The health officer online

UNIVERSITY OF CALIFORNIA
AT LOS ANGELES




The Health Officer



By

FRANK OVERTON, A. M., M. D., D. P. H.

Sanitary Supervisor, New York State Department of Healtn



and



WILLARD J. DENNO, A. B., M. D., D. P. H.

Medical Director of the Standard Oil Company
Formerly Secretary New York State Department of Health



ORIGINAL ILLUSTRATIONS



PHILADELPHIA AND LONDON

W. B. SAUNDERS COMPANY

1920



Copyright, igio, by W. li. Saunders Company



Kv|>rinU-d l-'cbruary,



PHINTID IN AMIR1CA

PB88 OF

W. t. SAUNOERR COMPANY
PHILADtLPMIA



PREFACE



THIS book contains the information which the average
health officer must have in order to discharge his duties. It
tells the health officer what to do, how to do it, and why he
should do it. It describes the various activities in which a
health officer engages; his relation to boards of health, phy-
sicians, social agencies, and the public; his qualifications and
methods of work; the various diseases and unsanitary conditions
with which he deals; and the scientific principles on which the
specialty of preventive medicine is founded. It is the result
of the years of experience of the authors in public health work,
both in rural communities and in New York City, and as super-
visors of health officers under the New York State Department
of Health. While the book is designed primarily for health
officers, its simple language and untechnical form will commend
it to college students, public health nurses, members of boards
of health, social workers, teachers, and others who are interested
in public health work.

THE AUTHORS.



CONTENTS



CHAPTER I

PACE

ORGANIZATION AND POWERS OF A HEALTH DEPARTMENT 17

CHAPTER II

THE HEALTH OFFICER HIMSELF. .



CHAPTER III
THE LOCAL BOARD OF HEALTH ....................................... 34

CHAPTER IV
THE PUBLIC AND THE HEALTH OFFICER ...................... . . . . . 45

CHAPTER V

THE PHYSICIAN AND THE HEALTH OFFICER ........................... 50

CHAPTER VI
RURAL PUBLIC HEALTH WORK ............................. ........ 56

CHAPTER VII

RECORDS AND REPORTS ............................................... 63

CHAPTER VIII

STANDARD PROCEDURES ...................................... ..... . . 73

CHAPTER IX

LOCAL SANITARY CODE ............................................... . 81

CHAPTER X

VITAL STATISTICS ............................................... . ..... 97

CHAPTER XI
PUBLIC HEALTH NURSING ............................................. 112

CHAPTER XII
PUBLICITY AND EDUCATION ......................................... . . 119



CHAPTER

BACTERIOLOGY .................................................... . . 128

CHAPTER XIV
IMMUNITY ......................................... . ................. 140

13



14 CONTENTS

CHAPTER XV

PAGE

THE PUBLIC HEALTH LABORATORY 159

CHAPTER XVI
EPIDEMIOLOGY 168

CHAPTER XVII
THE MANAGEMENT OF A CASE OF COMMUNICABLE DISEASE 183

CHAPTER XVIII
THE MINOR COMMUNICABLE DISEASES 196

CHAPTER XIX
SMALLPOX 202

CHAPTER XX

DIPHTHERIA 212

CHAPTER XXI
SEPTIC SORE THROAT 225

CHAPTER XXII
SCARLET FEVER 229

CHAPTER XXIII
ACUTE RESPIRATORY DISEASES 236

CHAPTER XXIV
INFECTIONS OF THE DIGESTIVE ORGANS 254

CHAPTER XXV

INFECTIONS OF THE CENTRAL NERVOUS SYSTEM 267

CHAPTER XXVI
VF.NEREAL DISEASES 280

CHAPTER XXVH

TUBERCULOSIS 290

CHAPTER XXVIII

INSECT-BORNE DISEASES 301

CHAPTER XXIX
MISCELLANEOUS DISEASES 306

CHAPTER XXX

MENTAL DEFECTS 313

CHAPTER XXXI

VMKMIV . 327



CONTENTS 15

CHAPTER XXXII PAGE

MILK 344

CHAPTER XXXIII
FOOD SANITATION 371

CHAPTER XXXIV
FOOD VALUES 384

CHAPTER XXXV
SANITARY ENGINEERING 399

CHAPTER XXXVI
NUISANCES 406

CHAPTER XXXVII

THE DISPOSAL OF HOUSEHOLD WASTES 422

CHAPTER XXXVIII
SEWAGE DISPOSAL 434

CHAPTER XXXIX
WATER-SUPPLIES 449

CHAPTER XL
VENTILATION 465

CHAPTER XLI

INDUSTRIAL HYGIENE 477

CHAPTER XLII
CAMP SANITATION 482

CHAPTER XLIII
CHILD HYGIENE 488

CHAPTER XLIV

LIFE EXTENSION. . . 502



INDEX 507



THE HEALTH OFFICER



CHAPTER I

ORGANIZATION AND POWERS OF A HEALTH
DEPARTMENT

Departments of Health. The prevention of diseases has long
been recognized as one of the duties of a government. This
duty in the United States of America lies primarily with the
several states. Nearly every state in the Union has a depart-
ment of health to which various powers are given for the purpose
of suppressing epidemics, preventing diseases, and promoting
the strength and vigor of the people.

United States Public Health Service. The government of
the United States maintains an efficient organization, called the
Public Health Service, in order to deal with health problems
which are beyond the jurisdiction or power of the states. The
principal activities of the national organization are as follows:

1. The control of health work on vessels entering the sea-
ports of the United States and its colonies.

2. Detailed public health work on United States Govern-
ment reservations.

3. Advising and assisting state and local authorities, par-
ticularly in conditions which may effect the health of people in
adjacent states, as in the poliomyelitis epidemic of 1916.

4. Investigation, research, and standardization. Examples
of these activities are recording contagious diseases throughout
the w T orld, researches into the causes of typhus fever, and. main-
taining a supply of antitoxins of standard strength to be used for
testing purposes.

State Departments of Health. Experience has demonstrated
that the essential staff which is necessary for conducting pub-
lic health work in a state is as follows :

1. A central staff of technical experts, administrators, and
clerks.

2. A field staff to supervise the local workers in the various
municipalities.

3. Local health officers.

2 17



18 THE HEALTH OFFICER

The manner of organization of the staff differs widely in the
various states. The State Departments of Health of Pennsyl-
vania and Florida conduct all phases of public health work, and
the local municipalities have little or no legal duties or responsi-
bilities. The State Departments of Health of Michigan, Cali-
fornia, and Indiana are responsible for most phases of local work,
but many duties and responsibilities are lodged with the local
municipalities. The original public health laws of New York
State placed the responsibility for public health wholly upon the
individual cities, villages, and townships. The local municipal-
ities are still supreme in carrying out the details of public health
work. Broad general powers are also given to the State Depart-
ment of Health, although they are not always clearly defined.
New York State may be classed among those states in which the
responsibility for local health work is placed jointly upon the
state and the local municipalities.

The activities of the health departments of some states are
merely statistical and advisory, and in these states the work of
the local municipalities is inefficient and confused.

A standard form of organization is that adopted by New
York, Massachusetts, Maine, and other states, and is as follows:

1. A commissioner of health and his staff.

2. A public health council to have legislative and advisory
powers, particularly the power to enact a sanitary code.

3. Directors of divisions and their staffs. The divisions in-
clude vital statistics, communicable diseases, sanitary engineer-
ing, laboratory, child hygiene, and public health education.

4. Local health officers in the various municipalities.

The form of the organization for doing public health work is of
less importance than the personnel of the staff, and the financial
means at the disposal of the officials; but the appropriations
themselves depend largely upon the personality and efficiency
of the members of the staff. Capable officials will find ways of
doing efficient work regardless of the form of the organization
under which they work.

Source of Power of Health Departments. - - The powers of a
department of health, or health officer, are derived from acts of
the legislature. \o act of a department or board of health is
legal unless authority for it is found in a law passed by the legis-
lature. The- legislatures of the various states have passed
general laws regarding health matters, and have delegated to
certain other political bodies and to certain officers the power
to make additional rules and regulations which have the force of
laws provided they are not inconsistent with higher laws. The
body of laws enacted by the legislature of a state constitute the



ORGANIZATION AND POWERS OF A HEALTH DEPARTMENT 19

trunk of the legal tree whose branches are the rules and regula-
tions and the modes of procedure of the state and local health
departments.

Consolidated Laws. The legislative enactments of a state
are collected and arranged in what are called the consolidated
laws, and comprise four different codes: 1, The penal code; 2,
the code of criminal procedure; 3, the code of civil procedure; 4,
the great mass of laws which correspond to the civil code, and
whose subdivisions are known by the names of the public health
law, the village law, the town law, and other descriptive titles.
Health matters are frequently mentioned in other laws than in
the particular ones relating especially to health.

A subject in a law is usually located by means of the title of
the law, and the number of the article and section in which it is
found. For example, the authority for the organization of local
boards of health in New York State is found in the Public Health
Law, Article 3, Sections 21 to 21c inclusive.

Court Decisions. Legislative enactments are called statutory
or written laws. In addition to these laws, the decisions of the
courts are the source of much of the authority of boards of health.
These decisions are founded on the written laws and make appli-
cations of them to specific cases and doubtful conditions. They
form a part of what is called the unwritten law of a state. They
indicate many of the details of what a health officer or depart-
ment of health can legally do under a statute law.

The decisions which are most frequently quoted are those of
the highest court of a state, and are referred to by means of the
volume and page of the report. For example, the cold storage
law of New York State was held to be constitutional, and the
decision is recorded in volume 160, p. 591, of the reports of the
New York Court Appeals. This is usuallv abbreviated as 160
N. Y. 591.

Public Health Council. The legislatures of some of the states
have established special bodies called public health councils,
and have delegated to them the power to make rules and regula-
tions which shall have the force of law in all matters relating to
public health. The Public Health Council of New York State
has drafted a sanitary code which applies to the whole state out-
side of New York City. The establishment of a public health
council is an advanced step in public health. It enables a body
of experts to keep a sanitary code up to date and to take advan-
tage of new discoveries as soon as they are announced. It also
makes possible a uniform method of procedure throughout the
state.

Local Ordinances. The legislatures of manv states have also



20 THE HEALTH OFFICER

delegated to local departments of health the power to make health
ordinances, provided they are not inconsistent with the laws
or sanitary code of the state. The local codes usually deal with
matters of minor detail, such as the suppression of nuisances,
while the state codes and laws deal with matters of greater im-
portance, such as the suppression and prevention of epidemics.

The Health Officer. The local executive officer is the health
officer. It is essential that he be a trained sanitarian, and in
most states he must be a physician. His duties will depend
largely on the population of his district and on the attitude of the
public toward health matters. New York State has over 1000
health officers. The great majority of them are in rural districts,
in each of which the health officer constitutes almost the entire
executive force of the health department. The position is one of
responsibility, and demands a considerable degree of skill and
more than ordinary medical knowledge along all lines of public
health work. The efficiency of the local health department de-
pends almost entirely on the health officer.

Powers of the Health Officer. The local health officer is
charged with the duty of enforcing the health laws that apply
to his district. His powers are strictly limited to those conferred
on him by the statute law and by the sanitary codes of the state
and of his district. His acts are subject to review by the courts,
and he is personally liable for acts for whose authorization there
is no specific law. But the laws and the code are sufficiently
broad to enable him to cope with every condition that is actually
unsanitary, and the health officer is clothed with abundant power
to remedy practically all conditions that are a direct menace to
life or health.

The health officer has no power over conditions which do not
alTect health. When he receives a complaint, his first concern is
to determine whether or not the condition has an effect on the
health, as distinguished from the feelings and wishes, of the com-
plainant. A country health officer receives all sorts of complaints
about conditions which do not affect the health of human beings.
Examples of these complaints are those about sick chickens,
barking dogs, and ash heaps. A health officer some-times feels
that he must act on these complaints, for he is often the only
public officer whose scope of work is at all related to the subject
of the complaint; but his powers are no more than those of any
other public-spirited citi/en. except that the prestige of his
office and the righteousness of his cause may enable him to se-
cure remedies when other persons fail.

A health officer derives part of his authority from the state
laws and part from local ordinances. When he- acts under a



ORGANIZATION AND POWERS OF A HEALTH DEPARTMENT 21

state law he has the prestige and power of the state to support
him. But when he acts under a local ordinance he is not always
sure of the support of the local board of health. If he has the
active co-operation of his board of health he may be reasonably
sure that he has sufficient power to carry out his work. If the
board is lukewarm or hostile, he can do little under the local
ordinances. Whatever he does, he must be able to refer to a
definite section of a law or code which specifically covers his act.
Failure to know the law accurately is responsible for most of the
legal troubles of a health officer.

While some health officers are overzealous and are inclined
to exceed their authority, others shirk their duty and refuse to
act when there is no special law ordering them to act under a
particular condition. A wise health officer will adopt a golden
mean of action between zeal and timidity.

Public sentiment and the courts grant almost dictatorial
powers to a health officer in the presence of an epidemic. The
same powers are conceded in the suppression of a nuisance in-
volving offensive odors, for many people still cling to the old idea
that gaseous emanations breed diseases. The public is not al-
ways willing to allow him power over disease carriers who are
apparently healthy. His success in handling this class of cases
depends on having proof of the dangerous conditions. Mere
suspicion is not sufficient. The burden of proof is on the health
officer, and he must have sufficient evidence to convict if the
case should come to court.

Police Power. The duties of a health officer often require
him to interfere w r ith private property and personal liberty of
action. For example, a village develops around the barnyard
of a farmer who claims that his neighbors voluntarily settled
around him, knowing that his business required him to keep
pigs, cows, and chickens. He objects to the investigations of the
health officer and claims that the health officer has no right to tell
him how to run his barnyard. The principle of law that applies
in such a case is that of the police power of a municipality. The
police power means the power to control the acts and property
of individual persons for the benefit of all the people of a com-
munity. This is one of the fundamental principles in law, and
its application to health departments and health officers has been
established by the highest courts in the land. Health laws and
ordinances are founded upon the principle of the police power of
the state.

Lines of Work. A health officer is the duly authorized person
in charge of the public health work in his municipality. This
work consists in the control of those conditions which are likely



22 THE HEALTH OFFICER

to harm the health of others besides the persons who are respon-
sible for the conditions. The health officer cannot interfere
with the liberty of choice and action of a private person unless
the acts are likely to have a harmful effect on the health of a
number of other persons. Public health work originally was
merely the suppression of epidemics of contagious diseases. It
was then extended to the control of whatever might produce an
epidemic, such as sewage and public water-supplies. Its newer
development includes all unhealthful conditions and practices,
whether the diseases which they produce are communicable or
not. Examples of the newer lines of public health work are the
control of child labor and the prevention of diseases which arise
from unhealthful occupations.

A health officer is an all-round practitioner in public health.
The health departments of the larger cities develop specialists
in each line of work, but most health officers are like general prac-
titioners in private practice, and must do all kinds of public
health work. A country health officer in the course of a year or
two will have to deal with as wide a range of problems as a city
health officer, but he will have very few cases of each kind. The
standard lines of work which a local health department is expected
to conduct under the supervisionof the health officer are as follows:

1. Communicable diseases their suppression and preven-
tion.

2. Laboratories the collection and transmission of speci-
mens for diagnosis and investigation, and the distribution and
administration of antitoxins and serums.

3. Nuisances their investigation and abatement.

4. Water-supplies their purity and purification.

5. Sewage and sewer systems.

6. Milk-supplies and dairies their inspection and control.

7. Food and meat inspections and the control of slaughter
houses, butcher shops, and grocery stores.

8. Inspections of public buildings.

9. Vital statistics, including a record of prevailing diseases.

10. Medical inspection of school children and the correction
of their defects.

11. Infant welfare work.

12. Insanity, commitments to hospitals, and preventive work
in mental hygiene.

13. Occupational diseases, dangerous trades, and child labor.

14. Educating the public by exhibits, lectures, circulars, news-
paper articles, etc.

15. Clerical work, correspondence, records, and reports.

16. Public health nursing.



ORGANIZATION AND POWERS OF A HEALTH DEPARTMENT 23

The laws sometimes impose duties on a health officer arbi-
trarily, probably because there may be no other available official
to do the work. For example, the New York State laws require
the health officer to examine children for labor certificates, to
inspect the means of comfort provided to women clerks in stores,
and to investigate the cause of death of persons who die without
medical attendance, and to supervise the commitment of the
indigent insane. The position of health officer is one of constantly
increasing responsibility and scope of duties.

The Staff of a Health Officer. The staff that is needed to
carry on the various lines of health work in a community will
depend upon the population of the district and upon the amount
of work which public sentiment demands of a health officer.
Usually a health officer is the only authorized employee of the
Health Department of a small municipality, and he gives only
a part of his time to the work, although he is supposed to be ready
to respond to public health calls at any time. Under normal
conditions a health officer can do all the public health work for a
community of 2000 or 3000 persons without undue interference
with his private business. If a population is more than 3000, a
health officer will be burdened with petty complaints and with
sanitary inspections which could be done by a layman as well as
by a trained sanitarian; but a part-time health officer can do all
the medical and other expert work for a community of 10,000 or
15,000 people if he has competent laymen for assistants.

The assistants which a health officer needs may be divided
into three classes: 1, office clerks; 2, inspectors; 3, public health
nurses.

Clerks to the Health Officers. Every act of the officials of the
health department of a city is reported in detail, and the annual
summary makes an impressive array of figures. Most health
officers have no idea how many inspections they make or how
many calls upon cases of contagious disease. They do their work
quietly and unostentatiously, and they modestly consider an
interview with a person on the street to be not worth mentioning.
A reason for the failure of the public to appreciate public health
work is that health officers do not report what they are doing.
Records of work will not be kept satisfactorily until clerks are
provided to keep them. A part-time clerk is needed for every
health officer.

A health department usually has a registrar of vital statistics
who does the clerical work of recording births and deaths and
issuing burial permits, but this officer usually acts independently
of the health officer.

Sanitary Inspectors. Every health officer of a community



24 THE HEALTH OFFICER

of over 3000 population needs a sanitary inspector whom he
may send to inspect nuisances and unsanitary conditions, and
serve notices, thus relieving the health officer of the burden of
the inexpert field work. He will be the agent of the health officer
in making reinspections and seeing that the orders of the health
officer are carried out. The work of a health officer is often a
failure because no one is charged with the duty of following up
his original visits and seeing that his directions are understood
and obeyed.

Public Health Nurse. Every community of over 3000 peo-
ple needs a public health nurse. She may also do much work
as sanitary inspector. She is an inspector and instructor of
persons, while the sanitary inspector deals with their environ-
ment. The nurse is almost indispensable to a health officer who
wishes to do constructive work. The only health officers who
object to public health nurses are those who wish to do only
routine work along traditional lines.

The ideal official staff for a country health officer will consist
of a part-time clerk, a part-time inspector, and a full-time public
health nurse. A health officer can also employ helpers in emer-
gencies, such as watchers at quarantined houses, and scavengers
to clean up unsanitary premises, provided their employment is
authorized by the health board. If a health officer does not go
to his board of health for the employment of his helpers, he may
have to pay them out of his own pocket.

The members of a board of health are usually willing to go
with a health officer to make inspections in difficult cases and to
assist him in the discharge of his duties, but they are not required
to do this work.

Unofficial Helpers. Most communities now have societies
for the improvement of civic conditions. These organizations
are composed of public-spirited persons who are willing to assist
the health officer and to educate the public in favor of his work.
They also provide funds for carrying on advanced lines of public
health work, such as public health nursing. Boards of health
are usually willing to allow a health officer to do advanced work
so long as it does not cost them money. The usual way in which
advanced work is undertaken, even in large cities, is by an organ-
ization providing the funds to support the work until boards
of health and the people recognize its value and necessity, and
appropriate the funds to support it. A health officer will find
civic organizations to be his best aids.