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< | Progress update: Still very much under construction, but taking shape. |
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> | Progress update: Still under construction. But the work feels like it is reaching an analytical plateau, I think I'll be able to call this finished (pending comments) within the next week or so - 01/27/10.
If you have time on your hands, help me out with some research tips for students doing this kind of work in the future?: http://emoglen.law.columbia.edu/twiki/bin/view/AmLegalHist/ResearchHelp |
| | Outline |
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< | I'm looking at quarantine laws between the late 1870s and the first decade of the 20th Century, to see how the States and federal government worked together in the area of public health. This timeframe spans several epidemics (yellow fever and cholera), and the creation of a federal body (the National Board of Health). |
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> | This project examines United States quarantine laws between the late 1870s and the first decade of the 20th Century, to see how the States and federal government worked together in the area of public health. This timeframe spans several epidemics of yellow fever, cholera and smallpox, the first national laws addressing quarantine, and the creation of a federal body called the National Board of Health.
The Board initially came into existence through an Act in 1879 with a sunset clause to expire in 1883. It came close to being revived by repeal of this sunset clause in early 1883, due to its excellent performance. But it was not ultimately revived. |
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< | The Board initially came into existence through an Act in 1879 with a sunset clause to expire in 1883. It was revived by repeal of this sunset clause in early 1883 due to its excellent performance. But after 1885, Board failed. I'm curious why it failed. My time frame ends with the creation of the first successful federal quarantine laws. |
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> | After three more years of existence in the shadow of the 1879 Act, with a series of rapidly diminishing grants, the Board failed. I was drawn to this project primarily out of curiosity as to why it failed, and what if anything could be inferred from its failure about systemic State and federal tensions. My time frame ends with the creation of the first successful federal quarantine laws and the federal Department of Health. |
| | Background: Disease and Quarantine in the Late 19th Century |
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< | 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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> | 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). 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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> | 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. For instance, a cholera-affected vessel that under new regulations did not have to destroy its cargo of hides or cotton or wool or food 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. |
| | 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. |
| | Timeline with linked sources |
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The 1878 yellow fever epidemic and its aftermath |
| | 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. 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 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). |
| | 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.
De-funding, and motives |
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< | 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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> | Clashes over funding were ongoing. In 1881, the annual report reveals that the Board received only one third of the funds it wanted to build new quarantine stations in Virginia, Georgia and Texas (link). |
| | 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. |
| | 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 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. |
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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. In some ways it is surprising that a national response to foreign-originated epidemics 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 could have a potentially significant effect on trade between States (see Louisiana v Texas 176 US 1 (1900), analyzed above). Also, the broad swathe of topics that were regarded as relating to 'health' was probably threatening to many States' sense of sovereignty without a tightly focused mandate, which the Board had in its theoretical statutory functions but not in its operational practice. Even today, with the federal government exercising power that was not contemplated in the nineteenth century, 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.
An even more important historical lesson from studying the Board, however, is its function signaling a national commitment to both preventative medicine and medical research. In a short span of years, both would take root in America on a scale to match even the optimistic predictions of the people involved in the Board's administration. Moreover the National Board of Health, even during the twilight of its chronically underfunded life, was instrumental in sparking and encouraging a layered regulatory commitment to public health measures. Its efforts and the ripple effects of these efforts undoubtedly saved many thousands of lives, and improved sanitary conditions for most Americans far beyond the levels they had been at when the Board came into existence. The many advocates of the National Board of Health and its work may have lost a battle for its renewal in 1893, but they went on to secure many far more significant victories in the war for the health of Americans. |
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