Rural Hygiene Part 26

_Principle of laws of hygiene._

It is particularly the laws which pertain to health and hygiene which we shall consider in this chapter. The principle on which laws relating to hygiene are pa.s.sed is that while nominally a person is always free to do with his own whatever he may choose, yet as a member of a community he must choose to do only that which shall not injure or affect the health or comfort of his neighbors. This principle was not at first invoked to prevent violations of laws of health, but rather to prevent the inconvenience which might come to a neighbor or to the public at large by some unreasonable though apparently legitimate use of individual property. As an example we may mention the law of New York State requiring each owner of property in the country to cut gra.s.s, weeds, and brush along the highway twice each year. Although this interferes with the right of the owner to have the land which belongs to him left as he chooses, it is legal because of the greater convenience and comfort it contributes to the larger number of persons traveling along the highway.

The state does not a.s.sume the right to interfere with the acts of individuals so long as such acts affect only their own individual well-being, but when those actions affect others, then the police power of the state may be invoked. It is on this principle that the law prohibits suicide, a.s.suming that no man can live or die without affecting the interests of other people. This is plainly so in the case of the head of a family or in the case of a man upon whom others are dependent and whose death removes their support and causes those supported to become dependent upon the state or county. This principle has been extended so as to include the cases where a method of living, a lack of care, or even a mere appearance in public may adversely affect the health of others in the same community. If, for example, a member of a family has diphtheria or smallpox, and such a child is isolated so that no danger of the spread of the disease exists, the state would not, in general, insist upon the use of any preventive or curative inoculation; but if a child with incipient diphtheria or whooping cough goes to school where other children may be infected and the disease spread, the state, acting through its Board of Education, would have a perfect right to send the child home and prevent its enjoying school privileges until recovery from the disease.

It is on this principle that the state says that no child in New York State may attend school unless vaccinated, the law reading, "No child, not vaccinated, shall be admitted into any of the public schools of the state, and the trustees of the schools shall cause this provision of law to be enforced." This law has been questioned and brought before the Supreme Court for review, and it was held by the judges that the protection to the community implied is of sufficient importance to justify its enactment.

For like reason, other restrictions governing the control of contagious diseases is a function of the police power of the state in which the rights of the individual must yield to the greater good of the community. The writer remembers a particularly malignant case of smallpox where the efforts of the local Board of Health had been concentrated on the enforcement of quarantine, and where by the aid of policemen, day and night, it was hoped that the disease was being confined in the one house; yet, after the death of the patient, and when apparently efforts for protection might be relaxed, a wake was held in the house, in the very room of the patient, which might have resulted in the spread of the disease through the entire town. Regulations, therefore, covering the conduct of funerals and of burials should be agreed to, since they are intended to prevent the spread of disease.

_Self-interest the real basis of law._

Many practices which are required by law in cities where the population is crowded are not required or are not enforced in country districts, since there the failure to carry out protective measures reacts only on those immediately concerned. Disinfection of rooms in which contagious diseases have occurred is one such provision. It rarely happens that a health officer of a country community concerns himself with seeing that a case of scarlet fever, for example, is prevented from spreading by a thorough disinfection of the rooms. That seems to be left to the good sense of the individual. It is hardly conceivable that a mother with three or four children (when one child has been sick with a contagious disease) will neglect ordinary and reasonable precautions to prevent the spread of that disease to the rest of the family.

It is inconceivable, when the small amount of trouble and expense is considered, that the parents of a family, after a case of diphtheria, will neglect to fumigate and disinfect the clothing and bedding which may be thus infected, particularly if such clothing or bedding is to be used by other members of the family; and yet instances are recorded where a child has died of scarlet fever and a year later another child, perhaps wearing some of the clothes of the previous victim, has been seized with the disease and has followed its brother or sister to the grave. Cases of tuberculosis have been known to follow each other almost year after year, as one member of a family after another occupied a room where the infection persisted, either in the carpet or furniture, which was never properly disinfected. Such cases must be left to the good sense, intelligence, and understanding of the persons concerned. The police power can never in this age take the place of an enlightened sense in the community, nor are laws, as a matter of fact, of any use except as they are sustained and enforced by public sentiment.

QUALITY OF WATER

There is another way in which the police power of the state exercises control over rural communities, and that is in the matter of food which the country generally supplies to the city. Perhaps the pollution of water, which is, after all, one kind of food, is as important as any matter covered by health laws.

In most cities to-day the pollution of streams is prohibited on two grounds, first, that the streams are public property, even though for a part of their course they may be owned individually. The sum of the parts making up the whole stream involves so many individuals as to imply public ownership, and inasmuch as one individual is limited in his uses of the stream by the principle already referred to, he cannot, even on his own land, do what he pleases with a stream or with its waters. When streams are navigable, according to the law of this country, no private ownership can exist, for the waters are controlled and owned by the federal government. This latter body, in general, does not undertake to control the quality of such waters, but there are many laws covering the quant.i.ty of water in such streams, limiting the amounts that can be withdrawn, restricting the filling up or silting of such streams, and qualifying the bridging or damming of such waterways.

In small streams, such as are generally found in rural communities, the vital principle of ownership is always limited by the requirement that no owner shall so interfere with the normal quant.i.ty or quality of water in the stream as to prevent their full enjoyment by the next man downstream whose rights are equal with his own. This means, in the matter of quant.i.ty, that while one individual may water stock in a stream or may pump water from a stream for household use, he may not withdraw from the stream the entire volume to use for irrigation, nor may he, as a riparian owner, sell the water to some city near by which might take out all the water of the stream.

The quality of a stream, likewise, may only to a certain extent be interfered with. If a stream flows through a meadow, cows pastured in the meadow have a natural right to wade in the brook, and if, in so doing, a certain amount of pollution is added to the waters of the brook, no one downstream can justly complain.

If, however, a sewer is carried from barns or houses into a brook which is later used for drinking purposes, the quality of the water is affected, and such a discharge is so revolting to the senses that complaint to the courts would result in an order to find some other method of disposing of such wastes.

In New York State, the legislature has delegated to the Department of Health certain rights in the matter of the protection from pollution of the waters of the state, particularly when those waters are used for drinking purposes. Upon application from the water company, this department, having carefully inspected the watershed, will prepare a complete and elaborate series of rules, giving in detail just what an individual may or may not do on the watershed, and, when enacted, these rules have all the force of law. They are, however, like all laws, subject to the const.i.tutional limitations, and particularly to the clause of the const.i.tution which provides that "no state shall make or enforce any law which shall deprive any person of property without due process of law." This means that if any law prevents an individual enjoying reasonable use of his own property, or if the deprivation of such use is for the special benefit of some special community or company, then that special body must be prepared to make compensation for that deprivation, although if it were for the general good of the community of which the individual was a member, no compensation might be required.

REGULATIONS GOVERNING FOODS

Laws covering the sale of adulterated foods are of two kinds, namely, those enacted by the national government at Washington, and those enacted by the local authorities, either state or munic.i.p.al. The laws enacted by the national government, which are comprehended in the recently enacted National Pure Food Law, deal particularly with the adulteration and misbranding, not only of foods, but of all sorts of medicines and liquor. Their effect, however, is limited entirely to such articles as make up interstate commerce. If an article is made and sold within the boundaries of any single state, it is not subject to the national law, nor could this national law be applied to the production or sale of any article from a farm unless that article was well enough known to be generally distributed. For example, maple sirup, widely advertised and generally sold, would be subject to the provisions of the national law. b.u.t.ter and cheese, sold locally, would not be subject to such a law. It is evident, therefore, that this law does not usually apply to farm products, unless, as in the case of some sausages, for example, a widely advertised campaign has been inst.i.tuted to promote their sale.

There are, however, in the different states, laws which do apply locally and which prohibit adulteration of all sorts. In New York State, for example, the law says that no person shall, within the state, manufacture, produce, compound, brew, distill, have, sell, or offer for sale any adulterated food or product, and the law further specifies that an article shall be deemed to be adulterated:--

"1. If any substance or substances has or have been mixed with it so as to reduce or lower or injuriously affect its quality or strength.

"2. If any inferior or cheaper substance or substances have been subst.i.tuted wholly or in part for the article.

"3. If any valuable const.i.tuent of the article has been wholly or in part abstracted.

"4. If it be an imitation or be sold under the name of another article.

"5. If it consists wholly or in part of diseased or decomposed or putrid or rotten animal or vegetable substance, whether manufactured or not, or in the case of milk, if it is the produce of a diseased animal.

"6. If it be colored, or coated, or polished, or powdered, whereby damage is concealed, or it is made to appear better than it really is, or of greater value.

"7. If it contain any added poisonous ingredient, or any ingredient which may render such article injurious to the health of the person consuming it. Provided that an article of food which does not contain any ingredient injurious to health shall not be deemed to have been adulterated, in the case of mixtures or compounds which may be now, or from time to time hereafter, known as articles of food under their own distinctive names, or which shall be labeled so as to plainly indicate that they are mixtures, combinations, compounds, or blends, and not included in definition fourth of this section.

"8. If it contains methyl or wood alcohol or any of its forms, or any methylated preparation made from it."

These provisions, just mentioned, are provisions of the New York State Health Law, and violations are in defiance of that law, the penalties for which are specifically stated to be $100 for every such violation.

There is also in New York a police code that prohibits adulteration of food, and in this code the adulteration of maple sirup or fruit juices or spoiled articles of food of all sorts, of milk from which part of the cream has been removed, and the sale of any article which is printed or labeled in such a way as to misrepresent the article, is called a misdemeanor, the penalty for which is left to the discretion of the judge and which would, under ordinary conditions, be a fine of several hundred dollars or imprisonment in a county jail for a term of months, or both.

_Basis of pure food laws._

Adulteration of food may be considered from two points of view, the hygienic and the economic, and, while the laws are generally intended to preserve the public from impure food on account of the economic loss involved thereby, the hygienic aspect is really the more important.

Adulterations which are plainly injurious to health are very few in number, and it is rather desirable that the economic phase should be the one to command attention of legislators, since, when that objection to adulteration has been so voiced as to result in laws prohibiting adulteration, the health of the public will be promoted by the elimination of objectionable foodstuffs. The long-continued discussion over the use of benzoate of soda in foods is an example of this twofold aspect; some, arguing against its use, protested that when long continued, it had a decidedly injurious effect upon the health of those eating or drinking it; others objected to the chemical, but contended that its use enabled spoiled fruits, like tomatoes, to be subst.i.tuted for fresh fruits, and the price of the latter obtained where the value of the former only was given. No one seriously thinks that b.u.t.ter with a small amount of b.u.t.ter color added could have any injurious effect upon the human system, yet it is, in the eyes of the law, an adulteration because its appearance indicates a quality of the b.u.t.ter which it does not naturally possess.

PROTECTION OF MILK

The one article of food produced on the farm about which the greatest amount of agitation has been centered has been the adulteration of milk, as well as the question of the production of milk under unclean conditions. The responsibility for pure milk rests on the Department of Agriculture of the State, on the Department of Health of the State, on the Department of Health of the city where the milk is sold, and on the Board of Health in the village or town where the milk is produced. In a way, these four departments divide the responsibility for the milk, and, as in all cases of divided responsibility, the very fact of the number subtracts from their efficiency. The local Board of Health of the village or town where milk is produced is not usually interested or concerned particularly in the question of its quality.

If a case of contagious disease in any farmhouse occurs, the local health officer should see that a proper quarantine is established and that the individuals in such a house are instructed in the danger of contamination and in the necessity of avoiding infection in the dairy.

It is, however, the Board of Health in the city where the milk is consumed who have a particular responsibility. Such a board has no jurisdiction or authority over matters outside of their city, so that their executive cannot go out into the country, into the district of another health board, and order improvements made in the methods of production. All that a city board can do is to enact and publish restrictions under which milk must be sold in that city.

This is the method pursued in the city of New York, where tons of milk are consumed every day and where manifestly the jurisdiction of the city officials cannot extend over the thousands of farms located in the five states from which the milk supply is drawn. In New York City the local sanitary code provides that no milk shall be received, held, kept, offered for sale, or delivered in the city of New York without a permit from the Board of Health, and the Board makes this permit depend upon the sanitary conditions existing at the dairy or farm where the milk is produced or handled. In order to find out whether the conditions at the dairies and farms throughout these five states are in a sanitary condition, the city has a force of twenty-five inspectors who are continually engaged in traveling among the farms and in reporting on their condition. If a farm is found where the cows are diseased, or if the buildings in which the cows are stabled or in which the milk is cooled and strained are not clean or are lacking in proper ventilation or otherwise unhygienic, or if the water-supply is bad, the farmer is notified that conditions are such that the city of New York will refuse to receive his milk. He is not forced to clean up, and no orders are given him, but the att.i.tude of the city authorities is made plain, and then it is left to him to decide whether it may not be wise for him to accept the suggestions made by the inspectors. Dr. Darlington, late Health Commissioner of the city of New York, reported in 1907, after two years of inspection, that out of 35,000 dairies inspected, only 47 were shut out on account of unclean conditions, although many more were warned with the result that remedial measures were at once taken. The same sort of procedure may be adopted by any city, and is, in fact, practiced by a number.

Another method of securing a better grade of milk which results in forcing farmers to clean up the barn and barnyard, at the same time allowing the local official to remain within the strict letter of the law, which gives him no direct authority over conditions on farms outside a city, is to limit the number of bacteria found in samples of milk supplied by the dealer. A common rule is that no milk shall be distributed which contains more than 50,000 bacteria per c.c., and when milk contains a number in excess of this, the milkman is warned, and if, at the next sampling, the number is still higher, the milkman is notified that his milk will no longer be received. Experience has shown that a reasonable regard for cleanliness in the stable and dairy room, with a prompt cooling of the milk, will limit the bacterial growth to this standard, and the requirement, meaning, as it does, only a decent regard for such cleanliness as a self-respecting dairyman would recognize as essential, works no hardship on any one. New York City prints its dairy rules on linen and has them tacked up in every cow barn concerned in the city milk supply, and while they have merely the force of suggestions only, practically they have the force of law in that a disobedience to these rules is likely to involve the refusal of the milk from that particular dairy.

LAWS GOVERNING QUARANTINE

It is much to be regretted that, in these days of scientific knowledge, when the exact and fundamental causes and processes of diseases are so clearly known to medical men and when laws based on this knowledge have been enacted for the purpose of reducing mortality and preventing the spread of disease, ignorant individuals should allow their prejudices to stand in the way of compliance with the spirit of these laws.

In New York State, Section 24 of the Public Health Law requires the local Board of Health to isolate all persons and things infected with or exposed to infectious diseases. They are required to prohibit and prevent all intercourse and communication with or use of infected premises, places, and things, and to require and, if necessary, to provide the means for the thorough purification and cleansing of the same before general intercourse with the same or use thereof shall be allowed. The Penal Code of the state further provides that a person who, having been lawfully ordered by a health officer to be detained in quarantine and not having been discharged, willfully violates any quarantine law or regulation is guilty of a misdemeanor, punishable by fine or imprisonment or both. In spite of this prohibition, it is very rare to find that a person in a quarantined house feels any personal obligation. He stays in or out, if obliged to by a policeman, or, if the sentiment among the neighbors is aroused in favor of quarantine, he waits until dark enough to escape observation.

In New York, two years ago, a case of diphtheria broke out in the family of a Christian Scientist. The health officer visited the house, offered to use ant.i.toxin, which was refused, and instructed quarantine. The mother and one daughter died, and the healer was imprisoned for entering the house in defiance of the quarantine law. This case ill.u.s.trates how the moral obligation may be distinctly repudiated because of religious prejudice. But even religious belief must be subservient to the laws governing the community in which a man chooses to live, and, so long as the residence continues, the laws governing quarantine, as all other laws, must be obeyed. In this case another count against parents may be found. Section 288 of the Penal Code provides "that a person who willfully omits without lawful excuse to perform a duty by law imposed upon him to furnish food, clothing, shelter, or medical attendance to a minor is guilty of a misdemeanor." It would seem, therefore, that the law is provided by which fanaticism may be overruled in the interests of the health of children, although it must be said that this phase of the law is generally disregarded. Again, in spite of the ample proof to the contrary, there are to be found persons who refuse to be vaccinated even in the midst of a smallpox epidemic. A law in New York State provides that no unvaccinated child shall attend public schools, the law being mandatory upon the school trustees. If this law were faithfully carried out, smallpox would entirely disappear from the state within a few years.

Other instances might be cited to show how the force of the law is invoked to minimize the effects of unhealthy living and to prevent that perfect individual liberty which a few irresponsible persons would a.s.sume to themselves. But it will always remain for the good sense of the individuals to direct their actions in such a way as to inflict no evil on the community. Unfortunately, laws are generally the result of some calamity. A law prohibiting child labor is pa.s.sed only after the evil effects of such labor have been demonstrated by sad experience.

Laws forbidding the sale of diseased meat or of spoiled fruit are pa.s.sed only after repeated cases of illness have demonstrated the need of such laws. Laws involving quarantine are the result of epidemics which have showed plainly, at the cost of valuable lives, perhaps, the need of such quarantine.

It is the aim of hygiene, whether rural or urban, to raise the standards of living to such a degree that not only will any violation of health laws seem unreasonable and obnoxious, but also every instinct, of the individual will, even without specific laws, direct him so to live that no hygienic offense will be directed towards those with whom he comes in contact. Only in this way will the present violations of the requirements of hygienic living be avoided, and the normal man be enabled to live as he should in absolute harmony with his environment.