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PUBLIC-HEALTH SUBJECTS 
 
 BEFORE THE 
 
 AMERICAN SOCIAL SCIENCE ASSOCIATION 
 
 ft ft 
 
 AT SARATOGA, N. Y., SEPT. 5-8, 1882. 
 
 THE MICHIGAN PLAN FOR GENERAL BOARDS OF HEALTH, 
 CARE OF CHRONIC mEBRIATES, HOUSE-DRAINAGE, 
 HEALTH OF CRIMINAL WOMEN. 
 
 REPORTED BY 
 
 HON. LEROY PARKER, OF FLINT, MICH., 
 
 President State Board of Health. 
 
 [Reprinted from the Annual Report of the Michigan State Board of Health, for the 
 
 year 1882 .] 
 
 [Reprint No. 137.] 
 
PUBLIC HEALTH SUBJECTS 
 
 BEFORE THE AMERICAN SOCIAL SCIENCE ASSOCIATION, AT ITS 
 MEETING IN SARATOGA, NEW YORK, SEPT. 5-8, 1S82. 
 
 BY HON. LEROY PARKER, OF FLINT, MICH. 
 
 Gentlemen of the State Board of Health: —In accordance with your 
 request, I attended as the representative of this Board, the annual meeting of 
 the American Social Science Association, held at Saratoga, Sept. 5, 6, 7, 
 and 8. 
 
 The meetings of the Association were more numerously attended than ever 
 before, and an unusual degree of interest was manifested in the proceedings 
 of the various departments. This was particularly noticeable upon the day 
 devoted to the Department of Health, when a number of interesting and 
 instructive papers were read, and some valuable discussions had upon the 
 various topics presented. 
 
 The meetings of this department were presided over by Dr. Walter Chan- 
 ning, of Boston, who for the past two years lias acted as chairman of the 
 Department of Health. Much of the success which attended this and the 
 previous meeting has been due to the careful and judicious management of Dr. 
 Channing in selecting timely subjects for presentation, and able and expe¬ 
 rienced sanitarians to prepare the papers to be read. A change in the Secre¬ 
 taryship of the Department of Health was made at this meeting, Dr. Ezra 
 M. Hunt, of Trenton, New Jersey, Secretary of the New Jersey State Board of 
 Health, being elected to succeed Eliza M. Mosher, M. D., of South Framing-, 
 ham., Mass. | 
 
 Dr. Channing in his opening address stated that correspondence among the 
 members of the Health Department had brought forward two prominent! 
 subjects for discussion, as follows: “Inebriety,” and “The influence of! 
 places of detention on the health of females,” which were presented in papers 
 read before the association, the first by Dr. A. N. Blodgett of Boston, and the 
 second by Eliza M. Mosher, M. D., Superintendent of the Massachusetts 
 Reformatory for Women at Sherborn, Mass. 
 
 Dr. Channing said, in reference to boards of health: 
 
 I cannot look at the vast work which has been accomplished by boards of health within the past 
 few years without amazement. Coupled with this surprise, I have a feeling of the liveliest satis- 
 faction; for in these boards I see the beginning of that rational struggle with disease which soon 
 will check our rapid progress toward physical degeneration. Dr. Farr, the great English specialist 
 in this branch, once said: “How, out of existing seed, to raise races of men to divine perfection 
 
NEED FOR BOARDS OF HEALTH. 
 
 329 
 
 iis the final problem of public medicine and this problem health boards have already done much 
 to solve. Only in the year 1869 the Massachusetts Board of Health, the pioneer State board in 
 America, was formed. We find in section 2 of the act which created it the following words, which 
 in some measure explain the contemplated nature of its work: “The board shall take cognizance 
 of the interests of health amt life among the citizens of the Commonwealth; shall make sanitary 
 investigations and inquiries in respect to the people, the sources of disease, and especially of 
 epidemics; the sources of mortality and the effects of localities, employments, conditions, and cir¬ 
 cumstances on the public health.” 
 
 Dr. Henry I. Bowditcb, of Boston, known far outside of Massachusetts as a prominent physician, 
 and a man of remarkable humanity and kindness, had the subject of sanitary science very deeply 
 at heart, and it is to his clear-sighted vision and appreciation of the needs of his fellow-men that 
 much of the success of this first board is due. He was its first chairman, and. in his opening 
 address he said: “Our work is for the far future as well as for the present.” It is not to be sup¬ 
 posed, however, that he even dreamed of what has already been accomplished in the thirteen years 
 since his address. 
 
 The only way in which it seems possible to account for this discovery, as it may be called, of 
 “ boards of health,” is that the time was ripe for their advent. We have found our nineteenth 
 century civilization bringing with it many, even innumerable advantages, improvements and 
 ameliorations, but we have found associated with these things a great variety of diseases. We 
 have civilized whole continents, built magnificent cities, turned night into day, conquered time, 
 but have lost the art of healthful living. Happily, however, the advances in medical science dur¬ 
 ing the last quarter of a century have established a more rational method of regarding disease, 
 and have brought us to think less of cures and more of prevention. This progress in medical 
 science, combined with the great pressure that has been made on us by the diseases of civilization, 
 so long unheeded, has obliged us to turn our attention in this direction. Furthermore, human 
 nature itself has become more rational and reasonable, and less inclined than in former times to 
 be pacified, cheated and cured by the mysticisms, panaceas, and dogmas of a well-meaning but 
 often misguided medical faculty. Education has made the masses less influenced by superstition, 
 and though investigations in hygiene were made prior to the establishment of boards of health, it 
 was not until after that time that systematic investigations were made. Increased knowledge of 
 the laws of health have educated the people to recognize that such laws are in force and must not 
 be neglected, but obeyed. While yet far from accomplishing all that can be done, the gigantic 
 work still goes on bravely, and it is to be hoped not only the faculty but also the laity will assist 
 in its furtherance. The terrible infant mortality in New York and other cities, for instance, 
 makes us painfully aware of the vastness of the work to be done. Dr. B. W. Richardson said 
 recently that he had never seen a perfectly healthy child, and it might be safely said that no child 
 was born free from the taint of disease. It was inherited defects which accounted largely for the 
 enormous infant mortality. These remarks indicate one of the directions in which health boards 
 should work. Other fertile fields of inquiry may be found in nervous diseases. A whole genera¬ 
 tion of nervous invalids has sprung into existence, reaching from simple irritability into fully- 
 developed insanity. The causes must be found in a wide study of American life, and they are 
 indeed multifarious. Continuous over pressure extends into professional and business life, and 
 the struggle to meet these extravagant demands becomes harder. Excessive education of boys 
 and girls of tender age is another evil. The minds of some will not retain the knowledge poured 
 in, but with others the pressure makes a break. Boys here have a great advantage over girls. In 
 the education of the future it will be imperative that more attention be paid to the physical edu¬ 
 cation and less to mere intellectual development. This attention is already beginning to be paid. 
 
 I We should, as an association, study deeply into the subject of heredity; the physical education of 
 girls and boys; domestic employments; the causes of nervous disease and insanity. 
 
 Dr. Ghanning closed his valuable address by quoting some words from Dr. 
 Oliver Wendell Holmes upon the progress in the art of prevention. 
 
 The opening address by Dr. Channing was followed by an exceedingly 
 interesting paper prepared by Dr. Henry B. Baker, Secretary of the Mich¬ 
 igan State Board of Health, which I here present in full: 
 
 THE MICHIGAN PLAN FOR GENERAL BOARDS OF HEALTH. 
 
 So far as known to the author of this paper, the Michigan State Board of Health was the first 
 board of health purposely established on its plan,—which plan may be briefly outlined as follows: 
 It provides for the collection and dissemination of information, and the general advisory supervis¬ 
 ion of all health interests of the people within the State; but does not give the Board power to 
 enforce any orders, other than those connected with its functions just stated. I say “ purposely 
 established,” because there have been and there still are many local boards of health which, 
 
330 STATE BOARD OF HEALTH—REPORT OF SECRETARY, 1882. 
 
 although theoretically supposed to he effective organizations lor the public safety, yet are so ham. 
 pered by lack of power and means which should be given them by the city council, or other local 
 authority, that they can do little or nothing for the public good. Such local boards may get hints 
 of methods of useful work, which even with their limited means they could adopt, from study ot 
 methods employed by the Michigan State Board of Health; but the theory of the law in Michigan 
 is that the local boards of health should have the power, and should do the work of combatting 
 local nuisances and all other local causes of sickness, including the restriction of contagious 
 diseases. The State Board was established to serve as a generalizing center; to do for the local 
 boards somewhat as the general does for the troops in the time of war,—ascertain the whereabouts 
 of the enemy, spy out and give -warning of the very first indications of threatened approach of an 
 epidemic disease, secure prompt report to headquarters of every item of information which can be 
 made available for the good of all, study up the best methods of drill and warfare, and communi¬ 
 cate the same to the several local officers and men who are constantly emploj^ed in the real -work 
 of combatting the enemies, which in this case are not very infrequently the same as in time of war, 
 namely, human beings, who think that they have interests different from and antagonistic to 
 those of the great majority. In such cases the local health authority needs to know just what it 
 can do, and the State Board of Health organized on the Michigan plan, can usually respond immed¬ 
 iately to the question by references to the law and to best methods of procedure. But oftener 
 than such demands for information come those on the occurrence of a communicable disease, such 
 as scarlet fever, diphtheria, or small-pox, when the local health board, which has usually never 
 before had to deal with such a case, needs to know immediately what are the measures which need 
 to be inaugurated and maintained until the danger is over; then if there is a State board of 
 health on the Michigan plan, appeal to it for instruction can usually have as ready response as an 
 appeal to a commanding general for orders, and the best available knowledge (which has resulted 
 from the collection of the information of the best methods of any or all of the local boards of 
 health) can immediately be placed at the disposal of the local.board, thus enabling it to do in its 
 emergency vastly better than would otherwise be possible. 
 
 That, in order to avoid or prevent a disease we need to know its cause, is considered a truism: 
 yet little general systematic effort to gain such useful knowledge is being made, nor is it likely 
 to be made, unless by some such means as by general boards of health. For any progress in the 
 knowledge of the causes of diseases, facts and statistics of great numbers of cases of sickness 
 from these diseases, and of the conditions which were coincident with such sickness, are essential; 
 and such facts and statistics cannot, by any local board, be collected in sufficient numbers, nor 
 over sufficiently wide areas, to throw out the influence of local circumstances; so that for any such 
 progress in knowledge it is essential that there be a general board of health to collect and collate 
 the fragmentary material which the local boards of health can supply, and from It learn the laws 
 which prevail in the production of disease and death. For such work, also, time is required, and 
 a more continuous length of service than is usual for local boards of health to give, because of 
 political and other changes. Until very recently there has been no material progress in 
 knowledge on such subjects; yet enough has been learned to show that such knowledge can 
 readily be gained by systematic efforts to obtain it. There is, apparently, no difficulty in learning 
 the causes of every disease. Sanitarians know enough to begin and carry on the study, the 
 collection and collation of the necessary facts, and the experimental proof of the modes of the 
 production of disease. They are ready to do this work as fast as governments are sufficiently 
 intelligent to appreciate it. They wait for governments because though it is work which benefits 
 all mankind, unless mankind through its organized governments provides recompense, the benefit 
 to the individual worker is not sufficient compensation; they can make more money as physicians 
 treating the people for diseases which the people do not know enough to avoid or prevent, but 
 which they pay roundly to be treated for when once the sickness has come upon them. 
 
 But such boards of health as we have known in the past could never ascertain the causes of 
 diseases. As well might one expect the soldier in the field, loaded down with his knapsack, his 
 rations, and his weapons, and fighting with a musket, to be able to learn the exact whereabouts of 
 the enemy’s forces and his reserves, and be able to plan and successfully execute a battle. The 
 commanding general does not carry a musket. So the general board of health needs to be free 
 from the immediate battling with local nuisances; and the- larger the nuisance, the greater is the 
 necessity for freeing the general board from combat with it. The Massachusetts State Board of 
 Health was first organized on the theory that the gigantic nuisances in the State were to be dealt 
 with by it. That Board did good work, but no one will deny that while engaged in the celebrated 
 case of “Tyler et al. vs. Squires et al.,” etc., it could not, as otherwise it might, devote all its 
 energies to searching out the causes of diseases, nor towards generalizing and systematizing the 
 public-health work of its State. That Board maintained its existence for about ten years, and 
 then ceased as an independent and separate board,— its functions, however, in its present 
 condition as a mixed board becoming more nearly like those of the ideal general board—on the 
 Michigan plan; although the public health, being only one of several subjects considered by the 
 present Board, it may not receive that undivided attention of specialists which the importance of 
 the subject warrants. 
 
MICHIGAN PLAN FOR GENERAL BOARDS OF HEALTH. 
 
 331 
 
 At the time, and long previous to the time, the National Board of Health of the United States 
 was organized, the author of this paper pleaded* and here continues to plead for the maintenance 
 of that general board of health, which shall do for the United States what a State Board of Health 
 on the Michigan plan aims to do for a State — a commission or board which shall systematize and 
 utilize the vital statistics in the United States Census, and all the information now collected by 
 all the Government departments, and which should otherwise collect and disseminate information 
 essential to the best imblic-health work in this country. 
 
 If the United States will maintain such a generalizingcenter of public health work in this country, 
 we shall soon see the grandest progress that the world has ever witnessed; for it will set in oper¬ 
 ation a movement which cannot fail to yield knowledge of the conditions under which each and 
 every disease proves destructive of human life and happiness. But in this most important work 
 which a government can undertake for a people—a work which is designed to accomplish a greater 
 amelioration of their condition than has any previously undertaken in this or any other country,— 
 it is essential in order to secure the best results, that the central generalizing body shall have 
 the confidence and co-operation of the great body of sanitarians throughout the whole country, 
 and of a large proportion of the local and State boards of health, whose work is by it to be consoli¬ 
 dated for the public good. Such has been and is the case as regards the National Board of Health; 
 but the government has recently taken a much regretted step backward by abolishing one of its 
 means of prompt dissemination of information, namely, the weekly bulletin, and by crippling one 
 of its sources of information,—that by its inspection systems, which had just begun to yield infor¬ 
 mation valuable for incorporation with that from other sources. 
 
 Members of Congress seem to be unable to appreciate the fact that movements for the preven¬ 
 tion of diseases, are of vastly greater importance than are those measures designed simply to 
 palliate the results of the neglect of such prevention; for we learn from the Congressional 
 Record that recently large sums of the public money were freely voted to build hospitals fora 
 small, special class of citizens, or at least persons, while these same Congressmen failed to vote to 
 freely sustain the National Board of Health in its work, which is for the good of every citizen of 
 the country, and even for humanity throughout the world. Palatial marine hospitals in each 
 large sea port, for the special benefit of a few sailors, sick with syphilis and other preventable 
 diseases, may be proper objects for Congress to spend the people’s money for; but sooner or later 
 stinging criticisms will attach to such action by our representatives; especially if, as was recently 
 the case, the neglect to provide the means for the most successful work by those charged with the 
 highest duties which can be undertaken,—inquiries into the causes and best means of preventing 
 all diseases which are yet permitted to interfere with the “life and the pursuit of happiness,” 
 by those who maintain this government for the people. 
 
 Comparatively little has yet been done in this country toward the systematic work which has 
 been suggested in this paper; for the reason that individual effort cannot accomplish it, and those 
 we elect to govern us have not all informed themselves on the subject. Sanitary science is one of 
 the latest sciences. It utilizes sciences which also are new. Already with reference to several 
 of the most important diseases, it enables us to predict their proportional increase or decrease 
 just as far in advance of their occurrence as the meteorologist can foretell the weather; thus giv¬ 
 ing, in general terms, the curves by seasons, and even by months of the year; and we are able to 
 add to this the specific prediction of the proportional increase or decrease for the immediate future 
 within about the range of probability reached with respect to the weather, upon which the partic¬ 
 ular diseases referred to greatly depend. Butin such studies it is needful to include facts rela¬ 
 tive to wide areas; in fact what the United States signal service gains for meteorological progress 
 by being able to generalize its work throughout the whole country, may easily be paralleled by 
 the gain in sanitary science by a similar broadening of the field of view, from local and State to 
 that of a properly sustained National Board of Health. Whenever that is done, the signal service 
 itself will have its usefulness wonderfully enhanced, because its work will be made available for 
 rise in saving human life in ways not now imagined by many people, yet which those most actively 
 engaged in public health work know, are not only possible but are entirely practicable. May the 
 day soon come when we may be permitted to see such beneficent results. 
 
 The paper by Dr. Baker was discussed by Secretary F. B. Sanborn, who 
 State Boards of Health should be invested with administrative 
 
 thought that 
 
 powers; that the outbreak of epidemics of small-pox and other diseases 
 dangerous to the public health could be better checked and suppressed by the 
 action which the State boards might take, than if administrative functions 
 were permitted to local boards alone. 
 
 * Pages 356and 360, Trans. Am. Med. Asstn, 1S74. Also pages 15-18 Reports and Resolutions Belating 
 to Sanitary Legislation, presenter! to the Am. Pub. Health Asstn., at its meeting in Richmond, Va. 
 Nov. UM52, 1S7S. Riverside Press, Cambridge, Mass., 1878. Also Vol. IV., Trans, of the Am. Pub. 
 Health Asstn. 
 
332 
 
 STATE BOARD OF HEALTH—REPORT OF SECRETARY, 1882. 
 
 In reply to Mr. Sanborn’s remarks, I advocated the theory of Dr. Baker’s 
 paper, and contended that it was not necessary for State Boards of Health to- 
 be invested with power to actively engage in dealing with particular cases of 
 dangerous disease; that the local boards could more effectively deal with the 
 cases within their jurisdiction than a State Board, whose members might be 
 remote from the place where a dangerous disease showed itself. That in our 
 State the aim had been to emphasize the system of local boards, and to throw 
 the responsibility of caring for diseases upon the municipalities themselves. 
 
 As an introduction to Dr. Blodgett’s paper on Chronic Inebriates, Dr. 
 Channing in his address made remarks of which the following is an 
 abstract:— 
 
 TVeare told that insanity has greatly increased during the last few years, and if we turn to 
 asylum reports for an explanation of this statement we see many causes assigned. Sometimes it is 
 ill health, business anxiety, family affliction, religion; sometimes more remarkable causes, such as 
 the following, which I saw mentioned recently: “Slander, fear, fright, remorse, revenge, anxiety, 
 spirit rappings, camp life, loss of law suit,” etc. At the asylum where these statistics were 
 tabulated, 5,052 patients had been under treatment since 1S55, and the assigned causes in these 
 cases were physical in 2,070 cases, moral in 1,260, and unknown in 1,722. We do not doubt that these 
 causes were the direct and exciting ones. But were there not many others? Could the moral be 
 separated from the physical causes ? Did not the heredity of the patient play a part ? Notwith- 
 standing the inference to be drawn from the medical testimony in the recent Guiteau trial, that 
 heredity is not of much account, I fear that we must agree with Dr. Richardson and others that it 
 is of vast importance. But the causes of nervous and mental disease are most varied and complex, 
 and we shall make a sad mistake if we attach too much importance to one element only of this 
 involved causative. 
 
 If we search for causes of mental and nervous instability in our daily life we shall be at once 
 impressed by the fact that our lives are too full; that we are laboring under a heavier load,, 
 socially, than we are able to carry. There is too much to be done. There is too much literature, 
 too much art, too much music, too much science, too many theatres, too much dress, too 
 much social gayety. Such a multiplicity of important objects in life wearies and overtasks 
 our mental powers, and renders us less able to successfully struggle against the cares and 
 responsibilities that are imperative. If Mr. Bert is right when he says, “ When you educate 
 boy, you perhaps educate a man; and when you educate a girl you are laying the foundation for 
 the education of a family,” we cannot well over-estimate the importance of the proper physical 
 education of young persons, especially girls. 
 
 Dr. Blodgett pursued the same topic in his long paper, and said, among 
 other things:— 
 
 The expression of increased nervous excitability is observed in nearly all the ordinary walks of 
 life, and in all conditions of people. Within the memory of most of those present there have been 
 such changes in the personal observation of each one as to verify this assertion. The causes are 
 manifold, and reach into almost every avenue of life. The abolition of principle, which is to the 
 mind what the pole-star is to the mariner, is one of the most fatal accidents which can befall any 
 individual. Its absence leaves the mind without a proper degree of rectitude; without that neces¬ 
 sary steadfastness of purpose and consistency of method which are essential to healthy and vigor¬ 
 ous mental activity. Weakness and debility of the mental functions must as surely follow its loss 
 as physical infirmity succeeds the loss of any material condition of animal life. The cumulative 
 result of this defect is continually augmenting, like that of the opium habit, or any other profound 
 and growing influence operating upon the foundations of being in the individual. Business specu¬ 
 lation has been a powerful agent in disturbing the mental equilibrium of very many people within 
 the past few years. Increased mental vulnerability of our population is caused by changes in the 
 private and domestic life of the people. The aggregation of people in large cities tends to injure 
 the home life, and its quiet restraint and peaceful influences are lost to those natures which most 
 need them. If, now, unfortunate individuals become the slaves of passion or appetite, in any 
 specific form, their bondage will be more oppressive from the lack of a powerful will to resist, 
 and a firm principle to guide, and the danger from encroachments of other vices will be augmented 
 owing to diminished power of self-control due to the degeneration or abolition of standard mental 
 qualities. Human nature cannot indefinitely support the increased strain to which a continually 
 enlarging number of persons is continually exposed. Natural food and natural rest will not pro¬ 
 vide for unnatural and superhuman exertion. There is a limit to all healthy energy. Beyond this 
 limit labor is acomplished only at the expense of vitality. In this extremity—which is exactly the 
 condition in which a large number of our people find themselves—the use of artificial stimulants is 
 
CAEE OF INEBRIATES. 
 
 333 
 
 necessary in order to follow an irrational and insane ambition. There is a sensation of exhaustion, 
 which imperatively demands the aid of a stimulant, and is temporarily relieved by its employment. 
 The individual is led to think that the remedy has been found, and continues the use of an agent 
 which has afforded such marked benefit. Any article which thus becomes necessary to the per¬ 
 formance of daily labor may gradually acquire such power over the individual that the force of 
 habit, combined with the physiological action of the substance, may at length render all efforts at 
 its abandonment entirely futile. The cumulative effect of prolonged over-stimulation is two-fold: 
 first, the action upon the nervous system as a spur by which an extra amount of energy may be 
 temporarily evolved, with a gradual encroachment on the normal powers of the organism, until no 
 extra energy can be awakened except from the effect of stimulation; and second, a change in the 
 physiological and organic relation of the structural elements composing the nobler functional 
 organs, with gradual degeneration of the higher mental and moral qualities, so that the founda¬ 
 tions of character are undermined, and the powers of reason are perverted, while the emotions 
 and sympathies are excited to increased activity, and the unfortunate individual becomes a slave 
 to sudden and irresistible impulses. 
 
 It is, therefore, not strange that the victim of drink often becomes a charge to society. lie 
 should not be considered a hardened criminal but a sick and diseased person. These persons 
 should be treated, but there is not an institution nor an establishment adapted to give them reme¬ 
 dial or curative treatment, or for their care, if incurable. These victims are {generally found 
 among the poorer classes and are brought to notice through the commission of crime, though his 
 lack of moral perception may be entirely wanting. Of the institutions founded to treat these 
 unfortunates, some are conducted by private enterprise to make money, and those established by 
 government at public expense. The first has many defects, the first being that the patient is a 
 boarder and is kept only as long as he pays, without regard to his condition. Also the patient dis¬ 
 likes the restraint, and often leaves before cured. The only institutions recognized by govern¬ 
 ments for such patients are prisons and madhouses, from whose walls he emerges with an indelible 
 stigma. In view of the existing facts, we are safe in asserting that no wise, humane, and practical 
 plan has been found to insure protection to society and justice to the individual. To suggest a 
 remedy is not so easy. There must be, however, a suitable disposition of authority which shall 
 place these people within the control of some restraining force. There must be a judicious 
 amount of physical toil to induce fatigue and desire for sleep, open air life, strong and nutritious 
 but unstimulating diet, regular habits, and abundance of sleep. 
 
 Dr. Blodgett’s paper was earnestly discussed. President Wayland said if a 
 drunkard can be cured he should be in a reformatory, and if he cannot be 
 cured he ought not to be outside of one. 
 
 Judge Peabody, of New York, said the drunkard was insane, not only as 
 regards his appetite but in other respects. He is responsible for the course of 
 conduct which has brought about his insanity. 
 
 Rev. Mr. Huniphstone believed that drunkenness was a disease. 
 
 Dr. Channing differed from Mr. Huniphstone and contended that drunken¬ 
 ness was a crime. 
 
 Rev. Irenaeus 0. Prime, editor of the New York Observer, earnestly insisted 
 that intemperance was a crime and not a disease. It begets disease. Crime is 
 sin against God and man, and that is what intemperance is. This is not a ques¬ 
 tion to be looked at in the light of remedies for disease ; not what we shall do to 
 cure men of intemperance as we cure men of small-pox and the fever and ague. 
 Physicians and social scientists who teach this doctrine have committed an 
 immense injury to the cause of reform of our unfortunate fellow men, because 
 they paralyze the arm put forth to save them, and set us upon a track which 
 has hitherto lamentably failed in its efforts to save and reform. The remedy 
 for this great evil was in the hands of the State, and the way to do that was 
 to prohibit the sale of intoxicating liquors. We must legislate to destroy the 
 source of the evil. If it is-a disease, let the law arrest it. If it is a crime, 
 apply the law to stop it. 
 
 A paper prepared by Dr. Ezra M. Hunt, Secretary of the New Jersey State 
 Board of Health, upon the health care of households, with special reference 
 to house-drain age, was read, of which the following is an abstract: — 
 
I 
 
 334 
 
 STATE BOARD OF HEALTH-REPORT OF SECRETARY, 1882. 
 
 The term house-drainage, as now most frequently applied, has reference to the removal of all 
 soiled liquids, and of such offaling, secretions, and excretions as are easily or naturally reduced to 
 a liquid or semi-liquid state. 
 
 The principal fact as to this removal is that it shall he made without undue delay. The rule is 
 that in a health-preserving or disease-breeding sense, no such liquid or offaling is objectionable 
 until 12 to 18 hours after its production or voidance.* Hence all arguments as to the insanitary 
 effects of its handling, or of its conveyance to rivers, are futile, if only you can insure prompt 
 delivery. To call it filth , in a diseased sense, at the start, and to argue against its conveyance 
 because it has odor, or, because of detention, it becomes pestiferous, is no more reasonable than 
 to judge tomatoes unwholesome because decayed tomatoes are sickening. This point is important 
 to be made, because so many arguments as to river-pollution, or as to the evils of other transporta¬ 
 tion and delivery of sewage, are based upon the assumption that fresh sewage is unsafe. It is 
 only unsafe to those who store it, or who do not succeed in getting rid of it before it becomes 
 stale. The one centre problem to solve in house-drainage is, how to get clear of fresh sewage. 
 
 An answer often, and perhaps always in order, is to have as little of it as possible. If a proper 
 care is taken not to over-produce in certain directions; not to use water extravagantly; to prop¬ 
 erly separate such dry material as does not necessarily find its way into 'water-carriage, and thus 
 to fairly limit quantity in feasible directions, much of the evil arising from needless accumulation 
 Avould be prevented. 
 
 A second answer, in many cases, is to apply the principle of separation and separate dealing with 
 different products, as well as that of quick removal. Thus, in a small garden, it is very proper to 
 throw the Monday wash-water around the grape-vines, and the dish-water of each day around 
 some other selected plants in succession, when it would not be feasible to throw all in one place 
 or to throw some of the products in any visible place. The principle of division of labor as 
 required by plants is as applicable as when applied to animals. It is with this view that there are 
 many advocates of a dry-earth system which seeks to take charge of the more solid excreta, to 
 carefully select all garbage, and then to jiass to the flush tank and drain-tile system, or small 
 sewer system, all other composit liquids. 
 
 Where there are no sewers, the close application of methods of separation is of the greatest 
 importance. The laundry and kitchen slop fluids can be largely disposed of upon the lawn, or in 
 a cultivated strip of the garden. Garbage can be separated for punctual delivery, to classes not 
 difficult to find, if only there is this kind of selection. The ashes are carefully sifted for admixture 
 with the excreta, or dry earth is made the safe deodorent and disinfectant therefor. The greatest 
 objection to it is that it serves as a kind of excuse for the longer retention of refuse about the 
 house, which is of doubtful propriety, as the rendering innocuous is not always perfect. 
 
 Where this separating plan is adopted, the same kind of care as to material used for conveyance 
 is to be employed as where the conveyancer is a pipe. Since the vessels are at times open, and so 
 traps do not avail, soap and water, scrubbing, airing, and drying, and all cleanliness come largely 
 into requisition. Tubs should be metal-lined, or so handled as to secure them against saturation; 
 the kitchen sink should always be of metal that admits scrubbing, and the delivery pails equally 
 adapted. The garbage-barrels should be of size, shape, and material adapted to quantity, and 
 should be replaced by a cleansed one each time there is removal, and so secure the advantage of a 
 prompt replacement by a vessel that brings back neither particles nor odors of what was carried 
 away. 
 
 The earth-closet must also have its mode of use and frequency of earth removal, such as to 
 avoid all odors, or all possibility of a retention of stored filth instead of clean dirt. It is too often 
 forgotten that the closet must have its well-aired room, of easy access to draughts, and that the 
 commode used must be so left and kept as to admit of the freest circulation of air. Without this 
 there comes a confined smell and a mawkish, sluggish air, both uncomfortable and unhealthy. 
 Every law as to ventilation applied to a house water-closet needs equal provision and enforcement 
 where an earth-closet is kept. Indeed, the rooms or places in which any vessels are kept, which 
 are used for soiled liquids, garbage-tubs, etc., need more care of ventilation, dryness, and sunlight, 
 than do any other parts of the building. 
 
 It must be remembered as to all rooms in which garbage or other material is being separated for 
 removal, that fresh, pure air, free from undue dampness, is a great desideratum. It is a chief 
 objection to cellar kitchens or to underground store places for refuse, that the absence of light, 
 the dampness and the impeded circulation of air afford conditions favorable only to the lowest 
 forms of vegetable life, and that these seem easily to invade animal life as found in man. 
 
 The first principles of house drainage are, (a) that wherever there is a sink, bowl, closet, or any 
 other contrivance for the reception of slops or excreta, it must be made of such smooth, non-ab¬ 
 sorbent material as will not retain either soiling or odor and be so accessible as to admit of the 
 free use of soap and water; (6) that at, or near the joining of the out-going pipe to such receptacle, 
 
 * [Dr. Hunt would probably not assert this of sewage containing excreta from persons sick with 
 specific or communicable diseases; cholera, however, being one disease of which the statement is 
 generally believed to be true.—H. B. B., Sec. S. B. of EL] 
 
HOUSE-DRAINAGE. 
 
 335 
 
 there should be a trap or seal which will not admit of the return of any gas through it; (c) that 
 beyond that trap and at the exit of the pipe from the building, there should be free opportunity 
 for the circulation of common air. This generally means that at The point where tlie main house- 
 pipe emerges from the building, there should be such communication of the pipe itself with the 
 outer air as to freely admit it. 
 
 The complaint that the water which forms the trap is soiled and absorbs gases from the outer side, 
 so as to pass them within, does not seem to be sustained unless the liquid itself is already poison, 
 or the trap is so seldom used as to allow the trap-water to become intensely stale or to evaporate 
 entirely away. Because this often occurs in summer hotels during their disuse the rest of the 
 year, it has been proposed to remove all the traps at the end of a season, empty them and fill them 
 with oil, or pour down enough oil to force out the water in the trap. That water trap is most per¬ 
 fect which is just deep enough to make a complete seal, which is so smooth as not to retain any 
 organic matter, and which is of that shape which leaves the least inside surface untouched by the 
 flowing stream. It is because an S-shaped trap leaves less than a D that it is generally preferred. 
 Such traps as the Bell trap are disapproved because, in addition to an unwashed surface, they 
 provide a kind of small local cesspool. There is a slight modification sometimes from the S trap 
 such as w r e see in the Adee, to provide against possible syphonage in some cases, to which we shall 
 allude hereafter. 
 
 The Bower trap is a specimen of kinds which do not rely entirely on a water seal, but use the 
 water to float a ball or control a valve so as to close against the inflow of foul air. * * * 
 
 But a still brighter and better idea has of late supplemented the science and the art of a sweet 
 home. It is that the gases of decay, as found in house pipes or servers are mostly the result of the 
 deprivation of common air in circulation: that the way to avoid sewer or house gas is not to make 
 it, and the way not to make it as to correct it, if it exists, is to allow every pipe to be thoroughly 
 flushed and cleansed by the active circulation of pure air. That is the valuable thought on mod¬ 
 ern house drainage or sewerage. It is so to construct pipes as that at each extremity there shall 
 be the best opportunity for the ingress or egress of common air. It is for this reason that it is now 
 insisted that every main soil-pipe should have an opening above the roof, and another as it emerges 
 from the building, with no trap intervening in its course. It is assumed that all the pipes leading 
 into it from closets, etc., on the different stories, will be so short as that their connection with the 
 main pipes will secure for them a draught sufficient to dispense with that opening at each end, 
 upon which as a rule we depend for draught. 
 
 This principle of a soil-pipe permitting the free ingress and egress of common air is now, we 
 think, the ruling idea of house sewer-pipe arrangement. Details are not as yet completely set¬ 
 tled. We need a little more testing and computation to assure us when and where not there will 
 be such currents in pipes open at both ends, as will secure a sufficient flush of air. What is the 
 best size of tube; how in case of stagnant or insufficient current activity is to be secured; how far 
 the main tube can be depended upon to secure ventilation of side tubes; how far heat may be made 
 available as a motor of air in tubes; and many such questions not difficult of solution when accu¬ 
 rate tests in sufficient numbers shall be made. * * * Only we must be sure that in our pipes 
 
 air actually does flow as we believe it does. Every chimney does not draw enough, and every 
 tube heavy with foul or damp air does not have current enough. 
 
 An adequate draught here is not merely for carrying away, but for oxidation and other chemical 
 transformation. A large bellows blowing into a pipe will purify its air faster than water, while 
 suction not only displaces but propels the sewer air. 
 
 Alternate air-flush and water-flush can therefore be said to be the modern disinfectants for 
 pipes. We are yet to be assured just how best to make sure, sufficient currents of air through 
 pipes. We are to remember a calibre of from 4 to 6 inches is needed, that the ends should be so 
 situated as to command, and perhaps in some large cases have funnels like those of a large ship, 
 which can be turned so as to command draught. 
 
 If the house sewage is to go to sub-soil pipes, or to a house cesspool, or if there is an outside 
 privy, these of themselves may cause soil pollution or air pollution, if in near proximity to the 
 house. 
 
 Where the sewage is conducted to ft tank like Field’s flush tank to be distributed to loose laid 
 pipes undergrounds, two principles are made available. One is that the automatic flush every few 
 hours removes the liquid soon enough, and at the same time scours or cleanses by the force of its 
 motion. The other is by this intermitted flow air and water do alternate purifying service in the 
 pipes, while at the same time the sewage is distributed so few inches underground as to allow of 
 its natural appropriation by the herbage and crops. In the use of this plan, careful but not diffi¬ 
 cult administration is necessary, in order that the lank may be kept in cleanly condition, and not 
 become a cesspool, and that such tillage is used as enables the soil to appropriate the plant food 
 placed within it, thus preventing soil-pollution. 
 
 Where a cesspool is or has to be tolerated, there are two methods. The one is to have a cesspool 
 that is made without cemented bottom, or in whole or in part with the sides laid with loose stone 
 or brick, so as to allow all liquids to soak out, carrying with them much organic matter. This 
 
336 STATE BOARD OF HEALTH—REPORT OF SECRETARY, 18S2. 
 
 soakage will continue longer if the grease from liquids is separated before discharge into them. 
 The apparent success of this method will largely depend upon the character of the soil. If it is of 
 a loose or gravelly character, so as to admit air and liquids freely, no doubt much of this matter is 
 oxydized or llows off, even where too deep to be reached by the roots of grasses, plants, or trees. 
 But in all cities there is a limit to this process, and it is often fraught with risk in country places. 
 We know of a recent outbreak of typhoid fever, in which, owing to a change of strata at one point* 
 and a dip contrary to the contour of the surface, the sewage found its way around and into the 
 Avails of a cellar basement, and so without much odor saturated the building. In other cases 
 unusual heat of a season brings this unappropriated manure which has thus been lodged in the 
 soil into fermentative activity, and administers it to persons instead of to plants. In other cases 
 the debris which has been left in the uncleaned cesspool itself takes on degraded decomposition 
 and administers its own attenuated and peculiar poison to a household. The cesspool system, 
 therefore, needs always to be labeled “extra hazardous,” although au explosion cannot be tvar- 
 ranted each Summer. 
 
 The other cesspool system is to have a closed tank or cistern thoroughly cemented, and then to 
 depend on odorless excavating apparatus to empty it at proper intervals. Although these are 
 often crooked or seamed, as a rule they prevent soil pollution, and so are preferable to the unce- 
 mented ones. The emptying should, as far as possible, be done in late fall and early spring, 
 although perfection of method is now claimed to justify emptying at any time. 
 
 Should cesspools be ventilated or exposed to light? It is claimed by some that either air or light 
 in contact Avith stagnant filth or befouled liquids tends to excite them to decomposition, and so do 
 not mitigate such concentrated evils. 
 
 The other view is that light and air prevent the more degraded forms of decomposition, and so 
 moderate the evil. 
 
 No doubt these stagnant pools do provide themselves Avith a kind of scum or protection Avhich 
 partly seals them from the air, and for a time they are less nocuous than if disturbed. We think 
 the best sustained conclusion is that it is better not to expose them to sunlight, because of sun- 
 heat, but that it is better by means of an open tube or chimney, ora kind of double chimney, to 
 secure circulation of air between the top of the liquid and the ground level. Cesspools should in 
 all cases be as far removed as possible from the dwelling, so that the air about these may not be 
 directly contaminated. As to pipe connections by the methods already indicated, we believe all 
 influx of air from them or from other forms of sewers can be prevented. Having thus pointed out 
 the means for house sewer drains and their immediate connections, we leave it for others to apply 
 the same general principles to more extended sewers. 
 
 The paper by Dr. D. F. Lincoln, on The Sanitary Condition of Boarding 
 Schools, was read only by title, and it was announced that it would be pub¬ 
 lished in full in the Sanitary Engineer. 
 
 THE HEALTH OF CRIMINAL WOMEN. 
 
 An interesting paper on this subject by Dr. Eliza M. Mosher, of the Sher- 
 born Reformatory for Women, was read. The following is an abstract:— 
 
 The Avord criminal, though commonly applied to the inmates of penal institutions, includes in its 
 strict sense, all persons who commit an offense against law, Avhether convicted or otherwise. In 
 America the number of such persons within the precincts of each state, depends not only upon the 
 amount of its population, the stringency of its laws, and the vigilance of its police force, but 
 also upon the number and size of its cities, and the industries which it carries on. Wherever men 
 and women are herded together, as in the poor and squalid portions of large cities, or great 
 numbers are employed at special work, as in our manufacturing towns, there will be found those 
 influences which make criminals of men, and even more surely of women. 
 
 The physical condition of individuals often deteriorates pari passu Avith the moral nature, 
 especially in those cases where intemperance and unchastity are the underlying vices. 
 
 To study the diseases of such a class, with the hope of arriving at any but the most genei'al 
 conclusions is a formidable task; and yet, since the inmates of our jails, houses of correction, and 
 prisons are but representatives of a much larger number, Avho walk our streets, scattering 
 contagion, both moral and physical, and filling our hospitals and dispensaries with patients, it 
 seems Avorth Avhile to see Avhat can be deduced by a careful examination of a number sufficiently 
 large to represent the class. The object of this paper is, therefore, to ascertain if possible the 
 extent and direction of the influence which a life of crime exerts upon the health of individuals; 
 and, as our observations have been mainly confined to criminal women, avc have limited our study 
 to this class. The statistics which avc shall present have been taken from the records of the 
 Massachusetts State reformatory prison for Avomen, and extend over a period of four years. 
 During this time 2,196 Avomen Avere committed to the prison for crimes which, for the sake of 
 
the health of criminal women. 
 
 337 
 
 convenience, we have classified under the following heads, viz.: I. Offenses against person and 
 property. II. Offenses against chastity. III. Offenses against public order. 
 
 The first class includes all the cases of assault, fraud, larceny, arson, burglary, manslaughter, 
 etc. In this class we find but 310 commitments; the larger number of these women were of foreign 
 birth or parentage; their ages range between 15 and 53 years; nearly all could read and write, and 
 about half were unmarried. Many were sentenced tor the first time. 
 
 In the second class there were 515 commitments. Of those a majority were natives of the United 
 States and British Provinces; most of them could read and write, and more than half were 
 unmarried. 
 
 The third class includes the cases of drunkenness, vagrancy, disturbers of the peace, 
 common railers and brawlers, idle and disorderly persons (which is but another name for 
 drunkenness and unchastity), etc. There were 1,271 such women committed, mainly of foreign 
 birth; among the number were many old women, though the average age was about 30 years. A 
 large number could neither read nor write, and fully three-fourths were married. 
 
 It is 9 afe to say, that of the whole number committed during the lour years, more than four- 
 fifths were intemperate, and more than three fourths were unchaste. 
 
 Turning now to the hospital record, we find 2,076 cases of illness during this time. Some of these 
 were readmissions of the same individual. A small proportion were infants, which, with the 
 cases recorded under the head of “slight ailments,” we have thought best to exclude from our 
 analysis, thus leaving 1,704 cases of illness, of which a careful diagnosis was made, and a, c*. 
 
 symptoms and treatment kept. Upon tabulating these, we find syphilis to be the prevailing 
 disease, 305 cases being on record; to these might be added as many more in whom the disease was 
 not in a sufficiently active form to make their admission to the hospital a necessity. With these 
 figures before us, it is safe to conclude that one woman out of every four committed to the prison 
 was syphilitic. Thirty-two of these cases were found under class I, 100 under class II, and 173 
 underclass III. Of the 100 women sentenced for larceny, who were sick in the hospital during 
 
 the last two years, 86 were know r n to be unchaste. 
 
 Next in frequency we find cases of alcoholism, of which there were 198; of these U 1 were found 
 in class III., 11 and 16 in classes I. and II. respectively; 25 cases of delirium tremens occurred, all 
 but two of which belong in class III. There were 139 cases of tonsilitis, which were very equally 
 distributed among the three classes; 101 of these occurred during the winter of 1878 and ’79. Dys¬ 
 pepsia and rheumatism were common ailments, though but 63 cases of each were sufficiently acute 
 in character to need admission to the hospital. The number treated from the dispensary was large. 
 These patients were as widely distributed as the habit of intemperance. 
 
 Only 30 well marked cases of insanity were recorded during the four years, and several of these 
 were recommitments to the prison of women who had been transferred to a lunatic hospital dur¬ 
 ing a previous sentence; 20 of the 30 belong under class III.; also 12 of the 15 epileptics who found 
 shelter in the hospital. Paralysis, neuralgia and hysteria prevail most largely in class I., in pro¬ 
 portion to the number of commitments; here also are found the greatest number of cases of anoemia 
 and diabetes. Of the seven cases of puerperal fever which occurred, five belong to class II., 
 (offenses against chastity), also eight of the cases of masturbation placed under special treatment. 
 Diseases of the eyes, malarial fever, miscarriages and pulmonary consumption occur in excess also 
 in the second class. Of the last named disease, there were in all 28 cases, in most of which the dis¬ 
 ease was established when the women were admitted to the prision. But four cases of pneumonia 
 andei^ht of pleurisy occurred; 21 cases of bronchitis were treated in the hospital; 72 cases of 
 uterine disease were sufficiently severe to need hospital care for a time; a large number ot women 
 
 were able to work, but required medical supervision. 
 
 Coming now to the surgical patients, we find but 32 cases in class I. against 65 in class II. and 16- 
 in class III. Abscesses and ulcers occurred in great numbers, as might be expected in a popula¬ 
 tion like this. Rectal diseases also were common. Twenty-four deaths occurred among adults at 
 the prison during the four years; of this number, one died of alcoholism, two of apoplexy, one o 
 brain softening, one of diabetes, one of oedema, one of gangrene of the lungs, one of heart disease, 
 one of entero-colitis, two of peritonitis, five of consumption, one of puerperal fever two commit¬ 
 ted suicide, and five died of syphilis. Seventeen of these were found under class III., four under 
 class I. and three under class II. The danger of contagion with so many syphilitics congregated 
 together was great, and complete isolation in many cases was an absolute necessity. If committed 
 for less than two years, they had to be set at liberty before a cure could be perfected, perhaps to 
 
 become again a source of pollution. , , 
 
 The condition called alcoholism, so often seen in our penal institutions, is one of general Repres¬ 
 sion, following long continued stimulation by intoxicating liquors, with lack of proper oot . is 
 manifested by trembling of the hands and tongue, twitching of the facial muscles, profuse per¬ 
 spirations, an unsteady gait, and incoherence of thought and expression. One woman out of every 
 11 admitted to the prison was taken into the hospital in this condition. Under a nutritious diet, 
 and rest in bed, these patients soon recovered sufficiently to go to work, but many returned to the 
 
338 
 
 STATE BOARD OF HEALTH—REPORT OF SECRETARY, 1882. 
 
 hospital later on, with some other ailment, most often dyspepsia or rheumatism,—those strong 
 allies of intemperance. Some of the cases of delirium tremens were exceedingly violent, but no 
 deaths occurred. Dyspepsia and constipation of the bowels were the two affections of the digest¬ 
 ive tract most common among the prisoners, often taxing the skill and patience of the physician 
 more than many severer maladies. Most of the cases of rheumatism were of a chronic character. 
 The small number of cases of pulmonary disease leads us to conclude that affections of the res¬ 
 piratory organs are not a necessary accompaniment of prison life; proper food and clothing, good 
 ventilation, and a fair amount of sunlight, being here, as everywhere, their best preventive. There 
 have been 68 births at the prison; of this number but one mother died, although many were so 
 diseased that their infants died before or shortly after birth. Diseases of the reproductive organs,, 
 though common, were not disproportionate to the number of women committed. Among the sur¬ 
 gical cases, indolent ulcers, mainly of the leg, were of frequent occurrence, often detaining women 
 in the hospital for weeks who otherwise were able to work. Some of the cases of rectal disease 
 were of long standing, and exceedingly severe in character; while others were so simple not to 
 need admission to the hospital during treatment. An examination of the foregoing cases leads us 
 to the following conclusions: 1. Intemperance and unchastity are the two vices which fill our 
 penal institutions with women. 2. The influence of these vices is detrimental to health of body, 
 increasing its susceptibility to disease, and lessening its recuperative power. 3. The diseases 
 which follow as a direct result of these vices, are syphilis, alcoholism, dyspepsia, rheumatism, and 
 g^msiai ancemia. 4. Morbid conditions of body react upon the moral nature, increasing and per¬ 
 petuating the tendency to criminality; hence the importance of careful medical supervision, as a 
 reformatory measure. 5. More ample provision should be made in all large cities for the isolation 
 and thorough treatment of venereal patients of both sexes, either by the addition of special wards 
 to the general hospitals, or by the establishment of hospitals exclusively for this class. 6. The 
 women who commit high crimes only, that is, larceny, burglar}', arson, manslaughter, etc., possess 
 a more sensitive nervous organization than those who commit offenses against chastity and public 
 order. 
 
 After the reading of this paper Mrs. Leonard of Springfield opened the 
 debate on it, by speaking of the general characteristics of criminal women, and 
 what is done for their moral reformation at Sherborn, touching also on the 
 Lancaster industrial school for girls, and what it accomplishes for younger 
 persons of the same class. 
 
 A paper on “ International Relief in War” was read by Miss Clara Barton, 
 in which the history, the work accomplished, and the objects and aims of the 
 “Association of the Red Cross,” an international association for the relief of 
 sufferings by war, pestilence, and famine, and other great national calamities, 
 were set forth in an interesting and scholarly manner. 
 
 This paper concluded the series read before the Department of Health. 
 
 LeRoy Parker. 
 

UNIVERSITY OF ILUNOI8-URBANA 
 
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