The Relation of the Board of Health to the Public. BY ALBERT VANDER VEER, M. D, ALBANY, N. Y., Professor of Didactic, Abdominal and Clinical Surgery, Albany Medical College. AN ADDRESS DELIVERED BEFORE THE ALBANY INSTITUTE, MAY, 1891. Albany, N. Y.: Taylor & Roberts, Printers. 1891. The Relation of the Board of Health to the Public. BY ALBERT VANDER VEER, M. D., ALBANY, N. Y., Professor of Didactic, Abdominal and Clinical Surgery, Albany Medical College. AN ADDRESS DELIVERED BEFORE THE ALBANY INSTITUTE, MAY, 1891. Albany, N. Y.: Taylor & Roberts, Printers. 1891. THE RELATION OF THE BOARD OF HEALTH TO THE PUBLIC. BY ALBERT VANDER VEER, M.D., ALBANY, N. Y. Mr. President and Gentlemen : The history of every nation, the development of every government, has exhibited a desire and determination, an actual carrying out, of ideas relative to the care of the public health. From the time of the development of the admirable system of sewers in Rome to the present time, sanitary matters have claimed the attention of scien- tists, and the subject of legislation, on these subjects, has kept fully abreast of all that has gone to make up modern civilization. Beyond a doubt the English-speaking nations have, up to within a few years, led in much that appertains to the care of the public health, and this reference is especially applicable to England and her colonies. In the United States it has been an intelligent, constant and pro- gressive work. It is true, some states are far in advance of others in the'sanitary care of the people, but it may be truly said that our state has been of the number which have occupied an advanced position, having been among the first to organize a Board of Health, and leading, as she has done in many instances, in this progressive work. The Board of Health of this city was created by Chapter 431 of the Laws of 1881, in which Albany was under the supervision of the State Board of Health, and was organized January 31st, 1882, with the following members: H on. M. N. Nolan, city mayor; Jacob S. Mosher, M.D., chairman pro tern.; A. Vander Veer, M.D., John Boyd Thacher, Thomas H. Dwyer, John McKenna, Wm. H. Keeler, with Daniel V. O’Leary, M.D., health officer. May 25th, 1885, a law was passed (Chapter 297, Laws of 1885), exempting Albany from the provisions of the State Board of Health (Senator Thacher’s bill). Of the work that has been accomplished by this Board, I desire to speak somewhat briefly, and yet when I come to look into and investigate the record that has been preserved in its archives, I am somewhat embarrassed to know just how much to select that will repay you for listening — a recital of what I 4 believe to be the honest, earnest administration of one of the best bureaus of our city government. It seems somewhat singular that in the care of our neighbors’ health, not less than our own, it has been found necessary to enact some of the most rigid laws that are to be found upon the statute books, and while authority has been given quite to the fullest extent to the Board of Health of the city of Albany, yet I believe it has seldom, if ever, been abused. There have been complaints and statements made at times by parties—it may with charity be said—in the heat of discussion, yet the Board has never failed to do its full duty, and it must be understood that sometimes these duties are of the most exacting and difficult. There are perhaps very few actions.or conditions that seem to antagonize human thought so much as for one person to charge another with being negligent in the sanitary care of his premises. To be thought the source of creating a nuisance or nuisances immediately arouses the indignation of the party accused, the latter looking upon it, not unfrequently, in the light of a disgraceful or insulting accusation. To be told that their cesspool, drain or vault is creating a nuisance at once arouses a spirit of antagonism and illy fits the mind for the performance of justice to the parties who feel injured, and who are certainly being injured in many instances. Therefore, it is shown beyond a doubt, on many occasions, that the wisdom of our law-makers in establishing Boards of Health among the wisest of their acts. In a city of this size, were it not for the authority of the Health Officer, there would be many evidences of absolute neglect, on the part of many worthy citizens, of prevent- ing the spreading of preventable and contagious diseases. Take, for instance, the subject of vaccination. You may establish dispensaries, you may offer the services of your hospital staffs to vaccinate without charge, and yet it would be impossible to protect the city from the spread of small-pox, were it once to enter, without the Health Officer seeing that every so many years the city is thoroughly vaccinated. The health officer has, on several occasions, found it necessary to employ a corps of physicians to go over the city and vaccinate from house to house in order that the city might be properly protected. Notably was this the case in March, 1882, when Dr. O’Leary had the western part of the city thoroughly can- vassed in this manner. The wisdom of this action was soon shown later on. Small-pox did reach Albany, but found no lodgment; that is, not more than four or five cases developed. Later on, our neighboring city, Troy, which had been somewhat negligent 5 in the matter of vaccination, had a decided epidemic, resulting in the loss of thousands of dollars to the business men, occasioned by the isolation of the city that followed for some weeks before the loathsome epidemic was controlled. Money thus invested is well invested by the tax-payers. There are citizens who make an honest effort to correct nuisances when their attention is called to them, and who spare no expense to put their houses and premises in the best sanitary condition, but they are often ignorant of the manner in which they should proceed, and their best efforts are not always attended with success, until aided by more experienced persons. Let me illustrate : Mrs. A., living at 124 Blank street, was suprised to have mem- bers of her family becoming ill in a manner that evidently was due to some imperfection in the drainage. She was told by her physi- cian that the drains of her house should be thoroughly examined. This was done by a competent plumber, he making such tests as he was accustomed to, but assured her that her drains were in good condition ; that he had thoroughly attended to them but a few years previous, and that she had no cause for alarm. However, the sickness continued, the physician became more emphatic, and Mrs. A. requested her neighbor, Mr. B., living at 126 Blank street, to examine his drains, stating that she believed there was a leak in his house drain, and that her premises were being poisoned by it. Mr. B. a man of wealth and a thorough gentleman, was surprised to know his house was brought under suspicion, had his drains tested immediately and was told that they were in good condition. In order to convince Mrs. A. that the offensive water, that found its way occasionally into her basement, particularly in the vegetable cellar, did not come from his premises, he took up the floor of his basement the whole length of the partition wall, dug a long ditch, and showed conclusively that there was no leakage in that direction. Still the difficulty continued on the premises of Mrs. A. Thus far an effort had been made to get at the cause of the difficulty in a quiet, harmonious manner. Now the physician advised Mrs. A. to consult the Board of Health. This was done. An inspector was sent who made careful tests and found that the plumbing of each house was in a fairly good condition, although he did discover a break in the pipe leading from the premises of Mr. B., opposite the basement wall and under the sidewalk. This was connected, but the trouble was not relieved. The inspector was again sent for. The vegetable cellar connected with Mrs. A.’s house was the source 6 of the trouble beyond a doubt, but how did the nasty, disagreeable water get there? A well was dug a few feet deep and it was found that it would fill with water of an unpleasant odor, sometimes much faster than others, especially after a rain. After much study, the inspector felt that there was something wrong in the block, and began to inspect the buildings, first-class in every respect, and occu- pied by the best citizens. Nos. 128, 130 and 132 were all found in good condition, but on examining 134, a fine residence that had changed hands about eighteen months previous, he discovered that an alteration had been made in the plumbing, and that a cistern, no longer used, had been made use of to connect direct with the water closets of the house; evidently the family being of the belief that this cistern communicated with the drain in some mysterious manner. It did have an over-flow, but this over-flow was far from being perfect. In the course of a few months this cistern became filled, to a certain extent, with fecal matter. It still had its connection with the roof of the dwelling, and it was also found that the over- flow had become stopped, changing its current in such a manner that now through the front walls of the houses and basements the sewage had formed a channel and worked its way down under the foundations of the different houses, not making its escape into any of the cellars until it reached the house of Mrs. A. Here was a solution of the entire question. When the plumbing of 134 was corrected, the cistern closed, the proper connection made with the street drain, the premises became sweet and pure again. Think you that the best of people, residing on any street, would have worked in harmony with each other to have found this source of trouble? Think you but for the law and authority of the Board of Health that the owner of No. 134 would have allowed his neighbor to have made the charge that he was using an old cistern as a vault for his water-closets ? This is but one illustration of many that I might call your attention to. Of the work that has been accomplished by the Board of Health, he abatem ent of stagnant ponds and the correction of worthless drains has been among the most important. Time will not permit me to refer to the different instances where the Board of Health, either as a whole or through their Sanitary Committee, have inspected and recommended to the Common Council the putting in of drains and sewers and the making of such repairs and corrections as were absolutely necessary. It would be impossible to abate such conditions as the stagnant ponds that existed at the head of 7 Van Woert street, at Allen street, at Quail street, Myrtle avenue, west of Dove street, and others I might mention, but for their being condemned as nuisances by the Board of Health. But for their persistent and continuous efforts (it is true their attention being called to it constantly), Martinville to-day would be far worse than it is, and yet there is much to be accomplished in the way of improvement there still. All along the line of the stream that passes through this unfortunate part of our city, can we see the improvements that have been made, and which had their origin in the absolute, positive recognition and recommendations of the Board of Health. One of the best things done by this Board, a few years ago, was the directing of the Health Officer to ascertain the sanitary condition of emigrants arriving in the city to work on the West Shore railroad. In several instances the spread of contagious diseases was, beyond a doubt, arrested. One good result following a resolution adopted by the Board of Health in August, 1882, was notifying the Secretary of State as to the nuisance situated in the basin between Columbia and Lumber streets, a copy of the same being transmitted to the Board of Public Works, and which notifi- cation resulted in the relief and abatement of the nuisance for that time. From a study of the condition of the basin the Board, later on, felt that it was their duty to know more about the intake of our water-supply, and on December 15th, 1884, a resolution was passed authorizing Prof. Mason, of Troy, to analyze the water of the Hudson river above Albany. This report contained many valuable points suggestive of the condition of the water at the intake, with which most of us are now familiar. Said report was presented to the Board May 28th, 1885, and accepted. This report was the means of demonstrating that at certain times the flood tide carried our own sewage back to the intake. The removal of night soil from privy vaults and the method and manner of doing it, has been very much improved under the Health Officer. Privies and urinals in our public schools have received proper attention and have been greatly improved by suggestions and orders from the Health Officer. In August, 1883, a very able report was presented by the Sanitary Committee on the condition of Beaver creek, the Penitentiary grounds, the Martinville sewer, and again in June, 1884, called the attention of members of the Common Council to the nuisance that existed along the line of Beaver creek. 8 Also in July, 1884, Patroon’s creek was condemned as a public nuisance, the Board requesting the Common Council to pass a law to have proper drainage secured along the line of this system from the river to Tivoli lake, owned by the city, also through West Albany through lands under the control of the Board of Water Commissioners, also suggested repairs to Fox creek sewer. It is astonishing to look over the wotk done by the Board of- Health and see how many stagnant ponds have been either properly drained or condemned in such a way that the owners of the land were obliged to have them put in proper sanitary condition, either by filling or draining. On May 25th, 1885, the Board very reluctantly accepted the resignation of Dr. O’Leary, who had been a very faithful and efficient Health Officer. In June, 1885, Dr. Balch was appointed Health Officer by Mayor Banks, and has certainly proven himself a very worthy and admirabie official. June 29th, 1885, the Sanitary Committee, with Commissioner Bingham and Health Officer, made an examination and recommen- dation for the disposition of sewage emptying into Tivoli lake ; also directing the secretary to correspond with the Board of Water Commissioners and ascertain if sufficient water could not be obtained without Tivoli lake for the months of July, August and September, 1885. This communication was answered immediately by the Board, stating that the whole flow of Patroon lake, Rensselaer and Tivoli lakes was now taken into the city’s consumption, therefore the supply could not be cut off. Knowing for some time that the city wells had been the cause of producing certain local troubles, such as cerebro-spinal meninigitis, diphtheria and typhoid fever, the Board directed Dr. Willis G. Tucker, of this city, to examine the public wells and report upon their con- dition. The report, which I here submit, was presented to the Board of Health July 14th, 1885, and is very instructive. Dr. Tucker clearly stated that many of the wells were in bad condition, some doubtful, some fair, and not more than two out of the thirty- six were found in good condition. The report was accepted and a resolution was passed directing the Health Officer to close up forth- with the condemned wells mentioned in the report. It was found difficult to close only the bad ; to close all the doubtful was almost impossible, and it will probably remain the case until the city supply of water becomes pure and wholesome. It is astonishing to see with what tenacity the people hold on to the use of these wells. I 9 is true the water is found clear, being cold and pleasant to the taste, yet contains some of the most serious forms of disease germs. In time it is to be hoped every well will be closed and this source of water-supply shut off entirely. The inspectors of the Board have demonstrated that there are situated within the city certain areas in which springs are to be found, which have given very much trouble at times in the laying of foundations and the controlling of leakage from one house into the other. Noticeably so is this in the case of sections where Jefferson street is the centre, also State street and Portions of Arbor Hill, but these springs are in themselves dangerous and should not be used by the people for drinking pur- poses. The annoyance of building where these springs exist, and the error of digging sub-cellars deeper than the adjoining property, is very well illustrated by the following report of the inspectors in a complaint made during the past year: “ The case has up to the present time baffled the inspectors. It is situated at 148 Blank street; it is occupied and has a sub-cellar under the basement about seven feet, which is much lower than any house in the neighborhood. When first complained of a test was made of 146 Blank street ; the drain was found defective and leaking into 148. A new iron drain was put in at 146 and the leak stopped for about six months, when another complaint was made. The house No. 144 Blank street was tested, found very defective and leaking into 148. This old drain was removed and replaced by an iron drain. The leak stopped for about four months when another complaint was made. No. 142 Blank street was then tested, that was also found defective and leaking into 148. A new iron drain was put in there and the leak stopped for a short time. Another complaint was made, and from last October up to the present time the inspectors have been unable to find the leak, although every house from 146 Blank street to 130 has had new iron drains put in, except No. 140, and that house has been tested as well as all the houses in the adjoining block from No. 2 Blank street to the corner of Blank street, also the alley drain. The water that comes into 148 Blank street is clean and cold, but has an odor of sewage and when the house is closed up the cellar smells very badly. The inspectors have spent eight weeks on the case with the above results, the cellar being so low that it is likely to draw all the water from around the foundations in the row of houses north. No doubt this condition of affairs is due to some spring furnishing the water, that becomes more or less contaminated as it comes in contact with old 10 drains, cesspools and covered vaults. These conditions are only- remedied by an extra iron drain, well trapped, taking the water from a well dug at the most dependent point in the sub-cellar, carrying it far enough out into the street to connect with the sewer sufficiently low to ensure good drainage.” This is very expensive. This form of leakage from one cellar to another causes more angry feeling between neighbors than can be imagined, and the trouble can only be settled by the Board of Health. In August, 1885, the city having expended much money from time to time in the repairing of Fox Creek sewer, the Board recom- mended that this sewer be condemned and a new drain be laid in Canal street, but this has not yet been fully carried out. In June, 1886, District Attorney Herrick appeared before the Board, and said that he had a communication to make. He desired that the Health Officer, who was familiar with the state of affairs, should make a public statement regarding the trouble at the Penitentiary. The Health Officer reported that on December 26th, 1885, he was requested by the District Attorney to inspect the Penitentiary, as he had been informed that day that several cases of typhoid fever existed there, and ascertain if the sanitary condition of the prison was im- perfect. A thorough inspection was made, the disease was found to be typhus, and the Penitentiary put in a state of quarantine. But for the prompt action of Dr. Balch in this matter, the city would probably have suffered a severe epidemic of this dreaded disease. A very comforting communication was presented by the Health Officer in 1886, declaring the city free from small-pox, typhoid fever, and diphtheria. To save expense in repairs and to put the property in a more healthful state, the Board also recommended that the Ruttenkill sewer be condemned and the same be filled ; that to take its place a drain be laid in Beaver street, from Green street to Broadway, in Broadway from Hudson avenue to Beaver street, and also in Dean street from Hudson avenue to State street, doing away with much of the use of Ruttenkill sewer. The Board have found much trouble in keeping the present hos- pital for the reception of small-pox cases and other contagious dis- eases in proper condition. The Health officer has, on several occa- sions, presented very excellent reports for the construction and maintenance of a hospital for all contagious diseases, but the Board 11 have felt that they could scarcely afford the expense at the present time. The Board have found much difficulty in having proper drains constructed in the many alleys that are to be found in the city, on account of the irregular contour of the ground in many cases. Noticeably so was this the case in the alley between First street and Clinton avenue, and which tested the power of the Board to its fullest extent, but the nuisance and trouble was thoroughly treated and disposed of. The Board has always found much trouble in the enforcement of the rules regarding physicians reporting contagious diseases, and I feel embarrassment in apologizing for members of my profession for their not taking more interest in this matter; but the Health Officer has been glad to announce, and has at last presented the law so for- cibly to physicians living within the city, that they have met him in the spirit he desired, and are now very punctual in reporting such cases. In order to facilitate this work the health officer has fur- nished them with postals, with blank spaces, that can be filled within a minute and dropped in the mail boxes, giving the physician very little trouble, so that now a fair return is made to the Health Officer of such cases as the following: Small-pox, scarlet fever, diphtheria, measles, chicken-pox, typhus and typhoid fever, membranous croup and cholera. In May, 1885, the Health Officer called the attention of the Board to the subject of disposing of horses suffering from glanders. He was directed to employ a veterinary surgeon, and since then some very excellent work has been done in this direction, lessening the danger among animals to the minimum. The Health Officer and Inspectors have been very much an- noyed in the past by the imperfect manner in which plumbers were allowed to do their work. Some very serious errors were committed by the latter, their workmen sometimes not connecting the house drain with the sewer at all, and in other instances using such poor material and doing their work in such a manner that within a year new houses became unsanitary. The health officer, with the Mayor and Corporation Counsel, succeeded, in the winter of 1888, in secur- ing a law (Chapter 399, Laws of 1888, entitled “An Act to secure registration of plumbers and a plan of the plumbing, drainage and ventilation of dwellings in the city of Albany’’). This law was put into effect June, 1888, by the appointment of R. T. Gorman an in- 12 spector of sanitary plumbing, and who has proven himself a most efficient and competent officer. September, 1888, rules and regulations for plumbing, drainage and ventilation of buildings were adopted, and some extracts are taken, as follows: “ It is the duty of the inspector of plumbing to pass upon all plans submitted, to keep a daily record of his work, including viola- tions, to make quarterly reports, inspect all houses in course of erection, alteration or repairs, and see that all work for plumbing, drainage and ventilation is done in accordance with the provisions of the regulations.” “To inspect all sewer connections and external house drains within twenty-four hours after notification, all waste and vent pipes and other inside plumbing within three days. Under no considera- tion will any boss mechanic be granted a permit to use the street until an order from this office is procured.” No plumber is allowed to do any plumbing in this city unless he is registered in this office. At this meeting the Board passed a resolution requesting the Health Officer to visit Montreal, Canada, to ascertain what method they had of disposing of the garbage of the city. In his report, October, 1888, the Health Officer said of his visit to Montreal that he examined the garbage and night-soil cremato- ries, and recommended that Albany make use of the same. This has not been done. It was also recommended at this time that an examination of the public schools be made by the inspectors, and recommendations sent to the School Board to put them in sanitary condition. In September, 1889, occurred the outbreak of typhoid fever in the western part of the city and at West Albany. The Health Offi- cer visited the locality, and found those who had been taken ill had all used water from a certain well, formerly a spring, which had received drainage from Third street, Livingston avenue, and leakage from privy vaults near by. The well was closed, and about 250 cases of typhoid reported as the result of the epidemic. Complaints have been made about the water from the reservoirs (Bleecker and Prospect Hill) having a fishy taste, and the Superintendent of Water- works has been more than once advised to seine the reservoirs, but so far the advice has not been followed. December, 1889, the Health Officer was directed to make a care- ful examination of the theatres of the city, recommending to the 13 owners that they be placed in a condition not dangerous to life in case of a panic. This recommendation was thoroughly complied with. Recommendation was also made to the Common Council to lay proper drains in North Albany, which was soon done and carried out. The Board have found much trouble in having the slaughter houses situated at Allen street, and other portions of the city, con- ducted in a proper manner, but, on recommendation of the Board, their instructions have been complied with, and the work is now carried on in the latest and most improved manner. One of the most troublesome problems that has come before the Board is the removal of vaults from the yards of dwellings and the substitution of proper water-closets. The leakage from these vaults creates frequent serious annoyance to adjoining property owners, and yet it is astonishing to see how unwilling people are to have them removed, particularly the owners of the property, and substituting better sanitary arrangements. The matter of testing drains is one that requires the most care- ful attention, and those making such tests must be very careful in doing it, so that no injustice will be done the parties owning the property. In some cases all testing fails to show the defects. I will cite two instances where the tests failed, although the inspectors were satisfied that the drains were defective. The cellar of premises on the nosth-west corner of Blank street was found to have several inches of sewage water in it. Complaint was made and the inspector examined and tested several houses around the place complained of, without success, until he visited No. 33 Blank street, which they tested with both peppermint and blueing, found the drain defective, but could not find any traces of the tests on the premises complained of. The occupant was induced to make a complaint, and when the old drain was removed and an iron one put in, the leak in the cellar stopped and is now perfectly dry. The reason the tests did not show was the amount of water under the floor, making a water seal against the test. Another instance when the test failed was at 120 Blank street, the drain of this house being one of the worst that has come to the notice of the inspectors. The parties living next door west were troubled with bad odors, so much so that the man’s wife was sick all of the time. They had their drain tested and it was found defective. A new iron drain was put in and after that the odors were very bad, more so than ever. Complaint was first made to 14 the owner, who sent his plumber to test it, but who could find nothing wrong. Then complaint was made to the Board of Health and the inspectors made a test, but could discover no odor from same. The smells continued to enter the house next door ; the inspector had the front of the house dug up to the drain, and when the opening was made the water came running from under the house, and it took about two hours for it to run out. When the drain was reached it was found all broken down. Since this drain was taken out and a new drain put in the odor disappeared from the house next door. The same cause prevented the test showing as at 33 Blank street. Of the attack of typhoid fever in this city during the past winter I have not the time to speak. The subject has been thoroughly discussed, and opinions pretty freely and positively expressed. Dr. Balch has presented two very able reports to the Board upon the subject, which have been printed in the daily papers. The duties of the inspectors, in connection with the Board, are at times very laborious. They are obliged to give their entire time ; they make reports to the Board ; they examine into all complaints, no matter what kind ; they notify owners or agents to abate nui- sances, fumigate, disinfect, etc., remove small-pox cases, when neces- sary ; also have an inspector in the Public Market every day in the year; look after wholesale houses where poultry and fruit are sold ; see to vaccine supply, etc. The principals of public schools are notified when a case of con- tagious disease exists in the house in which a scholar is attending his or her school. The average number of complaints yearly is about 2,500, of which 80 per cent, are found necessary for correction, and proper attention to correction made. Each member of the Board serves without pay. It ought to be pleasing to the tax-payers to know that this Board has always worked within its appropriation, and has some years carried over from $500 to $1,500 to next year’s budget. The following is a list of the gentlemen who have occupied these positions : M. N. Nolan, Jacob S. Mosher, M.D., John Boyd Thacher, A. Vander Veer, M.D., Wm. H. Keeler, Thos. H. Dwyer, John McKenna, Rob’t Bryce, Albert Gallup, Sam’l B. Ward, M.D., John V. L. Pruyn, Thos. F. Corcoran, R. H. Bingham, and Elmer E. Larkin, M.D. 15 The present Board is made up of Mayor James H. Manning, A. Vander Veer, M.D., F. C. Curtis, M.D., L. C. B. Graveline, M.D., Max Kurth, P. E. McCabe, Horace Andrews. The names of the employes are, at present, as follows: Lewis Balch, M.D., health officer ; Edward H. Long, secretary and registrar ; Edward Brennan, inspector; Geo. F\ Backman, inspector; John Hannigan, inspector; Richard T. Gorman, inspector of plumbing. For most of the material that I have made use of in presenting this incomplete report, I am indebted to the very efficient, courteous and gentlemanly Clerk of the Board, Mr. Edward H. Long.