arouse the people to the importance of initiating public sanitary measures. A case of cholera had already been reported at quarantine in New York harbor in December 1848, the disease was prevailing with unusual severity in eastern countries, and there was great fear, specially in the eastern states of the Union (which were then more permanently occupied with settled towns and cities than the western states), lest the experience of 1832 should be repeated. It l was this condition of affairs which undoubtedly led the Massachusetts legislature of 1849 to enact a resolve calling for the appointment of a commission to make a sanitary survey of the state and to report upon the same. This commission was appointed by the governor of Massachusetts, July 3, 1849. The appointment was made none too soon, for in that year the general sanitary condition of the state, as shown by the succeeding report of the commission, as well as by the unusually high death-rate, was deplorable. Only a few towns had then introduced public water-supplies, cholera was beginning to appear again, and dysentery and other infectious diseases were more destructive than they had been for many years. The report of that commission was an extremely valuable document. It was at once intelligent, thorough, comprehensive and prophetic, and though several years elapsed after its publication before a general board of health was established in any state,1 it is nevertheless true, that when such boards were established, the general plan laid down in this report was adopted, and now appears essentially in the organic acts establishing such state boards throughout the Union. The first 3 state boards of health were organized in 3 widely separated states, Louisiana, Massachusetts and Cali- 1 fornia, in the order named; and these were followed by 1) The Louisiana board created in 1855 could hardly be classed as a state board of health though so named in its organic act, since it was created almost entirely for maintaining a quarantine to protect the city of New Orleans. See appendix 3. the establishment of similar general boards in Virginia, Minnesota and Michigan. The states and territories which have thus far established state boards of health, with the dates of organization, are given in the following list: Louisiana, 1855 Massachusetts, June 1869 South Carolina, December 1878 North Carolina, 1879 Iowa, March 1880 New York, May 1880 Kansas, March 1885 Vermont, November 1886 New Mexico, February 1895 Further comment on the organization of these boards may be found in appendix 3. As social civilization has proceeded from the less to the greater, from the town and city to the county, and from the aggregation of these to the state, and then to the general government, so also the history of sanitary organization shows a similar order, the town board being the earliest unit of sanitary authority, then the state boards, and finally the national board which was not organized till 1879. The city or town board of health is and always has been the most firmly established organization, and is usually clothed with the most arbitrary powers for the protection of each local community or municipality. In general, it may be said that the work of state boards of health has not been largely of an executive character, but has been eminently didactic, and much good has been accomplished by the publication and distribution of tracts, circulars and pamphlets relating to the various departments of public health, and by the holding of frequent conventions or assemblies for the free discussion of sanitary subjects. As a general rule state boards of health do not have authority over local boards in sanitary matters,' but in some instances are authorized to exercise coordinate power with them in preventing the spread of infectious diseases, either within the limits of municipalities or along the border of other states or countries. The most important branch of public hygiene is the management and control of infectious diseases, and while the state boards of health are, from their necessary composition, not so closely in touch with the people as the municipal boards, yet they are capable of doing excellent service in educating the people in this important sanitary question. In those states which are the most densely settled, and are of comparatively small area, it has been possible for the general boards to perform a considerable amount of executive work, and to carry out the provisions of such laws as have given them authority to act for the protection of the public health. In several of the states, notably those of the western part of the Union, the function of regulating the practice of medicine has been added to the more distinctive duties of public sanitation. A valuable summary of the powers and duties of state boards of health as they existed in 1879, may be found in Dr Billings' Introduction to the volumes on hygiene published in New York by Dr A. H. Buck. In this summary Dr Billings says "The state board of health should be the central 1) See appendix 3, for note on a new law of the state of Indiana. 2) A Treatise on hygiene and public health, edited by Albert H. Buck, M.D. v. I, p. 55. W. Wood & Co., N. Y. 1879. supervising authority, having much the same relation to local boards, that the local board has to the households. Its functions may be classed as follows: 1) to promote the organization of local and municipal boards; 2) to obtain medical and vital statistics; 3) to investigate the causes of undue sickness and mortality; 4) the removal of these causes, acting as far as possible through the local sanitary authorities; 5) the supervision of the hygiene of state institutions; 6) the supervision of quarantine.” The following table presents the per capita expenditure of each state board of health in 1898, upon an estimated population for that year. For a more extended explanation and table see appendix 1, and chart facing title-page. ANNUAL PER CAPITA EXPENDITURE OF STATE BOARDS OF HEALTH (POPULATION ESTIMATED TO 1898) NATIONAL HEALTH ORGANIZATION At the present time the United States is in the unfortunate position of being without any general health organization representing the national government, which can in any manner be compared with those of the countries of Europe, for example, the Comité consultatif d'hygiène of France, the Imperial board of health of Germany, or the Local government board of England. It is proper in this connection to give a brief review of the establishment, history and overthrow of the National board of health of the United States. The stimulus which led to the formation of this board was undoubtedly the same which has proved to be the initiative in the establishment of other similar general organizations, namely, the unusual prevalence in some part of the country of an epidemic disease. Asiatic cholera had visited the country in 1872 and 1873 to such an extent as to lead to the appointment of a commission by congress to investigate the prevalence of the disease and to report on it.1 This epidemic became general throughout the southern and western states, but did not extend eastward beyond the Alleghany mountains. Another disease which has visited our shores at irregular intervals, coming invariably from tropical regions south of the United States, is yellow fever. Wherever it makes its appearance the population becomes alarmed, is more or less demoralized, and industry is paralyzed for the time being. In 1878, yellow fever had prevailed with unusual severity in the Gulf states and Tennessee, and to some extent in Kentucky and Missouri, and had caused the death of nearly 16,000 persons out of a total of about 74,000 cases.2 These facts proved to be a sufficient incentive for the organization of a general board of health which should have 1) See U. S. government report upon cholera in 1873, 43d Cong., 2nd session. Ex. doc. No. 95. 2) Dr Sternberg in Wood's reference handbook. v. 8, p. 45. |