upon thl~ ul1dert~,:k:er or other person ha;v1.ng cha.rge of
the interm.ent, removl1"~l Qr other di. spasition of l~Le body.:Te
Sh01JJ.d th.erefore be rna-de pr:i,m.a.r'11;1 respcnsibl(j, under penal tTY
.for neglect t for presenting the certifjcate (if de<t h t~nd Clb­t~
in1!'lg the bur- lor removal per-ml tbefore trlla body fL3 di5w,
posed of .'£11e at tend:Lng phYBJ.cian, corc,Hier, health officer
or other offie:ia.lshould be requi 1'6(1 to cert try the oa.US3 of
dea.th and to funl115h, upon d.ern~nj~ a,ny' a.thl!u" ir;:format'lon he
m~1 P()SlHH:HI~ that isr"\Elqulred to complete the reco!'d of the
case. '.rho personaJ, data relating to tbe decedent may be sup­p1i~
d b:r a,nymemb~r <>f the :fl1.'.mi 1:r, TIext of' kin, l?mdlc;rd,
or person j,n cb.~~rge of th,$ pr"emi Be e ~ upon which the death 00­ourred.,
a.nd they, li1.nd 1'111 other persons cognizant of' t)it;1
fa.cts, ahould be re-iuired to furniah
underta.ker, physioian or other person ;",l1t~pa;tt1:;1ta'Sl~j,
and a.ddress of' t.hf3 pOT'l;'>orl
da.ta should ;.t:ppear in the r(~t'tlrn.
effect of' lliw.
"The central ragi strat:lon office of the state, should
have dl.:rect superv1.sion and control of all ma.tter jt;lating
to local n:'lgi strat ion. 1 t sholl.1d 'be chfuged with tb.e rn.ail1te ..
nance of com'plett~ l~acord21 and wi tll the efficient and urdform
enforccreent of tho law. To this end, it shQuld be a.ble to com­InQ.
nd the a.asistance of the legfi.l department of the state. It
should also be empowered to remove inefficient or negligent
local registrars and to appoint others in their stead; to pre­scribe,
print and distribute the forms of certifica.tes. a.nd re...
oord~ for local use; to rece1.Vl'l the returns from local regia­trars;
f'!\.nd to preserve the recorda j.!'l sui frs.hIe order for con..
venient reference.
"'7 The transmi&s1on and preservation of the r.ecords
should be 2rov1dedfor.
Ii A complete, p(:3!"manent record of each deat 11 should be
kept in the offioe of the local registrar and in the central
reg:LstratiG off'ice , and provisions should be made f()l~ index..
ing the rscords in alpha.betical ord.er.
"Returns should be rnade monthly to the central regi 6'"
trati<ln offioe, and within a certain specified period after
'the cl06e of' eaoh month. This is necessa.ry in order to enable
the central offioe to ascertain the efficiency of local re­1etration,
and to scrutinize the certificates and secure
corrections if they are found defective as soon aa possible
a.f't(l!" th('~ casr,J5 have been reported.
"Retrun3 should be made to the central office in onE! of
tIlli::1U'; two -ways:
{a.} Ii copy of each record may be made by trJ.e local re ...
gistrar, in :;;"h;..ch C"i.BC, the ori,gina.l record wi 11 brs forwarded
to the ata.te offioe;
(0) the original record may be retained by' the looal
registrar, in Which case ~ a £"O!!'Elet.e., copy should be made ln 113,
ne.rm~.nent form. oertified bY the local registrar. and for-
wanted t;;) the13ta.t.e off'Jce.
"Tho first mentioned form is considered prBferable.
npenalt:1.ils shc)uld -be provi<led for the v.tolation of any
\'Jf t:l0 pr'Ol'r.iflLiO!1Gof the law .I!;ach section $1:.wuld city the
penifil,l'to iea 1mpolSed, which should "be -based on the impo:r't,~nC{ll f)
of its requirements.*'
The gre~t~~:r difficulties of enf'orctng >:I. law for the re-glstr~,
tton of 011%h8 makes it 3eem unwise to enact a compul­50ry
1 aw forlifLl,ch registra,tion. In view of' the ilTlportance
tha;t regiatt'if;,tion of births m~,jt have for the ones registered
or f or their p~,rentB "".'.!il,,"$]loper jo provide for
educiIi,te them in thia l.mportnnca. The (~hief ~;tat18ticiB.n of
follow those adopted by the st &B of
With the exoeptioD of the sections relating to the r8gistrat-ion
of births. A copy
playeJd the le1?~,ding role as the ca.V58 ot' doaths .in thia
terri tor;r. Practi.oally of the deatha fr~m this disease
pai, which are much frequented by tho atl'\n1i.TIc,.:d oaZ3ea i.i.>3nt
out by ill-advised ph:rsicians and mls ... inf'orrned, friends of
complete, that the returns of dellt he from other counties
are not 50 nea.rly representative of the conditions therein
as those from the counties above manto ioned'. The probabilities
are that owing to the better understandi ng a,monn: physicans of
I
the condi ton~ favoring rt~Govery and the largfl: amount of in-formation
that has been di~Be:minated G1.l'\'lQng the la.i ty by the
various boards of he altL and 'by chari table organizations.~ tlv':;
immigrati of advanced cafH3ts (and o:f others also) b.as measure
bly decreased. The auvantagee of our elim.at:::: art;» tor many
of" them» m.orE; than counterbalanced. by the lack of the vvhere··
withal to" proper food and ehel ter. :Many an un.f ortun(.il,te 1'1.(.il,1;)
/i
come to our ter'f'itory vdth littll;; b~f:jides the elQtb.es on his
back» possibly b.aving spent his l&st cei1t on the ticket that
brought cting to find work at onee and to live wi tllOut
shelter until paid; expecting milk and e~~g6 to be as
plentif\.ll and b\J:J cheap as in tbe ea:ctor'nmarket5; Ii ttle
out. doors the
year roundIt» 'olie do not r~lean 1trc do so vli tx;ou t covering 0
Undue exposure and lack of l)f'Ol)l;;i r n'Jur.6~li.hmen tare consUl'llptions
nt IS. Casee have their ().rigin in
this count.ry just a53 'Nell a,fi the conditione
sease arc not bO easily found.
The indiscriminate manner in 'Nhich people havs been
sentto th£ tbrritory in thepast, 'Voluntary coming of many
e J [n.an.y uf 0011',i so soon a f'ter
counties that is not to be 1 tly dj.sregarded. lI"my of tIl..em
proper'
manner of caring for 8 or the IJrOper Y:lanner of caring
fQr' their sputum 1'" the tecti.on of oth,crs and irl CO'luHH;l.ue!l<;e
the ordinary rules
the me an It"; 0 l' re cove ry ~
+,0 1 VIi as a case of hysteria, theMe
rulem never cemB to the notice. ~r hi..UTy to a.n untimel:,/
too often start 0
hi gh'W'Gi.y •
I
",he problerll of the elilnination (If t'LLberculosis has. pro-bably
reCeiV(3d more 5tudy by the worlds brightest minds in
the Piol.5t two decadee than any disease since the dawn of
civilization. There are many things tllat 'Ive might do for the
tU,bercula:n;f, as Dr Porter~ rommissioner of Health of Uew York
has 6 d ~ but there il5 one tl1ing 'we must do ~~('that il5 to insist
u.pon the registration 01' all cases of tuberculosis. It i5
absolutely 6ssentit1.l that the location and distribut of
tIlese cases b(;:1 knovm in order that they may be instructed
in b,O'11i to conduct the:mselves, not vnly for their Oiim good
but for that of the pUblic; f'or the purpose of calling att('ntion
the unhygienic
to direct the aid of chari.table stitutions to their releif~
prote et those may come afti;;r theIl1~ by
proper ()leaning of t~h.eir recent habitats. I'1'his does nnct
mean that the registe:r should be open to public inspection j
for as a mattli-,;!" of' fact;, it shOUld. be strictly guarded from
s of the
that print.tid matte:r f;';hould. b~~ ee to tho~f; wb.o are guided. by
the ad:vice u:f' co:mpe nt physic ian. without hie dl;;6iring i.
it doe6 not mean that a puliey of' officious a.nd unneceefiary
inepecti.on eb adop'Gede It doe:::: mean that as
a commun ic.;).ble disease, the hea~th authori ti es should have
a right :k.rtO'll'! where to ex.pend their efforts. The cheal'
biJiil.rding hQU:J6» the ill-lighted and ill-vent.ilar,ed adobe
ehack are places firtit fi;c:ute 8 on. We
mU.st knOVi v:rhether or not theee houses are frequented by the
foreign tullercular pat nts who come here and v:be r OX' not
:h.> an. a.ppreciable number of the natlve population a0"
qUiring the disease in such eurroundillg~. It i~ not sUffi-cient
data collected ela6vlhere. The
germicidal properties of' our glorious 6unlight is atltribu.'ted
with the power to kill germs that bunli t never reaches.
I
9ur dr;y at:m08phen~ is given cn;di t ae L'\, destroyer of infection
inlJlacGs vlhere it. seldom hlit8 a to\enter. In order to be
convineing, we must be able "to deliver the goode", to ah(Yw
by maps and charts
'ed.': ,
J"; i
what we Bay i6 true~
rro many, tb.e quel.:lti,on may present itself) lIIW"ell, why
not go ahead and regiiter thes6 caees"1 The answer is, that
under our p:n~sent law!3, the re~i8trati.on can not be mad.a
effective. If a patient has tuberculcHds and h.i1.3 case i8
not repor'ted v/hen that patient diE,S, his death i:s not recorded
and except in the cities mentioned before, we requiring burial
perr.'li te, ~ then~ i,s no way of di8cove ring thifi eva::;dc,n. $0
that the ultimate solution of the problem of registration is
the securin~ of reli~)le mortality reports--the proper re 6-
tration of deaths. UnleSf:l a. registration regulation is enforc-ad
that are gOOd reason 'll'lhy it snould not be made. 'fhere is
always mOl~e or less oPJHJsi tion to registraticm by the people:
regi~ltered and. the contlcientiotls physicir4.n 'Who reports his caaei-'
loses some of them , whilE: the one w110 8.vad€fi) t:he law ~ a.ddB to
his clientele» and urJtil;li!fisuranc{:l is ltad that injust:lce will
not 'b e done thereby ~ 1t i8 better to have no regulat ion at all.
Some e1 ty councils are in the habi t of pasei.ng all sorts
of ordinances in the interest of public health~ many of them
excellent ~ hut. '/Ird, th no provision for their enforcement.
In order to en:force tl1€i\ordinsmces of some of our c1 ties it
would req'ldre tIl.e ent tre time of the health officEH' on
al aid of others under hili) direction 8 '!h.iIE! thifl requirement is
perfectly proper in my opinion~ yet the c1 should be willing
to pay the salE~r:y commensurate wmth such servicea and should
refrain fnnil pawsing ordinancea until there art: willing to do
so. '1'he laxity of enforcement of these laws only serves to
bring them into public eontempt and. alcmg with them are dragged
laws vlhich are enforceable and perIl_ape 1l10re eS6entia.1 to the
general welfare
I
-9-
The resolutions a40pted by t'he Interna.tjonal Congress
on Tuberoulosis on October 3, 1901'1, are here given. It will
be noticed tha,t obliga.tory notifica,tion is given first place
in these resolutions •
The esta.bli5r~ent of a sanatorium by this territory is,
a.t present, not to be thought of. }l1or this territory to take
upon itself the expenae of suoh an institution which would i
immediately be filled by the tubercular citizens of less
favored states, would be a burden too great to be considered.
The Committee on Resolutions preants the following
resolutions:
"1. The attention of5t~te and genera.l governments
should be called to the importance of prop~r la.ws f or the
obligatory notifj.cation by medical attendari. to proper
health authorities of all oases ottuberculosia coming to
their notice, andfor the registration of such cases in order
to enable the 'health offi.cens to put into operation adequate
measures for the prevention of ths disease. We urge on the
publio and all governments the establishment of hospitala for
the treatment of advanced CIa,5eS of tuberculosis.
2 .We urge the eatabllshm,ent of sanat aria for curable
cases of tuberculosia.
3. We urge the establishment of dispensaries and day
campa and night camps, for anbulant case s of tuberculosis
which can not enter hospitals and sanatoria. Again, the utmost
efforts should be continued in the strup,gle aga.inst tuber­culosis
to prevent conveyance from man to man of tuberculous
infection as the most important souroe of the disease.
Further , preventive meansures must be continued against bo­vine
tuberculosis and the possibility of the propagation
of this to man should be recognized.
REt'iOl:vED: That this Congress endorses such well­considered
legislation for the regulaion of the factories and
workshops, the abolition of premature and iniurioa labor to
women and cl1 ildren, a.nd the securing of sanitary dwellings
a.s willincrease the resi sting power of the indiyidw?,l,l to tu­berculosis
and other disease; that instruction in persona.l
and·school hygiene should be given in all schools for the pre­fessionalt
training of the teachers; tha.t wherever possible
~ such instruction in elementary hygiene should be entrust-ed
to properly qualified medical instructors; tha.t colleR6s
and universities should be urged to e~,t8blish C01..n'"5e8 in
hygi.ene and sanitation, amd a.lso to tnclude these subjects
a.mong their entrance requirements to stimulate useful element-
I
ary instruotions in the lower sohools. That this Congress
endorses and r'I'H',lorn.menda the establishment of pla;rgrounda;~8 an
importa.nt menas of preventing tuberculosis through their in­fluenoe
on health and resistance to disease.
The mecond most fre~lent case of death during the past
two years acoodding to our statistics is pueumonia. As trans..
oripts of the deaths have never been sent t () this office, no~~
thing mQl~la than the total number of deaths ,and these under
the general term, it is not posa1ble to say how many of these
were of the lobar or croupous form and how many of the
bronohial or lobular form, how many of the oases were primary
a.nd how many seoondary. Lobar or ordinary pueumonia has quite
a marked tendency to become epidemic in certain portions of th
this country particularly in the mining camps. It is a dis-ease
with a very high. mortality rate under the best of cir-
OUffistanoes and it is commonly credited with betng much more
aevere in such a locality as Bisbee. That the altitude, it­self
haa little to do with this inoreased mortality rate l if
it exists, is ~.own by the studies made in Leadville, Colo­rado
where t,he altitude ie over ten thousand feet and the
mortality r~te, acoording to the collected oases studied i
aotually leas than in :New; York Oity. Though thee4ais'tH3 of the
d;'sease is known, little can be said as to the means of pre-
"lft"lntion beyond the general admonition to keep the general
resiliilt~~nce as high {Ui possible. Though strong a.nd healthy
men are often attacked yet unque stionablp , a.lsoholism and
undue exposure play important parts in predisposing to tho
disease. Undoubtedly tOOt the breathing of foul air by
people cooped up in houseB has its effect in greater inci-denae
of this disease as well as others.
Bronch",pueumonil3l. uBual1:l occurs 13eaondllY'"~ to some otber
disease affecting the bronohial tunes, moatCY'""(Hluently
I
roeaslea and whooping cough, and when so oClcurring should be
entered as the secondary cause of the death. It i8 to be
feared that this haB hot heen done and that it accounts in a
mEH'l5Ure at least for the few deo,thfS reported under meaales
a.nd whoopi1'1.g cough.
TYPHOID ]'"i11'\fER.
H&l1)(ing third among the CeilU'3es of d.eath 'd!:'s typhoid fever.
It is said that the incidenoe of this disease is the sanitary
index at' the cOImrlunity. Aa;. t ia not 1;";,8 highly contagious
a disease in the sense th:;,t smallpox fi\,nd BC!,,l.rlet fever are,
it has not been commonly repJiorted to hefJ,lth affic·era. Yet t t
.'
:i.s elluu!ll'J.tially tranamisi5a.ble and. should be reported: tkat the
sources should be investigated and measures taken to stamp
it out. Unlike the cities of the eaet, our public water
auppliea are not usually t a.ken from. streams and thE:;refol"e
3ub,j ect to pOlltion and it is qujte prob!able th.at milk, flies
and contact with thi;~ infected 9,1"'e the most freguent means of
transmi.se.ion. It is however. a subj ect tra,t requ:\. res invest...
gat ion as no mere impressions should be allowed to stand when
positive ~~owledge oan be obtained. General mea.sures of
so
sanitation while perfectlY proper are ~J~ to beAslow in pro-duo
L'1.gthe desired results that ma.ny lives mati' be lost &.nd.
many days wasted in a sick bed before the rea.l source of in­fection
i5 rea.ohed. The distribution of printed circulars
warning the public of the da.nger of the disease and telling tl3.
them how to avoid it, 1I.1"e commonly necessary. The spoken
word 15 too often forgotten 0 a.nd Where some startling truth
may be remembered. an apparently trifling detail that is.
neTertheless, essential will slip the memory all too soon.
The registration of cases of typhoid. like tuberCUlosis,
I
...12­depends
ultimate on the registra.tion of deaths and) 1.n order
to prevent the plea of mistaken diagnosis being madA, the
territory /Should Bupport a. laboratory for the examination
,,>fthe blQ{.Hl or the lQu~pect$. The city where a la.boratory
mig'tl,t be loo!ltet\ cCiuld well alt'ord to contrHmte to its
rf\lliJ'1ten~nee. '-Phe fa.ot that some physj.cians have priva.te
laboratories of their own makes no difference. Every body is
not trea.ted for by those physicians a.nd tbeir laboratories
are not for general use.
DIPUTHll;IUA.
This di5el~lSe :rrmks fourth in the d,e:~t:bs due t{) speci"
fied er~U13e5. In 190't, there were r'E.'rported 123 c;aBe 5 th 25
dea..thli and in 1908, '70 Cii.5C13 \v11:.11 15 deathf'. A1U!(iug'h a, high­ly
conttti.gious dhl\et~.ae, it 1$ 1'(ulte appa.rent thllt e:i:tlH~r f;tll 13
ot' these calUHI have not been reported as they Sh01)1(1 hElv6 'been
or thl~t sane of' OU1' physicianii'> need j.nl'struction in the une
ot fimti""toxin. A mar-ta.lity rate of over 20;:t seems 2.1most
medieval 6,nd i. t. 1'5 110t b(;,;l ie'Ved tha.t it is the tr\.H~ e.
In a disease of this cho.t~acter, tho (HUeS should not a1··
lowed to go unnoticed. Houses should be placarded, the pa.~
tlenta con:fined to the house until 11 and efforts sho'L::ld
be made to discover the source o:f' infection and the mean6 of
transmil6sion. No children from auch houses eho;;ld be a,llowed
to at.nd:. school until granted perElission in wrtting frOIl":
the health of'ficer. I feel $;oure that teachers :::md school
superintendents haVing ,j ur1sdict ion woul d be only too glad
to cooperate a,nd if practiced for only 6\. ~~hort while 0 the
pl"inciple would, become f'irrtt.ly establish(HL It 18 ttl€) law at
pre.ent although 1t is not gonerally enforoed.
'1'h1s is another disl1H.l.Sel that f'requentlj& demanda the aid
of a labor<~,tory :tor its positive identifioation. 'nlr,>ugh
physicia.ns will sometimcs giY6 a.nti-toxin on 5uspiciotl@ ·tho',
I
-13
the~v will not roport on thEUHl suspicions. Whili3 it is very
alinioal eour~0 the caSB pur.ued. This he 1s at perfeotly
liberty to do while awaiting the result of a. bacteriological
patient and the r'Bstrictions p~.cod on those iT, c onta,ct with
them. Aft~er }]fl,irinp q.l'lfen. anti-toxin r:md the recovery of
1s
the patient. the physleilul ! IS to be illlr;V1Eld to 6;ay th;;il.t the
turn 11
co:mrauni t:{ of the publ:Le sohool?
Doubtleaa~ thia has been done with perfectJy homest mo-tiVC3.
but it afforda a loop-hole 80 apparent and aD wide
that it should not be allowed to continue.
diphtheria thttt are not due tothe speed-fic germ of t};.i:3 disEHlse
Thf2HSG cases 'uhich inclu.de t()sillltis and. other
f.' OY'.c,".••• '''f' '~01~"" J·,.'.-lr,':,lr.:..t. t.111.~,Jur"'"h. t,11~.,....r • -In.. n' _'''''' '" _.v i.l] _~, _ -. 6 _, __ .... !0!:lrJ.y cr...see~ are con'~
are contagious for a s'horter period and t~re not accompRnied
by a high mortality ~ tl'he clinj.c£'~l dia.gnosis of diphtherio
if ~i.l.lowed to atand~nd tl1e proper sa,fegUi~.~-d:i.ng of the pu1)1C&
h~H:1J.th is enforcH''l.d, results i.Y'. unjustly restraining i1JJ10eent
l:.eople, a. thing tha.t is far from the deeire of the health
I
amY receive a word. Whereas the vic tims of these maladies
should not of necessity be quarantined, yet in view of the fad;
that many mild ca,ses are rea11y unrecognized cases of diph..
theria or scarlet fever ~ no child 11S;ving a sore throat shOUld
be;llowed to attend soh.oo1, or any gathering where children
may gather. Wisdon'\. would further extend this prohibition
to teachers under 11.k:e oirom!.lstances. It is beleived that
regulation would prevent ma.ny a..n epidemio and tha.t the 9.ctual
school days would. be materlaJ.ly increased. ::)cliI..rcely a winter
paSSElS but that one or two schools are closed on account of an
epidem::tc among the pupils. It may come early or la.te or in
the middle of the term but the effect is to throw back the WD
work of all and not a few.
but
Though one death was rep~rted from this disea.se during
the year I 1908, it is safe to say that it cost the territory
more iXl money from direct taxes , than a.II the other combined.
~
,.,.,he neergy' displayed by hea,lth officers in seizing and qua.r""
antining these patients, the publj.c' panic, the "loosening up"
of the Boa.rd ;:;upervisors and the genera,l hule,ba,loo ~ are
almost amusing. Why is it that we are so stirred to action
by a disease
Ed-which will not spread to the recently va.ccinated, e, dis-
Eruu;e whose means of prevention are simplE! a,nd have been
known for more than a century,
iQ;n~;;zmant, why i sit ,
Our smallpox ca,ses a.re plEl.ced under a, rigid quarantine
a.nd fed and shelt.ered a,11.d nursed SI.t the expense of the county
:til early a.ll of them are indigent and so whi Ie the burden of
their C(:l,re would fall upon the county e.11.yway I yet there is
-15"
no good reason why' the pul.llic SiJi.)Uld bear the expense of
speoial nurses gu.ards and pay tilE:: attending phyt.!l:lcian thr.::6
or four times his re~ularl fee for attendanoe. There 18 no
more reason why til. ph:n~ician sbould. 'be paid more :fOI' i;~t,t\c~ndtng
a. sffia.llpox case than for. attending a. t'HUHil of scarlet fever or
diphtheria. rr;here are reasona whya aO.mewhat higher fee is
proper in at~ending these diseases, owing to the necessity
of disinfeo'tloll and other precautions a.ge,inat (say'eying the
contagion and to the posaible taIling practice due to people
fearing infeotion, but; if the pJ1ysioians do not charge more
in the la.tter 01:UHllB of their private patient.a there is no
reason wh.y 'they should chanstl more of tJ!\~ county.
The proper way to prevent smallpox is by vaooina.tion.
While we have a vaccina.tion law in tlti,p territory fllr' minora
it 15 not generally enforoed exoept in times of epids''flio6. A
reasonable requirement would be that whie'}.'l 'fl6LfJ 'been i:n foroe
in most states for some time past, of' requr1nglnu),dnation
before a.llowing a child to enter school. 'rhos€; a,dmit'!,eci to
our county hespita,ls should also be vaocinat~od as ~houlc1 the
prl£;onera in the county .1 a1l:li. A pOliQt':.f Bueh as this would
practically' eradioate the dillH!Hi.Eie from our ten·'it~'ty. 'The
5m~.1.1 add:\. t 10nal expense being more tha.n cQ'vered by t.lltj lesseno
ed coat of q,uara.rrtine whic h is eo often naco i:H:\a.r'j'.
Those vacoinated should be given a oertificate of 7acoi-na.
tion and record should be malia of' :it in a book keJJt for tha t
purpose. 'l'ha a'S l"tifici1.te should !lot he issued» howe"ver, unt 11
it has been dCft'lj~n"!llined that the vaocination Was 5:,ICCdSI.,ful.
'fhe practice of gi'ving vaccinat i un certificates hil'1H?diately
atter va,ccin,?J.,tion io absurd, fortht?l"'s is no way of telling
whether 01" not 111 a pa.rt icula.1" instance the re 6u1 t '1\1111 1:;..;, a,
Ittake". This pract.ice is qui.te a common one a,nd Sh<HJ.ld. $top
at once.
I
-16-
As to the protective influen.ce of vaccination, there can
be no doubt whatever to the fair minded. The statlsti.cs have'
been given again, and a.gai.n, a_nd it is not nee6ssary tha.t
they be repeated. Vfuen we remember, that during the eighteenth
century, one person out of every three bore pockmarks, we can
" underst.and the remark tha.t if a gentlemen of EeauErmrn1'letl! s
day were to retu.rn now to Pica-dilly' and Rotten Row, his great­est
surprise would be at the number of smooth skinned faces.
That this not due sole to improvement in general sanitary
conditions, as held by some, is shown by the epidemicsof
exanthe:matic typus which "prevailed extensively throughout
Eurppe during the first ha~r of the nineteenth century", a.nd
/? ".
is a disease requiring: surroUJldings for its development ,,·····.ii~iiff~'
One death was reported from this affection during the
yertr, 1908, and 2 during the year 1907. It is safe to say,
however, tha.t it was the primary cause of death in a number
of cases of pneumonia reported, and tha.t the number of cases
exceeding the 49 reported. In view of the fact t,ha.t this
disease has of late frequently exceeded in 8.ctual m.ortality
scarlet fever, the importa,nce of having these cases reported
;
is appa.rent. While rig:Fttf{quarantine is probably not necessary
yet the children from these houses should be plsLced under re­strictions
and the houses should be plac@.rded. It is import­ant
too, tha.t there should be a more general dissemination
of the facts concernirlg the de.nger of the disea,se and its com-pli.@
ation. The fact that j.t is not harmless and tha.t it is
not better f or the children to have it While they are young
cs,nnot be too strongly imprssed upon the pare nts.
::;CARl.ET FEVl4';H.
Nearly every county in the terri torY hAS been ,d I'd b=!rl "h"
DG~rlet fever during t:he year 1908 though no fat ali ties were
reported as the result .. During 190?, lim epidemic of a sever form
of the disease prt;vailed in Jerome, Yavapai County. A total
of 41 case!.') and 10 deatb.s were reported :t'rom this cOLl.nty dur­ing
the second aVJ.d tldrd q,uart,t:rs, VJhich would give a deatri.
rate of nearly 25/~>. A number o:f these caBes occurred among
tl'Je Mexica.ns arnid f:mrroundings that wen: :far from fa;vorable
and among a claiH1 (,11' peopl€; too that are inclined to hide their
cases thus rendering an efJ'€:etive quarantinE; a rna tter of ex-treme
diffi,cul tJr. more enliglJtened people 8,re generally
fully aJ.ive to ttl.€; da:nger of the disease and are perfectly will
ing to under~o the inconvenience of' isolation for' benefit
of tb.e pu'blico Hpwev(;r prj.ntcd pamphlets of instructions
:8:1lOu1d be published by the Terri tori al :Board of Health and on
tbe appearance of Hie di~1ela.se » tbey should 'he sent into the
cted communi.ty and given a free distri'butiono the press
1~ ~,l;Vl<il,:;ra quite willing to help in iJUch matters ;..nd by having
reliabl e informa.tiGn at l'Jand would be a:bl e to accomplisb much
more than the Board could pOBBible do unaided. At the present
time ~ t'b.e infonnati on obta,ined by them, is sometimes inaccurate
and frequently the opi.nion of some physicians given in an off
hand way t:h.e.t is not conducive to reliability.
IJJiPROSY.
1'hree cases of leprol::y were rE,ported liy tbe Supt:r:i,ntend...
ent ()f llealth during trte year, 1908, one from Globe, one from
f;lifton and orIe from 'I'onJr\stone. It is regretta.hle::: that the
S,lIna prmnptness is not shuvm in re}Jorting some other more
common and contardOlle diesesa8. leprc1s:;r is not a. highly
contf~gio'Ul:) disease. In fact) it reci'uires tb.e most intimate a.nd
prolonged contact in order that it he transmitted. This
is Ei\hov.:n. ....),ro"",1l"'vI "...'.".JJ leper
island ian group, hut oy one of theBe very cases
The husband of the
r continu.~ly for a
t".l,jled .In
ol)lenn of
an.d T,('H' :\;5
kept on the move by
os of keeping onm or two i601~t-natiun"",
l inst:Ltll.tion were exi~)ttint,
territories CQuld wall 01""c1 t G
i t·~~t i 0[1 ..
An ep.l. availad in the city of Tuc~Qn
&VI~ mince, ~!t the
becorr.:·1 Buell a focua WQu'ld &1] likl1hood apr
the
...19
which acts as a host of the infectinf; organism. QitpOSSibility
not to be disregarded is the fact that this disease is
80mlbtimes mistaken for yellow fever and vict::versa and has
"f""'';
led to t.he quarantinj,ng of t01Jme on th1s aceount. ~fe immense
10S8 1.n business t1L&.t such measures occa,sion makes it well
worth 1Jll11j,ilt:i to expend a suff'ici€;nt Bum to eradicate the 'breed-ing
places o:f mosquit06B, and avo SBibilityo
One of the moet regrettablEl fea:cure5 at' the method of re ...
porting deaths that haB been in vogue in the past is that
it is 1mp05~d'ble to tell :from the returns made to this office~
the number dt.:i6 to these dhHHHles" 'fhey are reported under
the C1fiLS t:, of "DifHHiI.SeS of the DigestjYB Systeml'o lfhether
of not trlere is a large infant mortality in the summer
montrls due to thenl can only be sunnised a.nd the significance
of the dler figures for this class in the second and third
quarters of' each year can only be deduced from the experiece
of o'tller 16tat€::s and citi.8S" not only should thel;ie deaths be
rep()rted separately ~ ·bu t t:b.€ case s should be repo rte are
of.
scarlet fever and Bmallpo~" The fre quency wi th which they
are associated with contaminated milk sllould lead to a closer
supervision of the milk supplies of our large cities and
towns, while mothers should be informed of t11e danger of
bottle feeding.
IllFA1JT :MORTAI,ITY.
From the reported statistics, there is no way of telling
the number o:f death8 from the various diseases in the dift'erent
age period. These period are commonly dividf.ld as follows:
Below 5 yearB» 5,10, 10-15~ 15-20, 20-25~ 25-35, 35... 45, 45-
55, 65... 75 ~ and over '75 though in recent years t~here has been
a tendency t.o increa.s~; the numbtJr of periods by making each
year of the separate years under fivB a d18tinct
In
first two ye~rs are riod, from 2 to 5 the
adom
of InaJeing a.t 1
perJod ia
de
i, ty of' ac~ur e informa~ion concerning t~em. The TIepar~
ment 01:'
the purpo58 of oODeideri the Du~mer care Q~
ment. It is deal
tllc1 B of the new born ml somethinp to prevent the 1e
1()~3S of ~dgh "Nhid:1 iE rwt :i.nfrequent among the children of
tlle
» eepecia.lly vr1th regard to the
rangemtmt ofw::!.namv5 for ligh.t,
t(;~ete CO!ll.f:1'only know i'tt1Orea, baut such matters thfA.n. the local
health affie rs yet the school trustees are not usually in-formed.
on such matters '~nd t:hey Cf'.n not gi Ife the sanitary r:-.ide
.It, closer ~<tt.ntion t,) the construction of E>chool build...
ingsrni l!l('l\teria,lly lClSsen the incidence of sick:C1ess not
OflJy front the epj d.ei!tie diseeuses of childhood but from the
otberaff' ec:t 1ens to whic h tbey' &.r e s,lJsce:pt. i ble.
The medioal inspection of sobool children is a matter
_ .3 __ .J
-21
go by, a,nd a,s '1/0 1"(\ 1ze ::1",0 re ;:~d mOJ"!i, the import:::.nt part
eelj. 10s18 has long been believed by
ion of Dchool children
:'11'
whose sloga.n
bodtem is increasing every
001 children as indicated
a,bove. Inatructi.ons 1.n the ct:1,v,se r,:,nd prevention of tubercu""
10e18 and t~Jilioid fever Bre especially noeded and would be
especially benefic!
Al m':>;!! t. of' our irn,''!orpo1''ti\ted cit:l. em have ordinances
o!J.ly in wh:l,el1 d,Llut~d
through the p()3sibl~ t nfeot ion of it, o:,{ d:trt or cont:s,ro1nated
honest)' of
ed to the d.oll{~l"tJ thiCl,t a,n1 spent b;r 1;:113 community in doctor 3 e
b ,:~nodio.in:)e and nunsea and the p!~,r~phe!"nal:is of the siel ,
roo:m in an endl!Ii,VOr to bring aOO1Jt, recovery of old Idren sick
wi.th
ftirther.
often
doubt rl1,l,t 1d :111
pair hiB efficienoy. It. eral in caBe the
outcome is death 1m Also to be ~orne in mind.
Intestinal dise~B8B only onos that are borne
.;
v
were wet"tO due to
can ben) d
tho frQ~ other causes
have
our rnt
;..,...y. It .no". del el
genna of
vitali. tJ,1~lt
.~
'.",
opP<Jrt
and b;l
digest::)::,},
t :re::mlt;B f'rQr: 1:npsr:fect
the dLt+:' .~a,nd
cause of these disorders. In or r to
milk inspection begin ~
and be tb
for tU1:l8 e udder, for gene
healthf
also [,!()
BSB and for cleanl1ioosB Id
aoon to do 80 , shOUld be excluded.
The general clea,n'linesa of the cowe, milkers) etables» pail~ J
and cans» mille hm.U:«;S 1 separators and in fa(~t eVt';ry thing that
is in connection with tb.c ~upplying of milk, should be insi:;;t",
ed u:pon. The water Bupply sb ouid lie t.estt~d and unless uncon"
tatdnatt;;d th.e milk sbould" "'be excluded from sale. The sale (.If
milk from dairil:::s when.: then: arc caBes of ccrntntmj.cabl,;;: dis..
eaBe exiatant bhould be prohibited. The details of dairy
un
i118pec"t ien, .it is nece ~HHl,r::l, to go into any rna re extenl:>:l.vely
here. The
it is ne(~e5sary to take in to con:;;iderat io n.
The testing lk for the ad.ulteration
formali.n or other foreign bul/stancE: fi-.>hould 'Le carrled on alflo,
though :l.t is even Inore neCel.\Hmry trlat bactE;rial counts be made
to dettJr:rni1'1e the eff'ecti"\i'eness of tIle infipecth)n and to de-teet
any l:iLJd ty in t}-:e rcem£nt of the re
could 1)\.:; done 'by the local ht:alth officers while from ti:me to
time ~ trIe Te Board of Ella! th conld. ex-a,minen af,td
verify the il~ findingfi-.>. This is done in many (Jf the sta s
and regular. cnt:t"its for field work along these 1
easily prepared. It understood that the production
of clean milk, weans a.n increase in the post of thc·):production
and tb.at peOl)lE; must expect to pay 8. price that wi.11 permi t
the dai.ryman to make a profl t • If they find that tbey are
unal,le to !nake a profit at the prices h~;retofore charged~
they are likely to be forced out of the bueiness or the con-tamination
of the milk will continue. This should not, how-ever
» em to give inspection as an excuse for illegiti-mately
adv,mcing prices c:md it it:; qui toe probable that the prices
at present received for milk in this territory would be qui t,e
sufficient G
Along with tbis inspection of dai.rie5 and milk ebould
go instruction of "the public in the danger of dirty milk and
in the inrlerent eoonomy of olean mill<: even at a higher price •
This is done in many states by sterioptican illustrations
of conditions at the ordinary dairy farm and on the properly
conducted farm and. by lectures accolppanying the illustrations,
by p~phletB in plain and easily understood language illus­trated
with half tones of actual photographs od condtions
existant in the neighborhood, by articles in the press and
by teaching in the schools. This part of the work should
properly be taken up by the Territorial Board of Health a.s
the expense of preparing a sepa.rate pamphlet or a separate
series of lantern slides for each city or county would pro­bably
prevent many of them from doing it, a.nd would be a ,
dUPl1cat~A'6f 1l/ork that would be unnecessary.
It is my belief that the inspection of milk and dairies
should be borne in part by the counties and'liiIlpart by the
cities. While the citi~_:s a.re the ones most frequently af-feated
yet it must not be forgotten that the rural districts
come in for their share of the mischief and that they would e
benefited accordingly by any regulations 10r the good of the
01 ties. While the treasuries of tb.e cities are not usuaJ ly
overflowing J the trel1l,sur 1e s of the count iE's are generally
able to take care of the extra expense, vWhich While it would
not be great as compared to the expense going on every da.y in
interests of the preservation of the property and of the
prevention of deaths from. violence would be a, noticeable
ad.dition to the expense of the preservation of health and of
the prevention of deaths from disease.
meant that there would be an jn~".$,t
In saying this it 1s
the.fixed charges" ~""::2~mjt'F'4~'" .. .i
for, except in a few of the oounties, I am convince~l that
there would be a corresponding decrnase in the incidenta,l
expense for quarantine';: and the care of persons under quaran..
tine, and in the expense for the care of the indigent sick
-25­and
the "burial ofthe ind.igent dead.
The examination of milk and dairieiS should be done "by
the health officers. While the inspection of dairies does
not usually require the serv~&es of a physician yet a layman
can 6eldom appreciate the necessity for oare and cleanliness
a.s can a properly qualified physician a,nd i twould therefore
be proper that the health officer have 6upervi6ion. The ex­aminatian
of milk is a different matter and requires a man
with a technioal training for both the chemical and bacterio­logical
determinat ion of its pu.r tty t {;,nd ahou1d never be left
to a person Without this training,
Ll1:G I tiLAT I ON •
It is said tha.t it is common t)'~ing for physioiane to
look: u,on pegielati::m as the panacea. that will cure all
the ills the state 1s heir to. and especia11y does this seem
to be true,when the cures of the pllablic lD alth legislation
is followed a little way. .rust what good a statute will do f
if it is not enforced is not quite clear. For the small
advanta.ges of having something to refer to with pride S,6 a.n
up-to-date , we are a.pt to pay with contempt for that law
and its requirements • The present public health act of this
territory is, with the exoeption of the seotions providing
for the oollection of Vital '·~.ta.tistics a.nd the organization
of the Territoria.l Board a.nd the pay and allowance of the
ijuperintend.ent of Publio Health about as good as we oa.n expect
at this time. The subject of Vita 1 titatistics has a.lrea.dy
been referred to. As regards the organiza.tion ofthe Board,
it is now almost unique in its personnel. The ijuperintend­ent
of Public Health is without offioial advisers in the
teohnical work that devolvee uron him. He must be guided in
these matters, to a large extent at least, by the opinion of
the lll.edicw.. profession as he comes in 00 ntaot with it or notat
all.
Furthermore tl'le medica.l profession as a. whole, does not pay
IlL great deal of attention to ma.tters pertaining to public hea
hea,lth"'-I,t least not to the extent of being well informed on
the sub,j eot of h,ygiene abd that of practica,l health adminis-t:
cati'':;.n. Fe'V'J of' them ha.ve a book on the subject of hygiene
their
thlii,t is of a la.ter date than '1'l.e first year college while
th,~ latter :sub,j ect 80 far as I know is not found in a text
book, but must be learned by reading the reports of others
engaged in this work. Reports of other boards of bealth, re­ports
of conferences of sanitary officers and the constant re~
ing of articles appearing in the current literature are the
sourcesof inf ormat ion. It requires medical training in order
to rsad these articles and reports with understanding and ap-preciat1on,
80 that the question 1s one of getting rhysioians
to take more interest in the matter in 0 rder th9.t thejr may as.
vise out of a. full knOWledge ofthe subject.
I would therefore recommend that the law be changed. in
this respect a.nd that the Board of Health be made to co:nalst
of four or five or six physicians ,a. civil engineer 8..nd a
secrwta,ry Who shall be the executive oCficer. The members of
the Board, with the exoeption of the secretary should be choe...
en by the Governor and their terms made to expire in dU'fereilt
years sothat a. board of entirely new men \yould not l;e e.ppoint-ed
at the same time. The secretary should be chosen annually
by the board andhis tenure of office made dependent entirely
:tt!l~
on the 81~il5factory discharge of his duties. Th board should
rmlJe't once in each quarter andprovisions be made f~1:r oalling
meetings jn oases of emergency~ They should be paid sufficiert
to make it worth their while to be absent from their practice
for the required time consumed in going to and from and a.t ...
tending meetings and considering sanitary problems.
The secre:ll;.ary of the board should receive a 8Et.lary that
will enable him to devote his entire time to the work and
-27-
should be given such 01 eri.ca.l ai6SistarlCC a.s may be necessary •
lath the exception.s of the seotions of the law providing for
the orgf:l:,nizG4.tion of the boards of h~fj.lth a.nd those pertaining
to the sillar:tee and t\11owancee» no part of the public he8,1th
law 'las been lived up to and enforoed. The reason for this
can be found in the fa.ct, tb.at enforcement of thie 1.aw would
rEltluire tha..t the super:i.ntendent of pUbli.o health gtve &.11. of
hie time t{) the off:lo e, while the salary is not such that he
ca,n afford to do so. It is s8.id tra t the salary was put thus
s'nall in the bill 11"1 order to ensure ita pasfla.ge. If' 50, wha,t
loodAwas served thereby? The effect has been to create a /.",.
sinecure. There has bl\'Hm no supervision of the cc>unt;y boards
of health worthy of' the name; no monthly reports have been re
quired of' (~/U11ty Buperintendents of hea,lth; no repo1"'ts of
been r0quired or reo(;Jiv~d; contagious diseases have not been
reported imrnediately. 'but -llIl,t the end ofthe qua.rter and in
totals; births ha.ve been report61d in total without names,dates
Qr a.nything (glee; dElH.., t/hs have been reported only in totals
existant s,nd the only benefit to be observed i5 that the
terri torlSi.l hea,ltb. officer can Dlllkethecounty officers more
i5 needed and it aoes not take a physician to secure
While in tb.i5 wa.y they rft&\y be of value to the proln:,te C01Jrt,
n.umben~. Dea,th returns vihen pr oper, y made are not
a.otive in ssecur1ng birthe 3,nd deaths
th&~;j are not of grea.t value~ to the sanitarian. ACGur ate
stati:atics to be of vajAe should be acted upon. 'While the
accumulaticm ma.y make them of vc~lu for future comparisons,
there is the better rea.son. for truninp; them to ll,COounta,t
once.
If we are able to "ha'V'e inspect i on of rnilk,
...28
of schoo};;ta,nd sohool eh'lldren, inve~tiga.tion of water supplies,
conu1J,urdcr",bhl diseauj 15.8 for public ai stributi on, arrange fOl~
:in sho rt» if '1i'H~ ;:U"'e to have a rea.l public health VJo'~k:j) it is
going to keep one m;:,;,n lmsy supervising. Th~ fa.ct that $()lfl e
m,:idica,l 50oi.et.i~ii$ i3 no rer.~son why thnY sholld continue to un-their
time and f110ney, We do not look to
our oral tHiU"Y criminals. rrhe t irees when la:wvyer8 voluntex·r
thl.'il se!"vicea are times th"il,,t T!lay bc:! liksnadt 0 those 'J,han
the vigilantes in the suppression of orime
should it longer continue in the suppressdon of disea8~?
yearly maid and rnore a.D· special study and to £.\,,11 extent not
!?/IY"i/"'t'f.,, fully realiaed~b~·the medical prof••sion. There aho' bea
I
good reference library in oonneotion with theaffioa of the
hlalth officers af reprl~t8 of artioles bearing on publio
f'or' the.m pr{)hlbits the usual health offi()t1r from buying th\!lm,
8Bpecially in v1ww afthe fact that they are of little practic~
1.1,.:,. to h.lm in g(';meral practice. The time con8uX3d and the in-
11 not be ordered. The Becret~y of the territorial board
SIl'Juld attend the annual conference of the clurg<aon Genenil
01' th~ U.\::5. P'lt"blic Hea.lth and the Marine..Hoepit:a.l Service
d Territorial Offioers and the annual confer-anoe
of the ~tate and Provine 1 Boards of
America.
In this w.,,*y
reports, and he will unquestionahle learn th:i.ngs that
do not appe~r in these ~enorts. The salary of tho sea
for th.e o?3.:rr:-ring em
it will be requir~d to do,
to reHD J no
th~ of'f'icH~ 11I10U Id e ontJrlU.e 3. >,....
a.t present) doe snot a.ffect thJ3 idity of thi8 belief. ~.
science "lit
It i8 ~ far ory from the statuB of publio hdalth w in
America to th.t which h~B for years been i~ vDg~e in England •
in this territorv. ~.t it is time that the mRdieal solon
it may be in pl~co to show
physic n before he hec
the first part of the examination)
year's of age and he,ve been a. qual:tfied practioner of
-30
of medicine for twelve months, and~"ft.er hi.s graduation he
tion crr7ers the follow1
peirasitee. 4: Baot,,;!"iolog~r, in relat ion
to sanitary work.
'Before cJ(lrni.'I:.Hl:t<.m to the eecon.d part of the examinati on,
after'his graduation, he spent
of pu"b'lic lth.,adminlk>tration under-a. medica 1 officer of
health irJ ,3, tty of not 1856 th~ 30,OOO,aud. haa also had three
months! e r:l.enCf:1J in a hOlSpital forinfectiou6 diseases. The
folloN::l' -- l·~ Cl.d.gin, patt1010gy ,,:md pre vention of' diseases,
iQn to infectioua diseases. I-Bffects of
re ti,.)l] to
unhflt:hy t
m1niGitra1on i.n the r;,;latinntothe :requ'jrement 'Of houses and
othorbuildin . 7. Canst
relaticln
including by-laws, 9rdersand
regulations. In- Duties ofsanitary offioers.
significant sentence
speech Dr. ~i111:i.am iLWlilllch (if .John Hopkina Un1versit--.
"In England the decline
and has contin:ued to the' present time, 1mt in that country,
there have been tl::rough out thifi f:·eriod, special hoepi tale
for ccnsumptiV'e s and intelli.g(:~nt publicc sani tation. "
Ifew Jersy now r€lqulres eJi.aminations prii)l~ to appoint-ment
» 1:Tew YQrk and. Pennsylva,nia are Ct~!~tainly appro aching it»
and with the passing of these offices to a clasB of civil
service, pUblic heal tl1 Bchoo1 s will become as common in .tId.s
country as in England.
Th.G county l;Juper1rltt:.endents o~ pUblic bea.ltb shOUld, in
my opinion, be :pedd a Ba,lary alone and. tb.e board of Bupervi-sorB
given the sante discretion a.b to th.e amount ae the ci t.y
salaries paid to city health aftic-t're.
The pre fJent me tilod is conrnon enough in tIli 5 coun t17,
three hUll(.in~d dollars a yea:r and tE:n dollar;., a day for each
da.y la,c"tui;i,lly a.nd nece~')saril:y" spent :i.n a court 1) a.nn allow ~
him no ng fort!.\€; time 5:,pent in p:n-:;pan."ition of Ids CaetH"
for the county heal o:f'flcer to make a }lrE:;tty good thing out
of his off ye t render no ade ciuate btH'V1Cf:; in re turn.
The tax-payers prE~eume that he j.B receiving only the twenty-five
dollars per month and expect Iitt.ltl or' not.hing from him.
The fees he TI12<.Y receive de; not ente r into their calculations~
If an epidemi.c b :ns they do not in0.l.uire v/hat eonditions
led to the disease getting a foot-hold. All they want 1s to
have it stopped. If it occurs for several years , they
finally take act ion ~ but it is S6 Ido TIl to t"Ye heal tlJ. off icer'tl
th~t they look for advice.
ThtHH~ thinga are ce ainl.y no t as th e:! .should 116 and. it
Perhaps •
salary. 2.... ]I[ake Boar.d of Health to con-
~32
sists (;If' two phyt:;ici.ans in addi t.iO!l to the present membership"
3.. Make tb,e payment of the sal ary dependent upon the perform-ance
of tb.e d.uties of the office ~ (il,nd let, the Board of' HE:e~ltb
uBc:i.de upon this matter. 'lA/hen a good officer is found j ke
him, even if hiB salary has to be raised a little from time
to tiTI:e"
wprk and wOLlIn be ablE: to advhH:1 the Board at; to whe th5~" or
not a health officer wa~ doing his work properly ; they would
incresl.f·ewould 'be mone;)' well slH:mt a· d speedily to be return-
I t; may be said t:ha t thi s is ask::l.ng too much--that the
Sanitary'legislation and eSI;ecially sani tary appn)pri.ation
strictive medic country
forty years agoi the diploma. iII :b.ad no alumni aL."long
the ranks of practicing p:hysicians» f'.uppoae that the pUblic
had received ito knowledge
trained physicians and not from blatant
quackiJ tUld froIr1AfralHtullimt venden; of nOt:;tru!'1o; sUPIJose that
i''';
lectuf"C:i5 on tul"Jerculoj;;,i1i.\ and typhoid fever had "bet:n as nU1l1erOUS
asthe biennial crop of speeclJe e on stf;.l,tehoodi E:H1PiHH:le that
the sani tar;v }:nowledge thb public had kept pact:: wi th i te
a,Bked :for if/hat they needed int::teLi.d of' vlhat thl;;~
political knowledge- tr.!.ese be cil.dvanced under these
least i t ma~! be doubted.
The pu ic a..'1d the legislEttors need to be hllpreSf;,ed
with th€ importance of thee;;; raeasure:::,. They not lott.k upon
33
every bill introduced by a l.avvyer as a measure to irwrea66
litigation even th\ii) increased litigation m&~y result from its
enact:ment s They have 110 !:1or e rtlaBon to look upon a bill in-trodtu.:
t:d by !llt:dical ;nt:n as a measure to increase the income
of physi.cian8 s We n:-: legislators l;preely made u}) of physic:i ana
it may easily be conce
>
d that there might )':50me dtf'f'icul ty
in making/certain class of casee appealable ... " efipecially
so if there happened to l-.:,e an increased expense involved and a
lawyer ot tIN(') in good standing to say that it was unnecessaryo
Yet the great majori ty of well.-inforL'1ed lawyers woulcl perhaps
see tfJ.e adva,nt of such a measure to toll.1i) pulllic at a. gl.anee.
The timeto do it is nows While we al~e growing up. 'l'o do~
50 that w'e will not ·have to undo. So t.hat lITe will not have to
face the problems tbat are being faced in the east. So that
an €HlOrmOUe expendi turD at bcm.e future t.iIae will not be
neceasary • "An ounce of prf;;ven tion is 1:;rorth a pound ot' ot,re" J
and if an:;rwhere t118.t motto is true » it is in the prevent ion
of infectiouB diseases. We are toe far behin4
o E p,~ ~ T ~j~ E N or 0 1F ­'
t
Ina.t t e r S '0 f