Volunteer Sanitary Organiza- 
tions as an Aid to Official 
Boards of Health. 
BY 
HORATIO R. STORER, M.D., 
OF NEWPORT, R. I. 
Read in the Section of Stale Medicine at the Fortieth Annual Meeting 
of the American Medical Association, held at 
Newport, June, 1889. 
Reprinted for the Newport Sanitary Protection Association, 
from “The Journal of the American Medical 
Association,” May 10, 1890. 
Printed at the Office of the Association. 
CHICAGO: VOLUNTEER SANITARY ORGANIZA- 
TIONS AS AN AID TO OFFICIAL 
BOARDS OF HEALTH. 
The question that I am desired to present to 
you has been often discussed, generally, how- 
ever, from a merely abstract standpoint. Viewed 
from the position of public boards, voluntary as- 
sistance, even if well organized, has too often ap- 
peared interference, while upon the other hand, 
the private citizen is inclined to criticise the av- 
erage board official as indolent and the creature 
of red tape, or else too zealous and inclined to 
magnify his office. 
TWO FIELDS FOR SANITATION, DISTINCT FROM 
EACH OTHER. 
It will be my endeavor to avoid these ex- 
tremes, and to show from a practical experience 
in this matter of nearly a dozen years, that in 
American communities there exist two distinct 
fields of operation. They are side by side, and 
necessarily everywhere present, though in some 
places more markedly so than in others. With 
the limitation that the law provides as to the 
supervision of private households by civic or 
State officials, in the absence of epidemics or 
complaints of a nuisance, this can be attained, if 
anything like completeness of result is desired, 
only by a method of surveillance wholly distinct 
from that provided by the public authorities. 4 
THE PRIVATE FIELD REACHED ONLY FROM 
WITHIN. 
Domestic privacy, which means not merely 
that of the family circle, but the retirement of 
the home water-closet and bath room, the cham- 
ber ventilation, the furnace air supply, the first 
disposal of the laundry and kitchen waste, can 
hardly be reached save upon personal invitation 
from the head of the household. This entrance 
is not likely to be given to representatives of the 
press ;• still less, to the town constable. The 
family plumber knows of some of the conditions 
that are present; so does the family carpenter, 
and so also the family physician. This knowl- 
edge is, however, all of it of a confidential char- 
acter, and if asked for outside would not be 
certain to be given. 
The only key to the situation is through vol- 
untary admission from within, and this is a privi- 
lege hardly to be expected save as the outcome 
of a purely self-interested motive upon the part 
of the occupant of the premises. 
Dwellings, like their owners, grow old and 
decay. As even infants have their diseases, so 
do also the newest residences. The rule concern- 
ing every house, no matter how recent its date, 
should be that it requires a thorough periodical 
inspection, at least once each year. The “Spring 
cleaning” should be a virtual taking account of 
stock, and employed as the opportunity of ascer- 
taining defects and of making all necessary alter- 
ations and repairs. This is essential for the 
protection of its own occupants ; but since dwell- 
ings like individuals become the subject of in- 
fectious disease, it also is necessary for the safety 
of its neighbors. As owners are usually careless 
NEED OP INSPECTIONS. 5 
and nearly as often incompetent for the purpose, 
the examination should be made by a specially 
skilled adept. How then to obtain admission for 
the practical sanitarian to the most secret recesses 
of a private house? 
Self-interest, as has been implied, is the most 
potent of all motives that influence mankind. 
Formerly the mere idea of domestic inspection, 
otherwise than by the owner, would have been 
laughed at. Till of late, if a pipe leaked or burst, 
the plumber was sent for, repaired it, and then 
took his leave. If a privy was foul it was 
emptied, just as in croup, scarlet fever and 
typhoid the physician was summoned, attended 
the patient till death or recovery occurred, and 
then discontinued his visits. 
With the progress of popular knowledge it 
is becoming appreciated that in plumbing and 
scavenging, and in the practice of medicine as 
well, prevention is far better than cure, though it 
is still through preventable zymotic disease that 
almost every household is thinned of its dearest 
members ; and that when such misfortune has 
occurred, there remain effects that, if not neutral- 
ized, may become doubly disastrous and wide 
spreading. 
INSPECTIONS REQUIRED BY SELF-INTEREST. 
At this point, self-interest, well understood, 
assumes another phase. The money formerly so 
lavishly spent upon the physician, the pharmacist 
and the sick nurse, is now much of it begrudged, 
although to be sure all these succeed in protect- 
ing themselves by a steadily increasing tariff. 
The same is true of the undertaker. Not nearly 
as many infants in proportion now die as form- 
erly—indeed there are not, in parts of this country 
at least, as many proportionately to die—but 6 
then the loss is eventually made good to the pro- 
fessional person in question by the greater ex- 
pense attending the funeral of a proportionately 
increased number of adults, whose lives through 
sanitary science have been prolonged to maturity. 
Having thus reached the financial point in the 
question, the manner in which the greatest sav- 
ing is to be effected, for even the millionaire who 
scatters his wealth most lavishly is as frequently 
addicted to the practice of prudent economies, 
the way becomes easier towards the desired re- 
sult. It is granted, we will assume, that an in- 
spection of one’s premises from time to time is 
found of pecuniary advantage, upon the ground 
that such eventually lessens plumbers’ bills, 
druggists’ charges, doctors’ accounts, and post- 
pones those of the undertaker. 
AN EXPERT NECESSARY. 
The inspection, to be of value, must be by a 
disinterested person, an expert. The family phy- 
sician cannot make it, save in a very general, if 
not indeed wholly superficial, manner. He has 
not ordinarily the technical skill, nor can he 
spare the several hours that are necessary to con- 
duct the examination thoroughly, and to prepare 
a detailed report. The family plumber should 
hardly be called upon to pronounce upon his own 
work, and to entrust the survey to a rival would 
be unfair to the first, and perhaps be as unlikely 
to elicit a perfectly unbiassed opinion. What 
else then remains ? 
Thanks to modern progress, the clearer define- 
ment of social needs and the more perfect subdi- 
vision of educated labor, the profession of practical 
sanitation, of sanitary engineering, has become 
recognized as a necessity. In its way, and to a 
certain extent, it is indeed to be classed above 7 
our own divine science of healing, though to 
this it owes its existence. It is admirable to re- 
store the diseased to health, but upon the whole, 
simpler though it may seem, is it not even a 
higher function to keep men well? Now for 
house inspections a skilled expert is plainly pref- 
erable, but the services of these gentlemen cost 
much money—no more to be sure than they are 
worth, or will eventually be prized at—but at 
this stage of the world’s progress a charge of 
fifty, or even thirty or twenty-five dollars for in- 
vestigating a residence, seems to most house- 
holders quite a sum for the purpose, and the 
average man who would spend this amount with- 
out another thought upon cigars or similar luxu- 
ries, hesitates a long time before giving its worth 
of additional protection to his wife and children. 
PROF. FLEEMING JENKIN’S PLAN. 
Under these conditions, “a happy thought” 
struck the late Prof. Fleeming Jenkin, of the 
University of Edinburgh. He applied to house 
inspections, the principle of cooperation or mu- 
tual insurance, called the new ‘‘Sanitary 
Protection,” and it was placed at once in success- 
ful practice. The Association at Edinburgh was 
the first to be organized, in 1877. Our own at 
Newport, R. 1., was the second, in 1878. Eon- 
don and other cities followed, and now the princi- 
ple is in extended application. Much has been 
written concerning its theory and practice. It is 
unnecessary for me here, to do more than merely 
state that a portion of its earlier literature eman- 
ated from Newport. As a consistent disciple of 
the Edinburgh school of thought and of practice, 
it has been a constant satisfaction to me to watch 
the development of Jenkin’s well concerted 
system. 8 
ITS FEATURES AND ITS COST AT NEWPORT. 
The general principle upon which this system 
is based is the following : To enable its members 
to obtain for a comparatively very small sum, an 
inspection of their houses of the same thorough 
character, as would otherwise cost several times 
the amount. At present the annual dues ot 
membership in the Newport Association are $2 
per year, which collectively defray the current 
expenses of printing, postage, etc., no salaries 
whatever being paid. For a house inspection, 
which may require the better part of a day, with 
considerable subsequent clerical labor in prepar- 
ing the report, $8 is charged, and for water 
analysis $5 ; these fees being given, entire, to the 
inspectors and analyst for their services. 
The city of Newport in its sanitary relations, 
is peculiar. The compact part of the town is 
like that of most old American seaports, which 
were originally wholly commercial. As sails 
were replaced by steam, and the carrying busi- 
ness, home and foreign, became centralized in 
what are now the great foci of trade, both wharf 
and residential property deteriorated in value in 
the smaller places, and so far from sufficient an- 
nual outlay being made to keep them in their 
former order, a condition of general neglect has 
necessarily obtained. The foreign have largely 
replaced the native born as laborers, and houses 
that were built for the needs of a single family 
have now to serve for two or three. Subdivision 
of use, whether of a dwelling, an out-house or a 
well, lessens individual responsibility for its care. 
From times far gone there has been a very gen- 
eral intermarriage between the “old” families 
within many of these retrograding cities. From 
NEWPORT SANITARY CONDITIONS. 9 
Newport besides, till of late years, and indeed 
the exodus continues, there has been a large emi- 
gration of its most energetic young people to 
places of greater activity, with the threefold 
effect of progressive loss of public energy, an in- 
creased general inertia, and a more marked dis- 
position upon the part of those who have been 
turning downwards with Fortune’s wheel, to be- 
come merely glorifiers of the past. 
Among the natural effects of this has been the 
very general retention of the countless old vaults 
and privies, some of which are in direct connec- 
tion with wells that are daily employed for house- 
hold purposes, that still honeycomb the compact 
portion of these old sea-board towns. In many 
of them, as here, a free artificial supply of water 
has been introduced; and in some of them, as 
here till quite recently, there has been no proper 
system of sewers to remove the flow, after its 
pollution. 
DANGERS RESULTING. 
Again, Newport has become for a portion of 
the year the centre of American fashion and 
wealth. Houses of the most expensive character 
have been built, increasing in number upon a 
constantly progressing scale. They are furnished 
with complicated systems of plumbing and drain- 
age. The needs of the place have therefore been 
twofold. Ancient conditions exist in close 
proximity to the most modern ones. The dangers 
of old towns, supersaturated by the retention of 
centuries of sewage, are supplemented by those 
arising from the introduction into dwellings upon 
which architects have lavished all the resources 
of their art as regards adornment, of every kind 
of modern so-called sanitary device, good, bad 
and indifferent, which for economy’s sake aside from that of safety, should be as intelligently 
placed at the outset as possible, and thereafter 
regularly receive the most intelligent supervision. 
Many of these establishments are so extensive, 
and the social demands upon their occupants so 
great, that all care-taking is entrusted to subordi- 
nates, whose only aim again is to play their own 
petty part in the year’s Vanity Fair with the 
least possible expenditure of trouble. The re- 
sult has been that more than one Newport palace 
has proved, wholly unnecessarily, the tomb of its 
possessor. It would be fortunate for all con- 
cerned if such occurrences were of the past alone. 
TERMS OF NEWPORT CHARTER. 
By the terms of the Charter of the Newport 
Association, for which the present efficient mayor 
of the city, Hon. Thomas Coggeshall, was one 
of the petitioners, it was established for “the 
purpose of securing the proper sanitary condition 
of the dwellings of its members, and of any 
other buildings or premises in said Newport, so 
as to aid in promoting the sanitary condi- 
tion of the said city.” At that time, January, 
1879, there existed no health authorities here 
save the Board of Aldermen, under whose direc- 
tion there were a city physician (the present in- 
cumbent and the senior of the Newport profes- 
sion), an inspector of nuisances (who at that time 
was also the only overseer of the poor), a health 
officer (in addition u now, the harbor master, a 
retired sea captain) and an overseer of small-pox 
(who was a blacksmith by trade). The Associa- 
tion fully recognized at the beginning the dual 
character of the responsibilities with which it 
had been entrusted by the State, to care for the 
premises of its immediate members, and for their 
sake as well as for the safety and good name of the whole city, to aid in improving the system 
that supervised the public health. 
CREATION OF NEWPORT BOARD OF HEARTH. 
From the beginning, therefore, the Association 
has persistently labored to obtain a properly or- 
ganized and sufficiently independent Board of 
Health, and it has endeavored to do this by 
repeated memorials to the City Government, by 
enlisting the interest of the General Assembl}*-, 
and by producing in many ways a change in 
public sentiment. In this, at the end of nearly 
a dozen years of unremitting effort, it may be 
said to have been in a great measure successful. 
To have obtained this advance in a city like New- 
port, with a century of apathy, inertia, and pre- 
judice against all innovations behind it, means a 
very great deal. The physicians of the place, 
without exception and year after year, have been 
in sympathy with the movement, and so have 
one or two of the clergymen. A general act 
passed the Rhode Island Assembly empowering 
Boards of Aldermen to transfer their powers to 
separate Boards of Health. Though this has not 
yet been entirely done in Newport, the progress 
towards its accomplishment is constantly increas- 
ing, At first aso called “ Advisory Board,” of 
whose members a portion were medical men, was 
appointed by the Aldermen, but it did not con- 
sider it was expected to volunteer suggestions, 
and its advice was not often asked for or followed. 
After a year or two, the at present existing im- 
provement was made. A board of five, three of 
whom are physicians, is created for a 
single year, and annually filled for that time by 
the Board of Aldermen. It is known as the 
Newport Board of Health, though often it is still 
called an advisory board, and probably by many 12 
considered as merely such, since the Aldermen 
occasionally convene “as a Board of Health.” 
Under such a transient tenure of existence, the 
Board could hardly at first have been expected to 
have a very definite policy or to show any re- 
markable measure of energy. Their suggestions, 
however, are now received with more and more 
respect. The appropriations for which they ask 
are now more generously granted them, and at 
present there is much more active sympathy be- 
tween the Board of Health and the Aldermen 
than ever before. The Board have an executive 
officer, appointed, upon their nomination, by the 
Board of Aldermen, and he also acts as their clerk. 
Neither the inspector of nuisances nor the 
“health officer” are appointed by them, though 
they nominate the former, and receive his reports. 
Both of the present incumbents of these offices 
are men of experience and well fitted for their 
duties. The latter has had, perhaps still has, the 
additional title of “ Sentinel,” as he is primarily 
the Harbor-master, and is expected to report the 
cases of disease upon shipboard that come with- 
in his notice. The City Physician happens, for- 
tunately, thought not necessarily, to be a mem- 
ber of the Board. 
THE PROGRESS OP THE BOARD. 
Frail as is yet the tenure of the Newport 
Board of Health, it yet deserves credit for what 
it has already accomplished towards lessening 
the sanitary dangers and retrieving the repute of 
the city. Thanks are due to the authorities for 
having thus far “ tried the experiment,” as it has 
been said, of yielding to the advice of those most 
familiar with such matters, and to the memorials 
of the heaviest taxpayers, and to what seem the 
dictates of common sense. The money worth of 13 
a bread producer is elsewhere recognized as 
representing a definite amount in dollars and 
cents, belonging to the whole community, to pre- 
serve which in its effective integrity is, aside 
from all motives, of private selfishness or mere 
philanthropy and sentiment, a public duty. It 
has taken Newrport a long time to recognize that 
Death knocks with equal beat upon the gate of the 
millionaire and the door of the laborer, and that 
every fatality from zymotic disease, even though 
from what are called so trivial affections as 
whooping cough and measles, is so far a disgrace 
to modern civilization and a robbery of the pub- 
lic treasury. “My father died of typhoid, there- 
fore so should I,” would seem to be one of the 
forms of ancestor worship that still pervades cer- 
tain of the old New England communities, but 
the more direct and constant their contact with 
the outside world, the more completely prejudice 
yields and the more warmly the at first dreaded, 
if not derided, innovations of modern science are 
welcomed. The final abandonment of a polluted 
site of ice collection, the filtration of the public 
water supply at, its source, the relinquishment of 
a project for a new cemetery within that area, 
and the construction of a garbage cremator,1 all 
of them since the commencement of the present 
year, are the direct effects of advice given by the 
Board of Health, upon public sentiment. 
Though the Sanitary Protection Association 
takes pride in having aided towards the develop- 
ment of a proper Board of Health, it can hardly 
be satisfied until much that still remains to be 
done has been accomplished. As at present con- 
stituted, there is probably not a single member of 
the Board whom the Association would desire to 
have changed, for it combines the decision of 
1 The latter, unfortunately, has not proved a complete success. maturity with the conservatism of age, and the 
practical ways of the business man with the 
scientific training of the physician. As to the 
extent of the powers of the Board under its pres- 
ent relations there have been differences of opin- 
ion, not only on the part of the people but of its 
own members, and from this it has been blamed 
for apparent slowness in its work. These ques- 
tions, however, have of late been clearly decided, 
and doubts removed, by an exhaustive statement 
of the law in the case, in its various bearings, 
enunciated by Judge Darius Baker of this city, 
at the request of the Newport Business Men’s 
Association. The communication referred to is a 
brief one, and contains so much that would be of 
value to other communities, similarly situated, 
that I present it entire. 
JUDGE BAKER’S STATEMENT OF JAW. 
“The protection of the public health belongs to what 
is known as the police power. All property is held sub- 
ject to this power, which regulates its private use and en- 
joyment by the owner. If he suffer injury from its ex- 
ercise, it is either damnum absque injuria, injury with- 
out wrong, or he is compensated for it by sharing in the 
general benefits which the regulations are intended to 
secure. This power, which is of wide scope and includes 
many other things for the preservation of the public 
health, for convenience of exercise and administration is 
usually delegated to municipal corporations. For pres- 
ent purposes we shall refer only to that branch of it 
which pertains to health. This has been expressly con- 
ferred upon our city by that portion of the charter which 
provides that ‘the City Council shall have power to make 
ordinances and regulations for the government of said 
city relative to the public health.’ 
“The Public Statutes also provide that ‘town councils 
and boards of aldermen shall be ex officio boards of 
health in their respective towns and may make such 
rules and regulations, not repugnant to the law, as they 
shall judge proper for the preservation of the health of 
the inhabitants thereof, the prevention and abatement of 
nuisances, the promotion of cleanliness, the removal of the causes and the prevention of the introduction and 
spread of any contagious or infectious diseases therein/ 
with authorit}' to affix penalties for the breach of such 
rules and regulations not exceeding three hundred dol- 
lars fine or six months’ imprisonment for any one offense, 
and with the proviso that the City Council may appoint 
a Board of Health, which shall have all or any part of 
the powers and duties of the Board of Aldermen as a 
Board of Health, as the City Council may determine. 
“In addition to this, extensive powers as to the abate- 
ment or removal of certan nuisances are conferred upon 
town councils (which may be construed to mean boards 
of aldermen)—such as slaughter-houses, bone-boiling 
establishments and fish oil works—as to the regulation 
or control of the ‘construction and location of all places 
for keeping swine, privy vaults, sinks, sink drains, sink 
spouts, cesspools, and the outlets thereof‘the sum- 
mary removal of reconstruction of all such as shall be 
by them deemed prejudicial to the public health, the 
location of stables and the time or manner of removing 
filth from them and from the vaults or slaughter-houses’ 
—also as to making suitable regulations and arrange- 
ments for the 'prevention of infectious and contagious 
diseases, and for the quarantine of vessels and persons 
on them, and for the burial of the dead. By public law, 
passed in 1885, a ‘town council may order the owner or 
occupant of any premises’ in the town ‘to remove at his 
own expense any nuisance, source of filth, filth or cause 
of sickness found thereon within twenty-four hours’ after 
notice, under penalty of not exceeding twenty dollars a 
day for a non-compliance with such order. It may also 
‘when satisfied upon due examination that any cellar, 
room, tenement or building in its town occupied as a 
dwelling place has become, by means of the number of 
occupants or want of cleanliness or other causes, unfit 
for occupation as a dwelling place and a cause of nui- 
sance to the occupants or the public,’ require the prem- 
ises in question to be suitably cleansed and, if the order 
is not complied with, may cause them to be cleansed at 
the occupants’ expense, or may forcibly remove the oc- 
cupants and close the building against future occupancy. 
‘ ‘The health officer required to be appointed in towns 
under this act is the agent of the town council for ‘mak- 
ing all sanitary inspections, ’ may ‘make complaints for 
the violation of any law, ordinance, rule or regulation 
relating to the public health of his town, without giving 
surety for costs or, in cases of emergency, when the council cannot be conveniently convened, shall have all 
the authority conferred by this act upon town councils.’ 
The city of Newport is exempted from appointing such 
health officer; but the power and duties of its Board of 
Health are commensurate with the powers and duties of 
the health officer as set forth in the act. 
‘‘We have by no means stated all of the powers speci- 
fically conferred in relation to the public health and its 
preservation, but enough has been said to show the scope 
or extent of the authority delegated to the city in this 
matter. It is undoubtedly adequate to the exigencies of 
the case. The next inquiry naturally is as to how far 
these powers have been exercised by the city. Under them 
the City Council has from time to time passed various or- 
dinances relating to most, and perhaps all, the subjects 
above referred to, including quarantine, the burial of the 
dead, and the regulation of a great many matters properly 
grouped under the head of nuisances, for example, as to 
the use of fish manure in this city, the localities of hog 
pens, the removal of offal, and other filth from private 
premises, when calculated to injure health, and other 
kindred matters. It does not seem necessary, as it is not 
my present purpose, to show how fully these powers have 
been used as to matters of detail. 
“These ordinances were most of them passed years ago, 
and while, perhaps, they may not be entirely adequate 
to the requirements of the modern view as to sanitary 
regulations, yet it is probable that whatever deficiency 
there may be in them as a system lies largely in the fail- 
ure to provide the proper means for the efficient enforce- 
ment of existing laws and regulations. In the present 
generally accepted views as to the origin spread and 
danger of filth diseases and the means to ‘be employed 
for their suppression, the old arrangement, under which 
the inspector of nuisances was the chief and perhaps only 
executive health officer of the city, is confessedly en- 
tirely insufficient. It furnished a way in which a nuisance 
could be abated, but it is not in harmony with the spirit 
pervading more recent health legislation, which provides 
for thorough sanitary supervision and intelligently at- 
tempts to prevent as well as to remove the causes of 
disease. 
“The requisites of such sanitary supervision are the 
gathering of complete health statistics, the right of local 
inspection, the compelling of a general observance of 
uniform and wholesome regulations and the power of 
quarantine and of summarily removing the cause of dis- 17 
ease in cases of emergency. I will not attempt to 
elaborate either of these points. It is difficult to con- 
ceive of anyone’s objecting to such a system if intelli- 
gently and wisely administered. It was a step toward 
the more efficient administration of health regulations 
when the City Council passed an ordinance creating a 
board of health and giving to it practically all of the ad- 
ministrative and executive powers of the board of aider- 
men as a board of health. The powers of the board under 
this ordinance are to ‘make all proper inquiries into all 
things in said city which may in any way affect the health; ’ 
to ‘prepare and compile all such statistics relating to the 
health of said city as it may deem proper;’ to ‘see to the 
enforcement of all laws pertaining to the health of said 
city as well as the regulations originating with said board 
and those of the board of aldermen acting as a board of 
health. ’ It has an executive officer, and the inspector of 
nuisances is also subject to its directions. From this it 
is apparent that tne board is clothed with large executive 
powers, which in emergencies are very reaching, when 
we take into account the provisions of the act above re- 
ferred to, passed in 1885. 
“I assume that legislative power is not conferred upon 
the board under the ordinance, notwithstanding the 
reference to ‘the regulation originating with said board,’ 
as that is obviously an allusion to a provision in the or- 
dinance as orginally passed in 1885 (since stricken out), 
that the board might prepare regulations and submit 
them to the board of aldermen for their approval. 
“Without here discussing the question as to whether 
events have shown that the power of the board of health 
might well be enlarged (as to which I simply say that I 
am inclined to the opinion that for the present the exist- 
ing division of authority is unobjectionable!, I think that 
it has beeh generally recognized that its existence has 
demonstrated its usefulness and necessity. And if its 
efficiency is to be greatly increased, that can be best ac- 
complished by bringing within its control all matters 
pertaining to the administration of that branch of gov- 
ernment relating to the public health. 
“The board itself is apparently open to criticism in not 
using all of its authority in this direction. It is under- 
stood that it has no direct knowledge or supervision of 
the regulations as to the proper disposal and removal of 
swill and garbage. Yet the complaints in relation thereto 
are made to the inspector of nuisances, who under the 
ordinance is expressly made subject to its order. In my judgment what is now most needed is in this same line 
of improving the administration of the health depart- 
ment, namely, some provision for the better enforcement 
of some of the existing regulations and ordinances. 
“For instance, a regulation requires a house-holder 
to get permission before connecting a private drain 
with a public sewer, and also that a trap shall be 
placed between the sewer connection and the house. 
These requirements are eminently proper ones. But the 
permit being obtained, there is no arrangement for pub- 
lic supervision to see that the work is properly done or 
that the trap is suitably placed. I am informed that 
there is at the present time in this city a case of diph- 
theria in a house where drain pipe connects directly 
with the public sewer without any intervening trap. 
There should be some regulation requiring public super- 
vision of such an important matter as this. 
‘ T repeat, therefore, that what now appears to be most 
requisite in this connection is the taking of those steps 
which tend to the more efficient enforcement of existing 
laws, ordinances and regulations. 
“Although most of our ordinances as to the preservation 
of health, as has already been indicated, have the sanc- 
tion of years, it is not improbable that many of them may 
be susceptible of improvement in some respects. The 
suggestion of such changes, if they are really needed, 
would naturally first come from those who are to discuss 
this question of public health as to its practical aspects. 
I only call attention to two or three things, which are 
important to be considered in the making of ordinances 
and regulations like these which have been referred to. 
These regulations are all infringements upon the rights 
of owners to use or enjoy their own property, and in con- 
sequence they should be no more burdensome than is 
necessary. Therefore; when a question arises as to the 
validity of an ordinance, some of the principal tests are: 
Is it in conformity with existing laws? Is it impartial, 
fair and general ? Is it oppressive ? Is it reasonable? 
At first thought it might seem that, when the power to 
make ordinances in relation to a certain subject is con- 
ferred by some general law upon different municipalities, 
they might all exercise it in the same way and to the 
same extent. But it requires no demonstration to show 
that the provisions of an ordinance might be reasonable 
as applied to the city of Providence and quite the reverse 
in reference to the town of Jamestown. 
“An ordinance prohibiting the burial of the dead in the lower part of New York city was held to be reason- 
able and valid. A similar ordinance, practically prohib- 
itive, in a suburban town, was held to be unreasonable 
and invalid. 
“ ‘The law will not allow the rights of property to be 
invalid under the guise of police regulation for the pre- 
servation of health’ when such regulation is not for pub- 
lic good. And the question of reasonableness is deter- 
mined by the courts, and not by juries.” 
PAST WORK OP ASSOCIATION. 
Leaving this portion of the subject, it may be 
said that the especial field of the labors of the 
Newport Sanitary Association has been of late 
among its own members. This is a sphere for ac- 
tivity that will necessarily always exist, even were 
there fifty boards of health, with all the powers 
conferable by common law or statute, behind 
them. For the first few years its meetings were 
held monthly, at private houses, when papers were 
read upon sanitary topics, followed by interesting 
discussions. These were reported fully in the 
newspapers, and in this way reached the whole 
community. Through the Association a consid- 
erable sum was raised for a house-to-house in- 
spection of the city, and it was made under the 
direction of the then existing National Board of 
Health. A report upon the sanitary condition 
of Newport was thus secured, which even the 
most unwilling were compelled to acknowledge 
as thorough and reliable. The Association has 
encouraged special researches by its members into 
questions of moment regarding the health of the 
city. The ice and water supplies2 of Newport 
have been subject to most careful investigation by 
Profs. Pumpelly, of the U. S. Geological Survey, 
and Hills, the Association’s analyst, and Capt. J. 
P. Cotton, one of its consulting engineers, with 
the effect of greatly improving their condition. 
2 “ The Dangers of Impure Ice.” The Sanitarian, May, 1882. 
“ Newport’s Water Supply,” Ibid., August, 188 S. 20 
In similar manner the merits of Newport as a 
residence for persons of phthisical tendency have 
been studied in a series of reports to the Associa- 
tion3 by the writer of the present paper, and the 
facts clearly brought out: i, that pneumonia and 
phthisis, originating here, are very rare as com- 
pared with the main land; 2, that most of the 
cases occurring are in unnecessarily damp and 
clearly circumscribed localities, as houses with 
wet cellars the number of which is constantly di- 
minishing; and 3, that the moisture of the climate 
is more than counterbalanced, if not indeed made 
a favorable feature, by its constant salinity,4 and 
the decided equability and comparative mildness 
of the winter temperature—the conditions being 
in the main like those of a ship at sea. The As- 
sociation has taken an active part towards in- 
ducing the citizens to adopt the general plan of 
sewerage and consequent drainage also, which is 
now in successful operation through the larger 
part of the compact portion of the town. Every 
year it has conducted for its members many house 
inspections, and analyses from private as well as 
the public sources of water suppty. For the latter 
3“ Newport, R. 1., as a Winter Resort for Consumptives,” Ibid , 
Jan. 11, 18 and 25 and Feb. 5, 18S3; “ Concerning Newport, R. 1., as a 
Resort for Consumptives,” Boston Med. and Surg. Jour., March 22 
and April 26, 1883; ” The Mild Winter Climate of Newport, R. 1., as 
the Effect of the Gulf Stream,” Medical Record, December 22, 1883. 
4 I am well aware of the discussion concerning the part played 
by chloride of sodium in pulmonary disease. Vide H. B. Baker, 
‘‘Relations of Certain Meteorological Conditions to Diseases of the 
Lungs and Air Passages,” etc. (Trans. Ninth International Medical 
Congress, Washington, 1887; Annual Report Michigan Board of 
Health, i 888.)_ The peculiar exemption of Ventnor and Newport 
from these diseases, except as imported, is, however, a sufficient 
commentary. Wholly independent studies of this question, as re- 
gards Newport, made by Dr. F. H. Rankin, Secretary of the New- 
port Board of Health, and based upon the more recent mortuary 
statistics to the present time, seem to completely confirm my pre- 
vious observations and conclusions. The Sanitarian for May, ISB9, 
in analyzing the Newport Board of Health’s Annual Report for 
1888, editorially states that the death-rate from consumption ‘‘is 
probably the lowest of any equal city population in New England.” 
(Loc. cit., p. 464.) 21 
duty it has from the commencement possessed the 
valuable services of Prof. Wm, B, Hills, of the 
Chemical Department of Harvard University, while 
it has had a succession of house inspectors. Its 
present inspecting engineers are Messrs. Chapman 
& Farquhar, whose names as experts in connec- 
tion with Col. Waring, are familiar to all sanita- 
rians. Through the moderation of the Associa- 
tion’s charges, possible only through its system 
of cooperation, the same thorough examination 
is made for members for a comparative trifle that 
otherwise would cost several times the amount. 
One of the two great ends for which it has labored, 
the establishment of a city board of health, hav- 
ing been attained, it now more closely confines 
itself to its private work; not hesitating, however, 
to express itself when it perceives a public need, 
and it at all times holds itself ready to assist in 
every way that may be within its power, any de- 
sire or project of the Board that may come to its 
knowledge. 
In conclusion, it may be stated that the estab- 
lishment of a Volunteer Health Organization at 
Newport of the character indicated has shown an 
important and possible way, previously untried 
in this country, in which such an Association can 
be of aid to official boards of health. 
There were special difficulties in Newport. 
1. The non-homogeneity, for evident reasons, 
of large portions of its population. 
2. The traditional, if not hereditary, apathy of 
the permanent residents regarding public ques- 
tions of the kind, partly the effect of circumstan- 
ces already stated, and perhaps also in part the 
result of the local, non-stimulating, climate. 
3. The commensurate lack of interest by the 
ORIGINAL, DIFFICULTIES OVERCOME. 22 
summer people in anything not of a purely social 
character. 
4. The very prevalent fear upon the part of 
each, lest sanitary agitation might injure the rep- 
utation of the place as a resort both for pleasure 
and for health. 
These obstacles are now surmounted. The 
summer people recognize that pleasures may be 
purchased at risk to life, unless they give reason- 
able attention to their surroundings. The winter 
people have come to see that no matter what the 
natural advantages of the place, they must pro- 
vide the same safeguards to the taxpayers that 
are given by communities elsewhere. The last 
year’s list of members of the Association com- 
prises no less than fifty-two, among them many 
of the most intelligent, most influential and most 
wealthy of the residents of Newport. 
In the present brief sketch of the success of an 
isolated experiment in public as well as private 
sanitation, I have purposely refrained from allu- 
ding to the admirable work that has been done 
elsewhere by volunteer sanitary organizations in 
aid of official boards of health during special emer- 
gencies, at New Orleans, Jacksonville, etc., for 
each deserves its own historian. 
REPORT OF PARENT ASSOCIATION AT EDINBURGH. 
It will be of interest, however, if I give a brief 
sketch of what is being done by the parent body 
of all the so-called Sanitary Protection Associa- 
tions, that of Edinburgh, the report of which for 
the past year has reached me while preparing the 
present paper. 
The President of the Edinburgh Association is 
Prof, Sir Douglas Maclagan, Kt., M.D., assisted 
by two Vice-Presidents, a Council of fifteen gen- 
tlemen, and a Secretary, who is also Treasurer. 23 
There are a Resident Engineer and three assist- 
ants. There were no less than 104 public build- 
ings (schools, club-houses, banks, hotels, and 
hospitals) inspected during 1888, besides many 
private residences. Since the foundation of the 
Association, 536 gentlemen’s country houses have 
been examined. The number of guinea subscri- 
bers the past year was 529. The balance in bank 
at the commencement of 1888 was ,£557 13s. gd. 
The income from all sources was ,£2,253 os. yd., 
making a total credit or “charge” account of 
,£2,810 14s. 4d. The total expense or “dis- 
charge” account for the year was ,£2,033 X7S id., 
leaving a balance of ,£776 17s. 3d. in the treasury 
at the opening of 1889. An Association whose 
assets thus reach from $12,000 to $15,000 yearly 
is clearly capable of accomplishing much good. 
The results show that the Edinburgh Association 
is fully competent for its mission. At its recent 
annual meeting, Sir Wm. Muir stated that “no 
institution in Edinburgh was of more value to so- 
ciety than the Sanitary Association.” 
Besides the Edinburgh Association, similar or- 
ganizations now exist at Glasgow and Dundee, 
Scotland; Eondon, Bedford, Bradford, Brighton, 
Cheltenham, Newcastle-on-Tyne, Wolverhamp- 
ton, Liverpool, Cambridge, Cardiff and Bath, En- 
gland; Dublin, Ireland; and Montreal, Canada.