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Progress update: Still very much under construction, but taking shape. |
| | The 19th Century overall brought with it groundbreaking advances in medical science. Pasteur's initially radical germ theory was beginning to be accepted in the medical and public health literature by the beginning of the timeframe in this project, although not universally (here is a review of its impact in Massachusetts in the early 1870s). The literature around this time reflects great hope for rapid scientific advancement in many areas including disease origins and nature. There were hot debates both about the validity of new discoveries, and how these could best be translated into frameworks for prevention and remedy. A broad movement for public health had begun in Great Britain around the 1850s, and was slowly taking off in America, with interest turning to sewers and school hygiene. Later within in my chosen time period, the introduction of publicly provided childhood vaccinations began. |
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< | Quarantine measures, a very old disease prevention technology, were being updated to reflect new understandings of the mechanics of infection. Good examples of this were in relation to cholera (which had recently been discovered to be transmitted from feces-contaminated water). See e.g. The Sanitarium, 1894, pp 3-4 |
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> | Quarantine measures, a very old disease prevention technology, were being updated to reflect new understandings of the mechanics of infection. Good examples of this were in relation to cholera (which had recently been discovered to be transmitted from feces-contaminated water) (see e.g. The Sanitarium, 1894, pp 3-4). It should be remembered that each change in regulations could have significant commercial impact: a cholera-affected vessel that under new regulations did not have to destroy its cargo of hides or cotton or wool or food, for instance, would face significantly different profit margins to one operating under older rules. The potential benefits to both lives and commercial enterprise strongly favored the constant change of processes to reflect advances in scientific and medical knowledge. |
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< | Until the work done by Walter Reed to confirm the transmission of yellow fever by mosquitoes in 1900, the disease was assumed to be transferred either from direct contact with infected people, or to be airborne. This pamphlet in 1879 favors the latter theory, recommending quarantine measures for ships based on the new science of thermodynamics.Yellow Fever, A Nautical Disease, Its Origin and Prevention (1879) |
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> | Nonetheless, the scientific understanding of transmission was incomplete for many diseases. For instance, until the work done by Walter Reed to confirm the transmission of yellow fever by mosquitoes in 1900, the disease was assumed to be transferred either from direct contact with infected people, or to be airborne. This pamphlet in 1879 favors the latter theory, recommending quarantine measures for ships based on the new science of thermodynamics that would have been largely ineffective.Yellow Fever, A Nautical Disease, Its Origin and Prevention (1879). In the face of this ongoing uncertainty, undoubtedly there were regulations adopted based on commercial convenience as much as scientific advancement. |
| | Many of the professional sources indicate a welcoming attitude to State regulation. An example is Henry I. Bowdich, Public Hygiene in America: Being the Centennial Discourse Delivered Before the International Medical Congress, Philadelphia, September 1876 p 2. His address opined:
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The yellow fever epidemic and its aftermath |
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< | Yellow fever was a recurring problem in the Mississippi region, but the epidemic of 1878 was particularly severe. It seems that the epidemic managed to galvanize institutional support behind a national response, and the form of that response was the creation of the National Board of Health. A National solution (although in the form of a national Sanitary Commission rather than Board per se) was recommended to Congress by the Commission set up to investigate yellow fever: |
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> | Yellow fever was a recurring problem in the Mississippi region, but the epidemic of 1878 was particularly severe. Over 20,000 people died. It seems that the epidemic managed to galvanize institutional support behind a national response, and the form of that response was the creation of the National Board of Health. A national solution (although in the form of a national Sanitary Commission rather than a Board per se) was recommended to Congress by the Commission set up to investigate yellow fever: |
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The public, we may almost now say national health, is too vast and important a concern to be entrusted to inefficient boards of health and spasmodic Congressional legislation (Report to Congress in the wake of the 1878 yellow fever epidemic from the Commission as to the Causes and Prevention of Yellow Fever. Link here.)
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< | State models and the Board's operation |
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> | State Boards of Health and the National Board's operation
Section 3 of the Act creating the National Board of Health ([the 'founding Act') sets out a two-step process. First, it encourages the co-operation of the National Board with the State Boards of Health and their regulations. Second, it allows the Board to displace these rules with Presidential approval. It seems reasonable to assume that this two-step process, and the Presidential approval requirement, was an attempt to secure State support for the Bill and the possibility of diminution of State authority. |
| | State Boards of health had been in operation for decades in the largest States. New York was the first State with such a Board. It had a State Board of health since 1805, and one fully independent from the Legislature since 1866 (reference link). Massachusetts had a well-organized State Board of Health since 1869 (reference link). In these States, and presumably others where the historical records are more scarce, the functions of the Boards of Health were broader than we would necessary associate with 'health' today, including such functions as the supervision of abattoirs, building codes and prostitution, as well as disease prevention, statistical analysis and providing a forum to produce and disseminate research and learning about medicine and diseases. |
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< | The report notes that 32 of the States had, in 1885, boards of health or 'other forms of sanitary organization charged with the duty of devising and enforcing such measures as may serve to promote the well-being of the people'. Note that in 1885 there were only 38 States. |
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> | The National Board of Health was modeled on these State Boards. Its statutory functions include making regular assessments of the conditions of foreign ports, and receiving weekly reports of the conditions of domestic ports. The founding Act for the Board requires it to publish weekly summaries of the information it receives for the benefit of the Marine Hospital Service, and State and municipal Boards of Health. The inclusion of municipal boards of health is an important reminder that not all parts of the founding Act fit into a simplistic dualist 'federal vs state' regulatory model. These municipal boards were also an important (and in some places long established) part of the regulatory infrastructure for disease prevention and public health. (reference link) |
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| | The last report of the Board takes a generally optimistic tone in parts in relation to the overall effects of the Board: 'it is believed that the country was never in better condition to resist the progress of epidemics than it is at the present time' declared the National Board of Health's Annual report for 1885. |
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> | The report notes that 32 of the States had, in 1885, boards of health or 'other forms of sanitary organization charged with the duty of devising and enforcing such measures as may serve to promote the well-being of the people'. Note that in 1885 there were only 38 States. |
| | In the mid 1880s there was a virulent cholera epidemic in Europe, and American authorities were anxious to resist its introduction as much as possible. Cholera spread to New York (city and quarantine station) in 1892. The Surgeon General reports that this anxiety prompted the passage of the Federal quarantine Act in 1893 link, at p 265. A plain English translation of the Bill is also in the report, linked here. The Surgeon-General does not comment on section 9 of the Act, repealing the National Board of Health. |