* 
 
 
 
 7 
 
 x v 
 
 
 
 the duties of the local health officer. 
 
 BY HENRY B. BAKER, M. D., SECRETARY OF THE STATE BOARD OF HEALTH, 
 
 A paper read at the Hastings Sanitary Convention 
 
 Dec. 1888. Reprinted from a Supplement to 
 
 the Annual Report of the Michigan State Board of Health for the year 
 
 [Reprint No. 297.] 
 
 Inasmuch as our health officers exist for the purpose of protecting us from 
 dangerous diseases, we may get an idea of what are them most important 
 duties by finding out what are the most important dangers from which they 
 
 ^In^McMgan the five diseases which cause the most deaths are: Con¬ 
 sumption, diphtheria, pneumonia, typhoid fever and scarlet fever. 
 
 pas a- 
 
54 
 
 HASTINGS SANITARY CONVENTION, DEC,, 1888. 
 
 DIPHTHERIA. 
 
 Concerning diphtheria, which is next to the most fatal disease, health 
 officers in Michigan now generally know how to restrict it, and thereby to save 
 hundreds of lives. If you ask how do we know that they know how, I 
 reply, some of the health officers in Michigan are doing this all the time, and 
 we have the facts to prove it; and to prove how it is done. For instance, in 
 
 1886, 464 outbreaks of diphtheria were reported to the office of the State 
 Board of Health, and the health officers were requested to report just what 
 was done to restrict the disease, and how many cases occurred in each out¬ 
 break. If under one method of work or neglect to work the disease spreads, 
 and under some other method of work the disease does not spread from the 
 first cases we can find it out if we devote sufficient thought and work to the 
 compilation of the reports which the health officers make, provided they 
 report the exact facts. I am sorry to say that in about 240 of the outbreaks 
 the health officers did not report with sufficient accuracy so that we could 
 tell exactly what they did do; but in about 200 outbreaks they did report 
 distinctly, and of these about one-half had secured isolation of the first cases, 
 and the thorough disinfection of infected things, while the other half had 
 not secured both isolation and disinfection, although some of them had 
 secured one or the other of these important measures. Careful compilation 
 of all of these reports showed that in those outbreaks in which either isola¬ 
 tion of the sick, or disinfection of infected places and things had been neg¬ 
 lected, the disease had spread so that there were about five times as many cases 
 and five times as many deaths as there were in those outbreaks in which both 
 isolation of the sick and infected, and the disinfection of all infected places 
 and things had been accomplished. In the 116 outbreaks in which all this was 
 done there was apparently a saving of about 300 lives and 1,500 cases of 
 sickness from diphtheria. Of course it is easy to find fault, and to say: 
 “What a pity these measures were not carried out in all of the 461 outbreaks 
 instead of only in the 116,” but we should not lose sight of the fact that 
 there was a positive saving of several hundred lives, in a single year, from 
 one disease, and that the compilation of the reports proved how it was done 
 and how it might be done again, namely by thorough and careful isolation 
 and disinfection under the direction of a capable and efficient health officer. 
 And now very much the same thing has been done again, as is shown by the 
 compilation of the reports of the health officers in Michigan for the year 
 
 1887. 
 
 SCARLET FEVER. 
 
 What I have said relative to diphtheria is applicable, with slight variation, 
 to scarlet fever. The compilation of the reports of the health officers in 
 Michigan relative to scarlet fever during the year 1886, showed that in the 58 
 outbreaks in which disinfection and isolation had been thorough, the disease 
 had not spread much, while in those outbreaks in which isolation or disinfec¬ 
 tion had been neglected, there were over five times as many cases and over 
 five times as many deaths. The compilation of reports relative to scarlet 
 fever in the year 1887 has demonstrated that the year 1886 was not exceptional, 
 the saving of life and health was again apparent. 
 
DUTIES OF THE LOCAL HEALTH OFFICER. 
 
 55 
 
 TYPHOID FEVER. 
 
 The measures for the restriction of typhoid fever are not the same as for 
 diphtheria and scarlet fever, and the evidences of success have not yet been 
 so P well elaborated, but I feel confident that a considerable proportion of the 
 sickness and deaths from this disease may be prevented by measures which are 
 described in a pamphlet, copies of which are distributed in this audience. 
 Some of the essential measures need the efforts of the health officer to make 
 them most effective; but in all of these diseases the co-operation of the people 
 with the health officer is important. 
 
 WILL IT PAY TQ, HAVE A HEALTH OFFICER? 
 
 It is plain, then, that some of the most fatal diseases that afflict us may be 
 in great part prevented, and that much depends upon the knowledge and 
 efficiency of the local health officer. 
 
 It is plain, too, that the measures by which these diseases are prevented 
 are m/those which in old times we associated with the duties of the health 
 officer. The abatement of ordinary nuisances should probably be attended 
 to bv the health officer; but the abatement of nuisances may have very little 
 to do with the prevention of diphtheria or scarlet fever; while it is certain 
 that isolation and disinfection of infected persons and things will save lives. 
 
 But when the health officer comes into very close relation to cases of some 
 of these dangerous diseases, he must himself refrain from ^ oin f ' h ^f y t ° 
 some child to whom he may carry the disease; and so he must lose his prac¬ 
 tice. He will also lose much by the antagonism of those whose movements 
 he will cause to be restrained. Consequently, whenever there is an outbreak 
 of one of these disease, if he attends to his duties as health officer it ^ 
 probable that he must relinquish his other means of income Is ^ thepublic 
 nreoared to guarantee him say, ten dollars a day during the outbreak, is 
 the^public prepared to insure him against loss by reason of his necessary 
 action as an P efficient health officer? If not, is the public willing to g^e him 
 such a fixed salary as will induce the health officer to take his own chances 
 
 My belief is that, except in Detroit and Grand Rapids, there are few if any 
 cities or villages in the State where these questions have been properly metAn 
 the interests of the people. Therefore, either the bealth 
 it should be, as is the case in many places, or it is what it should be simp y 
 through the public spirit or philanthropy of some physician, as I am glad to 
 testify is the fact as regards many of the cities and villages in Michigan. 
 
 Perhaps you may think I am wandering from the subject of the duties of 
 the health officer, and am giving a rather broad hint as be» thes dutiesi of the 
 people or their representatives to properly support the health officer , but it 
 necessary to examine into the question in some such manner, m order to see 
 how it is possible to have a health officer who can afford to perform his duties 
 faithfully. Taking into consideration the prospective losses in various.ways 
 mv own view is that no physician can afford to file his oath of office in th 
 Sty of Hastings unless he is assured of a salary or. compensation averaging a 
 thousand dollars a year. Can the city afford to give that much. Let us 
 examine into the facts. 
 
56 
 
 HASTINGS SANITARY CONVENTION, DEC., 1888. 
 LIVES MAY BE SAVED IN HASTINGS, AND MONEY TOO. * 
 
 The population of Hastings is about three or four thousand. If its death- 
 rate is about the average, the annual deaths number about sixty. Then about 
 seven or eight of these are from consumption, about five from diphtheria, about 
 two from scarlet fever, and about two from typhoid fever. These numbers may 
 not be exactly true for last year, but for a long series of years they are an 
 approximately true average. y 
 
 lJ« r0m ^ e 8 ^ P fi enCe J 0fthe h6alth 0fficers in Michigan during the years 
 1886 and 1887, I have demonstrated that at least 80 per cent of the eases of 
 the sickness, and 78 per cent of the deaths from diphtheria are prevented by 
 those who secure, after the first case has occurred, complete and thorough iso¬ 
 lation and disinfection, such as an efficient health officer can secure when his 
 people co-operate with him for that purpose. Therefore the lives of at least 
 m H ? St ! n i 8 e . aa he saved each year, on the average, from that 
 dreadful disease diphtheria. There may be single years when diphtheria 
 com ®, to blastings, and then some parsimonious grumbler might wish 
 to cut down the salary of the health officer, perhaps after the same health 
 officer had in some way prevented the first case being brought in as for 
 instance, by preventing a public funeral over the body of one dead fromdiph- 
 tWrt aDd k rou Sht here for burial; but I think you can be assured tha/in 
 these days of rapid transit and constant movements among the people Has- 
 
 1S i m 0f havi ° g d , i P htheria brought he're in every year, and you 
 
 need a health officer constantly on guard and in close correspondence with 
 he central office at Lansing so that, at a moment’s notice, he may take action 
 to prevent the introduction, or if that is impossible, then to prevent the spread 
 
 of this one of the most dangerous diseases to which our children can be 
 exposed. 
 
 LIVES MAY BE SAVED FROM SCARLET FEVER. 
 
 Then, too, nearly the same remarks apply to scarlet fever as to diphtheria; 
 although m recent years the deaths in Michigan are not so numerous Yet 
 taking the average of years in Hastings, at least one death per year from 
 scarlet fever should be saved by prompt and thorough action even after the 
 disease has been introduced, and, of course, the most important service of 
 a health officer is to prevent the introduction of such a dangerous disease 
 
 CONSUMPTION SHOULD BE LESSENED. 
 
 Enough is now known of the causation and spread of consumption so that 
 this most important cause of death should be very greatlv lessened: and it 
 may be lessened by spreading among the people information concern¬ 
 ing its causes and just how it may be in great part prevented. An intelli¬ 
 gent and faithful health officer whose time was not otherwise demanded for 
 the prac ice of medicine to support his family, might do much to put before 
 the people whom he was adequately paid for guarding, the facts collected by 
 sanitarians and State Boards of Health which would enable the people to guard 
 against this diseas e which ^ is so fatal to them at those ages at which they 
 
 abou^tl^ a sarn^'number^of 
 
 -name of any such otherpl£cemay the word Hastings, wherever it occurs, the 
 
DUTIES OF THE LOCAL HEALTH OFFICER. 
 
 57 
 
 should be in the prime of life. At least one death a year in Hastings should 
 be saved from consumption. 
 
 LIYES MAY BE SAVED FROM TYPHOID FEVER. 
 
 ** Some one, familiar with the ways in which typhoid fever is spread, has said 
 that for every death from typhoid fever some person should be held crimin¬ 
 ally responsible. I should not agree with that, because I think that among a 
 large proportion of the people the ignorance which still permits the disease 
 to spread should be pleaded in extenuation. But intelligent health officers 
 can inform the people under their care how to restrict the spread of typhoid 
 fever, and how to do many things which tend to prevent the occurrence of 
 the first case in a community. At least one death a year in Hastings from 
 typhoid fever ought to be prevented; and the person saved would be most 
 likely to be in the middle age when his work would be most productive. 
 
 Thus an efficient health service, having thorough cooperation of the people, 
 should save in Hastings each average year, seven lives, five of the persons 
 being children and two grown persons. I do not say positively that exactly 
 so many were saved during the past year, but I do claim, that, on an average, 
 this number can be and should be saved over and above what would occur 
 without such effeorts as those I have suggested. I claim that the health officer 
 should earn and have a thousand dollars a year to supervise the work, and 
 that all of your people should aid him whenever it is necessary, and that ex¬ 
 penses should be incurred by the city and by individuals which might aggre¬ 
 gate another thousand dollars; and that your people would not only save 
 those seven valuable lives of children and friends most dear to you, but that, 
 by this outlay, money in excess of the outlay would actually be saved which 
 otherwise is lost, that is, if the money were judiciously expended and you 
 secured the efficient service which I have indicated. Let me point out just 
 how some of the saving would occur: — 
 
 THE MONEY VALUE OF WAGE-WORKERS. 
 
 Political economists sometimes estimate that an average man in the early 
 part of the productive period of his life will afterwards earn, over and above 
 what it will cost to support him, one thousand dollars. It is within the 
 memory of some of us that a healthy negro slave could be sold at the South 
 for eight hundred or a thousand dollars, and we will all admit that slaves were 
 not the most industrious persons either. Now if we save from death, and 
 in good health, two adult persons in Hastings in each year, we have saved 
 in money value to the families to which those persons belong probably 
 the full amount of the two thousand dollars a year, which I advise you to 
 spend on your health service. Then there are the five children which are 
 saved from dipththeria and scarlet fever. They have cost hundreds of dol¬ 
 lars for their maintenance, and if they die all is lost, but if their lives are saved 
 they will soon reach the productive age. They are worth to their families, 
 for what they have cost and will earn, say one-fifth the value of an adult 
 person—or another full thousand dollars which we may look upon as profits 
 on our two thousand dollar investment. A 50 per cent profit ought to satisfy 
 any taxpayer in the city. And if one of these children chanced to be your 
 own, or the adult, the bread-winner of your own family, the argument 
 
58 
 
 HASTINGS SANITARY CONVENTION, DEC., 1888. 
 
 should be convincing; but there is another alternative suggestion which is 
 illustrated by a remark that I recently heard at the meeting of the American 
 Public Health Association,—Dr. Smart, of the United States army, was 
 deploring the slowness of the people in public-health work, and said there 
 was little comfort to be had from the thought that years in the future when 
 your name is mentioned some one will say: “Yes, I knew him well; 
 he died, prematurely, eight or ten years ago, of typhoid fever.” 
 Well, precisely that may be said of any one of us, because the 
 
 safety of each one is bound up with that of others; no man lives to him¬ 
 self alone; not only is he his brother’s keeper, but his brother, his 
 
 fellow-citizen, and even a person in a foreign land may send him 
 
 something or do that which will endanger his life. In fact I suppose that 
 
 all of our dangerous communicable diseases are brought to us—we do not 
 create them, and much can be done by ourselves, by our families, by the 
 community, and by the health department of our local government (which 
 exists for our common safety and welfare) to protect us from diphtheria, 
 from typhoid fever, and from the other dangerous diseases which may be 
 prevented or restricted.