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Progress update: Still very much under construction, but taking shape. |
| | Timeline with linked sources
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< | The yellow fever epidemic and its aftermath
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 1878 yellow fever epidemic and its aftermath
Yellow fever was a frequently recurring problem in the Mississippi region, but the epidemic of 1878 was particularly severe. Over 20,000 people died. There was mass panic and many people attempted to relocate to other States, and there were reported instances of communities enforcing 'shotgun quarantines', paralyzing trade and commerce around the country even away from the worst affected areas. The far-reaching consequences of 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 nationally co-ordinated 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.)
State Boards of Health and the National Board's operation |
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< | 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. |
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> | 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 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 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. Note that in practice it appears that the functions of the Board in relation to foreign ports were only partially carried out, if at all (link). 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 Board was composed of one medical officer from the Army; one from the Navy; one from the Marine Hospital Service. There were also seven members appointed by the President and confirmed by the Senate, not more than one from any State. |
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< | Funding |
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> | De-funding, and motives |
| | Clashes over funding were ongoing. In 1881, the annual report reveals that the Board received only 1/3 of the funds it wanted to build new quarantine stations in Virginia, Georgia and Texas (link). |
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< | Motives |
| | The historical documents are largely silent as to the motives behind the Board's slow death due to underfunding. My conclusion is that it was controversial. The address of the President of the American Public Health Organization in 1887 (reported in Science, Vol X No. 251, link here) notes that:_It is unnecessary for me to refer to the various circumstances that conspired to paralyze the effective energy of this Board. Unhappily it is a thing of the past, and the hopes which we had founded on this our bantling are but a thing of the past._ |
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< | These are words alluding to extreme and well-known controversy, not agreement. The battlelines of the controversy, however, are not apparent from the historical sources I have collected. It is possible that the change to a Democratic President in 1885 was part of the ultimate collapse of appropriations, but the funding gap for the Board predates this change of political leadership. |
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> | These are words alluding to well-known and perhaps serious controversy, not agreement. The battlelines of the controversy, however, are not apparent from the historical sources I have collected. Speculation is thus necessary, and can take several forms.
Potentially, the change to a Democratic President in 1885 was part of the ultimate collapse of appropriations for the Board. There is some evidence that the Board of Health in its early days was supported by business interests:
'The great transportation companies of the South, both river and rail, are unanimous in their approval of the action and method of the Board [in the 1879 yellow fever epidemic], because experience has shown that they give the necessary security against the spread of disease, without stopping, or retarding to any considerable extent, commercial intercourse' (link)
It is possible that the transportation companies continued to support the Board by the new political administration was less concerned with pleasing this constituency when the yellow fever crisis seemed to have abated. Against this reading, it is noteworthy that the funding gap for the Board predates the change of political leadership.
Another possibility is that of military views of health management clashing with civilian ones. One of the more expensive projects of the National Board of Health was the creation of the Ship Island quarantine station. A report for the Bill dismantling this station reveals that the United States Marine Hospital Service opposed this station from the outset (link and compare the report establishing the station). If construed along these lines, it is possibly significant that the 1893 Act, some time after the Board had been in practice abolished, vested its powers in the Marine Hospital Service(link), a strategy not favored by the American Public Health Organization (link). Against this reading is the presence of Army, Navy and Marine Hospital Officers on the Board, although they would not have been a majority. |
| | Situation after the Board |
| | Conclusions |
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< | The creation of the National Board of Health, even if it ultimately failed, was a significant step in creating uniformity of quarantine standards and broader public health measures more generally. Nonetheless, it is in some ways surprising that a national response to disease and quarantine took so long to formulate. Even before the Supreme Court's expansive reading of the commerce clause in the 1930s, it was relatively uncontroversial that the federal government had the power to regulate quarantine measures under this clause. My best guess as to why this is the case is the politically sensitive nature of quarantine regulations that have a potentially significant effect on trade between States (see Louisiana v Texas 176 US 1 (1900), analyzed below). Also, it is by no means uncontested that a national response to health and safety regulation beyond the specific issue of immigrant quarantine and epidemic management is most efficiently done at a federal rather than State level. The nature of federalism involves weighing State autonomy and ability to tailor regulation to local circumstances on the one hand, and the potential for national coordination, economies of scale and (relative) neutrality of regulation on the other. The rise and fall of the National Board of Health should be seen in the light of these competing forces, as an aspect of broader federal tensions inherent in the nature of the American political system. |
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> | The creation of the National Board of Health, even if it ultimately failed, was a significant step in creating uniformity of quarantine standards and broader public health measures more generally. Nonetheless, it is in some ways surprising that a national response to disease and quarantine took so long to formulate. Even before the Supreme Court's expansive reading of the commerce clause in the 1930s, it was relatively uncontroversial that the federal government had the power to regulate quarantine measures under this clause. My best guess as to why this is the case is the politically sensitive nature of quarantine regulations that have a potentially significant effect on trade between States (see Louisiana v Texas 176 US 1 (1900), analyzed above). Also, it is by no means uncontested that a national response to health and safety regulation beyond the specific issue of immigrant quarantine and epidemic management is most efficiently done at a federal rather than State level. The nature of federalism involves weighing State autonomy and ability to tailor regulation to local circumstances on the one hand, and the potential for national coordination, economies of scale and (relative) neutrality of regulation on the other. The rise and fall of the National Board of Health should be seen in the light of these competing forces, as an aspect of broader federal tensions inherent in the nature of the American political system. |
| | Acts |
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< | Both Links in table below. |
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| | 1) "An act to prevent the introduction of infectious or contagious diseases into the United States, and to establish a national board of health" 45th Congress, Session III, 1879 20 Stat 484. Although I scanned this in, google books has a publication called the Sanitarian from 1894 that is clearer, and contains the bill text at page 230. |
| | -- EmilyByrne - 14 Dec 2009
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Links to uploaded sources (others hyperlinked in text above) |
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- Quick_and_Garran.pdf: Quick, John & Garran, Robert (1901) The Annotated Constitution of the Australian Commonwealth Sydney: Angus & Robertson.
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| META FILEATTACHMENT | attachment="Quick_and_Garran.pdf" attr="" comment="Quick, John & Garran, Robert (1901) The Annotated Constitution of the Australian Commonwealth Sydney: Angus & Robertson." date="1257459533" name="Quick_and_Garran.pdf" path="Quick and Garran.pdf" size="597079" stream="Quick and Garran.pdf" user="Main.EmilyByrne" version="1" |
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| META FILEATTACHMENT | attachment="The_early_history_of_quarantine.pdf" attr="" comment="" date="1257460186" name="The_early_history_of_quarantine.pdf" path="The_early_history_of_quarantine.pdf" size="1055745" stream="The_early_history_of_quarantine.pdf" user="Main.EmilyByrne" version="1" |
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| META FILEATTACHMENT | attachment="Forty_fifth_congress_Ch_202_1879_Establishing_National_Board_of_Health.pdf" attr="" comment="The principal 1879 Act" date="1262566994" name="Forty_fifth_congress_Ch_202_1879_Establishing_National_Board_of_Health.pdf" path="Forty fifth congress Ch 202 1879 Establishing National Board of Health.pdf" size="506682" stream="Forty fifth congress Ch 202 1879 Establishing National Board of Health.pdf" user="Main.EmilyByrne" version="1" |
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| META FILEATTACHMENT | attachment="Letter_fiscal_deficit_1887.pdf" attr="" comment="Letter fiscal deficit 1887" date="1264115847" name="Letter_fiscal_deficit_1887.pdf" path="Letter fiscal deficit 1887.pdf" size="173403" stream="Letter fiscal deficit 1887.pdf" user="Main.EmilyByrne" version="1" |
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| META FILEATTACHMENT | attachment="Removal_of_Ship_Is_Quarantine_Station_1887.pdf" attr="" comment="Removal of Ship Island Quarantine Station 1887" date="1264118690" name="Removal_of_Ship_Is_Quarantine_Station_1887.pdf" path="Removal of Ship Is Quarantine Station 1887.pdf" size="135442" stream="Removal of Ship Is Quarantine Station 1887.pdf" user="Main.EmilyByrne" version="1" |
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| META FILEATTACHMENT | attachment="Creation_of_Department_of_Public_Health_1898.pdf" attr="" comment="Creation of Department of Public Health" date="1264118786" name="Creation_of_Department_of_Public_Health_1898.pdf" path="Creation of Department of Public Health 1898.pdf" size="75839" stream="Creation of Department of Public Health 1898.pdf" user="Main.EmilyByrne" version="1" |
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| META FILEATTACHMENT | attachment="Additional_Powers_1882.pdf" attr="" comment="Additional powers refused 1882" date="1264541933" name="Additional_Powers_1882.pdf" path="Additional Powers 1882.pdf" size="86741" stream="Additional Powers 1882.pdf" user="Main.EmilyByrne" version="1" |
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