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Progress update: Still very much under construction, but taking shape. |
| | Timeline with linked sources |
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The 1878 yellow fever epidemic and its aftermath |
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< | 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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> | 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. In 1878, Congress passed an Act that came to be known as the Woodworth law, allowing the Surgeon-General of the Marine Hospital Services under the Secetary of the Treasury to frame quarantine regulations. This had no appropriation attached to it, but was the United States' first national quarantine law (link).
Another national form of the yellow fever 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.)
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> | On 2 June 1879, the Act creating the National Board of Health came into effect, accompanied by a very large appropriation of $50,000. |
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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 1879 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. |
| | 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 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. |
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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. The Board's own reasoning is a defensible starting point. At times, its 1884 report waxes cynical with realpolitik considerations: 'the absence of epidemic among the people has resulted in the postponement of much-needed legislation' |
| | 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:
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| | 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. |
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> | Finally, State-level interests may have created a backlash against the nationalization of the Board's functions. There is no conclusive positive evidence of this, although the careful crafting of the Board's initial functions, as I have argued above, reveals a careful attention to the State/Federal balance. Additionally, the report recommending the repeal of the Board's sunset clause is clearly drafted with a mind to alleviate concerns about Congressional power under the commerce clause (link, see eg pp 4,5). Note that the 1884 report of the Board makes it clear that the prevailing constitutional interpretation was that Congress did not have the power to authorize a national compliance certificate that, once obtained, would guarantee a vessel entry into any State. Instead, State police powers were considered to trump a federal quarantine certification. In 1882, some petitioners in New York and Massachusetts were anxious enough about protecting State interests in health that they petitioned the Senate to prevent the Board gaining 'vice' powers (link). The official reply was that the Board's powers were very narrow, but it is clear from the Board's annual reports that it undertook investigations into matters such as livestock health and sewers, as well as its more publicized work on cholera, smallpox and yellow fever quarantine measures. The annual reports, however, also reveal instances of close cooperation with numerous State Boards of Health, and an interest in the strengthening of State sanitary legal infrastructure (for example, State legislation). If there was significant State resistance to the National Board's efforts, it does not appear to have originated in the State Boards of Health. Although State forces may have played a part in the unraveling of the Board, countervailing factors perhaps include that many of its core functions were returned to a national level after its demise, a situation which will be examined now. |
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< | Situation after the Board |
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> | After the Board |
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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 last report of the Board in 1885 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. |
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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. The 1884 report the previous year stated that there were 27 State boards of health, and noted the rapid increase in State and local preventative health measures sparked and facilitated by the National Board. |
| | 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. |