For the great class of citizens who cannot afford to pay for medical or hospital care cities have built and equipped large city or municipal hospitals. Here in airy, immaculate wards are brought patients from tenement homes. They are given every care, the kind of food they need, and expert medical treatment; and they are discharged only when they have fully

York City.

recovered. It has been said that in America there are two groups who are always assured expert medical care: the very rich and the very poor!

Special hospitals have been organized for particular groups of diseases. Among them are Orthopedic, Children's, Maternity, and Tuberculosis hospitals as well as those that treat only mental cases. Here labor the specialists in the various fields of medicine.

In connection with the hospitals there is also an ambulance service. Ambulances, accompanied by physicians, are ready for instant call in case of accident, or to bring sick persons

from their homes to the hospital. Private hospitals as well as the public ones are required to admit any case of emergency.

3. THE HISTORY OF HEALTH REGULATION

Public health laws and regulations are a comparatively new community function. In past years every man looked out for his health and that of his family without direct community aid. There were no boards of health, and the federal

Form G 46-10-m. 2-19

DEPARTMENT OF WELFARE-DIVISION OF HEALTH.
Bureau of Sanitation.
Dayton, Ohio,..

Το

.191......

Owner, Agent, Occupant

At No.......

Street

You are hereby ordered within...

..days to

health.

The present condition is a nuisance, and is a menace to the public

SANITARY OFFICER

COMMISSIONER OF HEALTH.

From Section 4414 of the General Code of Ohio: "Whoever violates any provision of this chapter, or any order er regulation of the Board of Health made in pursuance thereof, or obstructs or interferes with the execution of such order, or willfully or illegally omits to obey such order, shall be fined not to exceed one hundred dollars, or imprisoned for not to exceed ninety days, or both,............

This Notice from the Division of Health, Dayton, Ohio, Orders the Abatement of a Public Nuisance

Public Health Service was not organized. If a man kept his premises in a condition that endangered a neighbor's health, the latter's only recourse was a civil suit for damages. The bad neighbor could be sued in court for maintaining a “public nuisance." The law prescribed in great detail just what acts or omissions constituted a public nuisance.

The first move toward co-operative action in a community consisted of the appointment of a committee of citizensusually by the mayor-to study health conditions and to make recommendations to the city for improvement. We find such a committee in 1806 in New York City, reporting certain pre

ventive measures to secure the health of citizens. The report contains recommendations on the following:

"Ample supply of pure potable water; construction of common sewers; drainage of low marsh lands; construction of a masonry wall along the water front; the interment of dead bodies within the city; the planting of trees and healthy vegetables; prohibiting the habitation of damp cellars; prohibiting the use, as dwellings, of certain houses where malignant fever has recurred; pro

viding increased accommodations at Bellevue Hospital;

providing for the

erection of a private

hospital for people of means. ""*

During this period a City Inspector, usually a physician, was given the responsibility of the welfare of the people of our cities. He tested the water supply, and looked after street cleaning, housing, sewer systems, and general sanitation. The

general sanitary

condition at this

time may be judged from the fact that, in 1805, six hundred cases of yellow fever occurred in New York City, though the population was only 75,000.

* "Over a Century of Health Administration in New York City," by C. F. Bolduan, page 4.

After the Civil War state legislatures became more concerned about health conditions. They began to reorganize local health legislation, and provide for city boards of health. A national Board of Health, which later became the United States Public Health Service, was created in 1879, and from that time there was great progress toward making cities healthful places in which to live.

To-day we are in a period of intense interest in preventive medicine and sanitation. The national, the state, and the local boards of health are all co-operating in a general fight against the conditions that lead to disease.

4. How PUBLIC HEALTH WORK IS FINANCED

The money to carry on this campaign for community health comes out of the general tax funds of city, state, and nation. For the expenditure of vast sums of money each year in fighting disease, we are repaid by fewer epidemics, better community health, and greater efficiency. The money is not wasted.

5. HOW PUBLIC HEALTH WORK IS ADMINISTERED

To a great degree community health activities are under local control. The city's administrative officer is known as the Director of Public Health, or as the Health Commissioner, and he is appointed by the city's chief executive with or without the consent of the council. Together with other city officials, usually only three or four, he constitutes the Board of Health. To this Board the legislatures of the different states delegate wide powers of supervision over the community's activities.

In New York City the Commissioner of Health is appointed by the Mayor. The Police Commissioner, and the Health Officer of the Port of New York, together with the Health Commissioner, form the Board of Health, with sweeping powers over matters concerning the welfare of the city. The Board may even cause destruction of property, or restraint of personal liberty, if the public health requires it. In times of epidemics the Board of Health has almost despotic powers.

Philadelphia and Pittsburgh have each a Department of Public Health, headed by a Director appointed by the Mayor with consent of the Council. The Board of Health in these two cities consists of the Director and two other members appointed by the Mayor. At least two of the three members of the Board must be physicians.

In general the functions of the health officers are to prevent the introduction of disease from without, to control disease within the city, and to supervise the general welfare of all citizens.

State Health Administration. In 1849 the Massachusetts legislature appointed a commission to report on a sanitary survey of the state. The following year, this commission recommended to the legislature that state and local boards of health be established. It also recommended, among a number of other things, a census of the people; systematic registration of births, marriages, and deaths; the investigation of all causes of diseases; sanitary control of public buildings and factories; proper quarantine in cases of contagious disease; the abatement of the smoke nuisance, and the prevention of adulteration of foods and drugs.*

It was not until 1869, however, that the legislature finally established a State Board of Health.

Now every state has a State Board of Health, whose head is appointed by the Governor. The State Board divides the different branches of public health work under its jurisdiction among bureaus, as do the large cities. The duty of the State Board is to prevent disease entering the state from without, to control the inter-county or inter-municipal spread of disease, and to supervise the health of the people of the state from a general welfare point of view.

Federal Health Administration. The United States Bureau of Public Health Service, which is under the Treasury Department, protects the people of the United States from contagious

*"The State Board of Health of Massachusetts. A Brief History of Its Organization and Its Work. Published in 1912.