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chines of the two parties and as a recognition of the right of the public to vote for the man they wanted, offered himself as an independent candidate and who, notwithstanding the fact that it was a presidential year, beat both the regular Republican and the regular Democratic organizations' candidates. I refer to the triumphant victory of Judge Lindsey of Denver. [Applause.]

I feel also like saying a word in regard to the splendid work that the Mayor of this city is doing, work which most of us will not fully appreciate for years to come, so complete, so far reaching and so fundamental is it; a man who has kept his ante-election pledges and kept them seventy times seven; who has made good in the very best sense of the word by carrying them out with an eye single to the public good and with a full appreciation of his duty and obligation to the present as well as to the future.

I wish that I might have time to go over this audience and pick out the various men and women that I see here and intimate to you some small part of their civic endeavor. One man whom I see has not only given generously of his means, but far more generously of his splendid business ability, that the parks of his city might be an ever present help to the large population surrounding them; I might speak of the work that has been done here in the city of Pittsburgh by Mr. English the former president of the Chamber of Commerce, who has taken the splendid energies of this organization and directed them toward high and definite civic lines; and the splendid work Mr. Smith has done in carrying on that work. I might go on and in a practical way illustrate to you by personal references what are the American municipal tendencies of the present day. But there are other things that I want to say, and I am very much afraid if I permit myself to speak extemporaneously I shall not say them.

Mr. Woodruff then read abstracts of his annual review, “American Municipal Tendencies," which is printed in full in the Appendix.

THE CHAIRMAN: Now, that we have had this comprehensive survey of the general situation, we need to take up some of the details of the work for which we have gathered. The work of boards of health is of particular importance and significance. We are to have a paper on that by Dr. George A. Soper, of New York, Chairman of the Metropolitan Sewerage Commission of that city. As Dr. Soper is detained at home by illness Dr. Alexander C. Abbott will present the paper.

DR. ABBOTT: Ladies and Gentlemen: At the June meeting of the Committee on Municipal Health and Sanitation held in New York City, it was decided to authorize one of its members to prepare a paper that would represent the joint views of the committee and that would offer certain suggestions along which lines of improvement of public health might be projected. Dr. Soper was good enough to offer his services, and the paper which I shall read to you has been prepared by him, has been submitted

to the committee, approved by each member of the committee, and in a general way represents the voice of that committee. There are, however, several features of this paper and phases of the subject that have been touched upon that are open to debate and doubtless will be debated by others as well as members of the committee.

Dr. Soper's paper, on "The Work of Boards of Health," which was then read by Dr. Abbott is printed in the Appendix.

THE CHAIRMAN: The paper which has been read will now be discussed by Dr. Abbott.

DR. ABBOTT: The time remaining at our disposal admits of but a brief discussion of Mr. Soper's interesting paper. shall restrict my remarks, therefore, to that phase of it which appeals to me as most important, namely, his reference to the functions of the boards of health, whether the duties of such boards should be restricted to the application of those fundamental safeguards known to prevent disease, or whether their efforts should be extended so as to include what he refers to in his paper as the "æsthetics" of public health.

I know of no community in which the routine public health work is done as well as it should be, or as well as those responsible for its administration would like to see it. Until, therefore, the machinery for the correct administration of the elementary principles of preventive medicine is so perfected that it will practically run automatically, and will guarantee efficient safeguards against the commonest and most conspicuous dangers to health, I think it would be extremely unwise to require health authorities to extend their operations into fields which may be of but a doubtful public health significance. In other words, I would prefer to see a few important duties well done, than many duties either imperfectly done or not done at all, except on paper.

Esthetics of
Public Health

I would scarcely regard it as a function of the board of health, unless all of its other work is perfectly performed, to enter upon the control of noises in a big municipality. That question could equally well be settled by the police department, and I believe it is the proper function of that department to settle it.

Again, I can scarcely regard it as necessary for a board of health to take up such a matter as the smoke nuisance, for when that question is approached from the health standpoint, a division of opinion is sure to arise, and my thought is that if a successful war is ever to be waged against the smoke nuisance, it will be more certainly victorious if the health question be left out entirely. There can be no division of opinion on the nuisance maintained by an atmosphere charged with smoke. It is destructive to property and is in every way unpleasant, and there would be no dissenters from the declaration that smoke in the air con

The Smoke
Nuisance

stitutes a common nuisance, but if an effort be made to declare smoke in the atmosphere a nuisance prejudicial to the public health there will be almost as much testimony that smoke does not cause disease, as there will be that it does, and little can be accomplished where such division of opinion exists.

I would put nothing in the way of the appropriate extension of work of a properly organized and supported health department; provided, as I said above, their fundamental duties are performed in as perfect a manner as possible, but I would insist upon that condition being fulfilled before the extension of their functions and dissipations of their energies be encouraged.

Insofar as I am acquainted with the organization of public health work in different municipalities in this country, I think we will find that their work has been pretty well cut out for them, if detailed attention be paid to the control of contagious diseases in their manifold aspects; if the systematic inspection of children in the public schools, together with the giving of help to such children as may be benefited, be conscientiously pushed; if prompt abatement of conspicuous nuisances, generally admitted to be prejudicial to the public health be the watchword, and if the control of the food and drink supplies, and the 'correct registration of vital statistics be conducted in conformity with modern views.

THE CHAIRMAN: Ladies and Gentlemen: Dr. Abbott is from Philadelphia. I might be pardoned breaking in here to say that once having last year been a resident of Philadelphia (involuntarily because the hospital claimed me) I could have differed with the doctor as to the effect of noise on health and until the physiologists have changed the dicta we find in the text books, that the best gas to breathe is a combination of oxygen and nitrogen and that nicotine and carbon added do not improve it, I shall have to feel for myself that excessive smoke as well as excessive tobacco are both inimical to real healthy conditions as well as to real pleasant conditions.

But I am not in this discussion. Dr. J. S. Edwards, Superintendent Pittsburgh Board of Health, will speak on the subject from the Pittsburgh point of view, if he is so minded. [Applause.]

DR. EDWARDS: The last few years have witnessed a rapid advancement in the work of health boards. This is due chiefly to the increased knowledge of the causation of disease, especially that class of diseases coming under the category of "preventable," knowledge based upon scientific facts established in the laboratory by students and workers, both public and private. The application of this knowledge to preventive medicine has put the work of health boards upon a rational basis, in which obsolete traditions and quackery have no place.

Progress has been aided as well by the attitude of society, which is organizing to fight preventable diseases and to correct those conditions which tend toward physical deterioration of the race. No better evi

dence of this is needed than the study of the program of this convention, which gives a prominent place to a consideration of those conditions which make for the physical uplift of man. This attitude of society opens up new fields for the work of the health officer, and spurs him on to the attainment of results made possible by the spirit of cooperation. In his work there can be nothing of the mysterious or spectacular, nor can he surround himself with a halo of convention. He must take the public, whom he serves, into his confidence, and demonstrate, by common sense methods and definite results, that their confidence is not misplaced. Prepared as he should be by his position and its opportunities for gaining a practical knowledge of public health matters, he becomes the leader of the public in the application of the principles of sanitary science and the need for compliance with the rules and regulations neccessary to carry them out. Were the purpose of rules and regulations better understood, there would be fewer violations.

The Attitude of Society

Violations of health laws are frequently due to the lack of knowledge of their purpose or utility. In cases where violations are due to indifference or viciousness, the only remedy is the governmental "big stick." To put it more concretely-the public must be taught such things as the principles of prevention of communicable diseases, and the need of enforcing the regulations governing their control; the dangers of bad milk and the necessity for measures directed toward its improvement; the danger of impure water, of stream pollution, of bad housing conditions at home and in their places of work; the necessity for eradicating breeding places for flies; the proper care and feeding of infants; and the many things which concern their welfare as individuals and the welfare of the state. Many, the majority, will profit thereby, applying the knowledge gained to themselves, and become instructors and agents in bringing others into line. It remains for the health officer to protect the willful and the ignorant in spite of themselves, for the larger purpose of protecting others. Much of the most fruitful work of health boards lies in securing the active and continued efforts of private or unofficial agencies, thus enlisting a vast constituency to supplement and aid official work ere bringing them into closer touch with the public. The importance of this is well illustrated in this city by the work of various organization directe to the improvement of municipal affairs. Among others may be mentioned the Allegheny County Medical Society which, through its milk commission, has been carrying on a campaign of education for an improved milk supply-a movement carried on with the main object of securing good milk for Pittsburgh, and of supplementing the work of the health bureau;

By the work of the Civic Club and of the Chamber of Commerce, in educational and constructive measures having for their object the improving of housing conditions in the city;

Unofficial
Agencies

By the work of the Chamber of Commerce in holding a dairy and milk contest for producers, bringing them to a better practical understanding of the necessity for the adoption of improved methods of handling milk, through a frank discussion of the question with expert authorities;

By the work of the Tuberculosis League and of the State Tuberculosis Dispensary in the prevention of tuberculosis;

By the work of agencies outside of the city, but working harmoniously with its best interests;

By the Pittsburgh Survey, whose work has made for sociological advancement; and

By the Typhoid Commission, made possible by the Russell Sage Fund, working not only to find out the causes which produce typhoid in this city, but also to advance the fund of general knowledge as to the etiology of this disease and its relation to social and industrial conditions.

The education of the public in sanitary matters, and the coöperation of all social organizations, public and private, with the health officer is essential to progress. But in bringing this about, the everyday duties and routine of administration must not be neglected, but must be regulated from a business and commonsense point of view. Spectacular or sensational short-lived campaigns will not accomplish much if they are not followed by sustained and systematic effort. On the other hand, those not in touch with administrative difficulties frequently become impatient of results.

The idealist and theorist in sanitary matters may point out the way and suggest lines of progress, but the real and lasting results are accomplished by the practical sanitarian, who in his official capacity presses onward, marking his advance by prejudices removed and administrative difficulties and limitations overcome.

Spectacular
Campaigns
Ineffective

The essential function of health work is the prevention of disease, more especially that class which is known to be communicable. The importance of this has long been recognized everywhere, especially for the subclass of so-called contagious diseases. Recently other diseases, notably tuberculosis, have been added to the category of those coming under administrative control.

In measures of quarantine, isolation and disinfection, efficiency depends to a great extent upon the intelligence and coöperation of the public, and still more upon the medical profession. In order to secure this, the rules and regulations governing these measures must be based upon scientific knowledge, and the natural history of the disease to which they apply. The non-essentials must be eliminated. Interference with the wage-earners' means of livelihood and with school attendance must be minimized as much as possible, compatible with the safety of the public. Unnecessarily stringent rules and regulations often defeat the very purpose for which they are intended by putting a premium on the non-report

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