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The Shattuck Report

LEMUEL SHATTUCK - REPORT OF A GENERAL PLAN FOR THE PROMOTION OF GENERAL AND PUBLIC HEALTH DEVISED, PREPARED AND RECOMMENDED BY THE COMMISSIONERS APPOINTED UNDER A RESOLVE OF THE LEGISLATURE OF MASSACHUSETTS, RELATING TO A SANITARY SURVEY OF THE STATE. (1850)

This report is one of the fundamental documents in public health in the United States. It is the first systematic use of birth and death records and other demographic data to describe the health of a population. Its recommendations became foundation of the sanitation movement in the United States, which saw the life expectancy increase from 25 years in Boston in 1850 to more than 75 years by the year 2000. The proposed law in part four of the report is the first attempt to write a comprehensive public health code.

CONTENTS

Report of the Commissioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Subject stated and defined:

I.          Sanitary Movement Abroad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

            Greece and Rome, 14; France, 16; Germany, 24; Hamburgh, 25; Great Britain, 28;

            Conclusions, 46.

II.        Sanitary Movement at Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

            Sanitary legislation, 48; Means for curing disease, 55; Sanitary condition of the State, 61;

            Conclusions, 102.

III.       Plan for a Sanitary Survey of the State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Sections I - XXII

Sections XXIII to the end

Measures constituting the Plan:

             I.          Revision of the Health Laws of the State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
            II.        General Board of Health recommended . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  111
            III.       Composition of the Board of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
            IV.       Secretary of the Board of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
            V.        Local Boards of Health recommended . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
            VI.       Officers of Local Boards of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
            VII.      Sanitary Rules and Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
            VIII.    Compulsory Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
            IX.       Books for the use of Boards of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
            X.        Annual Reports of Boards of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
            XI.       Printing and exchanging Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
            XII.      Census or Enumeration of the Inhabitants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
            XIII.   Alteration of the State Constitution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
            XIV.    Registration of Births, Marriages and Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
            XV.      Atmospheric Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
            XVI.    Causes of Disease and Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
            XVII.   Laying out new Towns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
            XVIII.  Public Buildings regulated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
            XIX.    Manufactories and Private Dwellings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
            XX.     Over-crowded Lodging-houses and Cellar-dwellings . . . . . . . . . . . . . . . . . . . . . . 164
            XXI.    Public Squares and Ornamental Trees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
            XXII.   Special Sanitary Survey of different places . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
            XXIII. Mill-ponds and Stagnant Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
            XXIV. House-to-house Visitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .168
            XXV.   Observations concerning Sickness in general . . . . . . . . . . . . . . . . . . . . . . . . . . .  171
            XXVI. Observations concerning Sickness in Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
            XXVII. Periodical and Special Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
            XXVIII.  Observations concerning Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  181
            XXIX. Abatement of Nuisances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
            XXX.   Sanitary Evils of Intemperance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
            XXXI. Inquest on Dead Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
            XXXII.   Insane and Idiotic Persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
            XXXIII.  Interment of the Dead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
            XXXIV. Emigrant Ships and Seamen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  198
            XXXV.   Quarantine Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  200
            XXXVI.  Sanitary Evils of Foreign Emigration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  200
            XXXVII. Sanitary Associations recommended . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
            XXXVIII.  Tenements for the Laboring Classes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  207
            XXXIX.  Public Baths and Wash-houses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
            XL.      Refuse of Towns, for manure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  212
            XLI.    Abatement of the Smoke Nuisance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
            XLII.   Physicians' and Apothecaries' Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . .  218
            XLIII.  Adulterated Food and Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
            XLIV.  Establishments for the Education of Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . .  224
            XLV.   Education in Sanitary Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
            XLVI.  Professional Records of Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
            XLVII. Clergymen interested in Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
            XLVIII.  Sanitary Observations in Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  238
            XLIX.  Sanitary Science useful to fathers and mothers . . . . . . . . . . . . . . . . . . . . . . . . . . 238
            L.         Personal Sanitary Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  239

IV.       Reasons for approving the Plan recommended . . . . . . . . . . . . . . . . . . . . . . . . . . 241

            I.          Because it is a practical measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  242
            II.        Because it is a useful measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  252
            III.       Because it is an economical measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   254
            IV.       Because it is a philanthropic and charitable measure . . . . . . . . . . . . . . . . . . . . .  262
            V.        Because it is a moral measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  266
            VI.       Because the progress of the age demands it . . . . . . . . . . . . . . . . . . . . . . . . . . . .  272
            VII.      Because it involves an important duty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   276

Objections answered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

            1.  Too complicated, 278; 2.  Not applicable to us, 279; 3.  Too statistical, 283; 4.  Interferes with private matters, 284; 5.  With private rights, 286; 6.  Creates an unnecessary expense, 289; 7.  Promotes quackery, 290; 8.  Alarms the people, 291; 9.  Interferes with Providence, 294; 10.  People have not time to attend to it, 294.

Closing Appeal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  297

            1.  To physicians, 298; 2.  To clergymen, 298; 3.  To educated men, 299; 4.  To the wealthy and philanthropic, 300; 5.  To the people, 301; 6.  To the periodical press, 302; 7.  To towns and cities, 303; 8.  To the State, 304.

BILL RECOMMENDED FOR ENACTMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307

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