THE

REPORT

OF

BOARD OF HEALTH.

1.-REPORT OF THE PRESIDENT.

I have the honor to submit herewith the fifth annual report of the board of health for the year ending the 30th of September, 1876.

In view of the fact that, at the last session of Congress, a law was passed appointing a commission for the purpose of making and presenting a plan for a new government for the District of Columbia, I think it opportune to review the proceedings and operations of the board of health during the five years of its existence. By this means, I may be able to impart to the commission and to Congress information useful in securing necessary sanitary protection to the District of Columbia. The history of communities has demonstrated the fact that individually man does not act in the preservation of the whole as in that of his own immediate interests, treating affairs of general import as abstract questions which he neither studies nor analyzes. This fact has given rise to civil organizations which in their corporate capacity act for the masses. The individual, having thus surrendered labor and responsibility to the government, remains generally indifferent, and submits to its authority. Thus individual responsibility has greatly decreased through the false assumption that the government should perform individual duty. This surrender of duty and responsibility on the part of the citizen has greatly added to the labors of governments, and widened their scope and sphere of action.

If man would do unto others as he would have others do unto him, there would be no necessity for police, courts, or prisons. If he would construct his house, drain his lot, build his road properly, there would be no necessity for boards of public works. If he would maintain cleanliness, observe and practice the laws of sanitary science, there would be no necessity for boards of health. But the individual does not do this; he has transferred these duties to the government, and therefore he holds himself free from any responsibility in the matter. If the road is not level or safe, he has the gratification of grumbling against the board of public works. If his closet is overflowing; if his garbage is reeking in his household; if the small-pox attacks him; if typhoid fever lays him low; if cholera, diphtheria, or the plague turns his cheerful household into a sorrowful sepulcher, he inveighs against the board of health. He feels no little relief in the belief that others, and not himself, are responsible for the calamity. He fails to look at home for the causes of the scourge; nay, he would probably scorn a suggestion to that effect, lest his observations may lead him into self-accusation. So long as this is the case, so long there will be a necessity for govern

ment, and particularly for such government as has reference to the health and safety of the people. In older countries, this indifference is so well understood that governments protect the people in spite of themselves. Man is not permitted to kill himself by recklessness or indifference; he is not allowed to go where his life may be in danger. The central government of France relies for advice in sanitary matters on the consultative committee of public hygiene; in England, on the health-officer to the privy council. From these high councils emanate all the sanitary laws that govern their respective countries.

In this country, boards of health are comparatively new institutions, and are not organized except in a few cities; and where legislators have failed to understand their scope and jurisdiction they are deprived of the necessary authority and means of support. New York, Boston, and Washington are probably the only three cities in the Union whose boards of health have been clothed with authority essential to

success.

It has heretofore been the custom of intrusting matters of health to committees of assemblies or city councils, composed generally of men ignorant of sanitary science, and little or nothing was accomplished in the way of sanitary reform.

In 1797, the District of Columbia was set aside for the seat of gov ernment of the United States, and General Washington made the plan for the city which was named after himself. The plan was on a mag. nificent scale, and may be taken as Washington's prophecy of the wonderful growth and prosperity of the new country. The ground selected for the city lay between Georgetown and the Eastern Branch, and a large portion of it was low and swampy. Under the auspices of the Government, the population, from that of seven thousand in 1797, has attained the remarkable proportion of one hundred and fifty thousand, and Washington is now the eleventh city in the scale of population in the United States. During these seventy-three years of transition and development, the city has passed through eighteen governmental administrations, and probably forty municipal; yet in 1871 this board of health found a flagrant nuisance known as the Washington Canal, which, in the emphatic words of Professor Henry, was "an open cess-pool, a fruitful source of discomfort and disease, receiving the sewage direct in its midst, and inconsistent with the intelligence of the age." This canal, traversing the city from Rock Creek to the Eastern Branch, passing within a few hundred yards of the White House, the War, Navy, and Treasury Departments, through the Agricultural, Smithsonian, and Botanical gardens to the very doors of the Capitol itself, its shores abounding in malarial poison, and the people abandoning its neighborhood as the Romans flee from the nightmantle of death of the Campagna. It moreover found hundreds of lots below grade, covered with stagnant water, endangering the lives and health of the residents of the neighborhood; hundreds of alleys, recepta cles of house offal, giving rise to dangerous effluvia that found its way into the windows of inhabited dwellings; hundreds of hovels, the abode of the poor, with leaky roofs, damp walls, no privy, or water-supply, and unfit for human habitation; hills of ashes and filth in open lots, the accumulation of many years; thirty thousand privy-boxes, many in bad condition or overflowing, and subject to an occasional emptying by a most barbarous and crude system, the operation of which awoke our citizens from their peaceful slumbers to shut out the stench from their sleepingrooms-the scavenger coming in the dead of night like a thief, afraid to be observed; house offal and garbage accumulated in large quantities in yards, subject to a vicious system of removal that cost the city $25,000

per annum; slaughter-houses strewn among our populated districts that claimed as a raison d'être the time they had been allowed to remain and carry on their filthy work in our midst; no quarantine laws or regulations to prevent the incursion and spread of infectious and contagious diseases; no bureau of vital statistics to record births, deaths, and marriages, and to prevent crime; no control over cemetery-superintendents or undertakers, so that persons were buried with or without a physician's certificate, whether death had occurred from poison or violence, small-pox, yellow fever, or cholera-the dead were put away under the sod and no questions asked, unless glaring and unmistakable evidence of foul play existed; no inspection of food, so that meats from blown to decomposed were sold in open market unobserved; no inspection of marine products, so that thousands of bushels of oysters, clams, and other fish unfit for human food found their way from the shambles of the vender to the consumer's table; domestic animals running at large, imperiling life and destroying ornamentation; thousands of hog and cow pens, the inhabitants of which found comfort and food in our alleys, streets, and parks; and innumerable other nuisances were discovered here, tolerated by the apathy of the citizens or their unsanitary authorities.

Thus Washington, the capital of this proud nation, where the President, his cabinet, the foreign ministers, and three thousand officials reside; where Congress and all citizens having business with it congregate, had, under this maladministration, this culpable neglect, acquired the unenviable name of being a city of disease, filth, and dust; a city which all prudent persons deserted during summer and fall, to flee from intermittent, remittent, and typhoid fevers. This general exodus for so many months paralyzed all business, so that hotels and many businesshouses were closed during the summer, and the few people who remained for want of means to get away sweltered in the summer heat in all the discomforts of a neglected and abandoned city. Such was Washington in old time.

Finally, in 1871, Congress came to its relief. It created a board of public works, which, with boldness, sagacity, and judgment, instituted reforms, built hundreds of miles of sewers, laid a great number of pavements, planted millions of trees, and in every way changed the aspect and prospect of the city. It created a board of health, whose duty is "to declare what shall be deemed nuisances injurious to health, and to provide for the removal thereof; to make and enforce regulations to prevent domestic animals from running at large in the cities of Washington and Georgetown; to prevent the sale of unwholesome food in said cities; and to perform such other duties as shall be imposed upon said board by the legislative assembly."

The wisdom of this law creating a board independent of all local and political influence was early apparent, for the legislature of the District, affected by the prejudice of the ignorant and the interests of political tricksters, became openly inimical to the board. The present board was organized about April 1, 1871. It divided itself into five permanent committees: a sanitary committee, having in charge all matters pertaining to nuisances, sanitary science, &c.; an ordinance committee, for the proper construction of ordinances, rules, regulations, and contracts; a finance committee, for expenses, payments, and accounts; a sanitary police committee, for the examination and recommendation, as well as for the observation and investigation of the conduct of the employés of the board; a committee on epidemics, for suggestions,

plans, and measures for the prevention of threatening epidemics and the means to abate the same when present.

To the constant vigilance of these committees is due the success of the board of health. Besides this organization and parceling of labor, the board elected from its own members a president, a secretary, a treasurer, a registrar of vital statistics, and an attorney; also a health-officer. Af ter two years, finding that the health-officer's duties were such as to require his whole time, it was decided to employ a health-officer under pay of the board. The board was appointed by the President and confirmed by the Senate. It is composed of three physicians, a lawyer, and a merchant. The board has public meetings twice a week, often three times, in which all subjects are debated and voted on with open doors. This organization has worked admirably for five years, and its labors have been acknowledged not only at home but abroad, and even by foreign governments; and although the physicians of the board thus appointed are of different schools of medicine, no jar, dissension, or discussions ever occurred regarding the theory and practice of medicine.

Now what has this board accomplished in the five years of its existence? The deadly canal was first to come under its ban. It was condemned, and the board of public works, through the demands of the board of health, buried it, like a carrion, under 15 feet of earth, and built over it a monument of enterprise and beauty, a grand road flanked by trees and gardens. The alleys are daily inspected, and, when foul, reported to the board of health, who make a reference and recommendation to the honorable Commissioners for the cleaning of the same. Hundreds of houses unfit for human habitation have been condemned and abated. The heaps of dirt and ashes are no longer seen in neglected and vacant grounds. Privy-boxes are constantly inspected, and not permitted to overflow as of old; and the barbarous system of removing night-soil by buckets has been replaced by an odorless system carried on during the day, without giving offense to the most delicate olfactory or violating the least sense of propriety. And this important service is done at 20 per cent. less than the cost of the old reprehensible method. The dumps that used to surround our city and alarm our people have disappeared, and the filthy material is now taken away by railroad in air-tight barrels, twenty miles into the country. Garbage is not allowed to accumulate in houses, and although the service is under the control of another department of the government, the board of health exercises that supervision necessary for the proper accomplishment of this important work. The slaughter-houses scattered in our midst have been condemned by the board and removed beyond the boundaries of the city. In this connection it is proper to state that the board has several times in their annual reports recommended the establishment by Congress of an abattoir for the District of Columbia, where the slaughtering might be done under its supervision and inspectorship. Not until such a law is passed and enforced will the District of Columbia be rid of this incorrigible nuisance.

CONTAGIOUS DISEASES.

Rules, regulations, and instructions for the prevention of the spread of epidemic infections and contagious diseases have been promulgated under an act of the legislature passed June 19, 1872, as requested by the board of health. In the fall of 1871, it became apparent that the small-pox had become an epidemic in various cities of the United States, and particularly in the neighboring cities north of Washington,

with which it has constant intercourse. In December, it was introduced here from New York, and in a very short time it prevailed to an alarming extent among the poor classes, and among the negroes particularly. There existed then no law or any authority by which to assume control of the scourge. But the board of health assumed the duty and the responsibility. It ordered general vaccination, and sent its officers from door to door to perform this duty without charge. Pure animal vaccine matter was supplied gratuitously by the board, and upward of sixty thousand people were vaccinated free of charge. It established a temporary hospital, provided itself with ambulances and disinfectants. It appointed a corps of inspectors for the removal and care of the afflicted ones; and the infected apparel was at once destroyed or disinfected. Whenever a person could not be properly isolated in his dwelling, he was removed to the hospital, his house disinfected, and all proper protection thrown around the members of his family or the people inhabiting the same dwelling. A boarding-house was established at the hos pital, so that the persons employed in removing small-pox cases or in disinfecting houses and clothing should be removed from the company and association of others. Telegraphic communication was established between the board-rooms and the small-pox hospital, so that at a touch of the wire ambulances and employés were quickly at work. Rules were promulgated that all physicians and citizens should report cases of smallpox to the board of health. Whenever a case was isolated in the house of a patient, a warning flag was hung at his door. In this manner, an epidemic that suddenly threatened to invade this whole city was confined to the quarter infected, and speedly stamped out. The city was so unguarded that before preparations could be made hundreds of cases were reported. As soon as the board of health grappled with it, it began to decrease, until it disappeared altogether. We had in all 1,738 cases, and yet not a dozen cases occurred among that intelligent class of citizens who observed the orders and regulations of the board.

The small-pox was raging while Congress was in session, and yet its members were scarcely aware of its presence; not a Senator, member of Congress, foreign minister, nor member of the cabinet suffered from the disease.

The board of health, being aware of the importance of a bureau of vital statistics, applied in vain to the local legislature for a bill providing for such a bureau. The local legislators had interests at variance with the board of health; they had votes to secure, and preferred to listen to the complaints of their prejudiced and ignorant constituents, rather than to the appeals of the board of health. We then appealed to Congress, and on the 23d of June, 1874, it passed an act "that it shall be the duty of the board of health of the District of Columbia to make and enforce regulations to secure a full and correct record of vital statistics, including the registration of deaths and the interment of the dead in said District;" and, in the words of the registrar, "the practical result of the enforcement of these regulations is to place under immediate observation the number of deaths occurring in the District, the cause and locality of each, enabling the board to arrest the spread and progress of epidemics, endemics, contagious or infectious diseases, and promptly abate existing causes of preventable maladies; to secure a perfect registration of marriages, births, and deaths, for testamentary evidence; and to bring all cases of death under immediate official observation for the prevention and detection of crime." That this important work may be comprehended, let it be illustrated: no dead person can now be buried indisinterred, or transported from the District of Columbia without a permit from the board of health.