Laws define rights. Men enforce them. For definitions we go to books. For record of enforcement we go to acts and to conditions.[3] What health rights a community pretends to enforce will, as a rule, be found in its health code. What health rights are actually enforced can be learned only by studying both the people who are to be protected and the conditions in which these people live. A street, a cellar, a milk shop, a sick baby, or an adult consumptive tells more honestly the story of health rights enforced and health rights unenforced than either sanitary code or sanitary squad. Not until we turn our attention from definition and official to things done and dangers remaining can we learn the health progress and health needs of any city or state.

[3] A striking demonstration of law enforcement that followed lawmaking is given in The Real Triumph of Japan, L.L. Seaman, M.D.

The health code of one city looks very much like the health code of every other city. This is natural because those who write health codes generally copy other codes. Even small cities are given complicated sanitary legislative powers by state legislatures. Therefore those who judge a community's health rights by its health laws will get as erroneous an impression as those who judge hygiene instruction in our public schools from printed statements about the frequency and character of such instruction. Advocates of health codes have thought the battle won when boards of health were given almost unlimited power to abate nuisances and told how to exercise those powers.

A Dairy Inspector's Outfit

The slip 'twixt law making and law enforcement is everywhere found. In 1864 New York state prohibited the sale of adulterated milk. Law after law has been made since that time, giving health officials power to revoke licenses of milk dealers and to send men to jail who violated milk laws. We now know that no law will ever stop the present frightful waste of infant lives, counted in thousands annually, unless dairies are frequently inspected and forced to be clean; unless milk is kept at a temperature of about fifty degrees on the train, in the creamery, at the receiving station, and in the milk shop; unless dealers scald and thoroughly cleanse cans in which milk is shipped; unless licenses are taken from farmers, creameries, and retailers who violate the law; unless magistrates use their power to fine or imprison those who poison helpless babies by violating milk laws; and unless mothers are taught to scald and thoroughly cleanse bottles, nipples, cups, and dishes from which milk is fed to the baby. We know that these things are not being done except where men or women make it their business to see that they are done. Experience tells us that inspectors will not consistently do their duty unless those who direct them have regular records of their inspections, study those records, find out work not done properly or promptly, and insist upon thorough inspection.

Whether work is done right, whether inspectors do their full duty, whether babies are protected, can be learned only from statements in black and white that show accurately the conditions of dairies and milk shops, the character of milk found and tested by inspectors, and the number of babies known to have been sick or known to have died from intestinal diseases chiefly due to unsafe milk. Any teacher or parent can learn for himself, or can teach children to learn, what steps are taken to guarantee the right to pure milk by using a table such as Table III. Whether conditions at the dairy make pure milk impossible can be told by any one who can read the score card used by New York City (Table IV).

Table III

MILK INSPECTION WITHIN NEW YORK CITY, 1906

 New YorkEach borough
StoresWagonsStoresWagons
FIELD    
Permits issued during 1906    
Permits revoked during 1906    
For discontinuance of selling    
For violation of law    
Average permits in force in 1906    
INSPECTION    
Regular inspections    
Inspections at receiving stations    
Total    
Average inspections per permit per year    
Specimens examined    
Samples taken    
Conditions Found    
Inspections finding milk above 50°    
% of such discoveries to total inspections    
Inspections finding adulteration    
Warning given    
Prosecuted    
% of adulterations found to inspections    
Rooms connected contrary to sanitary code    
Ice box badly drained    
Ice box unclean    
Store unclean    
Utensils unclean    
Milk not properly cooled    
Infectious disease    
Persons found selling without permit    
ACTION TAKEN    
DESTRUCTION OF MILK    
Lots of milk destroyed for being over 50°    
Quarts so destroyed    
Lots of milk destroyed for being sour    
Quarts so destroyed    
Lots of milk destroyed for being otherwise adulterated    
Quarts so destroyed    
Total quarts destroyed    
NOTICES ISSUED    
To drain and clean ice box    
To clean store    
CRIMINAL ACTIONS BEGUN    
For selling adulterated milk    
For selling without permit    
For interference with inspector    
Total