CHAP. XLVIII Organization less than the amount granted for police and fire protection or for education. In New York, where the most generous allowances have been made for health work, recent appropriations amounted to only about two per cent of the total annual expenditures, whereas five per cent went to the fire department and nine and twenty per cent, respectively, to police and educational activities. Few departments are brought into close contact with so many other branches of the city government as is the department charged with protecting the public health. It is brought into relation with the bureau in control of water supply and purification, with the department or bureau in charge of garbage collection and disposal, with the sewerage and street cleaning departments, with the police department in the enforcement of the sanitary code, and with the educational authorities, especially in the matter of medical and dental inspection of school children. Harmonious coöperation with all of these various bureaus and departments is, therefore, indispensable to the proper functioning of the health department, a condition which, unfortunately, by no means always exists. In commission-governed cities, health protection is usually combined with police and fire administration in the department of public safety; but elsewhere, especially in the larger places, there is a separate department of health, at the head of which a board or commission is more frequently found than in the case of the police and fire departments. In New York City, for example, health administration is in the hands of a composite board composed of the health commissioner, who is the department's responsible head, the police commissioner, and the health officer of the port, the latter a state official. In Chicago and many other cities, on the other hand, the health department is presided over by a single commissioner, appointed by either the mayor or the city council. Many places, especially small or medium-sized cities and villages, do not employ full-time health officers, and such public health activities as are carried on are looked after by a physician who devotes most of his time to his private practice. Under these conditions, a real health department is, of course, practically nonexistent, and public health activities are apt to be of a very restricted sort. Occasionally two or three small cities lying close together, e.g., La Salle, Peru, and Oglesby, Illinois, have combined to employ a full-time health officer and develop a joint health administration, to the great advantage of each community con cerned. Such a policy ought to commend itself, not only to neigh- CHAP. boring small cities, but to towns and villages as well. Probably no health department is better organized, carries on a wider range of activities, and is more efficiently administered, than that of New York City. Here the board of health enacts the sanitary code of the city, issues emergency health orders, and has very broad powers in all matters affecting the public health; on extraordinary occasions, it may even destroy property, imprison persons, and forbid traffic and intercourse in order to check the spread of disease. Under the general supervision of the board of health, and under the direct control of the commissioner of health, are the following nine bureaus: (1) The bureau of administration, which coördinates and supervises the activities of the other bureaus and serves as the medium of communication with other departments of the city government; (2) the bureau of records, which collects, preserves, and publishes vital statistics, issues burial permits, registers all practising physicians, assists in the enforcement of child-labor and compulsory-school-attendance laws, and conducts all other statistical work of the department; (3) the sanitary bureau, which has general jurisdiction over sanitary conditions, investigates reported nuisances, controls slaughter-houses and livery stables, and makes a detailed sanitary survey of the entire city; (4) the bureau of preventable diseases, which is responsible for the registration, sanitary supervision, and necessary care of all cases of communicable diseases, the maintenance of the ambulance service, the disinfecting of premises and goods, the holding of tuberculosis and other clinics, and the organization and distribution of a large staff of field nurses; (5) the bureau of child hygiene, which has general supervision and care of the health of infants and children (including medical inspection and physical examination of all school children), holds eye and dental clinics in the schools, and supervises infant milk stations, day nurseries, and all institutions caring for dependent children; (6) the bureau of food and drugs, which investigates and controls the food and drug supply of the city, and conducts not only the inspection of foodstuffs but also the sanitary inspection of the premises where foods are stored, handled, prepared, or sold, and inquires into the physical condition of persons who prepare or serve food in hotels, restaurants, and other public eating-places; (7) the bureau of laboratories, which carries on XLVIII Powers and activities of the New York health department CHAP. XLVIII Emphasis on preventive measures varied forms of research work, maintains supply stations at drug stores throughout the city where physicians may obtain diphtheria. antitoxin and vaccine, and makes scientific studies of such diseases as tuberculosis, diphtheria, cholera, and typhoid fever, and devises modes of combating them; (8) the bureau of hospitals, which supervises the five hospitals maintained by the department for the care of persons afflicted with communicable diseases; and (9) the bureau of public health education-one of the most recent and important divisions of the department-which has charge of the dissemination of information concerning the health of the community, the securing of better coöperation between the department officials and the public, the publication of health literature, including weekly and monthly bulletins for the information of physicians, the giving of health lectures to city employees and the public, the organizing of exhibitions and moving-picture shows, and not a few other activities.1 This summary will serve to give some idea of the great variety of functions that may fall to the lot of a health department in any large city. Many of the activities noted are not carried on at all in some cities, either by the health department or any other branch; on the other hand, the health department in some cities. is made responsible for the cleaning of streets and alleys, for tenement house inspection, and for other activities which in New York are assigned elsewhere. The summary also brings out forcibly the fact that whereas formerly the work of the health department consisted almost wholly in discovering and abating nuisances and in fighting epidemics that might have been prevented, effort nowadays runs chiefly along the lines of preventive medical or sanitary science. "Health departments, properly equipped and based on correct principles . . . are veritable armies waging war on the causes of disease, no matter how subtle or remote they may be, no matter whether lurking in the home, the school, or the workshop." REFERENCES W. B. Munro, Principles and Methods of Municipal Administration (New H. G. James, Municipal Functions (New York, 1917), Chaps. II, III, V. 1 Municipal Year-Book of the City of New York (1916) 208-209. See also N. M. Reed, "Protecting the Food of the City," Outlook, CXXIV, 114-117 (Jan. 21, 1920). C. A. Beard, American City Government (New York, 1912), Chaps. VI, X, XI. A. C. McLaughlin and A. B. Hart, Cyclopedia of American Government (New W. McAdoo, Guarding a Great City (New York, 1906). E. F. Croker, Fire Prevention (New York, 1913). A. Woods, Policeman and Public (New Haven, 1919). R. B. Fosdick, American Police Systems (New York, 1920). G. W. Alger, "The Police Judge and the Public," Outlook, XCVI, 356-364 (Oct. 15, 1910). W. W. Rogers, "Guarding the Health of the People," Outlook, CXXIV, 424427 (Mar. 10, 1920). CHAP. CHAPTER XLIX Public works: 1. Water supply OTHER MUNICIPAL ACTIVITIES-CITY FINANCE The preceding chapter sketched the principal city activities which spring from the primary function of all government, the protection of life and property. Many activities of the modern city, however, have little or nothing to do with the citizen's protection and involve the exercise of powers which are neither necessary nor peculiar to government as such. They are, rather, engineering, commercial, or social enterprises-undertakings such as might be, indeed often have been, carried on by private persons or corporations. To some of them, and to the subject of municipal finance, the present chapter will be devoted. A city's engineering activities are commonly grouped in a single department of public works, although in many instances they are distributed among several departments. At the head of the department of public works one rarely finds a board or a commission, as in the case of health and education departments, but almost invariably a single commissioner, who is often a person with some engineering experience, although this is not absolutely essential if his subordinates include properly trained engineers and other technical experts. But under any circumstances the headship of the department of public works in a city of considerable size calls for a man of large administrative ability and business experience. The most common forms of municipal public works in this country have to do with the water supply, the city's wastes, and the city's streets. First in importance comes the provision of an adequate water supply for domestic and industrial purposes. The storing and distribution of water is primarily an engineering enterprise, but one which in the great majority of cities has been made a municipal, rather than a private, business because of the intimate relation which the water supply bears to the health of the community and to the efficiency of its fire department. It is also one of the most remunerative of the city's enterprises and is therefore |