OF THE STATE BOARD OF HEALTH AND VITAL STATISTICS OF THE Commonwealth of Pennsylvania. VOL. II. Transmitted to the Governor December 4th, 1898. WM. STANLEY RAY, What Are the Principal Lines of Work of Your Board? How is each Accomplished? What modification, if any, ces the Experience in Your State Suggest? By Richard H. Lewis, M. D., Secretary. In discussing the topic just read, but little time will be required for North Carolina. In our state the population is largely rural, and practical health officers, such as hear my words, understand only too well, no doubt, the ignorance of and indifference to the ordinary rules of hygiene met with among country people generally. This is not so much due to want of intelligence-for the man who takes country people for fools will find himself sadly mistaken-as it is to the strong spirit of conservatism invariably found among people who travel little and who pass their lives within the narrow environment of a farm. It is hard for them to take up new things. And they cannot be made to do it against their consent-not the people who comprise the citizenship of the old North State, at any rate. Having received barely a trace of the blood of the subject races in Continental Europe since the state was first settled, the same blood in its purity flows in their veins as throbbed in those of the men of New Hanover, who, some time before the Boston "tea party," not only threw overboard the tea, but captured the vessels that brought it into the Cape Fear river; and of the patriots of Mecklenburg, who, more than a year before the general Declaration of Independence, declared their own independence of the mother country. They cannot be driven, and so they must be led. The principal line of our work, therefore, is educational. It is accomplished by the distribution of health pamphlets; by occasional articles in the newspapers; by the publication of a monthly bulletin, which is sent to every physician in the state, the board realizing the supreme importances of securing the aid and co-operation of the medical profession; and by popular sanitary meetings-"health conferences with the people," we call them. In addition to this, our chief work, we inspect all the public institutions and public water supplies of the state, and report to the powers in control of the same, with advice. We also furnish information on health subjects to anyone asking for it. With the single exception of authority to take charge and enforce sanitary rules in case of an epidemic of contagious disease in a town having no local board of health, our powers are purely advisory. The only modification, in the present state of public opinion, that our experience would suggest is a larger appropriation. This would permit more work of the kind above indicated to be done, and at the same time justify the employment of the whole time of a secretary, with an assistant as locum tenens in his absence. The secretary should be a missionary of sanitation. By lectures and by personal work with the various municipal authorities, he could do much to excite interest generally, and to promote the establishment and perfecting of local health organizations. As no law can be enforced in this country that is not supported by public opinion. it is manifest that the education of the people is the most important work any board can do. Statutory Regulation of the Right to Practice is Constitutional. H. Z. Gill, Topeka, Kan. The exercise by the states of these statutory powers is upheld as a valid exercise of the "police power" to protect the health of the community. When the constitutionality of such enactments has been questioned, it has been attacked upon the alleged ground that the statutes under question unjustly discriminated in favor of ene class of citizens and against another class, and as depriving those already engaged in the practice of medicine or surgery of "their property without due process of law." (State v. Penonyer, 18 Atl. Rep., 878; ex parte Spinney, 10 Nev., 23; People v. Fulda, 52 Hun. (N. Y.), 65-67; Brown v. People, 11 Gol. 109.) Opinion of United States Supreme Court. This subject has been carefully considered by the United States Supreme Court in a recent case, and the broad extent of the legis lative powers of the states to regulate such matters clearly and fully declared. (Dent. v. West Va., 129 U. S., 114.) The court says (pp. 121 et seq.), Mr. Justice Field, delivering the opinion, in which all the other justices occur: "The unconstitutionality asserted consists in its (the statute's) alleged conflict with the clause of the fourteenth amendment, which declares that no state shall deprive any person of life, liberty or property, without due process of law, the denial to the defendant of the right to practice this profession, without the certificate required, constituting the deprivation of his vested right and estate in his profession, which he had previously acquired. "It is undoubtedly the right of every citizen of the United States to follow any lawful calling, business or profession he may choose, subject only to such restrictions as are imposed upon all persons of like age, sex and condition. This right may in many respects be considered as a distinguishing feature of our republican istitutions. Here all vocations are open to everyone on like conditions. All may be pursued as sources of livelihood, some requiring years of study and great learning for their successful prosecution. The interest, or, as it is sometimes termed, the estate acquired in them— that is, the right to continue their prosecution-is often of great value to the possessors, and cannot be arbitrarily taken from them, any more than their real or personal property can be thus taken. But there is no arbitrary deprivation of such right where its exericse is not permitted because of a failure to comply with conditions imposed by the state for the protection of society. The power of the state to provide for the general welfare of its people authorizes it to prescribe all such regulations as, in its judgment, will secure or tend to secure them against the consequences of ignorance and incapacity, as well as of deception and fraud. As one means to this end, it has been the practice of different states from time immemorial, to exact in many pursuits a certain degree of skill and learning upon which the community may confidently rely, their possession being generally ascertained upon an examination of the parties by competent persons, or inferred by a certificate to them in the form of a diploma or license from an institution established for instruction on the subjects, scientific and otherwise, with which such pursuits have to deal. The nature and extent of the qualifications required must depend primarily upon the judgment of the state as to their necessity. If they are appropriate to the calling or profession, and attainable by reasonable study or application, no objection to their validity can be raised because of their stringency or difficulty. It is only when they have no relation to such calling or profession, or are unattainable by such reasonable study and application, that they can operate to deprive one of his right to pursue a lawful vocation. "Few professions require more careful preparation by one who seeks to enter it than that of medicine. It has to deal with all those subtle and mysterious influences upon which health and life depend, and requires not only a knowledge of the properties of vegetable and mineral substances, but of the human body in all its complicated parts, and their relation to each other, as well as their influence upon the mind. The physician must be able to detect readily the presence of disease, and prescribe appropriate remedies for its removal. |