the state. In the United States the management of the internal affairs of each separate state is left, for the most part, to the state concerned. Municipal charters are obtained from the state governments and in these charters the power to regulate conditions affecting public health are specifically granted. Cities and towns thus owe responsibility to the state governments and are answerable to them to a greater or less extent, depending upon local circumstances. In Massachusetts local boards of health are comparatively independent of the state authority, while in New York the state department of health is a central body to which the local boards of health are closely tributary.
State health authorities are in no case responsible or answerable to the general government. There is no national board of health.
In the management of health matters the smallest unit of responsibility is a municipal health officer or municipal board of health; the largest the state health officer or board of health. Whether municipal or state, the functions of health authorities are very much the same. The main differences arise from the differences in area over which the authorities are required to exercise supervision. Local boards have charge of the conditions which occur in the several localities in a state; they take cognizance of individual houses and of persons. The ultimate units over which state boards exercise jurisdiction are municipalities.
It is the first duty of all health boards to collect vital statistics, to collate them in tabular form, and to interpret these data so as to show the state of the public health. Local boards of health collect reports of deaths and of contagious and other diseases from physicians, interpret these data, for the benefit of the districts in which they apply, and then forward them to the state authorities. The state authorities so obtain a knowledge of the health in various sections of the state and are so enabled to judge the relative healthfulness of the different localities. An excessive prevalence of disease in one place can thus be promptly detected.
The methods of collecting vital statistics are often unsatisfactory and the results frequently deceptive. It may be remarked in passing that vital statistics are to-day available for only a part of the people of the United States, except during years when this government makes a census enumeration. The census returns are themselves unsatisfactory. In this respect the United States government is behind nearly every civilized country in Europe. The fault lies with our municipal and state governments.
In interpreting death rates careful account must be taken of the marriage and birth rates, total population, migrations of population, and other factors; and it would be well for boards of health to charge themselves with collating as well as collecting these vital statistics, in a more intelligent manner.