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REPORT OF THE SECRETARY OF THE BOARD.
To His Excellency George C. Ludlow, :
GOVERNOR—The State Board of Health of New Jersey begs leave to present to your Excellency its seventh report. The duty assigned to us in the constituting act was to take cognizance of the interests of health and life among the citizens of this State; to make sanitary investigations and inquiries in respect to the people; the causes of disease, and especially of epidemics; the sources of mortality, and the effects of localities, employments, conditions and circumstances on the public health, and to gather such information in respect to these matters as it might deem proper for diffusion among the people." Since that time various other laws have been placed upon the statutes of the State, which have assigned to us other important duties. In the fulfilment of these obligations we find ourselves charged with responsibilities that relate to high social and industrial interests of the citizens, and that most directly concern the welfare of our whole population.
While there is a general consent to the fact that health is a great blessing, and that the preservation of life is, as a rule, the essential duty of a good government, there is not an adequate appreciation of the value of wellness as a source of strength and prosperity to a State. Industry, capital and security depend upon it as a resource.' To foster it is to foster the dearest interests of a people. As science, observation and statistics are constantly showing how many deaths are avoidable and how many diseases are preventible, there is no direction in which intelligent judgment and reasonable expenditure yields better results. It cannot be concealed that premature death and burdens of sickness are constantly resulting from insanitary conditions which never should have occurred. The common consent that nuisances injurious to health must be abated, is an argument that such as could have been avoided should never had occurred. The liberal outlay made to stop an
epidemic after it has attained headway, suggests that a truer economy would have been to avoid its causes or deal with it in the first household. With regard to our own country and our own State, it is not unsafe to re-affirm that the same is true as was some time since asserted by Mr. Simon in reference to England:
“It is the common conviction of those who have most studied the subject, that the deaths which occur are by fully a third part more numerous than they would be if existing knowledge of the chief causes of disease were reasonably well applied throughout the country. This annual excess has the terrible further meaning that, as a rule, each death represents a number of other cases in which preventible disease, not fatal, has had far-reaching ill effects on the continued life, or added the many embarrassments which occur from more fatal attacks of sickness.
“Death accounts also, whose figures, arithmetically, make but little show, may, for administrative purposes, have immense meaning. One or two deaths in some village may, in hundreds of instances, correspond to long-continued local conditions of scandalous filth and unwholesomeness ; one or two deaths by scarlatina or small-pox, almost unnoted in regard of some considerable town, may represent the beginning of what, three months later, will be a terrible epidemic, agitating the community with distress and fear, and adding prodigiously to the whole year's death rate of the place. In proportion as a disease is present the time of preventing it is past; but, for practical purposes, it is indeed all-important to remember that sanitary administration has its hope of success in preventing, not in arresting, great epidemics ; and that if warnings are not taken from the smaller excesses of disease, catastrophes, not further warnings, may be next to come. It seems almost unnecessary to add, that a method of procedure which waits for death as its ground of action, may peculiarly dispense with cumulative proofs; and that, as no one preventible death can be remedied in regard of him who has suffered it, so the record of it may the more emphatically claim to be read as a protest on behalf of others.”
No one can make even a cursory or superficial study of the contrasts between the death rates and sickness rates of city and country, or parts even of the same city, without learning that these are often but the forcible declaration that either the persons or the places are not conforming to the known laws of healthful existence. Sanitary art, made up as it is of medical and mechanical knowledge, and having ascertained how it is possible to make ground and houses best adapted for human dwelling-places, and how men, women and children should live so as to be true to the demands of sound humanity, no longer admits that it does not know how to improve the social conditions of a people. The last annual report of the Registrar-General of England (44th, Abstracts of 1881) says: “ There is nothing in the series of annual reports issued by this office that comes out more distinctly and unmistakably than the wonderful effects which the sanitary operations of the last decade have had in saving life. The death rate for this year, in England, was 18.9 per 1,000 living. The death rate in the urban population, consisting of some fifteen and a half million persons, was 20.3; while that of the rural population, comprising some ten and a half million of persons, was 16.8. Comparing the years for 1862–71 with those of 1872–81, the deaths in the latter were so much less in proportion that 392,749 persons who, under the old regime, would have died, were, as a matter of fact, still living at the close of 1881. Add to these saved lives the avoidance of at least four times as many attacks of non-fatal illness, and we have the total profits as yet received from sanitary expenditure.” These facts are valuable to us for comparison, since they extend over twenty years, and are furnished by skilled observers, and accepted by the best authorities. They relate to a nation in which the teeming population, and the great obstacles constantly presenting, make such an attainment the best assurance of greater possibilities. “There can be no real doubt,” says the report, "that the saving effected in life was the direct product of the money and labor expended in sanitary improvement.”
The deaths for the State of New Jersey, for the year reaching from July 1st, 1882, to July 1st, 1883, were 23,310; which is a considerable decrease from the previous year, while the marriages and the births have increased. Fuller particulars will be found in the report of the Medical Superintendent of Vital Statistics. A review of the past year, and of the period to which these vital returns relate, together with abundant other testimony afforded to this Board, assure us that both the public and the local health authorities are realizing the great significance of health and care, and the value of those improvements which secure good water, proper disposal for decomposable substances, good houses, cleanly habits, and chances for employment deprived of all avoidable insanitary conditions. Several cities and townships have entirely modified their health administration, and others are so agitating the need as to be sure, eventually, to bring about desired results. The summary of reports from local Boards is well worthy of study as a guide. The relation of the State Board to local Boards has proved of signal advantage to both. Information and guidances are secured, and that unity and cooperation which gives a system of health administration more and more tending toward efficiency and completeness.
LEGISLATION AND PUBLIC HEALTH.
Sanitary art is so new in its practical application to the wants of communities that it cannot be expected that the courts should abound in precedents, which, in law, so much guide decisions. It is an encouraging starting-point that common law is very considerate of the rights of the individual to be protected from nuisances. It does not always claim that these must be shown to be injurious to public health ; but even if they cause decided, frequent discomfort to the public in general, or to ordinary persons of the immediate vicinage, the law calls for their abatement. If the nuisance is not one attended with smoke or odors, but is one which is shown to cause sickness, it is easily abated under the law of nuisances. So long as there are differences of opinion among medical men or sanitarians as to the relations of certain causes to disease, so long will courts and juries have to gather facts and opinions, and be governed by the weight of testimony. As there is often defect in testimony, or in evidence, it cannot be expected that every case will be decided according to the views of Boards of Health. So pronounced, however, is the common law in its declarations as to nuisances, and so evident is its possibilities of relief, as in the mill-dam case at Bound Brook, that the mode of indictment, grand jury complaint and jury trial is never to be lost sight of in that class of cases in which there is no occasion for haste. As, however, there are many cases where delay is dangerous, and as the assumption of danger to health, if real, is always a peril to somebody and to life itself, law is wise in providing methods of more speedy relief. One of these methods, which has been found very useful, is that by Court of Chancery. So far as we know, the claims to summary proceeding in cases where the public health is concerned have been fully recognized by this court.
In a case in Elizabeth, where a factory, in dealing with irritating acids and the sludge from petroleum refineries, was strongly complained of, Chancery granted an expert commission, with power to control, to experiment and to report, as to whether it would be possible to conduct the business and yet secure comfort to the residents of the vicinity. As the general law which gives this power does not reach