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To enumerate all the functions of boards of health, local and state, would far surpass the necessary limits of this paper, but enough has been said to show warrant for endorsing most of the work being done, to approve the extension of some and the limitation of some of the ever growing activities of health bureaus. A long paper could be written on any of a dozen phases of this subject.
Taking a rapid review of the subjects covered here, we may remark first that boards of health have ample power. The standards of public health and municipal hygiene are continually growing higher.
The dangers from disease in gross epidemic form are becoming less and less, and in their place a new set of hygienic standards is being erected. Some of these new standards verge upon the realm of æsthetics. To what extent boards of health are right in extending their efforts to improve municipal conditions which bear remotely, if at all, on disease and death, but undoubtedly affect public comfort, is a question for debate.
To be effective health work must be coöperative. must be promptly and accurately collected by the ultimate units of sanitary authority, municipal health boards, and transmitted to boards having jurisdiction over larger territory. Whether or not the largest unit of health control should be the state or the nation is a question which this paper need not discuss. It is to be remembered in this connection, however, that state boundaries are only imaginary lines and that some kind of understanding is indispensable between neighboring states for some forms of sanitary control, such, for example, as the purity of water supplies, the management of epidemics and the regulation of milk and other food products. Likewise the management of quarantine, a subject of importance to large portions of the population of the nation, should not be left to the regulation of any particular locality, but should be managed in accordance with laws which are general for the common welfare.
First and foremost among the defects and needs of public health administration must be placed the want of adequate knowledge of the principles and practices of public health work
on the part of officials having jurisdiction. It is a deplorable fact that special professional qualifications are not as a rule required of health officers in the United States.
If there is any department of municipal government which should be taken out of politics and put upon a high plane of professional efficiency, it is public health work. Generally, in the United States, appointment upon a health board means a thankless and gratuitous service performed for the sake of the small honor which is supposed to go with it. Where a salary is connected with the position the office is too often a reward of political rather than professional merit.
Until the need of high class health work is demanded, appreciated and properly rewarded by compensation in money and honor, men will not be prepared by the schools for a lifework in the public health service, and the most needed improvement in the work of boards of health will not be made.
Pittsburgh's Civic Problem
By ROBERT A. WOODS
In the progress of a community, as in the prosecution of personal interests, success depends not merely upon knowing that things are going right or going wrong, but upon painstaking and detailed search into the origin and nature of their good or evil influence. The serious difficulty about the American city is not merely that its administration has broken down. The very conception of the city has broken down, and we go through its streets every day with intentions that are earnest enough but ineffectual because confused and out of date.
The Pittsburgh Survey was undertaken in the conviction that the time had arrived for the study of one of the most typical American cities in its present-day living ensemble, as an example of what must be done in all our cities. The results of the Survey will naturally include, with the ascertained and properly arranged facts, a program which the facts demonstrate to be essential quite as much to the industrial as to the political and moral future of the city.
The source of the marvelous growth and power of Pittsburgh may be outlined in a few words: unparalleled material resources; an unique convergence of transportation facilities connecting all sections of the country; a serious, pertinacious, ardent people for the kernel of a population which has expanded quickly
and amply to each new extension of industry by a process of natural selection of vigorous types from every European nation; the insistent and unceasing spur of a world demand for two or three of the fundamental utilities of civilization.
The Source of
These characteristics had all been brought to their highest significance and intensity by a decade of unsurpassed prosperity as the Survey began. The specific attention of the Survey has, in the nature of the case, been fixed upon those phases of the life of Pittsburgh, which, increasing with its growth, have, under the very stress of that growth, not been soundly grappled with or have even been almost entirely overlooked.
The public physical well-being is coming to the very front as an issue for patriotic foresight. The Pittsburgh Survey has thrown new and clear light upon the subject of typhoid fever which has been epidemic in Pittsburgh for a generation. One of the direct results has been the creation of a special commission of experts to study the incidental causes of that disease, now that the main cause is being lessened by the great filtration plant which Pittsburgh has installed. The Survey has gone to the bottom of the situation as to one thousand typical cases of industrial accidents, and, aside from human considerations, will show in business terms the reckless and needless waste of seasoned and disciplined labor force that is involved. Already as a result, practical stimulus has been given to a movement for a workmen's compensation act; and, better still, to efforts both public and private toward the further elimination of the sources of danger. In the same connection, as the result of a vast amount of detailed inquiry, the Survey will exhibit the wholesale squandering of productive power,-as against the total experience of the civilized world,-involved in the overstrain of the twelvehour day and of seven days work in a week.
To provision, clothe and shelter an army, the United States learned in 1898 may sometimes be three-quarters of the war. The Pittsburgh Survey has placed experts of the engineering grade upon these aspects of Pittsburgh's great industrial campaign. The Survey will show that large numbers of the working class families of the city are living in places unfit for human habitation and therefore seriously undermining to health, productive power and character. Moreover, even including all such places, the total housing capacity of the city is insufficient now and will soon be inadequate to the extent of seriously hampering the growth of the city's industries in the renewal of prosperity.
The abundant supply of labor has established in many cases a low standard of wages and a low standard of life for the home and the local community, which the Survey distinctly shows to be unworthy and unprofitable from the point of view of genuinely farsighted economic leadership. The Survey finds a large amount of smouldering discontent among the rank and file of the industrial employees, centering upon wages, but including other vital conditions under which labor in the great plants is carried on; and it definitely propounds the question whether it would not be wiser to allow a safety valve for this unrest in the establishment of permitted and to that extent responsible trade unionism.
Fresh light will be thrown upon the fine human traits and possibilities of the people among immigrant nationalities who make up so large a proportion of the population of the greater city; and the value to the community, industrially and politically, of developing their varied latent powers will be clearly outlined. On the other hand, it will be shown from the sheer point of view of public order and safety that this population must be leavened effectually with wholesome and stimulating influences before the time comes-and it will soon come when into their hands the political and moral destiny of the community will to a large extent be placed.
Pittsburgh has been afflicted with the same political evils as other American cities. The recent extension of the city into the greater Pittsburgh may for a time embarrass the reform movement which is so substantially embodied in the administration of Mayor Guthrie. The hope of the future politically is in the application to the great new collective needs of an essentially new metropolitan community, of some of that practical individual and corporate sagacity which among all classes of Pittsburgh people has been thrown so strongly into industrial affairs. One of the best assurances of progress in this direction lies in the steady and dominating purpose of the Pittsburgh Chamber of Commerce, reinforced throughout the city by alert and active local boards of trade.
The ten years which have brought in the city's phenome
The Immigrant Population